早期生理盐水复苏后脓毒症患者血清氯水平 与急性肾损伤的关系

目的 探索脓毒症患者经生理盐水复苏72 h 后血清氯离子水平与急性肾损伤（AKI）的关系。 方法 选取2015 年1 月—2019 年5 月山西医科大学第一医院重症监护室收治并用生理盐水早期复苏的200 例 脓毒症或脓毒症休克患者,按照72 h 后的血清氯,分为高氯血症组（≥ 110 mmol/L）和非高氯血症组 （<110 mmol/L）,观察其初始血清氯离子浓度及肌酐、72 h 后最高血清氯离子浓度及肌酐、基础肌酐清除率 （Ccr）、初始急性生理功能和慢性健康状况评估Ⅱ（APACHE Ⅱ）评分、机械通气、肾替代治疗等指标,并 计算72 h 后血清氯离子变化值。结果 两组患者年龄、性别、机械通气、肾替代治疗、Ccr、APACHE Ⅱ 评分、72 h 后最高血清氯离子浓度及72 h 后血清氯离子浓度变化值比较,差异有统计学意义（P <0.05）。高 氯血症组AKI 发病率较非高氯血症组高（P <0.05）。单因素Logistic 回归分析显示,72 h 后最高血清氯离子 浓度与AKI 有关（P <0.05）。72 h 后血清氯离子浓度变化值≥ 1.5 mmol/L 和72 h 后血清氯离子浓度变化 值≥ 5.5 mmol/L 与AKI 也有关（P <0.05）。多因素Logistic 回归分析显示,APACHE Ⅱ评分[Ol ^ R=2.451 （95% CI：1.961,2.880）,P =0.000]、72 h 后最高血清氯离子浓度[Ol ^ R=2.023（95% CI：1.991,3.211）,P =0.010] 和72h 后血清氯离子浓度变化值[Ol ^ R=3.211（95% CI ：2.347,3.630）,P =0.006] 是AKI 发病的危险因素。 结论 脓毒症患者经生理盐水复苏72 h 后血清高氯离子与AKI 独立相关,且72 h 后血清氯离子浓度变化值、 APACHE Ⅱ评分也与AKI 有关。     

基于支持向量机与XGboost的成年人群肿瘤患病风险预测研究

背景　肿瘤风险预测对于提高人群健康水平、降低患者经济负担意义重大。但随着医疗大数据的产生,传统的统计预测方法逐渐无法满足需求,有必要尝试开展机器学习等新方法在肿瘤预测领域的应用。目的　探讨支持向量机与XGboost和逐步Logistic回归分析在成年人群肿瘤患病风险中的预测价值。方法　本研究时间为2011-2015年,数据来源于中国健康与营养调查（CHNS）,以我国12个地区（黑龙江、辽宁、湖南、山东、贵州、江苏、广西、湖北、河南、北京、上海和重庆）城乡成年（≥18岁）常住居民为对象,经过数据清理,最终纳入19 410人为本研究对象。将研究对象按2∶1分为训练集和测试集,基于逐步Logistic回归分析的变量筛选策略,在训练集上分别建立逐步Logistic回归分析、支持向量机、XGboost肿瘤患病风险预测模型,并在测试集上进行验证。通过比较各模型受试者工作特征曲线（ROC曲线）下面积（AUC）,分析各模型预测肿瘤患病风险的性能。结果　19 410例研究对象中,被诊断为肿瘤患者262例（1.35%）。训练集（n=12 919）中含有174例肿瘤患者,测试集（n=6 491）含有88例肿瘤患者。逐步Logistic回归分析、支持向量机、XGboost在测试集中预测成年人群患肿瘤的正确率分别为72.96%〔95%CI（71.86%,74.04%）〕、99.54%〔95%CI（99.34%,99.69%）〕、70.05%〔95%CI（68.92%,71.16%）〕,AUC分别为76.75%〔95%CI（72.35%,81.14%）〕、86.32%〔95%CI（81.64%,91.00%）〕、79.03%〔95%CI（74.96%,83.10%）〕。支持向量机、XGboost预测成年人群患肿瘤的AUC与Logistic回归模型比较,差异有统计学意义（Z值分别为-2.519、-2.138,P值分别为0.012、0.032）;XGboost预测成年人群患肿瘤的AUC低于支持向量机,差异有统计学意义（Z=2.081,P=0.037）。结论　支持向量机相较于逐步Logistic回归分析预测成年人群肿瘤患病风险的正确率、灵敏度、特异度、AUC等指标较好,而XGboost未见明显优势,但考虑到逐步Logistic回归分析操作的便捷性和可解释性优势,建议在肿瘤风险预测方面,采用支持向量机与逐步Logistic回归分析相结合的模式。     

羟乙基淀粉注射液致急性肾损伤的危险因素分析

目的 探讨羟乙基淀粉注射液致急性肾损伤（AKI）的危险因素,为临床安全用药提供参考。方法 回顾性分析2015年1月—2019年3月衡水市人民医院86例羟乙基淀粉注射液致AKI和同期使用羟乙基淀粉注射液但未发生AKI的767例患者的临床资料,采用单因素（χ²检验）及多因素（Logistic回归）对肾毒性危险因素进行分析。结果 AKI是羟乙基淀粉注射液严重不良反应之一,发生率为10.08%。单因素分析显示,体重指数、低蛋白血症、肌酐清除率、合并肾毒性药物、术中出血量、日剂量和用药时间与羟乙基淀粉肾毒性相关;多因素分析显示,日剂量（≥14 mL/kg）、肌酐清除率（<30mL/min）、用药时间（≥5 d）、术中出血量（>3 000 mL）、合并肾毒性药物和低蛋白血症（ALB<30 mL/L）是羟乙基淀粉130/0.4氯化钠注射液致AKI的独立危险因素。所有患者停药或经相关治疗后肾功能均逐渐恢复。结论 日剂量偏大、肾功能不全、长时间用药、术中出血量偏大、合并肾毒性药物和低蛋白血症是羟乙基淀粉致AKI的独立危险因素,临床中重点关注有独立危险因素的患者,以保证临床安全用药。     

Alcohol use disorders, nicotine dependence, and co-occurring mood and anxiety disorders in the United States and South Korea-a cross-national comparison

Background: The strong comorbidity between substance use disorders (SUDs) and mood and anxiety disorders has been well documented. In view of lack of research findings addressing the co‐occurrence of SUDs and mood and anxiety disorders, this study examined the pattern of comorbidity of alcohol use disorders (AUDs) and nicotine dependence (ND) between 2 culturally diverse countries, the United States and South Korea. Methods: Using the nationally representative samples of the U.S. and Korean general populations, we directly compared rates and comorbidity patterns of AUDs, ND, and mood and anxiety disorders between the 2 countries. We further examined the rates and the comorbidity pattern among individuals with AUDs who sought treatment in the last 12 months. Twelve‐month prevalence rates were derived to estimate country differentials, and odds ratios (ORs) and 95% confidence intervals were estimated to measure the strength of comorbid associations while adjusting for all sociodemographic characteristics in multivariate logistic models specific to each country. Results: The 12‐month prevalence rates of AUDs, ND, and any mood disorder and any anxiety disorder were 9.7, 14.4, 9.5, and 11.9% among Americans, whereas the corresponding rates were 7.1, 6.6, 2.0, and 5.2% among Koreans. These rates were significantly greater (except for any AUD) among Americans than among their Korean counterparts. With respect to comorbidity, both countries showed comparable patterns that the prevalence rates of mood and anxiety disorders were consistently the highest among persons with alcohol dependence (AD). Also, a disparate pattern was observed in Korea that the prevalence rates of mood and anxiety disorders were generally lower among individuals with ND than among those with alcohol abuse and AD. Furthermore, despite significantly greater prevalence of AD in Korea (5.1%) than in the United States (4.4%), alcohol‐dependent Americans were 4 times (OR = 3.93) more likely to seek treatment compared to their Korean counterparts. Conclusions: Our results indicated that the prevalence of AD in Korea was substantially greater than that in both Western and other Asian countries, suggesting a maladaptive pattern of alcohol use in Korea, which is different from the general use pattern of other East Asian countries. The low rate of treatment utilization among Koreans might be attributable to perceived social stigma toward SUDs or mental health problems despite the fact that the Korean government offers national health insurance.     

Apnea Diving: Long-Term Neurocognitive Sequelae of Repeated Hypoxemia

ABSTRACT

This article examines the neurocognitive sequelae of repeated exposure to hypoxemia in apnea (breath-hold) divers. A brief review of the literature on the physiological and neurological adaptations involved in the “human diving reflex” is presented. The results from a neuropsychological investigation of N = 21 elite apnea divers are evaluated. Standard neuropsychological tests, with known sensitivity to mild brain insults, included speed of visuo-motor responding, speed of language comprehension, response inhibition, and visual and verbal attention and recall tasks. Results indicated that the breath-hold divers performed tasks within the average range compared to norms on all tests, suggesting that 1–20 years of repeated exposure to hypoxemia including multiple adverse neurological events did not impact on performance on standard neuropsychological tasks. The results are discussed in relation to implications for clinical conditions such as sleep apnea, respiratory disorders, altitude sickness, and recreational apnea activities.     

急性外伤性颅内血肿开颅血肿清除术后迟发血肿相关因素分析

目的 分析颅内血肿开颅血肿清除术患者的临床特征及术后出现迟发血肿的危险因素.方法 以我院2009-03-2013-03收治的68例急性外伤性颅内血肿开颅手术治疗患者为研究对象,根据是否发生迟发血肿进行分组,采用Logistic回归模型分析术后迟发血肿危险因素.结果 多因素Logistic回归分析结果显示血浆凝血酶时间、手术时机、颅骨骨折为发生迟发血肿的危险因素.结论 急性外伤性颅内血肿患者多伴有重型颅脑损伤和颅内占位,术后迟发血肿一般发生于术后12 h内,以脑内血肿、硬膜外血肿、硬膜下血肿为常见,血浆凝血酶时间延长、手术时机短、合并颅骨骨折为高危因素,应引起高度关注.     

Partial least squares and logistic regression random-effects estimates for gene selection in supervised classification of gene expression data

Our main interest in supervised classification of gene expression data is to infer whether the expressions can discriminate biological characteristics of samples. With thousands of gene expressions to consider, a gene selection has been advocated to decrease classification by including only the discriminating genes. We propose to make the gene selection based on partial least squares and logistic regression random-effects (RE) estimates before the selected genes are evaluated in classification models. We compare the selection with that based on the two-sample t-statistics, a current practice, and modified t-statistics. The results indicate that gene selection based on logistic regression RE estimates is recommended in a general situation, while the selection based on the PLS estimates is recommended when the number of samples is low. Gene selection based on the modified t-statistics performs well when the genes exhibit moderate-to-high variability with moderate group separation. Respecting the characteristics of the data is a key aspect to consider in gene selection.     

胃食管反流病相关危险因素分析

胃食管反流病（GERD）的发病与多种因素有关,我国以及亚洲地区患病率呈上升趋势。目的：分析GERD相关危险因素。方法：纳入2010年5～10月新疆医科大学第一附属医院有典型胃食管反流症状、反流性疾病问卷（RDQ）评分〉12或内镜检查发现食管黏膜破损者作为病例组,以同期非GERD患者和健康体检者作为对照组,采用问卷调查的方式采集人口统计学资料、生活方式、饮食习惯等信息,对19个可能与GERD有关的变量行单因素分析,有统计学意义者进一步行多因素条件logistic回归。结果：病例组和对照组例数分别为100例和120例。单因素分析显示年龄、体质指数（BMI）、浓茶、进食过饱、辛辣饮食、高盐饮食、食管裂孔疝（HH）、幽门螺杆菌（Hpylon）感染、非甾体消炎药（NSAIDs）、民族、便秘11个变量与GERD相关（P〈0．05）。多因素条件logistic回归分析显示HH（OR：3．614,95％CI：1．188～10．993,P=0．024）、辛辣饮食（OR：5．469,95％CI：2．570—11．640,P=0．000）、便秘（OR：3．760,95％CI：1．592～8．884,P=0．003）、中老年（OR：5．229,95％CI：1．090～8．587,P=0．005;OR：2．275,95％CI：1．004～6．667,P=0．004）为GERD发病的危险因素。结论：认识和避免GERD发病相关危险因素,养成良好的生活、饮食习惯以及治疗HH将对GERD的预防产生积极影响。     

外伤性肠损伤预后相关影响因素研究

目的 探讨影响外伤性肠损伤患者行手术治疗的预后相关因素.方法 回顾分析本院2003年1月至2012年12月因外伤性肠损伤行手术处理的患者,使用单因素及多因素模型对相关因素进行评估.结果 纳入研究共73例(男57例,女16例),平均年龄54.7岁.小肠损伤46例(63.1%),结肠损伤27例(37.0%),其中含多处肠损伤的为16例(21.9%).单因素分析显示,患心脏病史、损伤至手术时间长(＞8小时)、高NISS评分(＞20分)及伴有休克是影响预后的主要因素,进一步行多因素分析显示,其中NISS评分及损伤至手术时间是改后的独立危险因素.结论 NISS评分及损伤至手术时间是影响外伤性肠损伤预后的独立危险因素.     

563例腰椎间盘突出症术后并发足下垂危险因素的相关性分析

目的探讨腰椎间盘突出症术后并发足下垂的危险因素,指导临床治疗与预防治措施。。方法回顾563例腰椎间盘突出症手术病例,对12个相关因素进行多因素Logistic回归分析确定危险因素。结果术后发生足下垂患者17例,多因素分析显示神经牵拉程度、术后血肿、神经根紧张度、椎间指数、神经根粘连与术后足下垂密切相关,差异有统计学意义。结论多因素分析结果表明神经过度牵拉、术后血肿形成、神经根张力较大、椎间指数≥50%、神经根粘连是腰椎间盘突出症术后并发足下垂的危险因素。合并危险因素者术前应做好手术准备,术中仔细操作,降低并预防神经损伤导致的足下垂。