老年性痴呆患者隐匿性肺炎风险预测模型的构建和验证

 目的 分析老年性痴呆患者隐匿性肺炎的危险因素并构建预测模型。方法 回顾性分析2019年1月—2020年12月安徽医科大学第三附属医院收治的明确诊断为老年性痴呆合并肺部感染患者病历资料,从确诊患者中随机挑选部分患者作为建模组,并根据是否具备隐匿性分为隐匿性肺炎组、非隐匿性肺炎组,其余病例作为验证组。分别采用单因素和logistic回归多因素分析老年痴呆患者发生隐匿性肺炎的危险因素,应用R4.0.3软件构建nomogram图并对模型进行验证。结果 共纳入216例患者。其中148例（隐匿性肺炎75例、非隐匿性肺炎73例）用于建模,68例（隐匿性肺炎37例、非隐匿性肺炎31例）用于验证。糖尿病（OR=2.565,95%CI：1.094~6.015）、重度痴呆（OR=3.079,95%CI：1.116~8.494）、痴呆病程≥10年（OR=5.782,95%CI：2.139~15.627）、年龄≥80岁（OR=2.737,95%CI：1.011~7.413）、长期卧床（OR=4.835,95%CI：1.716~13.625）为痴呆合并隐匿性肺炎的独立危险因素（均P<0.05）。通过该5项危险因素构建预测模型并进行验证,验证结果显示：建模组曲线下面积（AUC）为0.841,验证组AUC为0.756,提示该模型诊断能力良好;Hosmer-Lemeshow检验显示模型拟合优度良好;decision曲线分析显示该模型有较高的获益性。结论 年龄≥80岁、重度痴呆、痴呆病程≥10年、糖尿病、长期卧床是老年性痴呆患者发生隐匿性肺炎的独立危险因素,通过列线图模型个体化可预测老年性痴呆患者发生隐匿性肺炎的概率,从而尽早干预,改善预后。     

Guidelines for the diagnosis,treatment, prevention and control of infections caused by carbapenem-resistant gram-negative bacilli

The dissemination of carbapenem-resistant Gram-negative bacilli (CRGNB) is a global public health issue. CRGNB isolates are usually extensively drug-resistant or pandrug-resistant, resulting in limited antimicrobial treatment options and high mortality. A multidisciplinary guideline development group covering clinical infectious diseases, clinical microbiology, clinical pharmacology, infection control, and guideline methodology experts jointly developed the present clinical practice guidelines based on best available scientific evidence to address the clinical issues regarding laboratory testing, antimicrobial therapy, and prevention of CRGNB infections. This guideline focuses on carbapenem-resistant Enterobacteriales (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB), and carbapenem-resistant Pseudomonas aeruginosa (CRPA). Sixteen clinical questions were proposed from the perspective of current clinical practice and translated into research questions using PICO (population, intervention, comparator, and outcomes) format to collect and synthesize relevant evidence to inform corresponding recommendations. The grading of recommendations, assessment, development and evaluation (GRADE) approach was used to evaluate the quality of evidence, benefit and risk profile of corresponding interventions and formulate recommendations or suggestions. Evidence extracted from systematic reviews and randomized controlled trials (RCTs) was considered preferentially for treatment-related clinical questions. Observational studies, non-controlled studies, and expert opinions were considered as supplementary evidence in the absence of RCTs. The strength of recommendations was classified as strong or conditional (weak). The evidence informing recommendations derives from studies worldwide, while the implementation suggestions combined the Chinese experience. The target audience of this guideline is clinician and related professionals involved in management of infectious diseases.     

影响癫痫儿童生活质量相关领域的研究概况

癫痫是一种因大脑神经元的正常功能发生异常所致的神经系统慢性疾病,主要发生在儿童和青少年期,具有一定的遗传性。由于癫痫疾病本身打破了神经元的正常脑电生理,对大脑皮质产生重复累积的损害,可使患儿的认知功能、精神心理、社会行为、睡眠等受到严重影响,导致癫痫患儿后期的生活质量受到威胁,甚至可干扰成年以后的生活和发展。随着对癫痫疾病的深入研究,对癫痫的治疗不再仅局限于控制癫痫发作,关注患儿及其家庭的生活质量也变得同等重要。如何改善和提高癫痫儿童的生活质量已成为专科临床医师进行临床评估的一部分。文章就癫痫儿童生活质量相关领域的研究进行综述。     

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??OBJECTIVE To establish an interferon-resistant hepatitis B virus cell model and provide experimental basis for further investigating the mechanism of HBV resistance to interferon. METHODS HepG2.2.15 was continuously grown in the presence of 10,30,50 and 70 u??mL^-1 of interferon ??-2b for up to 48 weeks. The HepG2.2.15/IFN??-2b cell model was constructed after 48 weeks of induction. The cells were treated with the best-effect concentration. Then, the levels of HBsAg, HBeAg, and HBV DNA in the supernatant of cell culture medium before and after the treatment were compared. RESULTS After stimulation with low concentrations of IFN??-2b for 12 weeks, the 50 u??mL^-1 group showed significant resistance to the best-effect concentration of IFN??-2b. Compared with the levels before stimulation, the inhibition rate on HBsAg, HBeAg, and HBV DNA decreased by 25.48%, 8.40%, and 15.43%, respectively, suggesting that 50 u??mL^-1 was the best-stimulation concentration. After stimulated with 50 u??mL^-1 IFN??-2b for 12-48 weeks, the results showed that the inhibition rate on HBsAg, HBeAg, and HBV DNA after 36 weeks was the most significant. CONCLUSION Continuous induction with 50 u??mL^-1 IFN??-2b for 36 weeks could most easily induce drug resistance in HepG2.2.15 cells.     

阿托伐他汀钙对老老年高血压合并高脂血症患者的降脂作用及安全性观察

目的 探讨阿托伐他汀钙在老老年高血压合并高脂血症患者中的降脂作用及安全性.方法 选择68例老老年患者,均服用阿托伐他汀钙20 mg(每晚1次),观察服药前后血脂、肝肾功能及肌酸激酶的变化情况.结果 与治疗前比较,治疗后患者的甘油三脂(TG)、总胆固醇(TCH)、低密度脂蛋白胆固醇(LDL-C)水平降低,高密度脂蛋白胆固醇(HDL-C)水平升高,患者的丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、肌酐(Cr)、尿素氮(BUN)、肌酸激酶(CK)无明显变化.结论 老老年高血压合并高脂血症患者应用阿托伐他汀钙降脂作用明显,且安全性较好.     

Unusual hyperpigmented patches,an undeveloped breast and a cataract in a female with incontinentia pigmenti

A 19‐year‐old female and her mother visited our department with a history of unusual reticular brown‐black patches on their trunks and limbs since infancy. Besides the obviously fulsome hyperpigmentation, the daughter also showed other unusual clinical manifestations such as generalized hypohidrosis, especially on the hyperpigmented patches, cicatricial alopecia, a cataract on her right eye, abnormal teeth and a right dysplastic breast. The mother had a median diastema between her maxillary central incisors, hypoplasia of the enamel, hypohidrosis and hyperpigmented patches on her left thoracic region. Analysis of the NEMO (NF‐κB essential modulator) gene in the patient and her mother revealed a deletion of exons 4–10. Their EDA and EDAR genes were normal.     

Evaluation of adalimumab biosimilar candidate (HS016) in Chinese patients with active ankylosing spondylitis based on a health survey: sub-analysis of a phase 3 study

Clinical Rheumatology - The equivalence of the biosimilar HS016 to adalimumab (Humira) for the treatment of active ankylosing spondylitis (AS) patients has been previously validated. The aim was to...