Development of a predictive model for perioperative blood transfusion in elderly patients undergoing unilateral total hip arthroplasty / 基础医学与临床

Objective To analyze risk factors for perioperative blood transfusion in elderly patients undergoing uni-lateral primary total hip arthroplasty and develop a prediction model.Methods The study retrospectively collected 467 elderly patients receiving unilateral primary total hip arthroplasty between January 2013 and October 2021 at Peking Union Medical College Hospital.The 70%of the data were used as the training set and the 30%of the data were used as the testing set.Patients were divided into the transfusion and no-transfusion groups based on the presence or absence of perioperative blood transfusion.Univariate analysis and multivariable logistic regression were conducted to analyze patient demographic characteristics,surgical information,and preoperative laboratory tests for identifying risk factors.Clinical experience was combined to establish a prediction model and draw the nomogram.The receiver operating characteristic(ROC)curve and calibration curve were used to evaluate the model in the tes-ting set.Results A total of 91 patients(19.5%)received perioperative blood transfusion.Multivariable logistic re-gression suggested the history of coronary artery disease,prolonged operation time,and lower preoperative hemoglo-bin were risk factors for perioperative blood transfusion(P＜0.05).The prediction model was constructed based on the results of statistical analysis and clinical experience,including the history of coronary artery disease,operation time,preoperative hemoglobin,age,and American Society of Anesthesiologists(ASA)physical status＞Ⅱ.The area under the receiver operating characteristic curve(AUC)of the model was 0.809.Conclusions The prediction model for perioperative blood transfusion in elderly patients undergoing unilateral total hip arthroplasty had a good performance and could assist in clinical practice.

Quantitative analysis of myocardial fibrosis in dilated cardiomyopathy with deep learning joint segmentation model / 中华放射学杂志

Objective:To explore the effect of joint segmentation model of myocardial-fibrotic region based on deep learning in quantitative analysis of myocardial fibrosis in patients with dilated cardiomyopathy(DCM).Methods:The data of 200 patients with confirmed DCM and myocardial fibrosis in the left ventricle detected by cardiac MR-late gadolinium enhancement (CMR-LGE) in Xuzhou Central Hospital from January 2015 to April 2022 were retrospectively analyzed. Using a complete randomized design, the patients were divided into training set ( n=120), validation set ( n=30) and test set ( n=50). The left ventricle myocardium was outlined and the normal myocardial region was selected by radiologists. Fibrotic myocardium was extracted through calculating the threshold with standard deviation (SD) as a reference standard for left ventricle segmentation and fibrosis quantification. The left ventricular myocardium was segmented by convex prior U-Net network. Then the normal myocardial image block was recognized by VGG image classification network, and the fibrosis myocardium was extracted by SD threshold. The myocardial segmentation effect was evaluated using precision, recall, intersection over union (IOU) and Dice coefficient. The consistency of myocardial fibrosis ratio in left ventricle obtained by joint segmentation model and manual extraction was evaluated with intra-class correlation coefficient (ICC). According to the median of fibrosis rate, the samples were divided into mild and severe fibrosis, and the quantitative effect of fibrosis was compared by Mann-Whitney U test. Results:In the test set, the precision of myocardial segmentation was 0.827 (0.799, 0.854), the recall was 0.849 (0.822, 0.876), the IOU was 0.788 (0.760, 0.816), and the Dice coefficient was 0.832 (0.807, 0.857). The consistency of fibrosis ratio between joint segmentation model and manual extraction was high (ICC=0.991, P<0.001). No statistically significant difference was found in the ratio error between mild and severe fibrosis ( P>0.05). Conclusions:The joint segmentation model realizes the automatic calculation of myocardial fibrosis ratio in left ventricle, which is highly consistent with the results of manual extraction. Therefore, it can accurately realize the automatic quantitative analysis of myocardial fibrosis in patients with dilated cardiomyopathy.

Interpreting report of urinalysis based on intelligent data and machine learning / 中华检验医学杂志

Objective:To establish an interpretive reporting system for urinalysis based on artificial intelligence (AI).Methods:Urine tests were collected from the First Affiliated Hospital, College of Medicine, Zhejiang University from 2008 to 2018, including 2 899 917 patient tests and 710 971 physical check-up tests. Then we set up a large population distribution with the frequency of different results of each item and established a health index of each sample and an abnormal level of each item according to data distribution, importance and degree of abnormality. We collected data of seven diseases, such as diabetes mellitus, urinary tract infection, glomerulonephritis and nephrotic syndrome, and matched them with a same number of healthy control group by gender and age. An integrated learner based on the AdaBoost algorithm was used to establish a diagnostic model and assess its algorithm performance. JAVA was used to develop data presentation software. The accuracy of the AI model for disease judgment was assessed by manual verification using 199 abnormal urine tests.Results:Each report could be graded as four levels: normal, abnormal, ill and critical. Each item could be judged as normal, mild, moderate, severe or extreme and the population distribution was provided with big data. The training accuracy, true positive rate and area under the curve were ≥88.3%, ≥80.0%, and ≥0.954 respectively using the machine learning model based on AdaBoost. The developed JAVA software presented the above results and displayed medical records and results, historical results, personalized advice, patient education and position in large population data. By manual verification, the accuracy rate of the AI model for disease judgment was 82.41% (166/199).Conclusion:This study established an intelligent interpretive reporting system for urine test results. It can distinguish the abnormality of each report, predict the disease of patients, and make personalized clinical decisions.

Establishment of An Animal Model of Transfusion-related Acute Lung Injury and the Role of Soluble CD40 Ligand in the Development of Transfusion-related Acute Lung Injury / 中国医学科学院学报

Objective To establish an animal model of transfusion-related acute lung injury (TRALI) and investigate the role of soluble CD40 ligand (sCD40L) in the development of TRALI. Methods The TRALI animal model established by trauma-hemorrhage-transfusion. Lung edema was evaluated by histopathological examination and the protein and Evans blue dye accumulation in bronchoalveolar lavage fluid. The concentration of sCD40L in storage packed red blood cell (PRBC) and rat's plasma was measured by enzyme-linked immunosorbent assay (ELISA). Results There were obvious epithelial hyperplasia and inflammatory cell infiltration in the lung tissue of 7 d-PRBC-treated group. The accumulation of protein in bronchoalveolar lavage fluid of 7 d-PRBC-treated group [(13.17±5.76)mg] was significantly higher than that in normal controls [(1.21±0.66)mg] and normal saline (NS)-treated group [(4.94±2.15) mg] (F=17.605,P<0.001). The leakage amount of Evans blue dye in 7 d-PRBC-treated group [(0.0109±0.0067)%/min] was significantly higher than that in NS-treated group [(0.0026±0.0006) %/min] (t=2.998,P=0.03). The concentration of sCD40L of the 7 d PRBC [(451.58±73.28) pg/ml] was significantly higher than 0 d PRBC [(277.94±98.18)pg/ml] (t=2.834,P=0.03). The concentration of sCD40L in the plasma of 7 d-PRBC-treated group [(878.21±125.30)pg/ml] was significantly higher than those in normal controls [(289.78±62.60)pg/ml] and NS-treated group [(418.07±47.68)pg/ml] (F=78.715,P<0.001). Conclusion The TRALI animal model was successfully established with trauma-hemorrhage-transfusion. The concentration of sCD40L in plasma of rats with massive transfusion is remarkably increased,suggesting sCD40L may play a role in the development of TRALI.

Analyze causes of adverse reactions induced by traditional Chinese medicine injections from its quality standards / 中国中药杂志

Reviewing the literatures about adverse reactions induced by traditional Chinese medicine injections (TCMI) reported on CNKI from 1983 to 2013. Analyzing the causes of adverse reactions induced by TCMI from its quality standards. Provide ideas for improving security of TCMI and completing its quality standards. This review indicates that TCMI-induced adverse reactions have little relationship with the number of compositions, but have tight connection with chemical ingredients and solvents. Adverse reactions can be decreased by perfecting the quality standards of TCMI.

Experimental study on pseudoallergic reaction of Qingkailing injection / 中国中药杂志

Pseudoallergic reactions of Qingkailing injection (QKLI) was assessed by vascular hyperpermeability which were indicated by ear blue staining in ICR mice after single intravenous injection of QKLI mixed with Evans blue (EB) and skin blue spot formation in SD rats after intradermal injection of QKLI and intravenous injection of EB. In addition, QKLI-induced histamine, VEGF, TNF-alpha release was measured after ICR mice received the single dosing of QKLI iv. The mild vascular hyperpermeability characterized by ear blue staining could be observed in mice after intravenous injection of QKLI and EB. Intracutaneous injection of 50 micro L of test solution containing QKLI (25,50 microL) in rat back skin caused obvious local vascular hyperpermeability at the injection sites so as to result the larger diameters of blue spots than that in negative control group (P <0. 01). QKLI induced a significant increase of VEGF and a slight elevation of histamine in mice after intravenous administration, while TNF-alpha showed no change after QKLI iv. The results in this study indicated that both intravenous injection and intracutanous injection of QKLI could induce vascular hyperpemeability so as to cause pseudoallergic reaction in mice and rats. QKLI-induced pseudoallergic reaction may be associated with the release of histamine and VEGF.

Chemical constituents in Thunbergia from Africa / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate the chemical compounds from the ethanol extract with inhibitory effects against aldose reductase from Thunbergia.</p><p><b>METHOD</b>Guided by anti-aldose reductase assay, compounds from the bioactive fraction (ethyl acetate extract) were separated and purified by various chromatographic methods including silica gel, Sephadex LH-20, and reversed-phase HPLC. Their structures were indentified based on analysis of the spectroscopic data including 1D and 2D NMR data.</p><p><b>RESULT</b>Eight compounds were obtained and identified as 8-hydroxy-8-methyl-9-methene-cyclopentane [7,11] -1,4, 6-trihydroxy-tetrahydronaphthalene-12-one, named as thunbergia A (1), 3,4-dihydro-4,5,8-trihydroxy-2-(3-methyl-2-butenyl) naphtha[2,3-b] oxiren-1(2H)-one (2), 8-(beta-gluco pyranosyloxy)-3,4-dihydro-2-(3-methyl-2-butenyl)naphtha [2,3-b] oxiren-1(2H)-one (3), galangin (4), quercetin (5), luteolin (6), 5,6,3',4'-tetrahydroxy -3,7-dimethoxy-flavone (7) and upeol (8).</p><p><b>CONCLUSION</b>Thunbergia A was a new derivative of tetrahydronaphthalene, and compounds 2 and 3 were separated from the genus Thunbergia for the first time.</p>

Advance in studies on NGR peptide modified liposome and its anti-tumor performance / 中国中药杂志

Aspargine-glycine-arginine (NGR)-containing peptides are targeted peptides which can be integrated with CD13 receptors on tumor vascular endothelial cells. NGR peptides are connected to liposomes to obtain NGR peptide-modified liposomes. By intravenous injection of these liposomes, NGR peptides can be combined with CD13 receptors on tumor vascular endothelial cells, position liposomes in tumor tissues, and concentrate drug in liposomes in tumor, so as to enhance the antitumor effect. The article starts with NGR peptides, summarizes definition of NGR, NGR peptide-modified liposomes, strengths and weaknesses of NGR peptide-modified liposomes in antitumor and the latest study orientation of NGR peptide-modified liposomes, and looks into the future of studies on NGR peptide-modified liposomes.

Study on the spatiotemporal trend of Japanese encephalitis in Guangxi,based on geographic information system and space-time permutation scan statistic / 中华流行病学杂志

Objective To study the spatiotemporal trend of Japanese encephalitis in Guangxi Zhuang Autonomous Region between 1989 and 2006.Methods Retrospective space-time permutation scan statistic and inverse distance weighted (IDW) interpolation were employed to detect the spatiotemporal trend of Japanese encephalitis in Guangxi,from the year 1989 to 2006.Results The spatiotemporal pattern of Japanese encephalitis was divided into four phases by IDW interpolation maps,from 1989 to 2006.The first phase was spatiotemporal cluster located in southeast region,from 1989 to 1996.The second phase showed discrete distribution from 1997 to 1998.The third phase of spatiotemporal cluster located in Lingshan county,Pubei county and Bobai county,in 1999.And the last phase was spatiotemporal cluster located in northwest region from 2000 to 2006.Three statistically significant spatiotemporal clusters were detected by retrospective space-time permutation scan statistic.The primary cluster appeared in 1999 (LLR=253.25,P=0.001,RR=4.62),with 109°54′ E,22°28′ N (located in Pubei county) as its center and radiated 45.24 km.From 2000 to 2006,the secondary cluster showed in northwest (LLR=75.91,P=0.001,RR = 1.88),with center located at 105°23′ E,24°68′ N (Longlin county),and radiated 199.85 kn.From 1989 to 1996,the other secondary cluster appeared in the southeast area(LLR=46.29,P=0.001,RR= 1.16),with center located at 110°94′ E,24°03′N(Zhaoping county) and radiated 229.12 km.Conclusion Space-time permutation scan statistic and geographical information system could be applied to quantitatively detect the potentially spatiotemporal trend of the disease.The spatiotemporal cluster shifted from southeast to northwest,from 1989 to 2006.

Effect of electroacupuncture on proliferation of astrocytes after spinal cord injury / 中国针灸

<p><b>OBJECTIVE</b>To explore the mechanism of acupuncture in treatment of spinal cord injury (SCI).</p><p><b>METHODS</b>Adult Wistar rats were used to make SCI model by Allen's method. The SCI rats were treated with electroacupuncture (EA) at acupoints of the Governor Vessel for 3 days, 1 week, 2 weeks or 4 weeks. Normal group and spinal cord injury group were used as controls. The number and morphology of astrocytes in each group were investigated by electron microscope, immunohistochemistry and in situs hybridization methods. The expression of glial fibroblast acid protein (GFAP) mRNA in the injured spinal cord was detected by reverse transcription polymerase (RP-PCR).</p><p><b>RESULTS</b>The mitochondria and ribosomes of astrocytes in the EA group increased. The number of astrocytes increased after SCI, in gray matter being more than that in the white matter, in the caudal being more than that in the rostral. The expression of GFAP mRNA in the EA group was significantly lower than that in the control group.</p><p><b>CONCLUSION</b>Electroacupuncture can inhibit the reactive proliferation of the astrocytes after spinal cord injury and prevent formation of the glial scar.</p>

Effect of intracerebroventricular injection of adrenomedullin on catecholaminergic neurons and expression of c-fos in the rat brain nuclei involved in cardiovascular regulation / 中国应用生理学杂志

<p><b>AIM AND METHODS</b>Using double immunohistochemical method for Fos and tyrosine hydroxylase(TH) to examine the effects of intracerebroventricular (icv) administration of adrenomedullin (AM) on catecholaminergic neurons and the expression of c-fos gene in rat brain nuclei involved in cardiovascular regulation in order to define whether the effects of central administration of adrenomedullin (AM) were induced by activating the catecholaminergic neurons.</p><p><b>RESULTS</b>(1) Following icy administration of AM (3 nmol/kg), Fos-like immunoreactivity neurons were markedly increased in several brain areas of the rat, including the brainstem, the hypothalamus and the forebrain. (2) Following icy administration of AM (3 nmol/kg), double-labeled neurons for Fos and TH increased significantly in the area postrema (AP), the nucleus of the solitary tract (NTS), the nucleus paragigantocellularis lateralis (PGL) and the locus coeruleus (LC). (3) Pretreatment with calcitonin gene-related peptide receptor antagonism CGRP (8-37) (30 nmol/kg) significantly reduced the action of AM (3 nmol/kg) in the brain.</p><p><b>CONCLUSION</b>AM activates the nuclei involved in cardiovascular regulation in the forebrain, the hypothalamus and the brainstem, and that the central actions of AM are induced by activating the catecholaminergic neurons of brainstem nuclei involved in cardiovascular regulation. CGRP receptor can mediate the effects of AM in brain.</p>

An outbreak of SARS in Dongcheng District, Beijing during March to June 2003 / 中国医学科学院学报

<p><b>OBJECTIVE</b>To describe epidemiological characteristics of an outbreak of severe acute respiratory syndrome (SRAS) in Dongcheng District, Beijing during March to June 2003.</p><p><b>METHODS</b>Data of SARS cases notified from Dongcheng District Center for Disease Control and Prevention (CDC) and supplemented by other channels were collected. All data were input into dataset files by Microsoft Excel-2000 software and analyzed with SPSS version 10.0 software.</p><p><b>RESULTS</b>Totally, 572 cases notified were collected during this period in Dongcheng District, Beijing, and 99 of them were excluded from SARS, because of diagnosis of common cold, pneumonia, measles, or rubella, etc. Actually, 473 SARS cases were analyzed. Attack rate of SARS in permanent residents of Dongcheng was 28.3 per 100,000. Forty-one of them died, with a case-fatality ratio of 8.7%. Outbreak of SARS in Dongcheng District started on March 14, with a peak during mid- and late April, and dropped from May 5, 2003. Persons were all susceptible to SARS, with the highest proportion at ages of 20-50 years, which accounted for 68.7% of the total cases. Average age of the patients at their onset was 40.7 years. No gender difference in SARS cases was found. Number of SARS cases in health care workers (HCWs) accounted for 18.0% and that in the retired persons accounted for 15.4% of the total cases. Cases occurred in all 10 sub-districts of Dongcheng. Totally, 230 of the 572 notified cases (40.2%) hospitalized at local hospitals under the jurisdiction of Dongcheng District. Eighteen of 85 cases of SARS occurred in health care workers of local hospitals, accounting for 4.5% of the total number of health care workers working at the wards caring for SARS patients or at fever clinics. There were 34.7% of SARS cases without any contact histories before their onset. Familial aggregation phenomena were observed in 41.8% of the cases and 18.1% of households. And, 7.4% (attack rate) in those exposed to SARS cases suffered the illness during the periods of quarantine.</p><p><b>CONCLUSIONS</b>SARS appeared outbreak in Dongcheng District, Beijing during March to June 2003. People were all susceptible to SARS, which mainly threatened the young adults and the middle-aged, as well as health care workers and the retired workers. Main mode of transmission was exposure to SARS patients in a near distance at hospitals or families. Prevention and control of SARS should be focused on early isolation of patients and quarantine for the contacts. Current available measures to prevent and control SARS proved effective.</p>

Effect of NO on automaticity of rabbit sino-atrial node / 中国应用生理学杂志

<p><b>AIM</b>To investigate the effects of exogenous NO donors sodium nitroprusside (SNP) and 3-morpholinosydnonimine (SIN-1) on automaticity of the rabbit sino-atrial node in vitro and the action mechanism.</p><p><b>METHODS</b>The intracellular microelectrode technique is used to record the action potentials of rabbit sino-atrial node and APA (amplitude of AP), V(max) (maximal rate of depolarization), VDD (velocity of diastolic depolarization), RPF (rate of pacemaker firing) are analyzed.</p><p><b>RESULTS</b>SNP(10(-5) - 10(-2) mol/L) increased its RPF and VDD dose-dependently. 10(-3) mol/L SNP increased RPF (beats/min) from 163 +/- 10.8 to 195.0 +/- 13.1 increased VDD (mV/s) from 50.3 +/- 9.6 to 70.2 +/- 12.1 (P < 0.01). SIN-1(10(-3) - 10(-2) mol/L) also increased RPF and VDD (P < 0.01).10(-4) mo/L Methylene blue (MB), a blocker of GMP cyclase, prevented the positive chronotropic effect and increasement of VDD induced by 10(-3) mol/L SNP totally (P < 0.01). 2. CsCl (2 mmol/L), a blocker of I(f) prevented the increasement of RPF and VDD in part (P < 0.05). 3. NIF (0.46 micromol/L), a blocker of I(Ca-L, had no significant effects on chronotropic effect and increasement of VDD (P < 0.01).</p><p><b>CONCLUSION</b>Exogenous NO can increase the automaticity of rabbit sino-atrial node in vitro. The chronotropic effect is involved in NO-cGMP pathway and results from increasement of I(f) in the sino-atrial node at least in part; I(ca-L) is unlikely to play a major role in this effect.</p>