Background CC-Cruiser is an artificial intelligence (AI) platform developed for diagnosing childhood cataracts and providing risk stratification and treatment recommendations. The high accuracy of CC-Cruiser was previously validated using specific datasets. The objective of this study was to compare the diagnostic efficacy and treatment decision-making capacity between CC-Cruiser and ophthalmologists in real-world clinical settings. Methods This multicentre randomized controlled trial was performed in five ophthalmic clinics in different areas across China. Pediatric patients (aged ≤ 14 years) without a definitive diagnosis of cataracts or history of previous eye surgery were randomized (1:1) to receive a diagnosis and treatment recommendation from either CC-Cruiser or senior consultants (with over 5 years of clinical experience in pediatric ophthalmology). The experts who provided a gold standard diagnosis, and the investigators who performed slit-lamp photography and data analysis were blinded to the group assignments. The primary outcome was the diagnostic performance for childhood cataracts with reference to cataract experts' standards. The secondary outcomes included the evaluation of disease severity and treatment determination, the time required for the diagnosis, and patient satisfaction, which was determined by the mean rating. This trial is registered with ClinicalTrials.gov ( NCT03240848 ). Findings Between August 9, 2017 and May 25, 2018, 350 participants (700 eyes) were randomly assigned for diagnosis by CC-Cruiser (350 eyes) or senior consultants (350 eyes). The accuracies of cataract diagnosis and treatment determination were 87.4% and 70.8%, respectively, for CC-Cruiser, which were significantly lower than 99.1% and 96.7%, respectively, for senior consultants ( p < 0.001, OR = 0.06 [95% CI 0.02 to 0.19]; and p < 0.001, OR = 0.08 [95% CI 0.03 to 0.25], respectively). The mean time for receiving a diagnosis from CC-Cruiser was 2.79 min, which was significantly less than 8.53 min for senior consultants ( p < 0.001, mean difference 5.74 [95% CI 5.43 to 6.05]). The patients were satisfied with the overall medical service quality provided by CC-Cruiser, typically with its time-saving feature in cataract diagnosis. Interpretation CC-Cruiser exhibited less accurate performance comparing to senior consultants in diagnosing childhood cataracts and making treatment decisions. However, the medical service provided by CC-Cruiser was less time-consuming and achieved a high level of patient satisfaction. CC-Cruiser has the capacity to assist human doctors in clinical practice in its current state. Funding National Key R&D Program of China (2018YFC0116500) and the Key Research Plan for the National Natural Science Foundation of China in Cultivation P...

Objective To quantify the risk of overall and type specific cardiovascular and cerebrovascular diseases as well as venous thromboembolism in women with a history of gestational diabetes mellitus. Design Systematic review and meta-analyses. Data sources PubMed, Embase, and the Cochrane Library from inception to 1 November 2021 and updated on 26 May 2022. Review methods Observational studies reporting the association between gestational diabetes mellitus and incident cardiovascular and cerebrovascular diseases were eligible. Data, pooled by random effects models, are presented as risk ratios (95% confidence intervals). Certainty of evidence was appraised by the Grading of Recommendations, Assessment, Development, and Evaluations. Results 15 studies rated as moderate or serious risk of bias were included. Of 513 324 women with gestational diabetes mellitus, 9507 had cardiovascular and cerebrovascular disease. Of more than eight million control women without gestational diabetes, 78 895 had cardiovascular and cerebrovascular disease. Compared with women without gestational diabetes mellitus, women with a history of gestational diabetes mellitus showed a 45% increased risk of overall cardiovascular and cerebrovascular diseases (risk ratio 1.45, 95% confidence interval 1.36 to 1.53), 72% for cardiovascular diseases (1.72, 1.40 to 2.11), and 40% for cerebrovascular diseases (1.40, 1.29 to 1.51). Women with gestational diabetes mellitus showed increased risks of incident coronary artery diseases (1.40, 1.18 to 1.65), myocardial infarction (1.74, 1.37 to 2.20), heart failure (1.62, 1.29 to 2.05), angina pectoris (2.27, 1.79 to 2.87), cardiovascular procedures (1.87, 1.34 to 2.62), stroke (1.45, 1.29 to 1.63), and ischaemic stroke (1.49, 1.29 to 1.71). The risk of venous thromboembolism was observed to increase by 28% in women with previous gestational diabetes mellitus (1.28, 1.13 to 1.46). Subgroup analyses of cardiovascular and cerebrovascular disease outcomes stratified by study characteristics and adjustments showed significant differences by region (P=0.078), study design (P=0.02), source of data (P=0.005), and study quality (P=0.04), adjustment for smoking (P=0.03), body mass index (P=0.01), and socioeconomic status (P=0.006), and comorbidities (P=0.05). The risk of cardiovascular and cerebrovascular diseases was, however, attenuated but remained significant when restricted to women who did not develop subsequent overt diabetes (all gestational diabetes mellitus: 1.45, 1.33 to 1.59, gestational diabetes mellitus without subsequent diabetes: 1.09, 1.06 to 1.13). Certainty of evidence was judged as low or very low quality. Conclusions Gestational diabetes mellitus is associated with increased risks of overall and type specific cardiovascular and cerebrovascular diseases that cannot be solely attributed to conventional cardiovascular risk factors or subsequent diabetes.

Physical growth of children under 7 years old was undergoing a slowly positive secular trend during the latest decade in more economically developed regions of China. Urban-suburban difference of those measurements became smaller, while their regional difference persistently exist. Chinese healthy children under 7 years in nine cities was taller and heavier than WHO standards.

Oil production from tight and shale formations accounted for more than half of total U.S. oil production in 2015 (EIA, 2016). Such amount is expected to grow significantly as the active development of low permeability reservoirs continues. Since the primary recovery is becoming less effective and large amounts of oil are locked in matrix, IOR techniques should be considered to face such challenge. Many recent studies have evaluated the potential of gas injection in shale plays. However, few studies discussed the feasibility of water huff-n-puff process. This study evaluated the potential of cyclic water injection (CWI) in shale plugs and compared it with the performance of cyclic gas injection (CGI). Eagle Ford core samples were used in this study and saturated with dead shale oil. X-ray diffraction (XRD) technique was employed to analyze the mineral composition of the sample. To reduce clay swelling, 5 wt.% of potassium chloride (KCl) solution was used as the injection fluid in CWI tests. Two groups of experiments were performed to examine the effects of soaking time and injection pressure (P in) on the recovery performance. For one cycle of huff-n-puff, after reaching the P in , the core plug was soaked with water for a certain time, then the surrounding pressure was released to enter the production period. Under the same operating conditions, CGI tests were conducted to compare the two IOR performances. The CWI experimental results show that soaking time affects the recovery factor (RF) of a single cycle within a certain range, which was similarly concluded from the CGI tests. Injection pressure can affect the recovery performance of CWI significantly. For example, after performing 12 cycles of water huff-n-puff, the RF for tests with P in of 1,000 psi and 5,000 psi were 14% and 21%, respectively. When applying 5,000 psi, fractures were created on the plug and the size enlarged with further cycles operated. Comparing the two processes of CWI and CGI, different recovery characters can be observed. CWI showed the recovery potential at the first four cycles, and then the incremental oil recovery decreased dramatically in the subsequent cycles. By contrast, CGI presented a more continuous and steady recovery performance with high incremental RF, and then gradually diminished after seven cycles of huff-n-puff processes.

Cyclic gas injection (CGI), also known as huff-n-puff process, has been demonstrated as the most effective and promising IOR solution in shale reservoirs. Such process involves many operating parameters that can affect the recovery performance in different degrees. As soaking time and pressure depletion rate (PDR) are the two crucial factors, this study aims to further investigate their roles in the oil recovery process of CGI experimentally and numerically. A total of ten series of the N2 huff-n-puff tests were performed on oil-saturated Eagle Ford shale plugs in a matrix-fracture system. With the injection pressure (Pin) of 1,000 psi, two groups of tests were conducted: 1) under a constant PDR in blowout and five soaking times changed from 0.25-hr to 48-hr; 2) under a constant soaking time of 12-hr and four pressure depletion times changed from 0.05-hr to 48-hr. With the Pin of 5,000 psi, the CGI tests were performed under 12-hr soaking time and blowout pressure depletion to study the effect of Pin on recovery efficiency. Lab-scale simulation models were built and tuned to history match the experimental data. The experimental results show that recovery factor (RF) from a single cycle increases with soaking time within a certain range, and a longer time has no effect on improving oil recovery. For 1,000 psi Pin, during the soaking phase, the system pressure declined rapidly at the first 3 hr and then became stabilized. The pressure drop was relatively low (10 psi) in the first cycle compared with the following cycles. It tended to increase with the number of cycles performed, which was caused by the decrease of oil saturation thus more gas can be injected into the core sample. It reveals that a soaking period is necessary to the oil recovery process. On the other hand, increasing the pressure depletion rate can raise the incremental RF from each cycle. The blowout condition showed the highest cumulative RF. The performance of N2 huff-n-puff with 5,000 psi Pin outperforms the case of 1,000 psi, which can increase the ultimate RF with less cycles. The well-tuned simulation models were used to analyze and optimize the CGI recovery process.