亚健康状态预警指标体系构建设想

亚健康状态在人群中具有较高的发生率,严重威胁着人们的健康,如何进行预警一直是人们关注的焦点.初步提出从亚健康状态的危险因素、临床表现、实验室监测指标、量表和问卷评价指标、中医证候等方面构建亚健康状态预警指标体系的设想.     

Does chronic kidney disease affect the complications and prognosis of patients after primary colorectal cancer surgery?

BACKGROUNDThe effect of chronic kidney disease (CKD) on the outcomes of colorectal cancer (CRC) patients after primary CRC surgery is controversial.AIMTo analyze whether CKD had specific effect on the outcomes after CRC surgery.METHODSWe searched the PubMed, Embase, Cochrane Library databases and CNKI, from inception to March 14, 2022. Newcastle-Ottawa Scale was used for the quality assessment in this meta-analysis, and we used RevMan 5.3 was used for data analysis.RESULTSA total of nine studies including 47771 patients were eligible for this meta-analysis. No significant difference was found in terms of overall postoperative complications [odds ratio (OR) = 1.78, 95%CI: 0.64-4.94, P = 0.27]. We analyzed the specific complications and found that the CKD group had higher rates of pulmonary infection (OR = 2.70, 95%CI: 1.82-4.00, P < 0.01), cardiovascular complications (OR = 3.39, 95%CI: 2.34-4.91, P < 0.01) and short-term death (OR = 3.01, 95%CI: 2.20-4.11, P < 0.01). After pooling the hazard ratio (HR), the CKD group had worse overall survival (OS) (HR = 1.51, 95%CI: 1.04-2.20, P = 0.03). We performed subgroup analyses of the dialysis and non-dialysis groups, and no significant difference was found in the non-dialysis group (HR = 1.20, 95%CI: 0.98-1.47, P = 0.08). The dialysis group had worse OS (HR = 3.36, 95%CI: 1.92-5.50, P < 0.01) than the non-dialysis group. The CKD group had worse disease-free survival (DFS) (HR = 1.41, 95%CI: 1.12-1.78, P < 0.01), and in the subgroup analysis of the dialysis and non-dialysis groups, no significant difference was found in the non-dialysis group (HR = 1.27, 95%CI: 0.97-1.66, P = 0.08). The dialysis group had worse OS (HR = 1.95, 95%CI: 1.23-3.10, P < 0.01) than the non-dialysis group.CONCLUSIONPreexisting CKD was associated with higher rates of pulmonary infection, higher rates of short-term death, and worse OS and poorer DFS following CRC surgery.     

Conotruncal anomalies in fetal life: Accuracy of diagnosis, associated defects and outcome

Objectives

To assess the accuracy of prenatal echocardiography, associated anomalies, and outcome of fetuses with conotruncal anomalies (CTA).

Study design

We searched our database for CTA prenatally diagnosed between 1990 and 2005. We included tetralogy of Fallot (TOF), transposition of the great arteries (TGA), double-outlet right ventricle (DORV), truncus arteriosus (TA), pulmonary atresia with ventricular septal defect (PA-VSD) and posterior malalignment type VSD with aortic arch obstruction (pmtVSD-AAO). Data of 144 fetuses with complete follow-up were retrieved and analyzed.

Results

The main reason for referral was suspected heart defect on a routine obstetric scan (72%). Most cases were detected ≤22 weeks (55%). The presence of a CTA was confirmed postnatally in 143 cases (99%), and the diagnosis of the first fetal echocardiography was correct in 126 (87.5%). Most diagnosis of TOF (33/36, 91.7%), TGA (34/38, 89.5%) and DORV (34/38, 89.5%) were proved correct. Inadequate assessment of the interventricular septum, the distal aortic arch and/or the severity of the right outflow tract obstruction accounted for most errors. The accuracy rate was lower in TA (11/14, 78.6%) and PA-VSD (4/7, 57.1%), with evaluation of the branch pulmonary arteries as the main source of discrepancies. In 7/18 incorrect cases subsequent scans allowed to obtain a correct diagnosis. Most fetuses (64%) had an isolated CTA. Thirty-seven had chromosomal anomalies (26%) but none were found in TGA. 22q11 deletion affected 8.7% of the tested patients. Nuchal translucency (NT) was above 95th centile in 19/104 cases (18%) in which NT were measured. Fifty cases were interrupted. The overall one-year survival rate was 71%, with differences between cases with and without associated defects (9/25, 36% vs. 57/68, 83.8%; p < 0.01). The uncomplicated forms of TGA and TOF had the best survival rates (100%).

Conclusions

Most CTA can be diagnosed by fetal echocardiography with a high degree of accuracy. Chromosomal defects should always be ruled out, except for simple TGA. Current survival figures in many isolated CTA, especially simple TGA and TOF, support a change in the “classical” concept that congenital heart defects detected prenatally often have the worst outlook.

Condensation

Most CTA can be diagnosed by fetal echocardiography with a high degree of accuracy. Isolated CTA are more common and most of these may have a favourable outcome.     

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.     

儿童颅内压监测研究进展

颅内高压是儿科较常见的急危重症,颅内压(intracranial pressure,ICP)监测能动态评估脑损伤患者的病情变化,计算脑灌注压,指导临床治疗.ICP监测有其局限性,不能及时反映大脑微血管功能障碍和细胞功能障碍,因此需要在ICP监测的基础上开展多模态监测(multimodality monitoring).ICP监测和多模态监测的信息整合有助于进一步理解脑损伤的病理生理机制,有助于对患者进行针对性个体化治疗.     

胆汁酸类成分替代中药熊胆的药性分析

目的：探讨熊胆中主要胆汁酸类成分临床代替中药熊胆使用的合理性,分别分析它们和中药熊胆在药性上存在的差异。方法：根据医学典籍对中药熊胆药性的描述,并参考《中药学》总结熊胆的药性;根据CNKI数据库中胆汁酸类成分药理作用研究的相关文献,对主要胆汁酸类成分的药理作用进行梳理和总结;论文根据胆汁酸类成分的药理作用,运用本课题组已建立的药性预测模型,预测各胆汁酸的药性,并将预测结果与熊胆的药性相比较。结果：熊胆中的胆汁酸类成分大部分都有苦寒之性,它们药性的加合可体现熊胆的药性组合。结论：熊胆中的主要胆汁酸类成分均能发挥熊胆的部分作用,临床应用时需要根据具体情况注意调整使用方案。     

基于16S rDNA高通量测序研究针灸对克罗恩病大鼠肠道菌群的调节作用

目的：采用16S rDNA高通量测序技术分析针灸对克罗恩病（CD）大鼠肠道菌群物种相对丰度和多样性的影响,探讨针灸对克罗恩病的作用机制。方法：将40只SD大鼠随机分为正常组、模型组、隔药饼灸组、电针组和西药组,每组8只。采用2,4,6-三硝基苯磺酸溶液灌肠4周构建CD大鼠模型,隔药饼灸组和电针组选取天枢（双侧）、气海穴进行干预,西药组采用柳氮磺吡啶溶液灌胃干预。干预结束后取结肠组织进行HE染色,收取大鼠粪便进行16S rDNA高通量测序并对进行物种相对丰度、alpha多样性和基因功能代谢预测分析等。结果：隔药饼灸组和电针组大鼠结肠组织病理学评分显著低于模型组（P<0.01）。与正常组比较,模型组拟杆菌门、放线菌门、拟杆菌纲、拟杆菌目、紫单胞菌科、普雷沃菌科、拟杆菌科、普雷沃菌属等的相对丰度升高,厚壁菌门、变形菌门、梭菌纲、梭菌目、毛螺菌科、瘤胃菌科、乳酸杆菌属等的相对丰度降低;在经过隔药饼灸和电针治疗后,上述大多数微生物相对丰度均有不同程度改善。与正常组比较,模型组肠道菌群的Chao1、Observed species、Shannon、Simpson等alpha多样性指数均显著下降（P<0.05）;与模型组比较,隔药饼灸组和电针组上述指数均显著升高（P<0.05）。功能预测分析发现隔药饼灸和电针均能调节参与碳水化合物代谢、氨基酸代谢等的功能基因。结论：CD与肠道菌群结构变化有关,针灸能够调节CD大鼠肠道菌群物种相对丰度和菌群多样性。     

新冠肺炎临床评价核心指标集比较分析＊

目的 对已公开发表的新冠肺炎核心指标集及其研究方法进行比较分析，为临床试验和证据转化研究提供参考信息。方法 计算机检索COMET数据库，并补充检索CNKI、WanFang、PubMed、Web of Science、The Cochrane Library等数据库，收集发表的新型冠状病毒肺炎（Coronavirus Disease 2019，COVID-19）核心指标集（Core Outcome Set，COS）研究，检索时间截至为2021年3月31日。按照纳入排除标准筛选文献，并提取研究基本信息、研究方法及指标数据，对其进行描述性分析。结果 共纳入5项COVID-19核心指标集相关研究（4项为COVID-19-COS研究，1项为COVID-19核心指标测量工具研究）。相同的结局指标包括死亡率、病毒核酸检测、临床进展、恢复期、临床症状评分及临床分型等。指标来源主要来自临床试验注册平台和问卷调查；达成共识的方法主要采用共识会议；利益相关群体中临床专家、方法学专家和医疗管理人员涉及较多。结论 不同的新冠肺炎核心指标集研究有一定的共性，但由于应用场景不同，也存在一定差异。随着对疾病认识的深化，相关COVID-19核心指标需要加强测量方法和疗程推荐。     

在线近红外光谱监测桂枝茯苓胶囊流化床干燥过程水分的方法研究

目的采用在线近红外光谱(NIRS)技术,建立桂枝茯苓胶囊流化床干燥过程水分实时监测模型。方法通过NIRS漫反射探头采集16个生产批次共176个样本进行建模,优选移动窗口平滑法进行光谱预处理,采用间隔偏最小二乘法(si PLS)结合移动窗口偏最小二乘法(mw PLS)筛选特征变量为4 759.45～5 338.00 cm-1、5 503.84～6 101.67 cm-1、8 512.25～8 809.24cm-1,采用偏最小二乘(PLS)法建立水分含量多变量校正模型。结果水分预测的交叉验证均方根误差(RMSECV)为0.243%,性能偏差比(RPD)值为13.384,预测相对偏差(RSEP)为0.270%。以8个生产批次对在线监控方法的可靠性进行持续验证,结果 40个样本的相对预测误差均小于4.7%。干燥过程水分实时监测趋势图显示可准确判断干燥终点,终点样本水分含量位于控制限内。结论在线NIRS结合PLS建立的定量模型,可应用于生产规模桂枝茯苓胶囊流化床干燥过程水分含量在线监控且预测性能稳健、准确。     

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。