ABSTRACT
Sepsis associated-acute kidney injury (SA-AKI) is a common complication of sepsis, which has a high incidence and is closely related to a poor prognosis. However, delayed diagnosis and non-specific treatments make it difficult to systematically manage SA-AKI. Based on massive clinical data, machine learning could build prediction models, which provide alarms and suggestions for the clinical decision support system. Although there are still many challenges such as poor interpretability, it has shown clinical application value in SA-SKI risk prediction, imaging diagnosis, subtype identification, prognosis assessment, and so on. Based on a brief introduction of machine learning, this article reviews the application, limitations, and future directions of machine learning in the diagnosis and treatment of SA-AKI, and explores the possibility of machine learning in the medical field, in order to promote the development of precision medicine and intelligent medicine.
ABSTRACT
Sepsis is defined as a life-threatening organ dysfunction caused by the dysregulated host response to infection, and is one of the main causes of death in intensive care unit (ICU) patients. Coagulation dysfunction runs through the pathophysiological progress of sepsis whose severity should be closely related to the prognosis of sepsis. Neutrophil extracellular traps (NETs) is a three-dimensional network structure with DNA as the skeleton and inlaid with various protein components. The excessive production of NETs can lead to sepsis-induced coagulopathy (SIC) by activating the coagulation system, inhibiting the anticoagulation system, resisting fibrinolysis, damaging vascular endothelial cells and the interaction of platelets. At present, the treatment of SIC is mainly symptomatic treatment, and there is no recognized effective anticoagulation strategy. Interventions for NETs and their components, and drugs for antiplatelets are expected to become new directions for disease treatment.
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Objective To explore the effects of integrated treatment model (psychosocial interventions combined with drug therapy) in schizophrenia and analyze the influence of medication attitude on treatment compliance and psychiatric symptoms in different intervention models.Methods A total of 170 patients with schizophrenia were enrolled from 2012 to 2015.Patients were randomly divided into two groups:the integrated treatment group (86 patients) with drug therapy and psychosocial intervention,and the conventional drug treatment group (84 patients) with only drug intervention.Dug attitude inventory (DAI),self-awareness inventor (SAI),positive and negative symptoms scale (PANSS) were used to assess medication attitude,treatment compliance and clinical psychotic symptoms for all patients in the following 3 months,6 months and 12 months.Results Compared with medication-alone group,the integrated treatment group achieved significant improvement in psychiatric symptoms,including positive symptom and general psychopathology as well as significant reduction in scores in DAI and SAI (P＜0.05).In the conventional drug treatment group,the PANSS score was positively correlated with the increased score of DAI (β=0.31,P=0.02),which was mediated by the improvement in treatment adherence (β=0.18,P=0.18).There was no significant correlation between PANSS score and the increase score of DAI in the integrated treatment group(P=0.62).However,the increased score of SAI was positively correlated with the positive symptom of PANSS scale (r=0.31,P=0.01) and with the general psychiatric symptom scale (r=0.36,P＜0.01).Conclusion This study demonstrates that medication attitude can improve the treatment of mental symptoms by increasing compliance in the medication-only group.Symptom improvement is associated with improved compliance but not with medication attitudes in the integrated treatment model.
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ObjectiveTo explore the hemodynamic characteristics of parotid glands before and after acid stimulation test in patients with Sjogren syndrome.MethodsTwenty female patients with Sjogren syndrome were enrolled as case group,and 20 healthy women were selected in the same period as control group.The blood flow spectrums of bilateral superficial temporal artery and intra-parotid small artery before and after acid stimulation were detected by color Doppler ultrasonography.Peak systolic velocity (PSV),end-diastolic minimum velocity(EDV) and resistance index( RI ) were obtained and analyzed.ResultsPSV and EDV of intra-parotid small artery in case group were significantly higher than those in control group before acid stimulation test,and RI was obviously lower than that in control group [ ( 16.01 ± 6.18 ) cm/s vs.( 14.00 ± 5.23 ) cm/s,( 5.96 ± 3.00 ) cm/s vs.( 3.54 ± 2.03 ) cm/s,0.64 ± 0.07 vs.0.76 ± 0.06 ] ( P ＜ 0.05 ).In control group,PSV and EDV of superficial temporal artery and intra-parotid small artery increased and RI reduced after acid stimulation test,which had significant differences before and after acid stimulation test (P ＜ 0.05).There was no statistical significance in the hemodynamic indexes of case group before and after acid stimulation test(P＞ 0.05 ).Conclusions The reactivity of parotid artery to acid stimulation test in patients with Sjogren syndrome reduce,especially the intra-parotid small artery.Color Doppler ultrasonography can contribute to show the hemodynamic changes of the parotid lesions efficiently.
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ObjectiveTo discuss the epidemiological characteristic s of road traffic injuries in the Qinghai-Tibet Plateau and explore effective pre ventive measures against traffic accidents in the plateau as well as correspondi ng emergency treatment methods.MethodsA retrospective statis tical analysis was carried out in 1 894 cases of traffic injuries with detailed data admitted in our hospital from January 1980 to December 2000. Resu ltsMost of the traffic accidents occurred on the Qinghai-Tibet road, accounting for 68.0% (1 288/1 894). Of the patients with serious traffic inju ries, 54.0% (1 022/1 894) were in need of hospitalization. The patients who first entered into the plateau accounted for 61.1% (1 158/ 1 894). Death occurre d in 108 cases accounting for 5.7%. The duration from injury to treatment was ve ry long, average over six hours. Furthermore, the patients received no any manag ement before treatment in the hospital. ConclusionsHypoxia i n the plateau, unclear road sign and fatigue driving are the main factors leadin g to traffic accidents. Lack of health care units, serious hypoxia, long deliver y time and carriers' deficiency in medical knowledge are the main causes for gr eat amount of casualties.