优化操作流程在血液透析中应用的效果

目的探讨优化操作流程在血液透析患者管路预冲时间、透析充分性及感染发生率等方面的影响。方法方便性抽样选取上海市瑞金医院120例维持性血液透析患者,按随机数字表法将其分为两组:试验组60例采用优化操作流程,即透析液桶加盖、密闭式管路预冲、密闭式引血;对照组60例采用传统操作流程。比较两组患者在管路预冲时间、透析充分性及感染发生率等方面的不同。结果试验组在管路预冲时间及感染发生率等方面低于对照组,差异有统计学意义(P<0.01,P<0.05);在透析充分性方面,两组间差异无统计学意义(P>0.05)。结论优化后的血液透析操作流程能缩短管路预冲时间,降低透析患者感染发生率,而透析充分性不受影响,故值得临床推广应用。     

Multiple Plasma Biomarkers for Risk Stratification in Patients With Heart Failure and Preserved Ejection Fraction

BackgroundBetter risk stratification strategies are needed to enhance clinical care and trial design in heart failure with preserved ejection fraction (HFpEF).ObjectivesThe purpose of this study was to assess the value of a targeted plasma multi-marker approach to enhance our phenotypic characterization and risk prediction in HFpEF.MethodsIn this study, the authors measured 49 plasma biomarkers from TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) trial participants (n = 379) using a Multiplex assay. The relationship between biomarkers and the risk of all-cause death or heart failure-related hospital admission (DHFA) was assessed. A tree-based pipeline optimizer platform was used to generate a multimarker predictive model for DHFA. We validated the model in an independent cohort of HFpEF patients enrolled in the PHFS (Penn Heart Failure Study) (n = 156).ResultsTwo large, tightly related dominant biomarker clusters were found, which included biomarkers of fibrosis/tissue remodeling, inflammation, renal injury/dysfunction, and liver fibrosis. Other clusters were composed of neurohormonal regulators of mineral metabolism, intermediary metabolism, and biomarkers of myocardial injury. Multiple biomarkers predicted incident DHFA, including 2 biomarkers related to mineral metabolism/calcification (fibroblast growth factor-23 and OPG [osteoprotegerin]), 3 inflammatory biomarkers (tumor necrosis factor-alpha, sTNFRI [soluble tumor necrosis factor-receptor I], and interleukin-6), YKL-40 (related to liver injury and inflammation), 2 biomarkers related to intermediary metabolism and adipocyte biology (fatty acid binding protein-4 and growth differentiation factor-15), angiopoietin-2 (related to angiogenesis), matrix metalloproteinase-7 (related to extracellular matrix turnover), ST-2, and N-terminal pro–B-type natriuretic peptide. A machine-learning–derived model using a combination of biomarkers was strongly predictive of the risk of DHFA (standardized hazard ratio: 2.85; 95% confidence interval: 2.03 to 4.02; p < 0.0001) and markedly improved the risk prediction when added to the MAGGIC (Meta-Analysis Global Group in Chronic Heart Failure Risk Score) risk score. In an independent cohort (PHFS), the model strongly predicted the risk of DHFA (standardized hazard ratio: 2.74; 95% confidence interval: 1.93 to 3.90; p < 0.0001), which was also independent of the MAGGIC risk score.ConclusionsVarious novel circulating biomarkers in key pathophysiological domains are predictive of outcomes in HFpEF, and a multimarker approach coupled with machine-learning represents a promising strategy for enhancing risk stratification in HFpEF.     

Prioritizing Disease‐Linked Variants,Genes, and Pathways with an Interactive Whole‐Genome Analysis Pipeline

Whole‐genome sequencing (WGS) studies are uncovering disease‐associated variants in both rare and nonrare diseases. Utilizing the next‐generation sequencing for WGS requires a series of computational methods for alignment, variant detection, and annotation, and the accuracy and reproducibility of annotation results are essential for clinical implementation. However, annotating WGS with up to date genomic information is still challenging for biomedical researchers. Here, we present one of the fastest and highly scalable annotation, filtering, and analysis pipeline—gNOME—to prioritize phenotype‐associated variants while minimizing false‐positive findings. Intuitive graphical user interface of gNOME facilitates the selection of phenotype‐associated variants, and the result summaries are provided at variant, gene, and genome levels. Moreover, the enrichment results of specific variants, genes, and gene sets between two groups or compared with population scale WGS datasets that is already integrated in the pipeline can help the interpretation. We found a small number of discordant results between annotation software tools in part due to different reporting strategies for the variants with complex impacts. Using two published whole‐exome datasets of uveal melanoma and bladder cancer, we demonstrated gNOME's accuracy of variant annotation and the enrichment of loss‐of‐function variants in known cancer pathways. gNOME Web server and source codes are freely available to the academic community ( http://gnome.tchlab.org ).     

A Study of Zero Tolerance Policies in Schools: A Multi‐Integrated Systems Approach to Improve Outcomes for Adolescents

PROBLEM: School officials throughout the United States have adopted zero tolerance policies to address student discipline, resulting in an increase in out‐of‐school suspensions and expulsions. The introduction of police on school campuses also increased the referral of students to the juvenile courts. Although school personnel generally view zero tolerance policies as a constructive measure, this approach denies recent research on adolescent brain development that mischief is a foreseeable derivative of adolescence. METHODS: A case study method examined one juvenile court's innovative multi‐integrated systems approach related to the adverse trends associated with zero tolerance policies. FINDINGS: A multi‐disciplinary protocol resulted in more effective youth assessments that reduced out‐of‐school suspensions and school referrals; increased graduation rates by 20%; and decreased delinquent felony rates by nearly 50%. The resulting protocol changed how the system responds to disruptive students by significantly reducing out‐of‐school suspensions and school referrals, and putting into place alternatives as well as providing community resources to address the underlying causes of the behavior. CONCLUSION: A multi‐systems approach that targets the reasons for disruptive behavior improves student educational and behavioral outcomes.     

2007～2009年中山市建筑给水工程卫生学评价

目的对2007~2009年中山市建筑给水工程进行卫生学评价,为工程竣工验收提供依据。方法依据国家相关规范标准对相关项目设计资料、现场调查情况、水质抽检结果等进行评价。结果 2007~2009年中山市全部建筑给水工程720宗,二次供水设施项目达标73.33%,高浊水发生率逐年显著下降。结论中山市创新建筑给水卫生安全监管的模式,值得借鉴。今后要加强有效监管,消除减少卫生安全隐患。     

抗冠状病毒药物全球研发管线

2019年底,一种新型冠状病毒引起发热性呼吸道疾病(COVID-19)在武汉暴发,并迅速波及全国。冠状病毒在21世纪已经3次严重危害了人类健康。随着疫情的加剧,中国乃至全球人民均期待临床疗效明确的药物出现,缓解危机。瑞德西韦的同情用药,为患者带来了一线曙光。综述瑞德西韦以及全球抗冠状病毒研发管线中的疫苗和治疗药物,助力该类药物的全球研发,早日为人类建起防护墙。     

Investigational anticoagulants for hematological conditions: a new generation of therapies

Introduction: The introduction of novel anticoagulants has had contrasting effects on the agents in the pipeline, fueling the development of some and sinking the others. The complexity of the coagulation cascade offers interesting inhibition choices that might become valid treatment options.

Areas covered: This review will highlight some of the anticoagulants in the pipeline. Following the success of the direct thrombin and FXa inhibitors already in the market, new agents are being tested. These include AZD0837, betrixaban, letaxaban, darexaban, and LY517717. Targeting other components of the hemostatic pathway might lead to better safety profiles without influencing efficacy. Inhibitors to FVIIa–tissue factor (FVIIa/TF) complex, FIX, FXI, and FXII are being assessed. New inspiring inhibitors are antisense oligonucleotides (ASOs) and aptamers. These are highly specific agents with readily reversible effect and might be engineered to inhibit any coagulation factor. Currently tested ASOs and aptamers are inhibitors of FXI, FXII, thrombin, FIXa, and platelet GPIV.

Expert opinion: Some of the agents in the pipeline offer valid treatment option for long-term therapy, overcoming some of the drawbacks of the novel anticoagulants. Research is being driven by an expanding market in the anticoagulation field that has been unexploited for a long time.     

Emerging drugs for prostate cancer

Prostate cancer mortality usually occurs as a result of castrate resistant disease. Many approaches are currently being evaluated to improve the treatment of this condition. These include drugs that induce androgen deprivation, that is, LHRH antagonists; more active or less toxic chemotherapy agents; immunologic approaches, including passive and active immunization; drugs that target the androgen receptor and/or androgen synthesis; drugs that target specific pathways, including tyrosine kinase inhibitors, angiogenesis inhibitors, endothelin antagonists and matrix metalloproteinase inhibitors; and antioxidants and cell cycle inhibitors. Many of these agents seem promising. The rationale, biologic activity and therapeutic results of these emerging drugs are reviewed.     

The ‘rural pipeline’ and retention of rural health professionals in Europe's northern peripheries

The major advance in informing rural workforce policy internationally over the past 25 years has been the recognition of the importance of the ‘rural pipeline’. The rural pipeline suggests that people with ‘rural origin’ (who spent some childhood years in rural areas) and/or ‘rural exposure’ (who do part of their professional training in rural areas) are more likely to select rural work locations. What is not known is whether the rural pipeline also increases the length of time professionals spend in rural practice throughout their careers. This paper analyses data from a survey of rural health professionals in six countries in the northern periphery of Europe in 2013 to examine the relationship between rural origin and rural exposure and the intention to remain in the current rural job or to preference rural jobs in future. Results are compared between countries, between different types of rural areas (based on accessibility to urban centres), different occupations and workers at different stages of their careers. The research concludes that overall the pipeline does impact on retention, and that both rural origin and rural exposure make a contribution. However, the relationship is not strong in all contexts, and health workforce policy should recognise that retention may in some cases be improved by recruiting beyond the pipeline.     

母乳喂养服的设计制作及临床应用

目的：探讨母乳喂养服在母乳喂养中应用的简易性和有效性。方法：采用前瞻性、随机的方法将孕妇对母乳喂养自信心得分为（3.50±0.68）分的100例初产妇,按照母乳喂养服的不同制作方法分为试验组（穿着自行设计的母乳喂养服）和对照组（穿着传统一排扣开胸病人服）,各50例,对两组初产妇的满意度评价及母乳喂养有效性等方面进行对比分析。结果：实验组母乳喂养服满意度评价≥80分的50例,对照组传统服满意度评价≥80分的42例差异有统计学意义;实验组母乳喂养准备时间为（3.57±0.83）min,对照组所需时间为（8.31±0.95）min,试验组准备时间明显减少,差异有统计学意义。结论：母乳喂养服具有操作简便,易于掌握的特点,使产妇在更短时间内实施母乳喂养,提高母乳喂养的有效性,同时母乳喂养服的应用能提高产妇在实施母乳喂养过程中的舒适及保护产妇的隐私,从而提高了产妇的满意度,值得推广使用。