基于稀疏表示变量选择方法的影像遗传学数据分析

目的:采用影像遗传学研究方法探索精神分裂症的影像遗传学特征。方法:在传统稀疏回归模型的基础上，改进 了其在不同范数条件下进行变量选择的能力，形成一种基于稀疏表示变量选择算法，并将该算法应用于208 个受试者的 41 236个功能磁共振成像数据和722 177个单核苷酸多态性数据的综合分析。通过对两类数据施加不同的权重因子，并 使用不同的Lp （p=0、0.5、1）范数分别对模型进行求解，筛选出两类数据在不同条件下的显著特征。结果:基因DAOA和 HTR2A在3种范数下均被筛选出。此外，在影像学数据方面，发现中央前回、枕上回、顶下缘角回、角回、内侧和旁扣带脑 回、后扣带回脑区与精神分裂症相关，此发现与先前精神分裂症的临床医学研究结果一致。结论:基于稀疏表示变量选择 方法应用于影像遗传学数据分析是一个有效可行的途径，为今后精神分裂症的影像遗传学研究提供了一种新的研究 思路。     

Diagnostic impact of core-needle biopsy on fine-needle aspiration of non-Hodgkin lymphoma

We retrospectively reviewed 74 fine-needle aspiration (FNA) cases of presumptive non-Hodgkin lymphoma (NHL). All the cases had cytology and core-needle biopsy and 53 cases had concurrent flow cytometric analysis. FNA (cytology and flow cytometry) and core-needle biopsy were evaluated independently. FNA was diagnostic of diffuse large B-cell lymphoma (DLBL) in 25% (13/53) of cases and small B-cell NHL in 15% (8/53) of cases, whereas core-needle biopsy was diagnostic of DLBL in 37% (27/74) of cases and small B-cell NHL in 8% (6/74) of cases. Subclassification of small B-cell NHL was reached in 3/6 cases by core-needle biopsy. Insufficient cases were observed in both FNA (47%; 25/53) and core-needle biopsy (28%; 21/74) groups. With the combination of FNA and core-needle biopsy, diagnostic cases of DLBL increased to 43% (32/74) and insufficient samples were reduced to 16% (12/74). There was no clear advantage in the diagnosis and classification of small B-cell NHL by adding core-needle biopsy to FNA (14%; 10/74). We conclude that core-needle biopsy is a useful adjunct to FNA in the diagnosis of DLBL and shall be encouraged. In small B-cell NHL, core-needle biopsy does not add to the diagnostic ability of FNA. Cases insufficient for diagnosis may be seen in both core-needle biopsy and FNA. A combined approach reduces the number of insufficient cases and is recommended in routine FNA practice.     

A polyexponential deconvolution method. Evaluation of the “gastrointestinal bioavailability” and meanin vivo dissolution time of some ibuprofen dosage forms

A new deconvolution algorithm (DCON) suitable for pharmacokinetic applications is presented. It requires that both the impulse and input responses, typically systemic drug levels, be well described by polyexponential equations. DCON has a wider range of applications than an earlier method (DECONV) from which it is derived. A FORTRAN program is provided, making implementation of the technique a simple matter. DCON is demonstrated to evaluate the GI bioavailability, defined as the rate and the extent of gastrointestinal drug release, of various ibuprofen dosage forms. The GI drug release kinetics exemplifies a pharmacokinetic system which cannot be evaluated using the previous deconvolution algorithm (DECONV) because of an initial zero drug level response. This limitation is not found in DCON. It is also demonstrated how the mean in vivo dissolution time MDT can be evaluated by deconvolution.     

A comparison of three methods of scoring penile circumference changes

There are presently three widely used methods of scoring penile circumference data. The present experiment attempted to determine the ability of each method to explain the variance within a data set. A total of 19 subjects were presented with 20 photographic slides assigned to five categories: neutral, female adult, female adolescent, male adult, and male adolescent. Erectile responses to each slide were recorded and the data analyzed in terms of the raw scores, percentage of full erection, and a z-score transformation. Results indicated that the z scores captured the highest proportion of the variance (52.7%), followed by the percentage scores (32.5%), and the raw scores (30.1%). Findings are discussed in terms of their research and clinical implications.     

Histamine Intolerance in Children: A Narrative Review

Histamine intolerance is defined as a disequilibrium of accumulated histamine and the capacity for histamine degradation. This clinical term addresses a non-immunologically mediated pathology when histamine ingested with food is not particularly high, however its degradation is decreased. This paper aims to provide a narrative review on etiopathology, epidemiology, possible diagnostic algorithms and diagnostic challenges of histamine intolerance in children. The clinical picture of histamine intolerance in children is similar to that observed in adults apart from male predominance found in paediatric patients. Both in children and adults, a histamine-reduced diet is typically the treatment of choice. Diamine oxidase supplementation offers another treatment option. There is no symptom or test pathognomonic for histamine intolerance. Nevertheless, manifestations of chronic gastrointestinal symptoms, measurements of diamine oxidase deficits, positive results of histamine provocation tests and improvement in symptoms with histamine-reduced diet considerably increase the probability of histamine intolerance diagnosis. These factors have been included in the proposed diagnostic algorithm for histamine intolerance. In children histamine intolerance most likely co-occurs with allergies and bowel diseases, which creates an additional diagnostic challenge. As the evidence for children is poor further research is needed the determine epidemiology, validate diagnostic algorithms and establish possible treatment options regarding histamine intolerance.     

基于SMOTE算法的化疗肿瘤患者下呼吸道感染预警模型构建

 目的 构建基于少数类样本合成过抽样技术（synthetic minority over-sampling technique,SMOTE）算法的化学治疗（化疗）肿瘤患者下呼吸道感染预警模型。方法 共纳入西宁市4所三级医院2019年1月-2021年6月收治的2 384例接受化疗的肿瘤患者为研究对象,将所收集病例按照7：3的比例随机分为建模组1 668例和验证组716例,建模组数据用来建立模型,验证组数据对所建立的模型进行验证,利用单因素比较和logistic回归分析筛选下呼吸道感染影响因素,基于SMOTE算法建立化疗肿瘤患者下呼吸道感染预警模型。结果 logistic回归分析可得,年龄（x₁）、身体质量指数（BMI）值是否正常（x₂）、恶性肿瘤分期（x₃）、吸烟史（x₄）、合并糖尿病（x₅）、合并肺部疾病（x₆）均是化疗肿瘤患者下呼吸道感染的危险因素（均P<0.01）,获得原始数据预警模型：Logit（P）=0.055x₁+0.967x₂-0.195x₃+1.383x₄+0.968x₅+0.939x₆-14.073和基于SMOTE算法的预警模型：Logit（P）=0.090x₁+1.092x₂-0.249x₃+1.724x₄+1.136x₅+1.344x₆-14.859。基于SMOTE算法预警模型AUC为0.949（95%CI：0.937~0.961）,高于原始数据预警模型AUC 0.780（95%CI：0.734~0.846）。结论 基于SMOTE算法所构建的预警模型能更准确预警化疗肿瘤患者下呼吸道感染,有效解决感染与非感染患者样本数据不平衡所导致的预测误差,基于预测模型可选择相应的对策进行应对。     

深圳市新型冠状病毒肺炎社区传播风险快速评估方法研究

目的 探索基于街道的新型冠状病毒肺炎(简称新冠肺炎)疫情社区传播风险评估方法,提升政府的公共卫生管理水平。方法 采用综合评分法,整合深圳报告的新冠肺炎确诊病例的关键信息,建立新冠肺炎社区传播风险快速评估方法。结果 截至2020年2月29日,深圳市累计报告新冠肺炎确诊病例417例,其中感染来源为湖北武汉地区有224例(53.7%),湖北省其他地区80例(19.2%),其他省市38例(9.1%),深圳市内感染75例(18.0%)。选取“14 d内街道的新冠肺炎病例数(X₁)”、“14 d内新冠肺炎病例数的明确感染来源占比(X₂)”及“14 d内街道内发生新冠肺炎的社区占比(X₃)”作为新冠肺炎社区传播风险快速评估方法的关键指标,建立评价方程Y=0.4X₁+0.5X₂+0.1X₃。将前期已报告的392例具有明确现住址的新冠肺炎确诊病例回代计算,高风险街道15个(20.2%),中风险街道25个(33.8%),低风险街道共34个(50.0%)。福田区、南山区、龙华区、龙岗区的高、中风险街道的比例均超过60%。结论 新冠肺炎社区传播风险快速评估方法简易有效,有助于疫情的精准防控。     

肝硬化腹水患者预后的危险因素研究

为探讨影响肝硬化腹水患者预后的危险因素 ,建立判断其预后的评分系统 ,随机选择肝硬化腹水患者 1 80例 (存活组 89例 ,死亡组 91例 ) ,统计其年龄、肝硬化相关的并发症、肝脏生化、腹水检查结果等 2 2个指标 ,进行单因素分析 ,并将P <0 .0 5的指标进行Logistic回归分析。结果 :单因素分析发现 ,年龄、消化道出血、肝性脑病、肝肾综合征、休克、腹水白细胞数、外周白细胞数、凝血酶原活性、白蛋白、血清总胆红素、血清尿素氮及低钠血症与肝硬化腹水患者预后有关 (P <0 .0 5～ 0 .0 0 0 )。Logistic回归发现 ,凝血酶原活性、肝性脑病、血清尿素氮及低钠血症是影响肝硬化腹水患者预后的独立危险因素。以凝血酶原活性等 4个指标建立一个判断肝硬化腹水患者预后的评分系统 ,以总分≥ 5为判断死亡的临界值 ,预测死亡的正确率为 91 .2 % ,预测生存的正确率为 94.3 % ,符合率为 91 .7%。     

Criteria for intensive care unit admission and severity of illness

Intensive care is a specialist area of the hospital with concentration of resources and expertise to look after critically unwell patients. No set criteria exist for admission to intensive care, although patients usually have severe illness associated with physiological dysfunction and actual or impending organ failure. There are multiple scoring systems designed to assess severity of illness, all with significant limitations. The National Early Warning Score 2 (NEWS-2) is a commonly used ‘track and trigger’ system designed to detect and respond to the unwell or deteriorating patient. NEWS-2 is marker of physiological disturbance and high scores correlate with intensive care admission and mortality. Looking at the elective and emergency surgical population, patients at high risk of complications should be admitted to intensive care postoperatively. Increasing age, comorbidities, poor exercise tolerance and major surgical intervention are associated with adverse outcomes. Admission to intensive care often requires difficult time-critical decisions to be made with limited information. Intensive care admission can be the difference between life and death, but there are both physical and psychological harm associated with invasive organ support. The four pillars of medical ethics – autonomy, beneficence, non-maleficence and justice – can be used to guide these decisions.     

Development and Validation of Scoring Indication of Surgical Clipping and Endovascular Coiling for Aneurysmal Subarachnoid Hemorrhage from the Post Hoc Analysis of Japan Stroke Data Bank

There are no scoring methods for optimal treatment of patients with aneurysmal subarachnoid hemorrhage (aSAH). We developed a scoring model to predict clinical outcomes according to aSAH risk factors using data from the Japan Stroke Data Bank (JSDB). Of 5344 patients initially registered in the JSDB, 3547 met the inclusion criteria. Patients had been diagnosed with aSAH and treated with surgical clipping or endovascular coiling between 1998 and 2013. We performed multivariate logistic regression for poor outcomes at discharge, indicated by a modified Rankin Scale (mRS) score >2, and in-hospital mortality for both treatment methods. Based on each risk factor, we developed a scoring model assessing its validity using another dataset of our institution. In the surgical clipping group, scoring criteria for aSAH were age >72 years, history of more than once stroke, World Federation of Neurological Societies (WFNS) grades II–V, aneurysmal size >15 mm, and vertebrobasilar artery (VBA) aneurysm location. In the endovascular coiling group, scoring criteria were age >80 years, history of stroke, WFNS grades III–V, computed tomography (CT) Fisher group 4, and aneurysmal location in the middle cerebral artery (MCA) and anterior cerebral artery (ACA). The rates of poor outcome of mRS score >2 in an isolated dataset using these scoring criteria were significantly correlated with our model’s scores, so this scoring model was validated. This scoring model can help in the more objective treatment selection in patients with aSAH.