医院住院病人病因构成预测

编制区域卫生发展规划,合理设置医院各科室床位比例,有效地利用卫生资源,满足人民医疗保健需求.需要了解今后若干年住院病人病因构成情况.确定疾病防治重点也需要这方面的信息.我们根据1989～1994年山东省县医院住院病人疾病分类年报(ICD—9)资料,应用平滑法预测模型对县医院住院病人病因构成进行预测,现报告如下:1 预测步骤1.1 利用全省县医院住院病人疾病分类年报数据,分别计算出各年住院病人某病因构成.某年某病因构成二某年某病出院病人数÷该年出院病人总数×100%1.2 分病因列平滑计算表.现以损伤和中毒为例.

不同病原体致急性呼吸道感染患儿的炎症指标谱分析及建模应用

目的探讨不同病原体致急性呼吸道感染患儿的炎症指标谱的差别并构建病原体预测模型方法选取2021年7月至2022年6月顺序收治的200例急性呼吸道感染患儿为观察组,另取同期体检健康儿童30名为对照组,(1)采集患儿的血、尿、痰、口咽拭子进行炎症指标检测及微生物分析;(2)应用秩和检验和模式识别方法进行炎症指标谱及病原体预测分析。结果(1)根据微生物鉴定结果将患者分为革兰阳性球菌感染组(GPC,52例)、革兰阴性杆菌感染组(GNB,56例)、病毒感染组(VIR,42例)、肺炎支原体/衣原体感染组(MPCP,50例)。(2)秩和检验和主成分分析显示不同病原体致呼吸道感染患儿表达不同的炎症指标谱:GPC组C反应蛋白(CRP)、降钙素原(PCT)、白介素(IL)-4、肿瘤坏死因子(TNF)-α水平较高,IL-2水平降低;GNB组的CRP、PCT、IL-6、IL-10、干扰素(IFN)-γ和白细胞计数(WBC)水平较高,IL-2水平降低;VIR组IL-2、TNF-α、IFN-γ表达水平较高;MPCP组PCT、WBC表达水平较高。(3)最小二乘—支持向量机(LS-SVM)模型的病原体预测效能最高:对GPC组、GNB组、VIR组、MPCP组、健康组的诊断灵敏度分别为84.6%、83.9%、83.3%、80.0%、93.3%,特异度高于93.8%(GPC组)。结论基于多炎症指标构建的病原体预测模型,可准确、快速预测急性呼吸道感染患儿的致病微生物类型,有一定的临床应用价值。

多模式CT在缺血性卒中诊疗中的应用

缺血性卒中已成为危害人类健康的主要疾病,急需一种快速有效的影像学检查协助诊断、指导治疗、预测病因、判断预后。多模式计算机断层扫描(computed tomography,CT)检查可一次性获取脑组织结构、血管及血流灌注等方面信息,为缺血性卒中患者个体化治疗及二级预防提供客观的影像学依据。文章就多模式CT在缺血性卒中诊疗中的应用进行综述。

Upper gastrointestinal bleeding etiology score for predicting variceal and non-variceal bleeding

AIM： To identify clinical parameters, and develop an Upper Gastrointesinal Bleeding （UGIB） Etiology Score for predicting the types of UGIB and validate the score. METHODS： Patients with UGIB who underwent endoscopy within 72 h were enrolled. Clinical and basic laboratory parameters were prospectively collected. Predictive factors for the types of UGIB were identified by univariate and multivariate analyses and were used to generate the UGIB Etiology Score. The best cutoff of the score was defined from the receiver operating curve and prospectively validated in another set of patients with UGIB. RESULTS： Among 261 patients with UGIB, 47 （18%） had variceal and 214 （82%） had non-variceal bleeding. Univariate analysis identified 27 distinct parameters significantly associated with the types of UGIB. Logistic regression analysis identified only 3 independent factors for predicting variceal bleeding; previous diagnosis of cirrhosis or signs of chronic liver disease （OR 22.4, 95% CI 8.3-60.4, P 〈 0.001）, red vomitus （OR 4.6, 95% CI 1.8-11.9, P = 0.02）, and red nasogastric （NG） aspirate （OR 3.3, 95% CI 1.3-8.3, P = 0.011）. The UGIB Etiology Score was calculated from （3.1× previous diagnosis of cirrhosis or signs of chronic liver disease） ＋ （1.5× red vomitus） ＋ （1.2× red NG aspirate）, when 1 and 0 are used for the presence and absence of each factor, respectively. Using a cutoff ≥ 3.1, the sensitivity, specificity, accuracy, positive predictive value （PPV）, and negative predictive value （NPV） in predicting variceal bleeding were 85%, 81%, 82%, 50%, and 96%, respectively. The score was prospectively validated in cases （46 variceal and 149 another set of 195 UGIB non-variceal bleeding）. The PPV and NPV of a score ≥ 3.1 for variceal bleeding were 79% and 97%, respectively. CONCLUSION： The UGIB Etiology Score, composed of 3 parameters, using a cutoff ≥ 3.1 accurately predicted variceal bleeding and may help to guide the choice of initial therapy for UGIB before endoscopy.

Nonalcoholic fatty liver disease is a novel predictor of cardiovascular disease

AIM:To clarify whether nonalcoholic fatty liver disease(NAFLD)increases the risk of cardiovascular disease.METHODS:We carried out a prospective observational study with a total of 1637 apparently healthy Japanese men and women who were recruited from a health check-up program.NAFLD was diagnosed by abdominal ultrasonography.The metabolic syndrome(MS)was defined according to the modified National Cholesterol Education Program(NCEP)ATP Ⅲ criteria.Five years after the baseline evaluations,the incidence of cardiovascular disease was assessed by a self-administered questionnaire.RESULTS:Among 1221 participants available for outcome analyses,the incidence of cardiovascular disease was higher in 231 subjects with NAFLD at baseline(5 coronary heart disease,6 ischemic stroke,and 1 cerebral hemorrhage)than 990 subjects without NAFLD(3 coronary heart disease,6 ischemic stroke,and 1 cerebral hemorrhage).Multivariate analyses indicated that NAFLD was a predictor of cardiovascular disease independent of conventional risk factors(odds ratio 4.12,95% CI,1.58 to 10.75,P = 0.004).MS was alsoindependently associated with cardiovascular events.But simultaneous inclusion of NAFLD and MS in a multivariate model revealed that NAFLD but not MS retained a statistically significant correlation with cardiovascular disease.CONCLUSION:Although both of them were predictors of cardiovascular disease,NAFLD but not MS retained a statistically significant correlation with cardiovascular disease in a multivariate model.NAFLD is a strong predictor of cardiovascular disease and may play a central role in the cardiovascular risk of MS.

Overexpression of metastasis-associated in colon cancer 1 predicts a poor outcome of hepatitis B virus-related hepatocellular carcinoma

AIM: To investigate the intratumoral expression of metastasis-associated in colon cancer 1 (MACC1) and c-Met and determine their clinical values associated with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). METHODS: A retrospective study admitted three hundred fifty-four patients with HBV-related HCC. The expression and distribution of MACC1 and c-Met were assessed by quantitative real-time polymerase chain reaction and immunohistochemistry staining. Prognostic factors influencing survival, metastasis and recurrence were assessed. RESULTS: Intratumoral MACC1 level was found to be associated with HCC disease progression. Both median tumor-free survival (TFS) and overall survival (OS) were significantly shorter in the postoperative HCC patients with high intratumoral MACC1 expression, as compared to those with low intratumoral MACC1 levels (TFS: 34 mo vs 48.0 mo, P < 0.001; OS: 40 mo vs 48 mo, P < 0.01). Multivariable analysis indicated that high MACC1 expression or co-expression with c-Met were independent predictors for HCC clinic outcome (P < 0.001). CONCLUSION: High intratumoral MACC1 expression can be associated with enhanced tumor progression and poor outcome of HBV-related HCC. MACC1 may serve as a prognostic biomarker for postoperative HCC.

Predictors of new-onset atrial fibrillation in elderly patients with coronary artery disease after coronary artery bypass graft

Objective To identify the factors associated with the development of postoperative atrial fibrillation （POAF） after coronary artery bypass graft （CABG） in elderly patients with coronary artery disease （CAD）. Methods A total of 81 patients with CAD who underwent CABG were enrolled in the study. Patients were divided into two groups： Group 1, without postoperative atrial fibrillation （59 patients, 74.6% men, mean age 65.8 ~ 4.0 years）; Group 2, with early new-onset atrial fibrillation after CABG （22 patients, 90.9% men, mean age 67.7 ＋ 5.4 years）. Interleukin （IL）-6, IL-8, IL-10, C-reactive protein （CRP）, fibrinogen, superoxide dismutase （SOD）, N-terminal pro-B-type natriuretic peptide （NT-proBNP）, and troponin I were studied. Results During the observation period, atrial fibrillation occurred in 27.2% cases, an average of 4.9 ±3.8 days after surgery. In group 2, the left atrium （LA） dimension was larger than in group 1 （43.9 ± 3.4 mm vs. 37.6 ±3.9 rnm, P 〈 0.001）. Patients with POAF had significantly higher IL-6 （72.7 ±60.8 pg/mL vs. 38.0 ± 34.6 pg/mL, P = 0.04）, IL-8 （11.9 ± 6.0 pg/mL vs. 7.7± 5.4 pg/mL, P = 0.01） and SOD （2462.0 ± 2029.3 units/g vs. 1515.0 ± 1292.9 units/g, P = 0.04） compared with group without POAF. The multivariate analysis showed that the odds ratio （OR） for POAF development in patients with left atrium more than 39 mm was 2.1 [95% confidence interval （CI）： 1.2-3.8, P = 0.0004], IL-6 levels more than 65.18 pg/mL-1.4 （95% Ch 1.1-2.7, P = 0.009）, IL-8 levels more than 9.67 pg/mL-1.2 （95% CI： 1.1-3.7, P ： 0.009）, SOD more than 2948 units/g-1.1 （95% Ch 1.01-2.9, P = 0.04）. Conclusions In our study, the independent predictors of postoperative atrial fibrillation after CABG in elderly patients were left atrium dimension and the increased postoperative concentration of IL-6, IL-8 and superoxide dismutase.

Ankle-brachial index as a predictor of all-cause and cardio- vascular disease mortality in 3733 Chinese patients with high cardiovascular risk

Objective To assess the association between 1-year risk of all-cause and cardiovascular disease （CVD） mortality and ankle-brachial index （ABI） in Chinese patients who were at high CVD risk. Methods Totally 3733 patients with high CV risk had bilateral ABI measurements at baseline and were followed up for 1-1.5 years. Patients were divided to four groups： 1） coronary heart disease （CHD）; 2） ischemic stroke （IS）; 3） diabetes mellitus （DM）; 4） very high risk group（VHR）, low ABI was defined as 〈0.9. Results A total of 3179 patients were analyzed. The prevalence of low ABI was 28.1%. At 1 year, all-cause mortality was 8.7%, and 27.6% was attributable to CVD; mortality due to CV events was 4.8% and 1.5%. After adjusting other risk factors the hazard ratio of low ABI was 1.623 for all-cause mortality and 2.304 for CVD mortality. Similar in patient with and without low ABI, respectively were found in four groups.Conclusion ABI is a strong and independent predictor ofrnortality. Patients with a low ABI have a substantially increased risk of all-cause mortality and CVD mortality （J Geriatr Cardio12010; 7：17-20）.

Analysis of Methylation-Sensitive Amplified Polymorphism and Prediction of Candidate Genes Infected by SCMV in Zea mays Genome

DNA methylation is an important component of the epigenetic network, and it plays important roles in gene expression regulation and epigenetic change response to various stresses. In this study, the authors assessed the methylation patterns stressed by SCMV （sugarcane mosaic virus） in maize by methylation-sensitive amplified polymorphism （MSAP）, and identified important candidate genes related to SCMV resistance through combining microarray analysis with CpG islands prediction. The results of MSAP indicated DNA methylation levels appeared dynamic changes inoculated for 0 d, 1 d, 4 d, 5 d and 10 d. 118 candidate genes were identified infected by SCMV, which may participate in DNA methylation modification. Among them, eight candidate genes were mapped on Scmvl and Scmv2 QTL regions, which are crucial for SCMV resistance. In conclusion, DNA methylation is closely related with maize resistance to SCMV and plays an important role in regulating gene expression responded to maize resistance.

Predictive factors for liver dysfunction and failure after hepatectomy:Analysis of 467 patients with hepatocellular carcinoma

Objective： The aim of our study was to analyze hepatic dysfunction and failure after hepatocellular carcinoma （HCC） resection and relationship of clinical and pathological factors. Methods： Clinical and pathological data of 467 HCC patients was retrospectively reviewed, who underwent liver resection from January 2002 to December 2008 in the Affiliated Hospital of Medical College, Qingdao University, and the post-resectional liver dysfunction and failure risk factors were analyzed by univariate and multivariate analysis. Results： The morbidity of post-resectional liver dysfunction and failure was 1.7% and 2.1%. The post-resectional liver dysfunction and failure after HCC hepatectomy into the statistical analysis： univariate analysis revealed preoperative platelet level （〈 100 × 10^9）, serum albumin level （〈 35 g/L）, serum gamma-Glutamyl transferase （〉 64 U/L）, Child-Pugh classification （B）, MELD score （≥ 9）, intraoperative bleeding （-〉 1000 mL）, blood transfusion were positive factors, multivariate analysis （Logistic） revealed that preoperative platelet level （0.983, 95% CI = 0.971-0.995） and intraoperative blood transfusion （3.145, 95% CI = 1.027-12.028） were independent risk factors for post-resectional liver dysfunction and failure. Conclusion： Prevented liver failure and liver dysfunction occurring after liver resection, it is the key to accurate preoperative assessment of liver function and the patient＇s reserved liver functional, precise hepatectomy and reasonable blockage of hepatic inflow.