Changes and mediators of survival disparity among Black liver transplant recipients in the United States

A landmark 2002 study identified Black liver transplant (LT) recipients as having lower post-LT survival compared to other races. While persistent disparities exist, changes over time and mediating factors are understudied. Capturing LT recipients between 2002 and 2018 in UNOS, we used logistic regression and Cox proportional-hazard models to calculate differences in post-LT mortality among races. We examined interactions between transplant year and race. A mediation analysis assessed biologic and environmental factors potentially associated with race differences in post-LT survival. The cohort included 46,997 LT recipients (3898 Black;36,560 White;6539 Hispanic). In most years, Black (vs. White) LT recipients had a higher probability of age-adjusted mortality, not observed among Hispanics. In multivariable analysis, Blacks (vs. Whites) had higher (aHR = 1.15, 95% CI 1.07–1.24), whereas Hispanics had lower (aHR = 0.78, 95% CI 0.72–0.83) risk of mortality. Differences in post-LT mortality among Blacks (vs. Whites) narrowed between 2002 and 2009, were similar between 2010 and 2013, and may have worsened between 2014 and 2018. Race differences were larger for mortality beyond 1-year post-LT (vs. within 1-year), and among non-HCV (vs. HCV). Alcohol-associated liver disease (ALD) was the strongest mediator (13.9%, 95% CI 8.7–32.7%) of the Black–White disparity in 2010–2018. Our analyses suggest disparities may worsen with longer follow-up, as HCV recedes with elimination efforts, and with further increases in ALD.

     

医院感染监测系统的开发与应用

通过与软件公司联合开发满足医院要求的感染管理软件,实现感染管理的信息化.其功能包括疑似病例智能筛查、多重耐药菌监测、抗菌药物监测、专职人员与临床医生交互平台等.结果表明运用该软件系统能及时提供医院感染动态信息,提高工作效率,改善医院感染管理水平.     

基于网络药理学和分子对接探讨钩藤-全蝎药对治疗支气管哮喘的作用机制＊

目的通过网络药理学和分子对接探究钩藤-全蝎药对治疗支气管哮喘的药理作用机制。方法通过TCMSP、TCMIP数据库搜集钩藤、全蝎的活性成分及其作用靶点,并使用Cytoscape软件进行可视化分析成分-靶点网。通过OMIM、GeneCards数据库搜集支气管哮喘的疾病靶点,整合钩藤-全蝎药对与支气管哮喘的共有靶点。利用String平台构建对共有靶点互作PPI网络,并进行GO和KEGG富集分析,通过Cytoscape软件构建成分-靶点-通路网络模型。最后通过Autodock分子对接进行验证。结果经过筛选发现钩藤-全蝎药对37个活性化合物和234个药物靶点,与哮喘6010个靶点取交集得到35个共有靶点。钩藤-全蝎包含槲皮素、山奈酚、育亨宾碱、β-谷甾醇等重要活性成分;根据PPI网络分析,核心网络连接度高的潜在治疗靶点有IL6、CASP3、ECFR、ESR1、MAPK8等;根据KEGG富集分析结果显示,钩藤-全蝎药对主要通过PI3 K-Akt信号通路、TNF信号通路,HIF-1信号通路、M APK信号通路、NF-κB信号通路等来治疗哮喘;钩藤-全蝎药对活性成分与核心靶点的分子对接结果均显示出较好的结合活性。结论钩藤-全蝎药对治疗哮喘呈现出多成分、多靶点、多通路的特点,其核心成分槲皮素、山奈酚、育亨宾碱、β-谷甾醇等可能通过CASP3、MAPK8、ESR1、IL6、ECFR等靶点调节多条通路发挥抗炎、调节免疫、抗氧化应激、改善气道重塑等作用,从而对哮喘达到有效的治疗。     

基于网络药理学的藏药二十五味肺病丸防治新冠病毒肺炎(COVID-19)可行性分析及机制探讨＊

目的 采用网络药理学方法探究藏药二十五味肺病丸防治新型冠状病毒肺炎（COVID-19 ）的可行性分析及机制探讨。方法 基于课题组藏药大复方的研究经验，通过文献调研，筛选出二十五味肺病丸专属性、特征性化合物，并通过Chemical book数据库以及TCMSP数据库进行验证，确定二十五味肺病丸有效物质成分。将筛选出的成分通过Swiss Target Prediction数据库进行靶点筛选，进而运用Cytoscape软件构建药物-化合物-靶点（基因）网络进行可视化。运用CTD数据库查询与疾病COVID-19 相关的靶点，找出与二十五味肺病丸共有的靶点，将共有基因导入STRING数据库生成蛋白互作网络，并通过DAVID数据库进行KEGG通路富集分析和GO功能富集分析，预测藏药二十五味肺病丸的作用机制。结果 经筛选藏药二十五味肺病丸中檀香、悬钩木、山柰、红花、獐牙菜、甘草、藏木香、宽筋藤等19种药材被纳入到研究中。药材-化合物-靶点网络包含了19种药材，38个化合物和相应靶点419个。通过CTD数据库查询到COVID-19 疾病相关靶点基因472个，与二十五味肺病丸共有靶点基因77个，分别为ESR1、NOS2、PPARG、PTGS2、PPARA、HMGCR、CYP17A1、NR1H4、TLR9等。通过网络拓扑和蛋白互作网络分析筛选出关键靶点涉及PTGS2、ESR1、AKT1、EGFR等。GO功能富集分析得到339条生物过程条目（BP），45条细胞组成条目（CC）和81条分子功能条目（MF）。KEGG通路富集分析筛选得到102条信号通路，包括小细胞肺癌、非小细胞肺癌、膀胱癌、甲型流感、胰腺癌、T细胞受体信号通路等。结论 二十五味肺病丸可能通过作用于PTGS2、ESR1、AKT1、EGFR相关靶点并通过相关肺病通路、炎症通路、免疫通路对COVID-19起到防治作用。     

基于网络药理学及分子对接研究苦参治疗慢性乙型肝炎的作用机制＊

目的 本研究通过网络药理学及分子对接方法研究苦参治疗慢性乙型肝炎的物质基础与分子机制。方法 依据中药系统药理学数据库和分析平台（TCMSP）筛选苦参有效化学成分及靶点基因。检索GeneCards数据库及OMIM数据库获取慢性乙型肝炎（CHB）相关靶点基因。采用Cytoscape3.7.2构建苦参治疗CHB的“相关活性成分-潜在作用靶点”网络并进行拓扑结构分析，利用STRING平台进行蛋白质相互作用分析，构建PPI网络，通过R 3.6.2进行基因富集分析。依据AutoDock vina将关键活性成分与核心靶点进行分子对接。结果 获得苦参治疗CHB的相关活性成分23个，潜在作用靶点97个。网络分析结果提示苦参可能通过作用于IL-6、ESR1、AR、RELA、PPARG和CASP3 6个核心靶点及相关通路以达到治疗CHB的目的。分子对接预测结果提示关键活性成分与核心靶点稳定结合。结论 本研究初步揭示了苦参治疗慢性乙型肝炎多成分、多靶点、多通路的作用机制，为苦参的临床开发提供基础。     

基于VisualNet的立体化网络资源管理系统

数字化医院的基础是医院网络平台,随着医院业务的不断扩增,医院网络的规模也随之日益庞大复杂,这就需要有一个好的网络资源管理系统,它是当今数字化医院支撑医疗业务正常运作的保障。笔者提出了一种立体化的医院网络资源管理的实施方案,既可以用于正常时期的网络设备管理,一旦发生网络故障,更可以尽快帮助查错排错,有效地将故障影响降至最低。用VisualNet来进行大型复杂的网络综合管理,是目前逐渐受到重视的一个选择。     

Brief communication: The Mid-South Clinical Data Research Network

The Mid-South Clinical Data Research Network (CDRN) encompasses three large health systems: (1) Vanderbilt Health System (VU) with electronic medical records for over 2 million patients, (2) the Vanderbilt Healthcare Affiliated Network (VHAN) which currently includes over 40 hospitals, hundreds of ambulatory practices, and over 3 million patients in the Mid-South, and (3) Greenway Medical Technologies, with access to 24 million patients nationally. Initial goals of the Mid-South CDRN include: (1) expansion of our VU data network to include the VHAN and Greenway systems, (2) developing data integration/interoperability across the three systems, (3) improving our current tools for extracting clinical data, (4) optimization of tools for collection of patient-reported data, and (5) expansion of clinical decision support. By 18 months, we anticipate our CDRN will robustly support projects in comparative effectiveness research, pragmatic clinical trials, and other key research areas and have the capacity to share data and health information technology tools nationally.     

Influenza vaccination for HIV-positive people: Systematic review and network meta-analysis

BackgroundPeople with Human Immunodeficiency Virus (HIV) are highly susceptible to influenza-related morbidity and mortality. In order to assess comparative efficacy of influenza vaccine strategies among HIV-positive people, we performed a systematic review and Bayesian network meta-analysis (NMA).MethodsIn this systematic review, we searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL between 1946 and July 2015 for randomized controlled trials (RCTs) on influenza vaccines for HIV-positive adults reporting seroconversion or seroprotection outcomes. The NMAs were conducted within a Bayesian framework and logistic models were used for comparing the effect of the vaccine strategies on the two outcomes.ResultsA total of 1957 publications were identified, 143 were selected for full review, and 13 RCTs were included in our final analysis. Fourteen separate NMAs were conducted by outcomes, vaccine strain, and different outcome measurement timepoints. For example, compared with the 15 μg single vaccine strategy, the odds ratio was the highest for the adjuvant 7.5 μg booster strategy (2.99 [95% credible interval 1.18–7.66]) when comparing seroconversion for H1N1 at 14–41 days after the last dose of vaccination and for the 60 μg single strategy (2.33 [1.31–4.18]) when comparing seroconversion for strain B.ConclusionsThe adjuvant 7.5 μg booster and 60 μg single vaccine strategies provided better seroconversion and seroprotection outcomes. These findings have important implications for national and international guidelines for influenza vaccination for HIV-positive people and future research.