基于循环神经网络模型预测临床红细胞用量

目的探讨重大突发公共卫生事件背景下的临床红细胞用量的预测方法,为给血站血液采集工作及血液库存管理提供科学决策依据。方法采用人工智能方法中的循环神经网络(recurrent nerual network,RNN)模型对宜昌市2001—2017年临床血液各型红细胞用量进行分析和建模,并对2019—2021年36个月的临床红细胞用量进行科学预测。结果RNN网络模型预测性能较好,A、B、O、AB型红细胞预测值均方根误差RMSE分别为156.7、133.4、204.2、51.3,平均相对误差MRE分别为6.4%、6.6%、8.5%、7.1%。模型对第一轮新冠疫情期间(2020年1—6月)的红细胞用量变化趋势有较好的预判性,预测到了2020年2月份的用量最低点及随后的恢复增长,对第二轮新冠疫情期间(2021年1—6月)的红细胞用量的预测精度较高,如A型红细胞用量在2021年2月(用量低点1621.5 U)和5月(用量高点2397.0 U)时RNN模型预测相对误差分别为5.2%和2.5%。结论人工智能循环神经网络模型能较好地预测,重大突发公共卫生事件背景下的临床红细胞用量。

ARIMA模型在临床红细胞需求预测中的应用

目的利用临床红细胞用量的数据建立ARIMA模型,预测未来临床红细胞需求量,为采供血机构制定采集及招募计划提供科学依据。方法收集2006~2016年重庆市血液中心每月临床红细胞用量数据,利用SPSS软件对2006年1月~2016年6月的临床红细胞用量数据建立ARIMA模型,经模型识别、参数估计与检验,确定最优模型;运用该模型预测2016年7~12月红细胞临床需求量,验证预测效果。结果最优模型为ARIMA(3,1,0)(0,1,1)12,残差的自相关函数和偏自相关函数基本都在95%CI内,同时Ljung-Box Q统计量为19.274,P>0.05,无统计学意义,提示残差为白噪声。2016年7~12月临床红细胞预测值均在95%CI内,模型拟合值与实际值曲线趋势大致相同,平均相对误差为2.55%,预测精度较高,结果可靠。结论ARIMA模型能较好地拟合重庆市血液中心临床红细胞需求量变化趋势,适用于临床红细胞需求量的短期预测,有助于了解未来临床红细胞需求,为血液采集、招募及库存管理提供依据,突破采供血区域政策的限制,实现全市范围内血液资源的有效整合与合理调配。

临床红细胞需求量的时间序列分析及预测

目的·利用差分整合移动平均自回归模型(autoregressive integrated moving average model,简称ARIMA模型)建立临床红细胞需求预测模型,为制定血液采集及献血者招募计划提供科学依据。方法·收集2006年1月-2016年6月重庆市血液中心的临床红细胞出库数据,利用SPSS软件建立ABO血型的ARIMA模型。运用建立的模型预测2016年7月-12月ABO各血型红细胞的临床需求量,并与实际值比较以验证预测效果。结果·成功建立ABO血型各自的最优模型,A型为ARIMA(3,1,0)(1,1,0)12、B型为ARIMA(3,1,0)(0,1,1)12、O型为ARIMA(3,1,0)(1,0,1)12及AB型为ARIMA(3,1,0)(0,1,1)12。各模型的Ljung-Box Q统计量均无统计学意义,残差序列均为白噪声,拟合效果良好;且各模型于2006年1月-2016年6月的拟合值与实际值间动态趋势大致相同,2016年7月-12月的临床需求量实际值均在预测值的95%CI内,平均相对误差均在10%以内。结论·ARIMA模型预测精度较高,能较好地拟合临床红细胞需求量的变化趋势,适用于临床红细胞各血型需求量的短期预测。

基于ARIMA乘积季节模型的红细胞临床用量预测

目的:构建红细胞临床用量的ARIMA乘积季节预测模型,为科学制定采供血计划提供参考。方法:利用重庆市血液中心2006年1月至2018年12月的红细胞临床月用量数据,构建红细胞临床月用量ARIMA乘积季节预测模型,并对其进行识别、检验与优化,选择最优模型;再以2019年1~6月的临床月用量数据评估模型的预测效果。结果:获得的最优预测模型ARIMA(3,1,0)(0,1,1)12可较好地拟合预测红细胞临床月用量,经检验,其残差序列的ACF与PACF基本都落入95%CI内,Ljung-Box Q=14.749,P=0.396,提示模型残差呈白噪声。2019年1~6月红细胞临床实际用量基本落入预测结果95%CI内,且预测结果与同期红细胞临床实际用量基本吻合,平均相对误差为6.15%。结论:模型ARIMA(3,1,0)(0,1,1)12可用于预测红细胞临床用量的变化规律,为无偿献血招募、采供血及血液动态库存管理提供一定的依据。

基于红细胞分布宽度的肺炎临床评分对ICU社区获得性肺炎预后的判断价值

目的探讨基于红细胞分布宽度的肺炎临床评分(RPCS)对收住重症监护病房(ICU)的社区获得性肺炎(CAP)预后的判断价值,并与CURB-65评分、PSI评分比较。方法回顾性分析2017年10月至2019年8月在黄山市人民医院ICU住院的CAP患者的临床资料。根据患者在ICU的转归分为死亡组(n=30例)与好转组(n=74),比较两组患者3种评分和其他指标的差异。用受试者工作特征曲线下面积评价3种评分对CAP入住ICU预后的判断力。结果104例患者被纳入最后的分析,好转组74例,死亡组30例,病死率为28.85%。CURB-65评分、PSI评分和RPCS评分的ROC曲线下面积分别是0.652(95%CI:0.533~0.770,P=0.016)、0.798(95%CI:0.709~0.886,P<0.001)、0.858(95%CI:0.788~0.928,P<0.001)。PSI和RPCS的ROC曲线下面积均大于CURB-65评分,差异有统计学意义(Z=1.981,P=0.048;Z=3.167,P=0.002),RPCS评分和PSI评分的ROC曲线下面积比较,差异无统计学意义(Z=1.062,P=0.288)。结论RPCS对入住ICU的CAP患者预后有较好的判断价值,与PSI评分相当,优于CURB-65评分,且评分简便,值得在临床中推广使用。

Anemia and digestive diseases: An update for the clinician

Anemia and iron deficiency are so common in digestive diseases that often are underestimated and undertreated. Our goal is to review from classif ication to treatment of the diverse types of anemias in different digestive diseases to update our knowledge on diagnosis and treatment. With the goal of improving the prognosis and quality of life of digestive diseases patients, we will review current transfusion, intravenous iron, and erythropoietin roles in the treatment of anemia.

Effects of Kaiqiao Huazhuo prescription on the content of Matrix metallopro teinases-9 in brain of focal cerebral ischemia rats

OBJECTIVE:To observe the effect of Kaiqiao Huazhuo prescription on the content of Matrix metallopro teinases-9(MMP-9)in brain of focal cerebral ischemia rats.METHODS:The model of focal cerebral ischemia was established by inserting nylon thread,the effect of Kaiqiao Huazhuo prescription on brain edema and the content of MMP-9 in brain of focal cerebral ischemia rats were observed 6 h,12 h,24 h and 48 h after cerebral ischemia respectively and was compared with effect of Buchangnaoxintong.RESULTS:6 h after cerebral ischemia,compared with sham operation group,the content of MMP-9 in brain increased,and it reached peak value in 24 h(P<0.01);the change of brain edema is similar to that of MMP-9.Compared with model group,the content of MMP-9 in brain and the brain edema of each treatment groups were decreased(P<0.05 or P<0.01).CONCLUSIONS:Through decreasing the content of MMP-9 in brain of focal cerebral ischemia rats,Kaiqiao Huazhuo prescription could protect blood brain barrier and reduce brain edema.

Association of blood transfusion with acute kidney injury after transcatheter aortic valve replacement: A metaanalysis

AIM To assess red blood cell(RBC) transfusion effects on acute kidney injury(AKI) after transcatheter aortic valve replacement(TAVR). METHODS A literature search was performed using MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and clinicaltrials.gov from the inception of the databases through December 2015. Studies that reported relative risk, odds ratio or hazard ratio comparing the risks of AKI following TAVR in patients who received periprocedural RBC transfusion were included. Pooled risk ratio(RR) and 95%CI were calculated using a random-effect, generic inverse variance method. RESULTS Sixteen cohort studies with 4690 patients were included in the analyses to assess the risk of AKI after TAVR in patients who received a periprocedural RBC transfusion. The pooled RR of AKI after TAVR in patients who received a periprocedural RBC transfusion was 1.95(95%CI: 1.56-2.43) when compared with the patients who did not receive a RBC transfusion. The meta-analysis wasthen limited to only studies with adjusted analysis for confounders assessing the risk of AKI after TAVR; the pooled RR of AKI in patients who received periprocedural RBC transfusion was 1.85(95%CI: 1.29-2.67). CONCLUSION Our meta-analysis demonstrates an association between periprocedural RBC transfusion and a higher risk of AKI after TAVR. Future studies are required to assess the risks of severe AKI after TAVR requiring renal replacement therapy and mortality in the patients who received periprocedural RBC transfusion.

From stem cells to red blood cells:how far away from the clinical application?

The generation of red blood cells(RBCs)from stem cells provides a solution for deficiencies in blood transfusion.Currently,primary hematopoietic stem cells,embryonic stem cells and induced pluripotent stem cells have shown the potential to produce fully mature RBCs.Here,we discuss the advantages,induction protocols,progress and possible clinical applications of stem cells in RBC production.