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  • 文章类型: Journal Article
    2019-2022年B型流感维多利亚血统(Bv)的流行和爆发导致了对遗传,表位,带电氨基酸和Bv爆发。基于国家流感监测网络(NISN),2019-2022年分离的Bv72株是通过时空采样选择的,然后测序。使用比较手段,关联和集群,对疫情数据进行了分析,包括单核苷酸变异(SNV),氨基酸(AA),表位,进化率(ER),香农熵值(SV),带电的氨基酸和爆发。随着COVID-19的出现,非药物干预措施(NPI)的传播距离较短,只有Bv爆发。2021-2022菌株中的HA基因位于同一子集,但与2019-2020年菌株不同(P<0.001)。核苷酸中的密码子G→A转换比例最高,但C→A和T→A的颠倒对爆发的贡献最大,而以极性为特征的氨基酸突变的增加,酸性和碱性特征在2021-2022年的Bv疫情中发挥了关键作用。ER和SV在HA基因(R=0.690)和NA基因(R=0.711)中呈正相关,分别,然而,从2020年初到2022年,HA基因的突变数量是NA基因的1.59倍(2.15/1.36)。HA基因中的正选择位点174、199、214和563以及NA基因中的位点73和384是在2021-2022年流感爆发中进化选择的。总的来说,与2021-2022年流感爆发相关的流行因素包括流行时机,电视,Ts,电视/Ts,P137(B→P),P148(B→P),P199(P→A),P212(P→A),P214(H→P)和P563(B→P)。氨基酸突变对电荷/pH的偏好可能会影响传染病的流行/爆发趋势。这是传染病病原体进化的良好模型。这项研究,由于病毒学的进一步探索,遗传学,生物信息学和疫情信息,可能有助于进一步了解它们在传染病传播中的深层相互作用机制。
    The epidemic and outbreaks of influenza B Victoria lineage (Bv) during 2019-2022 led to an analysis of genetic, epitopes, charged amino acids and Bv outbreaks. Based on the National Influenza Surveillance Network (NISN), the Bv 72 strains isolated during 2019-2022 were selected by spatio-temporal sampling, then were sequenced. Using the Compare Means, Correlate and Cluster, the outbreak data were analyzed, including the single nucleotide variant (SNV), amino acid (AA), epitope, evolutionary rate (ER), Shannon entropy value (SV), charged amino acid and outbreak. With the emergence of COVID-19, the non-pharmaceutical interventions (NPIs) made Less distant transmission and only Bv outbreak. The 2021-2022 strains in the HA genes were located in the same subset, but were distinct from the 2019-2020 strains (P < 0.001). The codon G → A transition in nucleotide was in the highest ratio but the transversion of C → A and T → A made the most significant contribution to the outbreaks, while the increase in amino acid mutations characterized by polar, acidic and basic signatures played a key role in the Bv epidemic in 2021-2022. Both ER and SV were positively correlated in HA genes (R = 0.690) and NA genes (R = 0.711), respectively, however, the number of mutations in the HA genes was 1.59 times higher than that of the NA gene (2.15/1.36) from the beginning of 2020 to 2022. The positively selective sites 174, 199, 214 and 563 in HA genes and the sites 73 and 384 in NA genes were evolutionarily selected in the 2021-2022 influenza outbreaks. Overall, the prevalent factors related to 2021-2022 influenza outbreaks included epidemic timing, Tv, Ts, Tv/Ts, P137 (B → P), P148 (B → P), P199 (P → A), P212 (P → A), P214 (H → P) and P563 (B → P). The preference of amino acid mutations for charge/pH could influence the epidemic/outbreak trends of infectious diseases. Here was a good model of the evolution of infectious disease pathogens. This study, on account of further exploration of virology, genetics, bioinformatics and outbreak information, might facilitate further understanding of their deep interaction mechanisms in the spread of infectious diseases.
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  • 文章类型: Journal Article
    念珠菌是酵母中无性繁殖酵母的多系属,几乎在该亚类的所有家族中都有400多种物种,其名称与感染性念珠菌病密切相关。在过去的二十年里,大约一半的念珠菌物种已被重新分配到超过36个已经存在的属和14个新提出的属,但是该属的多系特征在很大程度上仍然存在。耳念珠菌是一个重要的,全球新兴的机会性病原体在全球医疗机构中引起了威胁生命的暴发。该物种属于Metschnikowiaceae中的念珠菌-念珠菌(CAH)进化枝,含有耐多药临床相关物种的进化枝,还有与自然环境隔离的物种。进化枝的系统发育位置远离念珠菌属的类型物种,后者是普通念珠菌(目前被解释为热带念珠菌的同义词),属于去重霉科。尽管先前的系统发育和系统基因组学研究证实了C.auris在Metschnikowiaceae中的位置,这些分析未能解决CAH进化枝在家族中的位置及其与Clavispora和Metschnikowia属的划界。为了解决CAH进化枝的位置,进行了系统发育和比较基因组学分析,以使用几种指标来解决C.auris和相关物种在Metschnikowiaceae中的系统发育位置,例如平均氨基酸同一性(AAI)值,保守蛋白(POCP)的百分比和直系同源物(PAPO)的存在-不存在模式。基于这些方法,提出了13个新属,用于各种念珠菌和杂交菌种,包括Metschnikowiaceae中CAH进化枝的成员。因此,耳弧菌和相关物种被重新分配给念珠菌属。引入了55种新组合和9种新物种,这将减少念珠菌属的多科性。引文:刘f,胡Z-D,赵X-M,etal.2024.Metschnikowiaceae中的念珠菌-念珠菌进化枝和相关分类群的系统发育分析,以及十三个新属的提议,55个新组合和9个新物种。Persoonia52:22-43。https://doi.org/10.3767/persoonia.2024.52.02。
    Candida is a polyphyletic genus of asexually reproducing yeasts in the Saccharomycotina with more than 400 species that occur in almost all families of the subclass and its name is strongly connected with the infectious disease candidiasis. During the last two decades, approximately half of the Candida species have been reassigned into more than 36 already existing genera and 14 newly proposed genera, but the polyphyletic feature of the genus largely remained. Candida auris is an important, globally emerging opportunistic pathogen that has caused life-threatening outbreaks in healthcare facilities worldwide. This species belongs to the Candida auris-Candida haemuli (CAH) clade in the Metschnikowiaceae, a clade that contains multidrug-resistant clinically relevant species, but also species isolated from natural environments. The clade is phylogenetically positioned remotely from the type species of the genus Candida that is Candida vulgaris (currently interpreted as a synonym of Candida tropicalis) and belongs to the family Debaryomycetaceae. Although previous phylogenetic and phylogenomic studies confirmed the position of C. auris in the Metschnikowiaceae, these analyses failed to resolve the position of the CAH clade within the family and its delimitation from the genera Clavispora and Metschnikowia. To resolve the position of the CAH clade, phylogenomic and comparative genomics analyses were carried out to address the phylogenetic position of C. auris and related species in the Metschnikowiaceae using several metrics, such as the average amino acid identity (AAI) values, the percentage of conserved proteins (POCP) and the presence-absence patterns of orthologs (PAPO). Based on those approaches, 13 new genera are proposed for various Candida and Hyphopichia species, including members of the CAH clade in the Metschnikowiaceae. As a result, C. auris and related species are reassigned to the genus Candidozyma. Fifty-five new combinations and nine new species are introduced and this will reduce the polyphyly of the genus Candida. Citation: Liu F, Hu Z-D, Zhao X-M, et al. 2024. Phylogenomic analysis of the Candida auris-Candida haemuli clade and related taxa in the Metschnikowiaceae, and proposal of thirteen new genera, fifty-five new combinations and nine new species. Persoonia 52: 22-43. https://doi.org/10.3767/persoonia.2024.52.02 .
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  • 文章类型: Journal Article
    中国国家癌症中心(NCC)定期报告全国癌症发病率和死亡率的统计数据。国际癌症研究机构(IARC)每两年计算并发布世界各国的癌症负担。为了确保中国的实际监测数据与IARC公布的数据之间的一致性,NCC已获得国家卫生委员会和IARC的批准,将在GLOBOCAN2022同时发布中国的癌症负担数据。
    2018年中国共有700个登记机构报告了高质量的癌症发病率和死亡率数据,其中2010年至2018年连续监测的106个登记机构用于建立年龄-时期-队列模型,以模拟癌症发病率和死亡率的趋势,并估计2022年中国的发病率和死亡率。此外,我们使用来自22个连续癌症登记处的数据,分析了2000-2018年间年龄标准化癌症发病率和死亡率的时间趋势.
    据估计,2022年中国发生了约4,824,700例新癌症病例和2,574,200例新癌症死亡。肺癌,结肠直肠,甲状腺,肝脏和胃是前五种癌症,占新发癌症病例的57.42%。肺癌,肝脏,胃,结肠直肠和食道是癌症死亡的五大主要原因,占癌症死亡总数的67.50%。粗发生率和年龄标准化发生率(ASIR)分别为341.75/100,000和201.61/100,000。粗死亡率为182.34/100,000,年龄标准化死亡率(ASMR)为96.47/100,000。在2000-2018年间,所有癌症的ASIR每年增加约1.4%,而ASMR每年减少约1.3%。我们观察到食管癌的ASIR和ASMR呈下降趋势,胃,还有肝脏,而甲状腺癌的ASIR显著增加,前列腺,还有子宫颈.
    癌症仍然是中国主要的公共卫生问题,具有反映发达地区和发展中地区共存的癌症特征。预防和控制措施的持续实施导致某些历史高发癌症的发病率和死亡率大幅下降,比如食道,胃癌和肝癌。坚持健康中国行动计划和肿瘤防治行动计划的指导原则,随着全面风险因素控制的持续努力,癌症筛查,早期诊断和治疗,以及诊断和治疗方案的标准化,是到2030年有效减轻日益增加的癌症负担的关键策略。
    UNASSIGNED: The National Cancer Center (NCC) of China regularly reports the nationwide statistics on cancer incidence and mortality in China. The International Agency for Research on Cancer (IARC) calculates and publishes the cancer burden of countries around the world every two years. To ensure consistency between the actual surveillance data in China and the data published by IARC, NCC has received approval from the National Health Commission and IARC to simultaneously release the cancer burden data for China in GLOBOCAN 2022.
    UNASSIGNED: There were a total of 700 registries reporting high-quality data on cancer incidence and mortality across China in 2018, of which 106 registries with continuous monitoring from 2010 to 2018 were used to establish an age-period-cohort model to simulate the trend of cancer incidence and mortality and to estimate the incidence and mortality in China in 2022. In addition, we analyzed the temporal trends of age-standardized cancer incidence and mortality from 2000 to 2018 using data from 22 continuous cancer registries.
    UNASSIGNED: It was estimated about 4,824,700 new cancer cases and 2,574,200 new cancer deaths occurred in China in 2022. Cancers of the lung, colon-rectum, thyroid, liver and stomach were the top five cancer types, accounting for 57.42% of new cancer cases. Cancers of the lung, liver, stomach, colon-rectum and esophagus were the five leading causes of cancer deaths, accounting for 67.50% of total cancer deaths. The crude rate and age-standardized incidence rate (ASIR) were 341.75 per 100,000 and 201.61 per 100,000, respectively. The crude mortality rate was 182.34 per 100,000 and the age-standardized mortality rate (ASMR) was 96.47 per 100,000. The ASIR of all cancers combined increased by approximately 1.4% per year during 2000-2018, while the ASMR decreased by approximately 1.3% per year. We observed decreasing trends in ASIR and ASMR for cancers of the esophagus, stomach, and liver, whereas the ASIR increased significantly for cancers of the thyroid, prostate, and cervix.
    UNASSIGNED: Cancer remains a major public health concern in China, with a cancer profile that reflects the coexistence of developed and developing regions. Sustained implementation of prevention and control measures has resulted in significant reductions in the incidence and mortality rates of certain historically high incidence cancers, such as esophageal, stomach and liver cancers. Adherence to the guidelines of the Healthy China Action Plan and the Cancer Prevention and Control Action Plan, along with continued efforts in comprehensive risk factor control, cancer screening, early diagnosis and treatment, and standardization of diagnostic and therapeutic protocols, are key strategies to effectively mitigate the increasing cancer burden by 2030.
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  • 文章类型: Journal Article
    中国国家癌症中心(NCC)每年使用来自中国所有可用癌症登记处的基于人群的癌症登记数据报告全国癌症发病率和死亡率的统计数据。
    2016年中国共有487个登记机构报告了高质量的癌症发病率和死亡率数据。使用汇总的癌症登记数据估计了全国范围内的新癌症病例和死亡人数。按地区(城市/农村)分层,性别,年龄组(0,1-4,5-9,10-14...85+)和癌症的发病率和死亡率,然后乘以相应的全国人口。世界Segi人口用于计算年龄标准化率。
    2016年,中国发生了约406.4万例新癌症病例和241.35万例新癌症死亡。肺癌,结肠直肠,胃,肝脏和女性乳腺癌是前五大常见癌症,占癌症新发病例总数的57.4%。肺癌,肝脏,胃,结肠直肠和食道是癌症死亡的五大主要原因,占癌症死亡总数的69.3%。粗发病率和年龄标准化发病率(ASIR)分别为每100,000人口293.91和186.46,分别。粗死亡率为174.55/100,000,年龄标准化死亡率(ASMR)为105.19/100,000。城市地区的ASIR较高,但ASMR较低。在过去的几十年里,ASIR在男性中相对稳定,但女性的总体癌症每年显着增加约2.3%。相比之下,在2000-2016年期间,男女ASMR每年显著下降约1.2%.值得注意的是,食管癌的癌症特异性ASIR和ASMR,胃,肝癌显著减少,而结肠直肠癌的发病率,前列腺,女性乳房,子宫颈,甲状腺明显增加。
    癌症仍然是中国的主要公共卫生问题,这需要广泛社区的长期合作努力。根据国家癌症预防和控制指南,不同地区需要量身定制的癌症预防和控制计划,以帮助减轻中国这些高致命性疾病的负担。
    UNASSIGNED: National Cancer Center (NCC) of China annually reports the nationwide statistics for cancer incidence and mortality using population-based cancer registry data from all available cancer registries in China.
    UNASSIGNED: There were a total of 487 registries which reported high quality data of cancer incidence and mortality across China in 2016. The nationwide numbers of new cancer cases and deaths were estimated using the pooled cancer registry data, which were stratified by area (urban/rural), sex, age group (0, 1-4, 5-9, 10-14…85+) and cancer site for incidence and mortality, and then multiplied by corresponding national population. The world Segi\'s population was applied for the calculation of age-standardized rates.
    UNASSIGNED: About 4,064,000 new cancer cases and 2,413,500 new cancer deaths occurred in China in 2016. Cancers of the lung, colon-rectum, stomach, liver and female breast were the top five common cancers, accounting for 57.4% of total cancer new cases. Cancers of the lung, liver, stomach, colon-rectum and esophagus were the five leading causes of cancer deaths, accounting for 69.3% of total cancer deaths. The crude and age-standardized incidence rates (ASIR) were 293.91 and 186.46 per 100,000 population, respectively. The crude mortality rate was 174.55/100,000 and the age-standardized mortality rate (ASMR) was 105.19/100,000. The ASIR was higher but the ASMR was lower in urban areas than that in rural areas. In past decades, the ASIR was relatively stable in males, but significantly increased by about 2.3% per year in females for overall cancers combined. In contrast, the ASMR significantly decreased by about 1.2% per year for both sexes during 2000-2016. Notably, the cancer-specific ASIR and ASMR of esophageal, stomach, and liver cancers decreased significantly, whereas both rates for cancers of the colon-rectum, prostate, female breast, cervix, and thyroid increased significantly.
    UNASSIGNED: Cancer remains a major public health problem in China, which demands long-term collaborative efforts of a broad community. With the national guideline on cancer prevention and control, tailored cancer prevention and control programs are needed in different regions to help reduce the burden of these highly fatal diseases in China.
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  • 文章类型: Journal Article
    欺诈活动,特别是在汽车保险和信用卡交易中,给企业和个人造成了巨大的经济损失。为了克服这个问题,我们提出了一种新的欺诈检测方法,将卷积神经网络(CNN)与支持向量机(SVM)相结合,k最近邻(KNN),朴素贝叶斯(NB),和决策树(DT)算法。这种方法的核心在于利用从CNN提取的深层特征作为各种机器学习模型的输入。从而大大有助于提高欺诈检测的准确性和效率。我们的研究结果表明,与以前的研究相比,我们的研究表现优异,突出了我们的模式在打击欺诈活动中被广泛采用的潜力。
    Fraudulent activities especially in auto insurance and credit card transactions impose significant financial losses on businesses and individuals. To overcome this issue, we propose a novel approach for fraud detection, combining convolutional neural networks (CNNs) with support vector machine (SVM), k nearest neighbor (KNN), naive Bayes (NB), and decision tree (DT) algorithms. The core of this methodology lies in utilizing the deep features extracted from the CNNs as inputs to various machine learning models, thus significantly contributing to the enhancement of fraud detection accuracy and efficiency. Our results demonstrate superior performance compared to previous studies, highlighting our model\'s potential for widespread adoption in combating fraudulent activities.
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  • 文章类型: Journal Article
    背景:药物分配错误会导致药物浪费并增加医疗成本,对患者造成严重后果。然而,很少有研究系统和完整地审查分配错误,对配药错误的客观规律性和风险因素关注不足。
    目的:探讨影响用药调剂差错发生率的潜在原因和危险因素。
    方法:我们从中国南方一家大型三级医院收集了11年来患者报告的用药错误。我们评估了配药错误的特征,标记为原因,将它们与2012年至2022年超过2500万张处方进行比较,确定了发生配药错误的易感因素,并分析了误差的特点和规律。
    结果:共记录376例患者报告的分配错误。患者平均需要5.2天才能发现错误。患者在24小时内仅审查了37.5%的错误。这些错误直接导致188406美元的药物损失。在记录的160名药剂师中,112(70%)犯了分配错误。配药错误受到药剂师使用机器的影响,工作量和每月假期的长度。在分配错误中,47.9%(n=180)是由药物包装或名称相似引起的。抗生素(n=32,8.5%)是最常见的药物分配错误,中药(n=31,8.2%)和免疫抑制剂(n=21,5.6%)最有可能配发量不准确。
    结论:可能有必要组织足够的人员并使用机器来准备药物,以减少分配错误。当药剂师离开工作超过72小时时,他们应该在分配药物之前在其他位置找到他们的节奏。在安排药物货架时,更重要的是优先区分包装相似的药物而不是名称相似的药物。
    BACKGROUND: Medication dispensing errors cause wastage of medicines and increase healthcare costs, with serious consequences for patients. However, few studies have systematically and completely reviewed dispensing errors, with inadequate attention to the objective regularity and risk factors for dispensing errors.
    OBJECTIVE: To explore the potential causes and risk factors influencing the prevalence of medication dispensing errors.
    METHODS: We collected patient-reported medication dispensing errors from a large tertiary care hospital in South China over 11 years. We assessed the characteristics of dispensing errors, labelled the causes, compared them with more than 25 million prescriptions from 2012 to 2022, identified the susceptibility factors for the occurrence of dispensing errors, and analysed the characteristics and patterns of the errors.
    RESULTS: A total of 376 patient-reported dispensing errors were recorded. It took an average of 5.2 days for a patient to find an error. Only 37.5% of errors were reviewed by the patient within 24 hours. These errors directly contributed to a medication loss of US$188 406. Of the 160 recorded pharmacists, 112 (70%) committed dispensing errors. Dispensing errors were affected by the pharmacists\' use of the machine, workload and the length of monthly vacation. Of the dispensing errors, 47.9% (n=180) were caused by medication packaging or names that were similar. Antibiotics (n=32, 8.5%) were the most common types of drugs dispensed incorrectly, and traditional Chinese medicines (n=31, 8.2%) and immunosuppressants (n=21, 5.6%) were the most likely to be dispensed in inaccurate quantities.
    CONCLUSIONS: Organising adequate staff and using machines to prepare medicines may be necessary to reduce dispensing errors. When pharmacists have been away from work for more than 72 hours they should find their rhythm in other positions before dispensing medicines. It is more important to prioritise the differentiation of medicines with similar packaging over those with similar names when arranging drug shelving.
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  • 文章类型: Journal Article
    背景:在中国医学生中,医学统计通常被认为是一个令人生畏的学科。虽然现有研究探讨了中国研究生医学生对统计学的态度及其对学业成绩的影响,缺乏研究中国医学本科生对这一主题的态度的研究。本研究试图审查中国医学本科生对统计学的态度,评估他们对学习成就的影响,深入研究人口因素的影响。
    方法:1266名医学本科生参加了这项研究,填写包括SATS-36和其他查询的问卷。此外,医学统计课程结束时进行了检查。分析包括SATS分数和考试成绩,检查总体参与者人口和特定的人口统计亚组。
    结果:本科医学生通常对有关情感的统计数据表现出良好的倾向,认知能力,和价值组件,然而,对SATS-36的困难部分抱有较少的好感,与以前的研究结果一致。与他们的研究生相比,本科生对医学统计表现出更高的热情。然而,他们在统计学方面表现出较低的认知能力,并且倾向于低估学习统计学的价值和难度。尽管存在这些差异,本科医学生对统计学表现出真正的兴趣,并表现出对掌握该主题的强烈奉献精神。值得注意的是,学生对统计的态度可能会受到他们的专业和性别的影响。此外,学习成绩与情感之间存在统计学上显著的正相关,认知能力,值,利息,和SATS-36的努力分量,而与困难分量呈负相关。
    结论:教育工作者应仔细考虑对统计学的态度的影响,特别是在制定加强医学统计教育的策略和课程时,观察到专业和性别之间的差异。
    BACKGROUND: Among Chinese medical students, medical statistics is often perceived as a formidable subject. While existing research has explored the attitudes of Chinese postgraduate medical students towards statistics and its impact on academic performance, there is a scarcity of studies examining the attitudes of Chinese medical undergraduates on this subject. This study endeavors to scrutinize the attitudes of Chinese medical undergraduates towards statistics, assessing their ramifications on learning achievements, and delving into the influence of demographic factors.
    METHODS: 1266 medical undergraduates participated in this study, completing a questionnaire that included SATS-36 and additional queries. Furthermore, an examination was administered at the end of the medical statistics course. The analysis encompassed the SATS score and exam scores, examining both the overall participant population and specific demographic subgroups.
    RESULTS: Undergraduate medical students generally exhibit a favorable disposition towards statistics concerning Affect, Cognitive Competence, and Value components, yet harbor less favorable sentiments regarding the Difficulty component of SATS-36, aligning with previous research findings. In comparison to their postgraduate counterparts, undergraduates display heightened enthusiasm for medical statistics. However, they demonstrate a lower cognitive capacity in statistics and tend to underestimate both the value and difficulty of learning statistics. Despite these disparities, undergraduate medical students express a genuine interest in statistics and exhibit a strong dedication to mastering the subject. It is noteworthy that students\' attitudes toward statistics may be influenced by their major and gender. Additionally, there exists a statistically significant positive correlation between learning achievement and the Affect, Cognitive Competence, Value, Interest, and Effort components of the SATS-36, while a negative correlation is observed with the Difficulty component.
    CONCLUSIONS: Educators should carefully consider the influence of attitudes toward statistics, especially the variations observed among majors and genders when formulating strategies and curricula to enhance medical statistics education.
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  • 文章类型: Journal Article
    目的:本研究旨在从包括血液学在内的疾病发作时现成的实验室生物标志物中确定脓毒症相关院内死亡率的预测因子。凝血,肝肾功能,血脂,心肌酶和动脉血气.
    方法:在一项涉及北京两家医院儿科重症监护病房(PICU)的前瞻性观察性研究中,连续招募了败血症儿童。2016年11月至2020年1月。人口统计数据,在PICU入院后的最初24小时内进行实验室检查,收集并发症和结局.我们使用最小绝对收缩和选择算子(LASSO)分析筛选了基线实验室指标,然后我们使用Cox比例风险回归分析构建了死亡风险模型。通过受试者工作特征(ROC)曲线评估危险因素预测住院死亡率的能力。
    结果:共纳入266名受试者,包括44名(16.5%)死亡和222名(83.5%)存活者。死者的住院时间较短,机械通气的比例更高,并发症和器官衰竭(p<0.05)。LASSO分析确定了13个与预后相关的临床参数,包含在最终的Cox模型中。甘油三酯(TG)升高仍然是最重要的死亡危险因素(HR=1.469,95%CI:1.010至2.136,p=0.044),其次是碱过量(BE)(HR=1.131,95%CI:1.046至1.223,p=0.002)和pH(HR=0.95,95%CI:0.93至0.97,p<0.001)。ROC曲线结果显示,TG+BE+pH-三项指标联合诊断曲线下面积(AUC)最好(AUC=0.77,95%CI:0.69~0.85,p<0.001),具有68%的灵敏度和80%的特异性。
    结论:TG的实验室因素,重症监护病房入院后最初24小时内的BE和pH值与PICU败血症患者的住院死亡率相关。三个指标的组合具有较高的诊断价值。
    OBJECTIVE: This study aimed to identify predictors of sepsis-associated in-hospital mortality from readily available laboratory biomarkers at onset of illness that include haematological, coagulation, liver and kidney function, blood lipid, cardiac enzymes and arterial blood gas.
    METHODS: Children with sepsis were enrolled consecutively in a prospective observational study involving paediatric intensive care units (PICUs) of two hospitals in Beijing, between November 2016 and January 2020. The data on demographics, laboratory examinations during the first 24 hours after PICU admission, complications and outcomes were collected. We screened baseline laboratory indicators using the Least Absolute Shrinkage and Selection Operator (LASSO) analysis, then we constructed a mortality risk model using Cox proportional hazards regression analysis. The ability of risk factors to predict in-hospital mortality was evaluated by receiver operating characteristic (ROC) curves.
    RESULTS: A total of 266 subjects were enrolled including 44 (16.5%) deaths and 222 (83.5%) survivors. Those who died showed a shorter length of hospitalisation, and a higher proportion of mechanical ventilation, complications and organ failure (p<0.05). LASSO analysis identified 13 clinical parameters related to prognosis, which were included in the final Cox model. An elevated triglyceride (TG) remained the most significant risk factor of death (HR=1.469, 95% CI: 1.010 to 2.136, p=0.044), followed by base excess (BE) (HR=1.131, 95% CI: 1.046 to 1.223, p=0.002) and pH (HR=0.95, 95% CI: 0.93 to 0.97, p<0.001). The results of the ROC curve showed that combined diagnosis of the three indicators-TG+BE+pH-has the best area under the curve (AUC) (AUC=0.77, 95% CI: 0.69 to 0.85, p<0.001), with a 68% sensitivity and 80% specificity.
    CONCLUSIONS: Laboratory factors of TG, BE and pH during the first 24 hours after intensive care unit admission are associated with in-hospital mortality in PICU patients with sepsis. The combination of the three indices has high diagnostic value.
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  • 文章类型: Journal Article
    近年来,孟德尔随机化(MR)已被广泛用于推断相关疾病风险暴露的因果关系。然而,该策略尚未应用于胆道闭锁(BA).
    41种炎性细胞因子的全基因组关联研究(GWAS)数据,731免疫细胞性状,从公共数据库中获得1400种代谢物作为暴露因子.结果信息来自对499名BA儿童和1928名正常对照的GWAS荟萃分析。反向方差加权是主要的因果关系分析。CochranQ-test,MR-Egger截获,MR多效性残差和异常值,和“留一法”分析用于敏感性分析。反向MR,斯泰格先生,和联系不平衡评分被用来排除反向因果关系的影响,遗传关联,和连锁不平衡。
    MR结果表明,共有7个性状与BA有潜在的因果关系,包括三种炎性细胞因子:eotaxin(比值比(OR)=1.45,95%置信区间(CI):1.08至1.95,pFDR=0.18),G-CSF(OR=4.21,95%CI:1.75~10.13,pFDR=0.05)和MCP-1/MCAF(OR=1.53,95%CI:1.12~2.10,pFDR=0.14);三个免疫细胞性状:CD8dimNKT/T细胞比值(OR=0.59,95%CI:0.45~0.77,pFDR=0.06),CD8dimNKT计数(OR=0.58,95%CI:0.43至0.78,pFDR=0.06),CD8dimNKT/淋巴细胞比率(OR=0.63,95%CI:0.49至0.81,pFDR=0.06);一种代谢物:X-12261水平(OR=2.86,95%CI:1.73至4.74,pFDR=0.06)。
    在这项研究中,eotaxin,G-CSF,MCP-1/MCAF,和X-12261水平被证明是BA的危险因素。然而,CD8dimNKT/T细胞比值,CD8dimNKT计数,CD8dimNKT/淋巴细胞比值是BA的保护因素。这些发现为病因学提供了有希望的遗传基础,诊断,和BA的治疗。
    UNASSIGNED: In recent years, Mendelian randomization (MR) has been widely used to infer causality of related disease risk exposures. However, this strategy has not been applied to biliary atresia (BA).
    UNASSIGNED: Genome-wide association studies (GWAS) data of 41 inflammatory cytokines, 731 immune cell traits, and 1400 metabolites were obtained from public databases as exposure factors. The outcome information was obtained from a GWAS meta-analysis of 499 children with BA and 1928 normal controls. Inverse variance weighting was the primary causality analysis. Cochran Q-test, MR-Egger intercept, MR pleiotropy residual sum and outlier, and \'leave-one-out\' analyses were used for sensitivity analysis. Reverse MR, MR-Steiger, and Linkage Disequilibrium Score were used to exclude the effects of reverse causality, genetic association, and linkage disequilibrium.
    UNASSIGNED: MR results showed that a total of seven traits had potential causal relationships with BA, including three inflammatory cytokines: eotaxin (odds ratio (OR)=1.45, 95% confidence interval (CI): 1.08 to 1.95, p FDR=0.18), G-CSF (OR=4.21, 95% CI: 1.75 to 10.13, p FDR=0.05) and MCP-1/MCAF (OR=1.53, 95% CI: 1.12 to 2.10, p FDR=0.14); three immune cell traits: CD8dim NKT/T cells ratio (OR=0.59, 95% CI: 0.45 to 0.77, p FDR=0.06), CD8dim NKT counts (OR=0.58, 95% CI: 0.43 to 0.78, p FDR=0.06), CD8dim NKT/lymphocyte ratio (OR=0.63, 95% CI: 0.49 to 0.81, p FDR=0.06); one metabolite: X-12261 levels (OR=2.86, 95% CI: 1.73 to 4.74, p FDR=0.06).
    UNASSIGNED: In this study, eotaxin, G-CSF, MCP-1/MCAF, and X-12261 levels were shown to be risk factors for BA. However, CD8dim NKT/T cells ratio, CD8dim NKT counts, and CD8dim NKT/lymphocyte ratio were protective factors for BA. These findings provided a promising genetic basis for the etiology, diagnosis, and treatment of BA.
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  • 文章类型: English Abstract
    天王补心丸在临床实践中已显示出治疗效果,而严重缺乏全面的质量控制来确保临床用药的安全性和有效性。在这项研究中,采用超高效液相色谱法(UPLC)建立了天王补心丸中7种成分的指纹图谱及含量测定方法。此外,采用化学计量学来确定质量稳定的关键因素,为该制剂的全面质量控制和评价提供参考。15批天王补心丸的UPLC指纹图谱共有25个峰,从中鉴定出13种化合物。建立了7种药理成分(α-亚麻酸,丹酚酸B,甘草次酸,schisandrinA,β-细辛脑,3,6'-二氨基蔗糖,和龟甲内酯)。采用主成分分析(PCA)和偏最小二乘判别分析(PLS-DA)确定关键药理作用成分,以控制天王补心丸的质量稳定性,其中包括3,6'-二氨基蔗糖,α-亚麻酸,和β-细辛醚。建立的指纹图谱和多组分含量测定方法具有较强的特异性,稳定性,和可靠性。此外,3,6'-二氨基蔗糖,α-亚麻酸,β-细辛醚是保证批间质量稳定性的关键药理作用成分,可用于天王补心丸的质量全面控制。研究结果为天王补心丸的质量评价和标准制定提供了科学依据。
    Tianwang Buxin Pills have demonstrated therapeutic effects in clinical practice, whereas there is a serious lack of comprehensive quality control to ensure the safety and effectiveness of clinical medication. In this study, ultra-performance liquid chromatography(UPLC) was employed to establish the fingerprint and the method for simultaneously determining the content of seven components of Tianwang Buxin Pills. Furthermore, chemometrics was employed to identify the key factors for the stable quality, which provided a reference for the comprehensive quality control and evaluation of this preparation. There were 25 common peaks in the UPLC fingerprints of 15 batches of Tianwang Buxin Pills, from which thirteen compounds were identified. A quantitation method was established for seven pharmacological components(α-linolenic acid, salvianolic acid B, glycyrrhetinic acid, schisandrin A, β-asarone, 3,6\'-disinapoylsucrose, and ligustilide). The principal component analysis(PCA) and partial least square discriminate analysis(PLS-DA) were performed to determine the key pharmacological components for controlling the quality stability of Tianwang Buxin Pills, which included 3,6\'-disinapoylsucrose, α-linolenic acid, and β-asarone. The established fingerprint and multi-component content determination method have strong specificity, stability, and reliability. In addition, 3,6\'-disinapoylsucrose, α-linolenic acid, and β-asarone are the key pharmacological components that ensure the quality stability between batches and can be used to comprehensively control the quality of Tianwang Buxin Pills. The findings provide a scientific basis for the quality evaluation and standard establishment of Tianwang Buxin Pills.
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