咽炎可由病毒、细菌等多种病原感染引起,其中A族链球菌(group A streptococcus,GAS)是咽炎最常见的细菌性病原。基于症状和体征的临床诊断很难将GAS咽炎与其他原因咽炎截然分开,经验性治疗势必会导致抗菌药物的过度使用。随着国内抗菌...咽炎可由病毒、细菌等多种病原感染引起,其中A族链球菌(group A streptococcus,GAS)是咽炎最常见的细菌性病原。基于症状和体征的临床诊断很难将GAS咽炎与其他原因咽炎截然分开,经验性治疗势必会导致抗菌药物的过度使用。随着国内抗菌药物管理工作和医保支付改革措施的深入,减少不必要的检测和抗菌药物处方势在必行。为促进GAS咽炎规范化诊治,该文梳理了国外不同指南中关于GAS咽炎临床诊断和鉴别诊断,尤其是指导GAS咽炎实验室检测和抗菌治疗决策的临床评分制及其应用建议,供国内同道开展研究和临床实践时参考。展开更多
The lack of validated tools to predict how long sow farms will remain PRRS virus-free following successful elimination of the virus has deterred veterinarians and producers from attempting to eliminate the PRRS virus ...The lack of validated tools to predict how long sow farms will remain PRRS virus-free following successful elimination of the virus has deterred veterinarians and producers from attempting to eliminate the PRRS virus from sow farms. The aim of this study was to use the database of PRRS Risk Assessments for the Breeding Herd in PADRAP to develop and validate an objective risk scoring system for predicting the likelihood of virus introduction in PRRS virus-free sow farms in the US. To overcome the challenges of dealing with a large number of variables, group lasso for logistic regression (GLLR) was applied to a retrospective dataset of PRRS Risk Assessment for the Breeding Herd surveys completed for 704 farms to develop the risk scoring system. The validity of the GLLR risk scoring system was then evaluated by testing its predictive ability on a dataset from a long-term prospective study of 196 sow farms to assess risk factors associated with how long PRRS virus-free sow farms remained PRRS virus-free. Receiver operator characteristic(ROC) curves were estimated to compare the performance of the GLLR risk scoring system to the risk scoring system based on expert opinion (EO), currently used in the PRRS Risk Assessment for the Breeding Herd, for predicting whether herds remained PRRS virus-free for 130 weeks. The GLLR risk scoring system (AUC, 0.76;95% CI, 0.67 - 0.84) performed significantly better than the EO risk scoring system (AUC, 0.36;95% CI, 0.27 - 0.46) for predicting whether to sow farms in the prospective study survived for 130 weeks (p 0.001). Dividing farms into 3 risk groups (low, medium and high) using a low and high cutoff values for the GLLR risk score was informative as the differences in the KM survival curves for the 3 groups were both clinically meaningful and statistically significant. The GLLR risk scoring system used in conjunction with the PRRS Risk Assessment for the Breeding Herd survey delivered through PADRAP appears to have the potential to help veterinarians predict the likelihood of virus introduction in PRRS virus-free sow farms in the US.展开更多
BACKGROUND The lymphocyte-to-white blood cell ratio(LWR)is a blood marker of the systemic inflammatory response.The prognostic value of LWR in patients with hepatitis B virus-associated acute-on-chronic liver failure(...BACKGROUND The lymphocyte-to-white blood cell ratio(LWR)is a blood marker of the systemic inflammatory response.The prognostic value of LWR in patients with hepatitis B virus-associated acute-on-chronic liver failure(HBV-ACLF)remains unclear.AIM To explore whether LWR could stratify the risk of poor outcomes in HBV-ACLF patients.METHODS This study was conducted by recruiting 330 patients with HBV-ACLF at the Department of Gastroenterology in a large tertiary hospital.Patients were divided into survivor and non-survivor groups according to their 28-d prognosis.The independent risk factors for 28-d mortality were calculated by univariate and multivariate Cox regression analyses.Patients were divided into low-and high-LWR groups according to the cutoff values.Kaplan-Meier analysis was performed according to the level of LWR.RESULTS During the 28-d follow-up time,135 patients died,and the mortality rate was 40.90%.The LWR level in non-surviving patients was significantly decreased compared to that in surviving patients.A lower LWR level was an independent risk factor for poor 28-d outcomes(hazard ratio=0.052,95%confidence interval:0.005-0.535).The LWR level was significantly negatively correlated with the Child-Turcotte-Pugh,model for end-stage liver disease,and Chinese Group on the Study of Severe Hepatitis B-ACLF II scores.In addition,the 28-d mortality was higher for patients with LWR<0.11 than for those with LWR≥0.11.CONCLUSION LWR may serve as a simple and useful tool for stratifying the risk of poor 28-d outcomes in HBVACLF patients.展开更多
文摘咽炎可由病毒、细菌等多种病原感染引起,其中A族链球菌(group A streptococcus,GAS)是咽炎最常见的细菌性病原。基于症状和体征的临床诊断很难将GAS咽炎与其他原因咽炎截然分开,经验性治疗势必会导致抗菌药物的过度使用。随着国内抗菌药物管理工作和医保支付改革措施的深入,减少不必要的检测和抗菌药物处方势在必行。为促进GAS咽炎规范化诊治,该文梳理了国外不同指南中关于GAS咽炎临床诊断和鉴别诊断,尤其是指导GAS咽炎实验室检测和抗菌治疗决策的临床评分制及其应用建议,供国内同道开展研究和临床实践时参考。
文摘The lack of validated tools to predict how long sow farms will remain PRRS virus-free following successful elimination of the virus has deterred veterinarians and producers from attempting to eliminate the PRRS virus from sow farms. The aim of this study was to use the database of PRRS Risk Assessments for the Breeding Herd in PADRAP to develop and validate an objective risk scoring system for predicting the likelihood of virus introduction in PRRS virus-free sow farms in the US. To overcome the challenges of dealing with a large number of variables, group lasso for logistic regression (GLLR) was applied to a retrospective dataset of PRRS Risk Assessment for the Breeding Herd surveys completed for 704 farms to develop the risk scoring system. The validity of the GLLR risk scoring system was then evaluated by testing its predictive ability on a dataset from a long-term prospective study of 196 sow farms to assess risk factors associated with how long PRRS virus-free sow farms remained PRRS virus-free. Receiver operator characteristic(ROC) curves were estimated to compare the performance of the GLLR risk scoring system to the risk scoring system based on expert opinion (EO), currently used in the PRRS Risk Assessment for the Breeding Herd, for predicting whether herds remained PRRS virus-free for 130 weeks. The GLLR risk scoring system (AUC, 0.76;95% CI, 0.67 - 0.84) performed significantly better than the EO risk scoring system (AUC, 0.36;95% CI, 0.27 - 0.46) for predicting whether to sow farms in the prospective study survived for 130 weeks (p 0.001). Dividing farms into 3 risk groups (low, medium and high) using a low and high cutoff values for the GLLR risk score was informative as the differences in the KM survival curves for the 3 groups were both clinically meaningful and statistically significant. The GLLR risk scoring system used in conjunction with the PRRS Risk Assessment for the Breeding Herd survey delivered through PADRAP appears to have the potential to help veterinarians predict the likelihood of virus introduction in PRRS virus-free sow farms in the US.
基金Supported by the National Natural Science Foundation of China,No.81960120 and 81660110the Postgraduate Innovation Special Foundation of Jiangxi Province,No.YC2022-B052“Gan-Po Talent 555”Project of Jiangxi Province,No.GCZ(2012)-1.
文摘BACKGROUND The lymphocyte-to-white blood cell ratio(LWR)is a blood marker of the systemic inflammatory response.The prognostic value of LWR in patients with hepatitis B virus-associated acute-on-chronic liver failure(HBV-ACLF)remains unclear.AIM To explore whether LWR could stratify the risk of poor outcomes in HBV-ACLF patients.METHODS This study was conducted by recruiting 330 patients with HBV-ACLF at the Department of Gastroenterology in a large tertiary hospital.Patients were divided into survivor and non-survivor groups according to their 28-d prognosis.The independent risk factors for 28-d mortality were calculated by univariate and multivariate Cox regression analyses.Patients were divided into low-and high-LWR groups according to the cutoff values.Kaplan-Meier analysis was performed according to the level of LWR.RESULTS During the 28-d follow-up time,135 patients died,and the mortality rate was 40.90%.The LWR level in non-surviving patients was significantly decreased compared to that in surviving patients.A lower LWR level was an independent risk factor for poor 28-d outcomes(hazard ratio=0.052,95%confidence interval:0.005-0.535).The LWR level was significantly negatively correlated with the Child-Turcotte-Pugh,model for end-stage liver disease,and Chinese Group on the Study of Severe Hepatitis B-ACLF II scores.In addition,the 28-d mortality was higher for patients with LWR<0.11 than for those with LWR≥0.11.CONCLUSION LWR may serve as a simple and useful tool for stratifying the risk of poor 28-d outcomes in HBVACLF patients.
