ObjectiveTo explore the pathogenesis of tuberculosis and provide new ideas for its early diagnosis and treatment.MethodsGSE54992 gene expression profile was obtained from the gene expression database. Differentially expressed genes (DEGs) were screened using National Center forBiotechnology Information platform, and GO enrichment analysis, pathway analysis, pathway network analysis, gene network analysis, and co-expression analysis were performed to analyze the DEGs.ResultsCompared with the control group, a total of 3 492 genes were differentially expressed in tuberculosis. Among them, 1 686 genes were up-regulated and 1 806 genes were down-regulated. DEGs mainly involved small molecule metabolic processes, signal transduction, immune response, inflammatory response, and innate immune response. Pathway analysis revealed chemokine signaling pathway, tuberculosis, NF-Kappa B signaling pathway, cytokine-cytokine receptor interaction, and so on; gene signal network analysis found that the core genes were AKT3, PLCB1, MAPK8, and NFKB1; co-expression network analysis speculated that the core genes were PYCARD, TNFSF13, PHPT1, COMT, and GSTK1.ConclusionsAKT3, PYCARD, IRG1, CD36 and other genes and their related biological processes may be important participants in the occurrence and development of tuberculosis. Bioinformatics can help us to comprehensively study the mechanism of disease occurrence, which can provide potential targets for the diagnosis and treatment of tuberculosis.
目的 研究美国国立卫生院脑卒中量表（NIHSS）评分、格拉斯哥昏迷评分（GCS）及指数记分法（BI）量表，预测脑梗死患者发病3个月后二便障碍预后的有效性。 方法 采取队列研究，登记2010年9月－2011年10月入院的脑梗死患者性别、年龄、婚姻、民族、职业，由脑卒中护士全面评定NIHSS评分、GCS评分、BI量表等指标。3个月后回访患者二便障碍恢复情况。 结果 分析显示NIHSS评分、GCS评分分值与脑梗死发病后3个月二便障碍恢复相关，BI量表评分分值与脑梗死发病后3个月二便障碍恢复无关。 结论 NIHSS评分、GCS评分分值可以预测脑梗死患者二便障碍恢复情况及预后情况，具有预测有效性。
The management of malignant pleural effusion remains a clinical challenge. In November 2018, American Thoracic Society, Society of Thoracic Surgeons, and Society of Thoracic Radiology summarized the recent advances and provided 7 recommendations for clinical problems of the management of malignant pleural effusion. This paper interprets these recommendations to provide references for management and research on malignant pleural effusion.
Objective To develop and validate a prediction model to assess the risk of depression in patients with chronic kidney disease (CKD) based on National Health and Nutrition Examination Survey (NHANES) database. Methods Data on patients with CKD were selected from the NHANES between 2005 and 2018. Participants were randomly divided into a training set and a validation set in a 7∶3 ratio for model development and validation, respectively. Multivariable logistic regression was used in the training set to identify independent risk factors associated with depression in CKD patients, with stepwise selection applied to determine the final predictors. Model performance was assessed using receiver operating characteristic curve (ROC), calibration plots, and decision curve analysis (DCA). Internal validation was performed through bootstrap resampling, and a predictive model was ultimately established. Results A total of 4413 CKD patients were included, including 2112 males (47.86%) and 2301 females (52.14%). Among them, 3089 patients were assigned to the training set and 1324 to the validation set. In the training set, 332 patients (10.75%) presented with depressive symptoms, while 143 patients (10.80%) in the validation set had depressive symptoms. Multivariate logistic regression analysis showed that other hispanic, current smoking, and sleep disorders were risk factors (P＜0.05). Male, middle or high-income, high school grad/ged or above, married or widowed were protective factors (P＜0.05). Finally, 7 variables were included to construct a prediction model, including gender, poverty income ratio, education level, marital status, smoking status, body mass index, and sleep disorders. The ROC curve showed that the AUC=0.773 [95% confidence interval (0.747, 0.799)] in the training set, the internal validation was evaluated by 1000 Bootstrap resampling methods, and the corrected C-index=0.763. The validation set AUC=0.778 [95% confidence interval (0.740, 0.815)], showed good discrimination ability. The calibration curve showed that the model’s predicted probability was highly consistent with the actual occurrence. Decision curve analysis showed that the model provided a significant net benefit for clinical decision-making at a threshold probability of 20%～50%. Conclusions The prediction model constructed in this study can effectively predict the risk of depression in patients with CKD and can provide guidance for early screening and personalized intervention for high-risk groups. However, the external validation and localization of the model still needed further research.
【摘要】 目的 对脑梗死患者施行静脉溶栓治疗前后的相关状况和指标进行评价分析。 方法 2003年1月-2010年11月对神经内科收治的29例脑梗死患者予以静脉溶栓治疗及护理，并就治疗前后各相关时间点血压监测及美国国立卫生研究院卒中量表（National Institute of Health stroke scale，NIHSS）评分情况进行分析。 结果 溶栓前后血压对比显示:溶栓后2 h收缩压相对于溶栓前和溶栓后24 h升高（Plt;0.05）；溶栓前后NIHSS评分差异有统计学意义（Plt;0.05）。 结论 溶栓后患者收缩压出现升高，护理上应该加强血压监控，为临床治疗提供支持。【Abstract】 Objective To investigate the correlated condition and clinical index changes before and after the intravenous thrombolysis of the cerebral infarction patients. Methods The blood pressure and the National Institutes of Health stroke scale (NIHSS) score of 29 cerebral infarction patients with the intravenous thrombolysis treatment between January 2003 and November 2010 were measured and analyzed. Results Two hours after the thrombolysis, the systolic blood pressure significantly increased compared with those before the intravenous thrombolysis and 24 hours after intravenous thrombolysis （P＜0.05）. NIHSS score was significantly decreased after the thrombolysis （P＜0.05）. Conclusions Systolic blood pressure significantly increases after the intravenous thrombolysis. Intensive blood pressure monitoring and controlling may be beneficial to the treatment and prognosis.
This paper interprets clinical practice guideline for abdominal aortic aneurysm of American Society for Vascular Surgery in 2018.
Abstract： Objective To validate the value of Cleveland Clinical Score to predict acute renal failure（ARF） requiring renal replacement therapy （RRT） and in-hospital death in Chinese adult patients after cardiac surgery. Methods A retrospective analysis was conducted for all the patients who underwent cardiac surgery from January 2005 to December 2009 in Renji Hospital of School of Medicine, Shanghai Jiaotong University. A total of 2 153 adult patients, 1 267 males and 886 females，were included. Their age ranged from 18 to 99 years with an average age of 58.70 years. Cleveland Clinical Score was used to predict ARF after cardiac surgery. ARF was defined as the need for RRT. Based on Cleveland Clinical Score, the patients were divided into four risk categories of increasing severity：0 to 2 point（n=979）, 3 to 5 point （n=1 116）, 6 to 8 point（n=54）, 9 to 13 point（n=4）. The rates of ARF, multiple organ system failure （MOSF）, and mortality were compared among the 4 categories. The predictive accuracy of postoperative ARF and hospital mortality was assessed by area under the receiver operating characteristic curve （AUC-ROC）. Results In the four categories, the rate of postoperative ARF was 0.92%, 1.88%, 12.96%, and 25.00%, respectively； MOSF rate was 1.23%, 1.88%, 3.70%, and 25.00%, respectively; mortality was 0.92%, 4.21%, 25.93%, and 50.00%, respectively. There was significant dif ference among the four categories in ARF rate （χ2=55.635, P=0.000），MOSF rate（χ2=16.080, P=0.001）, and mortality （χ2=71.470, P=0.000）. The AUC-ROC for Cleveland Clinical Score predicting ARF rate and hospital mortality was 0.775 （95%CI 0.713 to 0.837, P=0.000）and 0.764（95%CI, 0.711 to 0.817, P=0.000）, respectively. Conclusion Cleveland Clinical Score can accurately predict postoperative ARF and hospital mortality in a large, unselected Chinese cohort of adult patients after cardiac surgery. It can be used to provide evidence for effective preventive measures for patients at high risk of postoperative ARF.
Brain injury after cardiopulmonary resuscitation is closely related to the survival rate and prognosis of neurological function of cardiac arrest (CA) patients. Recently, the American Academy of Neurology (AAN) published a practice guideline which had updated the evaluation of different treatments for reducing brain injury following cardiopulmonary resuscitation. In order to master and transmit AAN 2017 practice guideline on reducing brain injury following cardiopulmonary resuscitation, this paper interprets the new AAN clinical practice guideline to assist Chinese clinicians for better studying the guideline.