基于Box-Behnken响应面设计优选中药复方便乃通的提取工艺

[目的] 利用Box-Behnken响应面设计法优化中药复方便乃通（BNT）的提取工艺。[方法] 基于单因素实验优选BNT提取工艺的影响因素及其范围,运用Box-Behnken响应面设计法构建三因素三水平实验设计方案,以番泻苷B、番泻苷A及橙皮苷的含量作为响应指标优选最佳提取工艺条件,并进行工艺验证。[结果] 中药复方BNT的最佳提取工艺条件为料液比1∶8,回流时间30 min,提取次数2次。[结论] 利用Box-Behnken响应面设计法优化中药复方BNT提取工艺方法稳定,可为BNT提取工艺提供参考。     

Simultaneous quantification of apolipoproteins A-I,E, and J in human plasma by LC-MS/MS for clinical application to diabetes mellitus complicated with cardiovascular disease

Apolipoproteins (Apos) play an important role in regulating plasma lipid concentration. Complex disorders of Apos are highly related with diabetes mellitus, cardiovascular and other diseases. Direct measures of lipoprotein fractions for risk assessment suffer from inaccuracy in the dyslipidemia and pathological states. Therefore, a reliable precise assay will be of high clinical utility. LC-MS/MS methods with multiple reaction monitoring modes have proven suitable for multiplexed quantification. We aimed to develop a simple, cost-effective and amenable LC-MS/MS assay for quantification of ApoA-I, ApoE and ApoJ in human plasma. Standards were constructed from substitute matrix and proteotypic peptides for external calibration and corresponding stable isotope labeled peptides were added as internal standards to remove matrix effects. Analytical validation of the assay included the assessment of linearity, accuracy (RE: −3.02% to 5.32%), intra-assay precision (RSD: 2.50% to 6.56%), inter-assay precision (RSD: 0.78% to 6.68%), spiking recovery rate (accuracy: 87.17% to 112.71%), matrix effect (accuracy: 88.03% to 114.87%), and reproducibility and repeatability of sample preparation (RSD: 1.95% to 7.26%). The performance of proteotypic peptides ApoA-I, ApoE and ApoJ was sufficient for triplex quantitation within a linear range from 16.26 to 1626.41 pmol mL⁻¹, 1.03 to 103.35 pmol mL⁻¹ and 0.86 to 86.46 pmol mL⁻¹ respectively. For all quantified peptides, the determination coefficient (R²) was >0.997. Besides, the validated LC-MS/MS method has been successfully applied to the quantification of plasma samples in diabetes mellitus and cardiovascular diseases. We anticipate that this assay may provide an alternative method for future clinical applications.

Simultaneous quantification of apolipoproteins A-I, E, and J in human plasma by LC-MS/MS.     

Using machine learning to aid treatment decision and risk assessment for severe three-vessel coronary artery disease

BACKGROUNDThree-vessel disease (TVD) with a SYNergy between PCI with TAXus and cardiac surgery (SYNTAX) score of ≥ 23 is one of the most severe types of coronary artery disease. We aimed to take advantage of machine learning to help in decision-making and prognostic evaluation in such patients.METHODSWe analyzed 3786 patients who had TVD with a SYNTAX score of ≥ 23, had no history of previous revascularization, and underwent either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) after enrollment. The patients were randomly assigned to a training group and testing group. The C4.5 decision tree algorithm was applied in the training group, and all-cause death after a median follow-up of 6.6 years was regarded as the class label.RESULTSThe decision tree algorithm selected age and left ventricular end-diastolic diameter (LVEDD) as splitting features and divided the patients into three subgroups: subgroup 1 (age of ≤ 67 years and LVEDD of ≤ 53 mm), subgroup 2 (age of ≤ 67 years and LVEDD of > 53 mm), and subgroup 3 (age of > 67 years). PCI conferred a patient survival benefit over CABG in subgroup 2. There was no significant difference in the risk of all-cause death between PCI and CABG in subgroup 1 and subgroup 3 in both the training data and testing data. Among the total study population, the multivariable analysis revealed significant differences in the risk of all-cause death among patients in three subgroups.CONCLUSIONSThe combination of age and LVEDD identified by machine learning can contribute to decision-making and risk assessment of death in patients with severe TVD. The present results suggest that PCI is a better choice for young patients with severe TVD characterized by left ventricular dilation.

Coronary artery disease (CAD) is the leading cause of death and disability worldwide.^[1] Three-vessel disease (TVD) is the most severe form of CAD and is characterized by significant stenosis in all three major coronary arteries. The application of myocardial revascularization techniques, including coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), has significantly improved the clinical outcomes of patients with severe CAD. CABG has traditionally been the standard therapy for complex coronary lesions, including TVD.^[2] In recent years, with the advancements in PCI technology and the accumulation of operators’ experience, the incidence of periprocedural and long-term adverse events of PCI has substantially decreased, and PCI has been gradually applied in the treatment of TVD.^[3,4] Current guidelines recommend use of the SYNergy between PCI with TAXus and cardiac surgery (SYNTAX) score and diabetes status to guide the revascularization strategy for patients with TVD.^[5,6] Current practice guidelines do not recommend PCI for patients with TVD with a SYNTAX score of ≥ 23. However, using the SYNTAX score to guide clinical decision-making between PCI and CABG remains controversial, and its reasonability has been questioned since a newly published meta-analysis showed no significant association between the SYNTAX score and the comparative effectiveness of PCI and CABG.^[7] Moreover, the SYNTAX score is a quantitative indicator of the anatomical complexity of TVD and does not include clinical variables that may have significant effects on the patient’s prognosis. Whether some patients with specific clinical characteristics can obtain a comparable or even greater survival benefit from PCI than from CABG is unclear. Moreover, risk assessment for patients with TVD after revascularization therapy remain challenging.^[8–10]Machine learning has recently emerged as an important research method and has been successfully applied in many scientific fields, including clinical medicine.^[11–13] The decision tree algorithm, a common approach in machine learning, can handle non-linearity, heterogeneous effects, and high-dimensional features and partition a trial population into subgroups characterized by multiple simultaneous characteristics.^[14] In the present study involving a large cohort of patients with TVD with a SYNTAX score of ≥ 23, we employed a decision tree algorithm to generate specific subgroups, compared the long-term prognosis between patients who underwent PCI or CABG in each subgroup, and conducted a comparative analysis of the long-term prognosis between subgroups generated by machine learning. We evaluated whether machine learning can help in selecting the optimal revascularization method and assessing risk in patients with severe TVD.     

农村居民癌症预防知识与健康教育需求现况调查

目的了解我国农村居民癌症预防知识现况、获取途径及健康教育需求,探索农村地区癌症健康教育模式,为有效开展癌症高发区预防控制工作提供依据。方法在河南、安徽、江苏、山东4省13个县/区分别抽取一定数量的乡镇/街道,并在每个乡镇/街道21~70岁居民中按年龄分为5层,每层随机抽取20人,每个乡镇/街道抽取100人,共23 000人作为研究对象。调查其癌症危险因素及可疑症状的认识,以及获取相关知识的主观需求和途径。结果调查对象对吸烟、饮酒、环境污染、不合理饮食、职业因素、微生物感染、肥胖及生殖因素与癌症关系认识的正确率分别为87.4%、73.0%、62.0%、45.4%、38.3%、36.5%、22.2%和13.5%;正确认识到逐渐增大的肿块或结节、吞咽困难、不明原因的出血、不明原因的消瘦、长期消化不良、长期干咳/声音嘶哑是癌症的可疑表现者分别占72.5%、62.0%、60.3%、56.7%、45.6%和38.8%;高年龄者癌症相关知识知晓率低于年轻人,女性低于男性。希望了解癌症预防、表现、诊断、治疗及当地发病情况者占调查总人数的比例分别为78.2%、63.2%、52.5%、37.7%和34.1%。获取癌症相关知识的前3条途径为电视、广播和村医,分别占调查总人数的81.0%、57.8%和47.8%。年龄越大者越倾向于从乡村医生、家人/亲戚/朋友获取知识;年龄越小者越倾向于选择电视、网络、书报、宣传册等途径。结论农村居民对癌症危险因素、症状认识不足,获取健康知识途径有限,进行健康教育时应针对不同目标人群合理选择电视、广播、乡村医生、宣传册、海报等方式。     

移动医疗信息系统技术架构分析与研究

目的 :探讨移动医疗系统部署中的各种技术架构。方法 :通过比较开发工具、技术实现和用户操作体验等方面,分析虚拟化架构的开发与应用前景。结果:提出了一种全新的跨平台移动医疗体系架构解决方案,降低了系统维护的复杂性。结论:虚拟化架构能够充分融合移动设备操作平台及对数据进行集中管理。     

库尔特STKS全自动血球分析仪测定血小板性能评价

评价库尔特STKS全自动血球分析仪测定血小板的性能。通过不精密度、不准确度、线性范围的实验观察,库尔特STKS全自动血球分析仪血小板测定的性能可以满足临床实验室的要求。     

湖北恩施州宽叶缬草含硒量测定

采用原子荧光法测定湖北恩施州3个地区的宽叶缬草及土壤样品的硒含量,发现当地宽叶缬草硒含量明显高于其它地区样品,可作为一项开发成道地药材的依据和有效鉴定评价指标。     

妊娠合并卵巢肿瘤的治疗及预后

目的 探讨妊娠合并卵巢肿瘤的特征、诊断、治疗、相互影响及预后。方法 对近5年我院收治及手术、病理诊断明确的105例妊娠合并卵巢肿瘤进行回顾性分析。结果 妊娠期卵巢肿瘤病理类型，生殖细胞肿瘤占44．8％(47／105)，体腔上皮来源的肿瘤和性索间质肿瘤各占19．0％(20／105)，卵巢非赘生性囊肿占17．1％(18／105)；恶性肿瘤发生率为1．9％(2／105)。恶性肿瘤多为I期，术后随访至今无明显异常。足月妊娠率95．2％(100／105)。孕中期因卵巢肿瘤蒂扭转急症手术2例、因肿瘤增大明显手术2例。结论 妊娠合并卵巢良性肿瘤可予定期监测、择期处理，良性肿瘤妊娠时手术最佳时间孕16～20周，恶性肿瘤则应及时手术。除急症或肿瘤可疑恶变需及时手术外，妊娠可至足月。     

生态环境改变对华支睾吸虫病流行的影响

目的研究南水北调后微山湖区生态环境改变对华支睾吸虫病流行的影响。方法调查湖区微山县的自然环境、水面积变化并对动物感染华支睾吸虫情况进行流行病学及居民的卫生状况调查。应用改良加藤氏（Kato-kata）厚涂片法粪检易感人群。结果南水北调后湖区水面积扩大，污染得到治理，有利于中间宿主水生动物繁殖和扩散。本次调查，麦穗鱼囊蚴感染率为3．14％，淡水螺体内未检出幼虫，家猫成虫感染率38．46％。人群华支睾吸虫感染率为0．06％，居民的华支睾吸虫病防治知识贫乏。结论微山湖区生态环境的改变，居民不良卫生习惯，可能导致华支睾吸虫病的流行和扩散；通过华支睾吸虫病防治知识的广泛宣传和教育，制定相应的防治措施，可防止华支睾吸虫病在湖区流行。     

重庆市沙坪坝区2020年登革热媒介白纹伊蚊密度及抗药性监测

目的 了解重庆市沙坪坝区登革热媒介白纹伊蚊密度季节消长及对常用卫生杀虫剂的抗药性水平,为合理使用卫生杀虫剂、科学防控登革热提供依据。方法 2020年4—12月在沙坪坝区城镇居民区、农村居民区、公园和旧轮胎堆放地等4类生境中采用双层叠帐法监测白纹伊蚊成蚊密度;6—7月在沙坪坝区渝碚路街道、天星桥街道、覃家岗街道、山洞街道等4个街道采集白纹伊蚊幼虫,饲养至成蚊采用诊断剂量法中的成蚊接触筒法测定其抗药性;利用SPSS20.0软件,采用一般线性模型对不同生境白纹伊蚊成蚊密度季节消长进行比较。结果 沙坪坝区2020年平均帐诱指数为1.81只/（顶·h）,其中,城镇居民区成蚊密度最高,帐诱指数为2.26只/（顶·h）,4类生境的白纹伊蚊成蚊活动高峰期在6—9月。不同生境白纹伊蚊成蚊密度差异无统计学意义（F=0.093,P>0.05）,不同月份白纹伊蚊成蚊密度有统计学意义（F=10.197,P<0.05）。白纹伊蚊成蚊对0.03%溴氰菊酯、0.4%氯菊酯、0.08%高效氯氰菊酯、0.07%高效氟氯氰菊酯产生抗药性,对0.05%残杀威、0.2%噁虫威、0.5%马拉硫磷、0.2%杀螟硫磷、2...