23例临床前代偿期肝硬化患者的Ishak组织学评分与其中医证候分布特点的相关性初步研究

目的：探讨23例经过肝脏大体形态学确诊的临床前代偿期肝硬化患者的Ishak组织学评分与其中医证候分布特点的相关性.方法：通过流行病学横断面调查的方法对23例研究对象的肝组织Ishak组织学评分及与其中医诊断资料的相关性进行分析.结果：①证候分布特点为：肝气郁结（60.87％）,湿热蕴结（21.74％）,水湿内阻（13.04％）,瘀血阻络（4.35％）.②从Ishak炎症坏死的评分值（反映炎症坏死的情况）看,分级A、分级B评分值在湿热蕴结证候中最高,在瘀血阻络、肝气郁结证、水湿内阻证候中逐渐略微减低;分级C评分值在湿热蕴结证候中最高,在水湿内阻、肝气郁结、瘀血阻络证候中逐渐略微减低;分级D评分值在湿热蕴结证候中最高,在瘀血阻络、肝气郁结、水温内阻证候中逐渐略微减低;分级总评分值在湿热蕴结证候中最高,在瘀血阻络、肝气郁结、水湿内阻证候中逐渐略微减低;③分期总评分值在瘀血阻络证候中最高,在水湿内阻、湿热蕴结、肝气郁结证候中逐渐略微减低,无脾肾阳虚、肝肾阴虚及无证可辨.结论：在该23例患者中,我们初步发现：①中医证候分布以肝气郁结、湿热蕴结为主,正虚尚不明显,相应的肝脏炎症程度评分较低,而湿热蕴结型的炎症程度评分相对偏高;②此组患者肝组织形态学活检诊断肝硬化存在一定的漏诊率.     

Risk Factors and Scoring System as a Prognostic Tool for Epilepsy After Neonatal Seizures

BackgroundNeonatal seizures may cause irreversible changes to the immature brain and. A scoring system for early prognostic information could be a useful clinical tool. The aim of the study was to analyze risk factors for epilepsy after neonatal seizures, to validate Garfinkle's scoring system, and to analyze whether a new scoring system is feasible.MethodsA retrospective study of 176 newborns (59.1% boys, 40.9% girls, 70.5% term, 29.5% preterm; mean birth weight 2820 g), admitted to the Department of Neonatology, Division of Pediatrics, University Medical Centre, Ljubljana, because of neonatal seizures (clinical and/or neurophysiological), was performed. Epilepsy rate between 2 and 12 years of follow-up was 18.1%. Five independent predictors from Garfinkle's study and other known predictors were entered into hierarchical binary logistic regression models and analyzed through four steps to identify independent predictors of epilepsy. We tested whether any of the predictors was an effect modifier.ResultsOf five potential predictors from Garfinkle's score, electroencephalograph background findings and etiology were predictive. Etiologies, gestation, mode of delivery, duration of seizures, and other risk factors at birth were found to be independent predictors. Duration of seizures has a different effect on prognosis depending on the gestational age.ConclusionGestational age determines the association between duration of seizures and epilepsy. Scoring systems to predict development of epilepsy after neonatal seizures need to limit interaction between important predictor variables.     

复苏单囊胚移植周期中囊胚形态学评分对临床妊娠的影响

目的分析在冷冻复苏单囊胚移植周期中,囊胚内细胞团和滋养细胞层质量对临床妊娠的影响。方法在复苏囊胚移植周期中,记录囊胚内细胞团、滋养细胞层的评分,采用二分类Logistic回归过程,分析两项评分对临床妊娠率的影响。结果在141个单囊胚复苏周期中,复苏的141个囊胚均存活,采用激素替代周期进行子宫内膜准备,临床妊娠率为41.1%(58/141)。所有囊胚在冷冻时均达到4期,内细胞团为A、B级,滋养细胞层为A、B、C三级。经回归分析,三个自变量即年龄、内细胞团质量和滋养细胞层质量中,滋养细胞层对临床妊娠有最大的预测价值(P=0.013)。结论与内细胞团的评分相比,滋养细胞层质量对复苏单囊胚的临床妊娠率有更高的预测价值。     

Validation of the Maryland Aggregate Pathology Index (MAPI), a pre‐implantation scoring system that predicts graft outcome

Predicting graft outcome after renal transplantation based on donor histological features has remained elusive and is subject to institutional variability. We have shown in a retrospective study that the Maryland Aggregate Pathology Index score reliably predicts graft outcome. We sought to validate the scoring system in our center and a second transplant center. We analyzed 140 deceased donor kidneys pre‐implantation biopsies from center 1 and 65 from center 2. The patients had a mean follow‐up of 695 ± 424 and 656 ± 305 d respectively. Although MAPI scores were similar, there were significant differences in donor and recipient parameters between both centers. Despite this, MAPI was predictive of graft outcome for both centers by Cox univariate, multivariate and time dependent ROC analysis. For center 1 and 2, three yr graft survival within each MAPI group was statistically equivalent. The three‐yr graft survival at center 1 for low, intermediate, and high MAPI groups were 84.3%, 56.5%, and 50.0%, respectively, p ≤ 0.0001, and at center 2 were 83.3%, 33.3%, and 33.3%, p = 0.006. MAPI, which is based on a pre‐implantation biopsy, demonstrated similar predictive and outcome results from both centers. As expanded criteria donors (ECD) criteria have redefined marginal kidneys, MAPI has the potential to further define ECD kidneys, increase utilization, and ultimately improve outcomes.     

Optimization of Compound Ranking for Structure‐Based Virtual Ligand Screening Using an Established FRED–Surflex Consensus Approach

The use of multiple target conformers has been applied successfully in virtual screening campaigns; however, a study on how to best combine scores for multiple targets in a hierarchic method that combines rigid and flexible docking is not available. In this study, we used a data set of 59 479 compounds to screen multiple conformers of four distinct protein targets to obtain an adapted and optimized combination of an established hierarchic method that employs the programs FRED and Surflex. Our study was extended and verified by application of our protocol to ten different data sets from the directory of useful decoys (DUD). We quantitated overall method performance in ensemble docking and compared several consensus scoring methods to improve the enrichment during virtual ligand screening. We conclude that one of the methods used, which employs a consensus weighted scoring of multiple target conformers, performs consistently better than methods that do not include such consensus scoring. For optimal overall performance in ensemble docking, it is advisable to first calculate a consensus of FRED results and use this consensus as a sub‐data set for Surflex screening. Furthermore, we identified an optimal method for each of the chosen targets and propose how to optimize the enrichment for any target.     

Anticholinergic Drug Burden and Delirium: A Systematic Review

ObjectivesTo investigate the association between anticholinergic drug burden (ADB), measured with anticholinergic drug scales, and delirium and delirium severity.DesignSystematic review.Setting and ParticipantsAll available studies.MethodsA systematic literature search was performed in Medline, Embase, PsycINFO, Web of Science, CINAHL, Cochrane library, and Google Scholar. Studies evaluating the association between ADB (measured as a total score) and delirium or delirium severity, published in English, were eligible for inclusion.ResultsSixteen studies, including 148,756 persons, were included. Fifteen studies investigated delirium. ADB was measured with the Anticholinergic Risk Scale (ARS, n = 5), the Anticholinergic Cognitive Burden Scale (ACB, n = 6), the list of Chew (n = 1), the Anticholinergic Drug Scale (ADS, n = 5), a modified version of the ARS (n = 1), and a modified version of the ACB (n = 1). A high ADB, measured with the ARS, was associated with delirium (5/5). Also with the modified version of the ARS and ACB, an association was found between a high ADB and delirium during 3-month (1/1) and 1-year follow-up (1/1), respectively. When ADB was assessed with other scales, the results were inconclusive, with only 1 positive association for the ACB (1/6) and ADS (1/5) each. The possible association between ADB and delirium severity has also been investigated (ADS n = 2, Summers Drug Risk Number n = 1). One study found an association between a high ADB, measured with the ADS, and an increase in severity of delirium.Conclusions and ImplicationsADB assessed with the ARS is consistently associated with delirium. The association found between the modified versions of the ARS and ACB and delirium needs confirmation. When ADB was assessed with other scales, the findings were inconclusive. The current findings suggest that the ARS might be a useful tool to identify patients at increased risk for delirium.     

The HIT Expert Probability (HEP) Score: a novel pre‐test probability model for heparin‐induced thrombocytopenia based on broad expert opinion

Summary. Background: The diagnosis of heparin‐induced thrombocytopenia (HIT) is challenging. Over‐diagnosis and over‐treatment are common. Objectives: To develop a pre‐test clinical scoring model for HIT based on broad expert opinion that may be useful in guiding clinical decisions regarding therapy. Patients/methods: A pre‐test model, the HIT Expert Probability (HEP) Score, was constructed based on the opinions of 26 HIT experts. Fifty patients referred to a reference laboratory for HIT testing comprised the validation cohort. Two hematology trainees scored each patient using the HEP Score and a previously published clinical scoring system (4 T’s). A panel of three independent experts adjudicated the 50 patients and rendered a diagnosis of HIT likely or unlikely. All subjects underwent HIT laboratory testing with a polyspecific HIT ELISA and serotonin release assay (SRA). Results: The HEP Score exhibited significantly greater interobserver agreement [intraclass correlation coefficient: 0.88 (95% CI 0.80–0.93) vs. 0.71 (0.54–0.83)], correlation with the results of HIT laboratory testing and concordance with the diagnosis of the expert panel (area under receiver‐operating curve: 0.91 vs. 0.74, P = 0.017) than the 4 T’s. The model was 100% sensitive and 60% specific for determining the presence of HIT as defined by the expert panel and would have allowed for a 41% reduction in the number of patients receiving a direct thrombin inhibitor (DTI). Conclusion: The HEP Score is the first pre‐test clinical scoring model for HIT based on broad expert opinion, exhibited favorable operating characteristics and may permit clinicians to confidently reduce use of alternative anticoagulants. Prospective multicenter validation is warranted.