Prediction of acute stroke progression by the National Institutes of Health Stroke Scale

Objective To determine the occurrence of neurological changes during the first 48 hours after acute stroke as it relates to the initial stroke severity assessment. Methods The assessment with the National Institutes of Health Stroke Scale (NIHSS) was performed serially for the first 48 hours on 68 consecutive ischemic stroke patients admitted to the Department of Geriatric Cardiology at the Khanh Hoa Hospital, Nha Trang, Vietnam. Incidence of stroke progression (a ≥ 3-point increase on the NIHSS) was recorded and analysis performed to determine its association with initial stroke severity and other demographic and physiological variables. Deficit resolution by 48 hours, defined as an NIHSS score of 0 or 1, measured the frequency of functional recovery predicted by the initial deficit. Results Overall progression was noted in 28% of events (19/68). Applying Bayes' solution to the observed frequency of worsening, the greatest likelihood of predicting future patient progression occurred with NIHSS score of =7 and >7. Patients with an initial NIHSS score of =7 experienced a 13% (6/47) worsening rate versus those of an initial score of >7 with a 62% (13/21) worsening rate (P<0.01). 42.5% (20/47) of those with an initial score of =7 were functionally normal at 48 hours, whereas only 4.7% (1/21) of those with scores of >7 returned to a normal examination within this period (χ2, P<0.05). Conclusions This study suggests that the early clinical course of neurological deficit after acute stroke be dependent on the initial stroke severity and that a dichotomy in early outcome exist surrounding an initial NIHSS score of 7. These findings may have significant implications for the design and patient stratification in treatment protocols with respect to primary clinical outcome.(J Geriatr Cardiol 2007;4:225-228.)     

CT抗原KM-HN-1 HLA-A * 0201限制性表位预测及其与HLA-A * 0201结合强度分析

目的通过对CT抗原（cancer-testis antigen）KM-HN-1进行HLA-A＊0201限制性表位预测,并对候选表位肽与HLA-A＊0201分子结合亲和力及复合物稳定性进行分析,为探索基于KM-HN-1的免疫治疗奠定基础。方法利用基于蛋白酶体剪切位点特异性的算法PAProc及基于肽MHC-I结合的算法BIMAS和SYFPEITHI对KM-HN-1进行HLA-A＊0201限制性表位预测．合成KM-HN-1相关候选表位肽KM-HN-I321-329（KLLPFRETV）,KM-HN-I303-211,（FLPTAPPNV）,KM-HN-I629-637。（TLLQIIETV）,KM-HN-I87-95（ILNKSIIEV）,KM-HN-I538-596。（QMMEALDQL）及阳性对照肽HBVcAg18-27（FLPSDFFPSV）;对这些合成肽与HIA-A＊0201分子结合亲和力及其复合物稳定性根据文献报道的方法进行分析。结果KM-HN-I321-329（KLLPERETV）结合亲和力最低,KM-HN—I203-211（FLPTAPPNV）结合亲和力最高,其余3条肽结合亲和力介于2者之间;稳定性实验（DC50）结果显示：KM-HN-I538—546（QMMEALDQL）DC50小于2h,KM—HN-I321-329（KLLPERETV）的DC50介于2～4h之间,KM-HN-I87-95。（ILNKSIIEV）的DC50介于6～8h之间,KM-HN-I233-211（HLPTAPPNV）及KM-HN-I629—633（TLLQIIETV）的DC50均大于8h。结论基于蛋白酶体剪切位点特异性的算法及基于肽MHC-I结合的算法对KM-HN-1进行HLA-A＊0201限制性表位预测,结合候选表位肽与HLA-A＊0201分子结合的亲和力与复合物稳定性实验分析,为该抗原HLA-A＊0201限制性表位的鉴定奠定了基础。     

药物靶标预测技术在中药网络药理学中的应用

近年来,随着网络药理学逐渐兴起,特别是"网络靶标"概念的提出,引发了中医药新的研究热潮。其所强调的整体性与系统性和中医药理论不谋而合,能够很好的解释中医药的深刻内涵,包括中药作用机制解释,药效物质的寻找,君臣佐使配伍机制阐释等,更加适合中医药的学术特点和实际。而如何高效快速地识别大量的药物与靶标蛋白间的相互作用则成为中药网络药理学研究中的一个关键问题。药物-靶标相互预测技术作为一种高效而高通量的手段,能够减少成本,快速预测成分靶标,为中药网络药理学的应用奠定基础。事实上,针对庞大的化合物和靶标数据库,不同的预测方法和技术都被开发出来,并用于预测药物和靶标的关系,且已经有许多虚拟筛选技术成功的应用于网络药理学中。根据预测原理的不同,药物-靶标相互预测技术和策略大致可以分为4类,即基于配体的预测方法,基于靶标的预测方法,机器学习方法和组合应用的预测方法。该文就药物靶标预测方法及其在中药网络药理学的应用现状进行较系统的阐述,希望能够为广大中药研究者提供有益的参考和借鉴。     

A prospective cohort study of the value of maternal plasma concentrations of angiogenic and anti-angiogenic factors in early pregnancy and midtrimester in the identification of patients destined to develop preeclampsia

Objective.?Changes in the maternal plasma concentrations of angiogenic (placental growth factor (PlGF) and vascular endothelial growth factor (VEGF)) and anti-angiogenic factors (sEng and vascular endothelial growth factor receptor-1 (sVEGFR-1)) precede the clinical presentation of preeclampsia. This study was conducted to examine the role of maternal plasma PlGF, sEng, and sVEGFR-1 concentrations in early pregnancy and midtrimester in the identification of patients destined to develop preeclampsia.

Methods. This longitudinal cohort study included 1622 consecutive singleton pregnant women. Plasma samples were obtained in early pregnancy (6–15 weeks) and midtrimester (20–25 weeks). Maternal plasma PlGF, sEng, and sVEGFR-1 concentrations were determined using sensitive and specific immunoassays. The primary outcome was the development of preeclampsia. Secondary outcomes included term, preterm, and early-onset preeclampsia. Receiving operating characteristic curves, sensitivity, specificity, positive and negative likelihood ratios, and multivariable logistic regression were applied. A p-value of <0.05 was considered significant.

Results.?(1) The prevalence of preeclampsia, term, preterm, (<37 weeks) and early-onset preeclampsia (<34 weeks) was 3.8 (62/1622), 2.5 (40/1622), 1.4 (22/1622) and 0.6% (9/1622), respectively; (2) Higher likelihood ratios were provided by ratios of midtrimester plasma concentrations of PlGF, sEng, and sVEGFR-1 than single analytes; (3) Individual angiogenic and anti-angiogenic factors did not perform well in the identification of preeclampsia as a whole; in particular, they perform poorly in the prediction of term preeclampsia; (4) In contrast, a combination of these analytes such as the PlGF/sEng ratio, its delta and slope had the best predictive performance with a sensitivity of 100%, a specificity of 98–99%, and likelihood ratios for a positive test of 57.6, 55.6 and 89.6, respectively, for predicting early-onset preeclampsia.

Conclusions.?(1) The PlGF/sEng ratio and its delta and slope had an excellent predictive performance for the prediction of early-onset preeclampsia, with very high likelihood ratios for a positive test result and very low likelihood ratios for a negative test result; and (2) Although the positive likelihood ratios are high and the positive predictive values low, the number of patients needed to be closely followed is 4:1 for the PlGF/sEng ratio and 3:1 for the slope of PlGF/sEng.     

TIPS术治疗的肝硬化并发EVB患者医院内死亡风险预测模型的构建与应用

目的 构建肝硬化门静脉高压症并发食管胃底静脉曲张破裂出血(EVB)患者医院内死亡的风险预测模型。方法 2018年6月～2020年6月我院收治的107例肝硬化门静脉高压症并发EVB患者,均接受经颈静脉肝内门体静脉分流术(TIPS)治疗。应用Logistic回归分析影响患者死亡的危险因素,基于独立影响因素构建医院内死亡的风险预测模型,应用Bootstrap法对预测模型进行内部验证,应用受试者工作特征曲线(ROC)下面积(AUC)评估预测模型的预测效能。结果 本组患者医院内死亡25例(23.4%),生存82例;单因素分析显示,死亡患者Child-Pugh分级、出血部位、门静脉内径、肝性脑病和失血性休克发生率等与生存患者比,均存在显著性差异(P<0.05),多因素Logistic回归分析显示,门静脉内径(OR=2.201,95%CI:1.544～3.139)、肝性脑病(OR=3.093,95%CI:1.731～5.524)和失血性休克(OR=1.101,95%CI:1.040～1.165)是影响患者医院内死亡的独立危险因素(P<0.05);对所构建的列线图预测模型,经内部验证,其C...     

Experiment and Theoretical Investigation on Fatigue Life Prediction of Fracturing Pumpheads Based on a Novel Stress-Field Intensity Approach

Fracturing pumpheads are typical pressure vessels that experience frequent fatigue failure under the effect of notches in their cross-bore. To enhance the fatigue life of fracturing pumpheads, the study of the notch effect is indispensable and important to establish a reliable mathematical model to predict their fatigue life. In the present paper, two novel fatigue life prediction models are proposed for notched specimens. In these models, two new geometric fatigue failure regions are defined to improve the weight function. Finally, the elaborated novel stress-field intensity approach was applied to three different types of notched specimens. Experiment results indicate that the new SFI approach achieves 47.82%, 39.48%, and 31.85% higher prediction accuracy than the traditional SFI approach, respectively. It was found that the modified SFI approach provided better predictions than the traditional SFI approach and the TCD method. The II-th novel SFI approach had the highest accuracy, and the I-th novel SFI approach was more suitable for sharply notched specimens.     

Fatigue Life Prediction of CFRP-Strengthened RC Beams with Flexural Crack under Hygrothermal Environments

The durability of reinforced concrete (RC) beams strengthened with carbon fiber-reinforced polymer (CFRP) is a worldwide concern in structural engineering. As an important part of the strengthened beam, the performance of the CFRP–concrete interface under hygrothermal environments is a delicate problem. In this paper, the fatigue behavior of CFRP-strengthened RC beams is analyzed by a theoretical model. In the model, CFRP–concrete interface degradation under hygrothermal environments is involved. Since interface debonding and rebar fracture induced by intermediate cracking are two typical failure modes, the damage models of rebar and the CFRP–concrete interface are established. Based on the theoretical model, the failure mode of CFRP-strengthened RC beams can be predicted, and fatigue life can be determined. The results showed that IC debonding is more likely to occur under hygrothermal environments. The accurate prediction of failure modes is essential for fatigue life prediction.     

评测纵览:面向“基因-疾病”的关联语义挖掘任务

介绍活跃基因注释语料库的设计目的和标注过程、特点,阐述标注规则、标签设计、标注实例,分析语料库在医药领域的应用场景,包括抗癫痫药物重定位、阿尔茨海默症关键基因提取等领域。     

连续性血液净化治疗患儿静脉留置导管感染风险预测体系的构建及应用

目的:探讨连续性血液净化治疗患儿静脉留置导管感染风险因素,据此构建风险预测体系,并检验其实际应用效果,以期为临床预防护理提供依据。方法:选取医院2018年4月—2020年4月收治的400例连续性血液净化治疗患儿,按两组基础资料具有匹配性原则将其分为构建组300例、验证组100例,统计构建组中静脉留置导管感染患儿例数,通过单因素分析、多因素Logistic回归分析筛选静脉留置导管感染的独立危险因素,据此构建风险预测体系,并检验其在验证组中的应用效果。结果:经统计得到,构建组中静脉留置导管感染患儿共66例,感染发生率为22.00%;单因素分析得到,连续性血液净化治疗患儿静脉留置导管感染风险因素有穿刺部位、导管留置时间、插管次数、血流速度、血红蛋白、遵医依从性、抗生素使用时间、操作人员手卫生(P<0.05);多因素Logistic回归分析得到,连续性血液净化治疗患儿静脉留置导管感染独立风险因素有股静脉置管、导管留置时间>7 d、血流速度>180 mL/min、血红蛋白<100 g/L、遵医依从性差、抗生素使用时间>7 d(P<0.05);构建得到连续性血液...     

女性压力性尿失禁风险预测的研究进展

综述女性压力性尿失禁(stress urinary incontinence, SUI)风险预测的研究进展。指出女性SUI风险预测相关文献普遍存在风险预测工具和指标缺乏临床大样本验证,指标、纳入人群不统一的现象,风险预测模型存在构建过程未按报告规范进行,未进行完整的模型验证以及模型性能评价指标不规范的情况。未来研究可以在现有风险预测工具或模型的基础上进行改进、完善,以期为女性SUI风险预测提供参考。