重型肝炎的预后判断

为了早期较精确地判定重型肝炎的预后，对２３８例重型肝炎病人的临床及实验室资料进行了筛选，对其中易得到的１６项指标做了单因素及多因素分析，从而成功地建立了ｌｏｇｉｓｔｉｃ回归模型：Ｐ＝１／（１＋ｅ），式中Ｓ＝２．５８３＋３．７４７×ＢＥＳ－１．７７１×Ｐａ＋１．４２１×ＡＳＴ／ＡＬＴ＋１．１６８×Ｅ＋３．９９６×Ｈ，如果Ｓ＞０则判为死，Ｓ＜０则判为活。以该式对另外５０例病人做了历史前瞻性判定，结果为：阳性预测值＝１，阴性预测值＝０．９３，敏感性＝０．９７，特异性＝１。     

6MV X线照射人离体血细胞遗传学剂量—效应研究——常规法的微核剂量效应曲线

本文应用医用直线加速器6MV X 线照射5例健康成人离体血研究淋巴细胞微核与剂量间的关系,发现微核率及微核细胞率可各配以回归方程 Y=6.6896×10~(-3)+1.2959×10~(-2)D~2及 Y=7.3906×10~(-3)+1.0824×10~(-2)D~2,其 R~2值分别为O.9948及0.9976,有较好的拟合度,可作为预测受照剂量的模型。     

CD HORIZON 前路内固定系统治疗退行性腰椎管狭窄症

目的探讨CD HORIZON前路内固定系统治疗退行性腰椎管狭窄症的应用价值。方法对21例退行性腰椎管狭窄症患者经从前路行椎管扩大减压植骨、CD HORIZON内固定术，术后经3～30个月，平均9个月的随访。结果17例术前腰痛、间歇跛行症状完全消除，下肢乏力基本消除，术后1个月戴腰围行走800～1500m，2例术前双下肢肌力0级，术后2个月恢复至4级。手术优良率90．5％。结论前路CD HORIZON系统治疗退行性腰椎管狭窄症可以达到有限化的椎管扩大、融合和固定，不过多干扰脊髓，临床效果满意。     

顽固性口腔溃疡复发的危险因素分析

【摘要】 目的 回顾性分析顽固性口腔溃疡复发的相关危险因素。方法 选取 2019 年 1 月至 2020 年 10 月沈阳七三九医院收治的 125 例顽固性口腔溃疡患者作为研究对象, 收集患者年龄、性别、是否饮酒、是否吸烟?是否喝茶、饮食类型、是否使用药物牙膏、牙刷毛硬度、刷牙次数、是否熬夜失眠、疲劳状态、心理状态、是否合并消化系统疾病等资料, 根据口腔溃疡治愈后3个月是否再发口腔溃疡将患者分为复发组和未复发组,多因素Logistic 回归分析顽固性口腔溃疡复发的相关危险因素。结果 125 例顽固性口腔溃疡患者愈后 3 个月再发口腔溃疡者 32 例,设为复发组;未再发口腔溃疡者93例,设为未复发组。多因素Logistic回归分析结果显示,年龄≥60岁、吸烟、饮食偏荤、使用药物牙膏、刷牙次数≤1 次/天、熬夜失眠、疲劳、心理异常、合并消化系统疾病是顽固性口腔溃疡患者复发的独立危险因素 (95% CI为1.016 ~ 1.134、1.003 ~ 1.164、1.001 ~ 1.397、1.024 ~1.364、1.029 ~ 1.413、1.019 ~ 1.433、1.027 ~ 1.389、1.041 ~ 1.397、1.024 ~ 1.369, P = 0.011、0.046、0.048?0.022、0.021、0.030、0.021、0.013、0.022)。结论 顽固性口腔溃疡的复发与患者的年龄、生活习惯、心理状态等多种因素密切相关。     

A common epigenetic clock from childhood to old age

Forensic age estimation is a DNA intelligence tool that forms an important part of Forensic DNA Phenotyping. Criminal cases with no suspects or with unsuccessful matches in searches on DNA databases; human identification analyses in mass disasters; anthropological studies or legal disputes; all benefit from age estimation to gain investigative leads. Several age prediction models have been developed to date based on DNA methylation. Although different DNA methylation technologies as well as diverse statistical methods have been proposed, most of them are based on blood samples and mainly restricted to adult age ranges. In the current study, we present an extended age prediction model based on 895 evenly distributed Spanish DNA blood samples from 2 to 104 years old. DNA methylation levels were detected using Agena Bioscience EpiTYPER® technology for a total of seven CpG sites located at seven genomic regions: ELOVL2, ASPA, PDE4C, FHL2, CCDC102B, MIR29B2CHG and chr16:85395429 (GRCh38). The accuracy of the age prediction system was tested by comparing three statistical methods: quantile regression (QR), quantile regression neural network (QRNN) and quantile regression support vector machine (QRSVM). The most accurate predictions were obtained when using QRNN or QRSVM (mean absolute prediction error, MAE of ± 3.36 and ± 3.41, respectively). Validation of the models with an independent Spanish testing set (N = 152) provided similar accuracies for both methods (MAE: ± 3.32 and ± 3.45, respectively). The main advantage of using quantile regression statistical tools lies in obtaining age-dependent prediction intervals, fitting the error to the estimated age. An additional analysis of dimensionality reduction shows a direct correlation of increased error and a reduction of correct classifications as the training sample size is reduced. Results indicated that a minimum sample size of six samples per year-of-age covered by the training set is recommended to efficiently capture the most inter-individual variability..     

Epigenetic age estimation in saliva and in buccal cells

Age estimation based on epigenetic markers is a DNA intelligence tool with the potential to provide relevant information for criminal investigations, as well as to improve the inference of age-dependent physical characteristics such as male pattern baldness or hair color. Age prediction models have been developed based on different tissues, including saliva and buccal cells, which show different methylation patterns as they are composed of different cell populations. On many occasions in a criminal investigation, the origin of a sample or the proportion of tissues is not known with certainty, for example the provenance of cigarette butts, so use of combined models can provide lower prediction errors.In the present study, two tissue-specific and seven age-correlated CpG sites were selected from publicly available data from the Illumina HumanMethylation 450 BeadChip and bibliographic searches, to help build a tissue-dependent, and an age-prediction model, respectively. For the development of both models, a total of 184 samples (N = 91 saliva and N = 93 buccal cells) ranging from 21 to 86 years old were used. Validation of the models was performed using either k-fold cross-validation and an additional set of 184 samples (N = 93 saliva and N = 91 buccal cells, 21–86 years old).The tissue prediction model was developed using two CpG sites (HUNK and RUNX1) based on logistic regression that produced a correct classification rate for saliva and buccal swab samples of 88.59 % for the training set, and 83.69 % for the testing set. Despite these high success rates, a combined age prediction model was developed covering both saliva and buccal cells, using seven CpG sites (cg10501210, LHFPL4, ELOVL2, PDE4C, HOXC4, OTUD7A and EDARADD) based on multivariate quantile regression giving a median absolute error (MAE): ± 3.54 years and a correct classification rate ( %CP±PI) of 76.08 % for the training set, and an MAE of ± 3.66 years and a %CP±PI of 71.19 % for the testing set. The addition of tissue-of origin as a co-variate to the model was assessed, but no improvement was detected in age predictions. Finally, considering the limitations usually faced by forensic DNA analyses, the robustness of the model and the minimum recommended amount of input DNA for bisulfite conversion were evaluated, considering up to 10 ng of genomic DNA for reproducible results. The final multivariate quantile regression age predictor based on the models we developed has been placed in the open-access Snipper forensic classification website.     

A new analytical cut-off point for determining 18 years of age using MRI on medial clavicular epiphysis

Evaluation of the ossification of the medial clavicular epiphysis plays a key role in forensic age estimation. The purpose of the present study was to assess a new numerical cut-off at the age of 18 years, taking into consideration Magnetic Resonance (MR) images of the medial clavicular epiphysis. We analyzed 163 MR scans of Italian subjects aged between 14 and 25 years. Using the data obtained we calculated two ratios: REM-1 (ratio between the length of the whole epiphysis and the length of the metaphysis) and REM-2 (ratio between the length of epiphyseal-metaphyseal fusion and the length of the metaphysis). In 68 out of 163 cases it was not possible to measure REM-2. The reproducibility was demonstrated using the Intraclass Correlation Coefficient (ICC) (Cronbach’s alpha > 0.80). REM-1 and REM-2 were compared in each category of age (adult and minor) by the Wilcoxon signed-rank test. The cut-off points for measurements of REM-1 and REM-2 were determined by logistic regression. For REM-1, the cut-off scores were 0.83 for all individuals (accuracy = 94.77%) and males (accuracy = 96.05%), and 0.86 for females (accuracy = 92.30%). For REM-2, the cut-off values were 0.40 for all individuals and males (accuracy = 100.00%), and 0.41 for females (accuracy = 100.00%). Finally, receiver operating characteristic (ROC) curves for age classification based on REM-1 and REM-2 were constructed, showing that REM-2 had the highest discriminative power. Thus, a new cut-off model for predicting the age of majority has been introduced, conducting a quantitative analysis thanks to the use of a high-resolution imaging tool.     

细菌性肝脓肿影响因素分析

目的探讨细菌性肝脓肿(pyogenic hepatic abscess,PHA)的患病风险。方法采用1∶1配对的病例对照研究,对31对病例及对照组相关9个危险因素进行条件Logistic回归分析。结果单因素分显示DM(OR=6.328,95%CI:1.787～22.409)、胆道疾病(OR=8.759,95%CI:1.006～76.097)和恶性肿瘤史(OR=4.444,95%CI:0.467～42.258)是PHA的可能风险因素(均P<0.20);多因素Logistic回归分析显示DM(OR=7.747,95%CI:1.975～28.275)是PHA的风险因素(P=0.003)。结论 DM患者患PHA的风险是非DM患者的7.75倍,提高对DM增加PHA患病风险的认识,早期诊治可能会改善预后。