Diagnostic value of FIB-4, aspartate aminotransferaseto-platelet ratio index and liver stiffness measurement in hepatitis B virus-infected patients with persistently normal alanine aminotransferase

AIM To assess the diagnostic value of FIB-4, aspartate aminotransferase-to-platelet ratio index(APRI), and liver stiffness measurement(LSM) in patients with hepatitis B virus infection who have persistently normal alanine transaminase(PNALT).METHODS We enrolled 245 patients with chronic hepatitis B: 95 in PNALT group, 86 in intermittently elevated alanine transaminase(PIALT1) group [alanine transaminase(ALT) within 1-2 × upper limit of normal value(ULN)], and 64 in PIALT2 group(ALT > 2 × ULN). All the patients received a percutaneous liver biopsy guided by ultrasonography. LSM, biochemical tests, and complete blood cell counts were performed.RESULTS The pathological examination revealed moderate inflammatory necrosis ratios of 16.81%(16/95), 32.56%(28/86), and 45.31%(28/64), and moderate liverfibrosis of 24.2%(23/95), 33.72%(29/86), and 43.75%(28/64) in the PNALT, PIALT1, and PIALT2 groups, respectively. The degrees of inflammation and liver fibrosis were significantly higher in the PIALT groups than in the PNALT group(P < 0.05). No significant difference was found in the areas under the curve(AUCs) between APRI and FIB-4 in the PNALT group; however, significant differences were found between APRI and LSM, and between FIB-4 and LSM in the PNALT group(P < 0.05 for both). In the PIALT1 and PIALT2 groups, no significant difference(P > 0.05) was found in AUCs for all comparisons(P > 0.05 for all). In the overall patients, a significant difference in the AUCs was found only between LSM and APRI(P < 0.05).CONCLUSION APRI and FIB-4 are not the ideal noninvasive hepatic fibrosis markers for PNALT patients. LSM is superior to APRI and FIB-4 in PNALT patients because of the influence of liver inflammation and necrosis.

Noninvasive assessment of liver fibrosis with combined serum aminotransferase/platelet ratio index and hyaluronic acid in patients with chronic hepatitis B

AIM： To construct a noninvasive assessment model consisting of routine laboratory data to predict significant fibrosis and cirrhosis in patients with chronic hepatitis B （CHB）. METHODS： A total of 137 consecutive patients with CriB who underwent percutaneous liver biopsy were retrospectively analyzed. These patients were divided into two groups according to their aminotransferase （ALT） level. The sensitivity, specificity, positive predictive value （PPV）, negative predictive value （NPV）, the likelihood ratio （LR） of aminotransferase/platelet ratio index （APRI） ≥ 1.5 or 〈 1.5 in combination with different hyaluronic acid （HA） cut-off points were calculated for the presence of moderate to severe fibrosis/cirrhosis （fibrosis stages 2 and 4） and no to mild fibrosis/cirrhosis （fibrosis stages 0 and 1）. RESULTS： The APRI correlated with fibrosis stage in CriB patients. The APRI ≥1.5 in combination with a cut-off HA cut-off point 〉 300 ng/mL could detect moderate to severe fibrosis （stages 2-4） in Crib patients. The PPV was 93.7%, the specificity was 98.9%. The APRI 〈 1.5 in combination with different HA cut-off points could not detect no to mild fibrosis in CHB patients. CONCLUSION： The APRI ≥ 1.5 in combination with a HA cut-off point 〉 300 ng/mL can detect moderate to severe fibrosis （stages 2-4） in Crib patients.

Detection of Internal Leaf Structure Deterioration Using a New Spectral Ratio Index in the Near-Infrared Shoulder Region

Spectral reflectance in the near-infrared （NIR） shoulder （750-900 nm） region is affected by internal leaf structure, but it has rarely been investigated. In this study, a dehydration treatment and three paraquat herbicide applications were conducted to explore how spectral reflectance and shape in the NIR shoulder region responded to various stresses. A new spectral ratio index in the NIR shoulder region （NSRI）, defined by a simple ratio of reflectance at 890 nm to reflectance at 780 nm, was proposed for assessing leaf structure deterioration. Firstly, a wavelength-independent increase in spectral reflectance in the NIR shoulder region was observed from the mature leaves with slight dehydration. An increase in spectral slope in the NIR shoulder would be expected only when water stress developed sufficiently to cause severe leaf dehydration resulting in an alteration in cell structure. Secondly, the alteration of leaf cell structure caused by Paraquat herbicide applications resulted in a wavelength-dependent variation of spectral reflectance in the NIR shoulder region. The NSRI in the NIR shoulder region increased significantly under an herbicide application. Although the dehydration process also occurred with the herbicide injury, NSRI is more sensitive to herbicide injury than the water-related indices （water index and normalized difference water index） and normalized difference vegetation index. Finally, the sensitivity of NSRI to stripe rust in winter wheat was examined, yielding a determination coefficient of 0.61, which is more significant than normalized difference vegetation index （NDVI）, water index （WI） and normalized difference water index （NDWI）, with a determination coefficient of 0.45, 0.36 and 0.13, respectively. In this study, all experimental results demonstrated that NSRI will increase with internal leaf structure deterioration, and it is also a sensitive spectral index for herbicide injury or stripe rust in winter wheat.

Combined acoustic radiation force impulse, aminotransferase to platelet ratio index and Forns index assessment for hepatic fibrosis grading in hepatitis B

AIM: To investigate the combined diagnostic accuracy of acoustic radiation force impulse(ARFI), aspartate aminotransferase to platelet ratio index(APRI) and Forns index for a non-invasive assessment of liver fibrosis in patients with chronic hepatitis B(CHB). METHODS: In this prospective study, 206 patients had CHB with liver fibrosis stages F0-F4 classified by METAVIR and 40 were healthy volunteers were measured by ARFI, APRI and Forns index separately or combined as indicated. RESULTS: ARFI, APRI or Forns index demonstrated a significant correlation with the histological stage(all P < 0.001). According to the AUROC of ARFI and APRI for evaluating fibrotic stages more than F2, ARFI showed an enhanced diagnostic accuracy than APRI(P < 0.05). The combined measurement of ARFI and APRI exhibited better accuracy than ARFI alone when evaluating ≥ F2 fibrotic stage(Z = 2.77, P = 0.006). Combination of ARFI, APRI and Forns index did not obviously improve the diagnostic accuracy compared to the combination of ARFI and APRI(Z = 0.958, P = 0.338). CONCLUSION: ARFI + APRI showed enhanced diagnostic accuracy than ARFI or APRI alone for significant liver fibrosis and ARFI + APRI + Forns index shows the same effect with ARFI + APRI.

Prediction of hepatocellular carcinoma development by aminotransferase to platelet ratio index in primary biliary cholangitis

AIM To investigate the usefulness of aspartate aminotransferase to platelet ratio index(APRI) in predicting hepatocellular carcinoma(HCC) risk in primary biliary cholangitis(PBC).METHODS We identified PBC patients between 2000 and 2015 by searching the electronic medical database of a tertiary center. The hazard ratio(HR) of HCC with different risk factors was determined by Cox proportional hazards model. RESULTS One hundred and forty-four PBC patients were recru-ited. Patients were diagnosed at a median age of 57.8 years [interquartile range(IQR): 48.7-71.5 years), and 41(28.5%) patients had cirrhosis at baseline. The median follow-up duration was 6.9 years(range: 1.0-26.3 years). Twelve patients developed HCC, with an incidence rate of 10.6 cases per 1000 patient-years. The overall 5-, 10-and 15-year cumulative incidences of HCC were 2.3% 95%CI: 0%-4.8%), 8.4%(95%CI: 1.8%-14.5%) and 21.6%(6.8%-34.1%), respectively. Older age(HR = 1.07), cirrhosis(HR = 4.38) and APRI at 1 year after treatment(APRI-r1) > 0.54(HR = 3.94) were independent factors for HCC development. APRI-r1, when combined with treatment response, further stratified HCC risk(log rank P < 0.05). The area under receiver operating curve of APRI-r1 in predicting HCC was 0.77(95%CI: 0.64-0.88).CONCLUSION APRI-r1 can be used to predict the development of HCC in PBC patients. Combination of APRI-r1 with treatment response can further stratify the HCC risk.

Aspartate transferase-to-platelet ratio index-plus: A new simplified model for predicting the risk of mortality among patients with COVID-19

BACKGROUND Coronavirus disease 2019(COVID-19)has a spectrum of clinical syndromes with serious involvement of the lung and frequent effection of the liver and hemostatic system.Blood biomarkers are affordable,rapid,objective,and useful in the evaluation and prognostication of COVID-19 patients.AIM To investigate the association between aspartate transferase-to-platelet ratio index(APRI)and in-hospital mortality to develop a COVID-19 mortality prediction model.METHODS A multicenter cohort study with a retrospective design was conducted.Medical records of all consecutive adult patients admitted to Al-Azhar University Hospital(Assiut,Egypt)and Chest Hospital(Assiut,Egypt)with confirmed COVID-19 from July 1,2020 to October 1,2020,were retrieved and analyzed.The patient cohort was classified into the following two categories based on the APRI:(1)COVID-19 presenting with APRI≤0.5;and(2)COVID-19 presenting with APRI(>0.5 and≤1.5).The association between APRI and all-cause in-hospital mortality was analyzed,and the new model was developed through logistic regression analyses.RESULTS Of the 353 patients who satisfied the inclusion criteria,10%were admitted to the intensive care unit(n=36)and 7%died during the hospital stay(n=25).The median age was 40 years and 50.7%were male.On admission,49%had aspartate transferase-dominant liver injury.On admission,APRI(>0.5 and≤1.5)was independently associated with all-cause in-hospital mortality in unadjusted regression analysis and after adjustment for age and sex;after stepwise adjustment for several clinically relevant confounders,APRI was still significantly associated with all-cause inhospital mortality.On admission,APRI(>0.5 and≤1.5)increased the odds of mortality by fivetimes(P<0.006).From these results,we developed a new predictive model,the APRI-plus,which includes the four predictors of age,aspartate transferase,platelets,and serum ferritin.Performance for mortality was very good,with an area under the receiver operating curve of 0.90.CONCLUSION APRI-plus is an accurate and simplified prediction model for mortality among patients with COVID-19 and is associated with in-hospital mortality,independent of other relevant predictors.

Human development index is associated with mortality-to-incidence ratios of gastrointestinal cancers

AIM:To identify the role of human development in the incidence and mortality rates of gastrointestinal cancers worldwide.METHODS:The age-standardized incidence and mortality rates for gastrointestinal cancers,including cancers of the esophagus,stomach,pancreas,liver,gallbladder,and colorectum,were obtained from the GLOBOCAN 2008 database and United States Cancer Statistics(USCS)report.The human development index(HDI)data were calculated according to the 2011 Human Development Report.We estimated the mortality-toincidence ratios(MIRs)at the regional and national levels,and explored the association of the MIR with development levels as measured by the HDI using a modified"drug dose to inhibition response"model.Furthermore,countries were divided into four groups according to the HDI distribution,and the MIRs of the four HDI groups were compared by one-way ANOVA followed by the Tukey-Kramer post-hoc test.Statespecific MIRs in the United States were predicted from the estimated HDI using the fitted non-linear model,and were compared with the actual MIRs calculated from data in the USCS report.RESULTS:The worldwide incidence and mortality rates of gastrointestinal cancers were as high as 39.4and 54.9 cases per 100000 individuals,respectively.Linear and non-linear regression analyses revealed an inverse correlation between the MIR of gastrointestinal cancers and the HDI at the regional and national levels(<0;P=0.0028 for regional level and<0.0001 for national level,ANOVA).The MIR differed significantly among the four HDI areas(very high HDI,0.620±0.033;high HDI,0.807±0.018;medium HDI,0.857±0.021;low HDI,0.953±0.011;P<0.001,oneway ANOVA).Prediction of the MIRs for individual United States states using best-fitted non-linear models showed little deviation from the actual MIRs in the United States.Except for 28 data points(9.93%of282),the actual MIRs of all gastrointestinal cancers were mostly located in the prediction intervals via the best-fit non-linear regression models.CONCLUSION:The inverse correlation between HDI and MIR demonstrates that more developed areas have a relatively efficacious healthcare system,resulting in low MIRs,and HDI can be used to estimate the MIR.

Effects of Use and Re-Use of Selected Vegetable Oils on the Proximate, Minerals, Mineral Ratios and Mineral Safety Index of Raw and Fried Plantain Chips: Note I

Raw and fried plantain chips obtained from the use and re-use of olive, refined palm olein and coconut oils were investigated for the proximate, mineral compositions, computed mineral ratios and the mineral safety index using standard analytical methods. For the selected oils (both use and re-use): first and second re-use and the fresh plantain chips (unprocessed plantain chips;UPC) had the following range results: proximate composition (%) (moisture: 8.20 - 12.3, crude protein: 9.70 - 8.60, fat: 7.40 - 12.9, fibre: 3.50 - 4.90, ash: 2.80 - 3.80 and carbohydrates: 63.5 - 64.8), % energy contributions (PEC: 63.4 - 70.8, PEF: 20.2 - 28.6, PEP: 8.03 - 9.66, UEDP: 4.49 - 5.08). The mineral composition (mg/100g) of the samples had the following greater than 80.0: Ca, Mg, K and P;Fe, Cu, Mn and Zn recorded values ranging between 1.00 and 4.00;Co, Se and Ni had their concentrations between 0.00 and 0.0363 whereas Pb and Cd recorded levels lower than 0.0006. In the mineral ratios, only K/(Ca + Mg) values fell within the acceptable ideal range. No MSI aberration was observed for the minerals from all the samples obtained from the various oils. The chi-square analysis showed that on parameter wise comparisons, there were no significant differences among the levels as treated based on the various oils except gross energy, Mg, K, P, Ca/P, Fe/Pb and K/Co. Also on pairwise comparison from linear correlation and regression, all these parameters were significantly different at r = 0.01 between the unprocessed and fried plantain samples: proximate, percentage energy distribution, mineral and mineral ratios. Generally, the first (day) frying showed fairly high nutrient concentration than the first and second re-use oils products. Therefore, for optimum nutrient preservation from fried plantain chips re-use of oil for frying should be sparingly allowed. However, olive showed highest level of nutrients in terms of proximate and mineral compositions.

准噶尔盆地东南缘页岩油储层脆性预测与评价

准噶尔盆地东南缘二叠系中下部发育页岩油致密储层,脆性预测与评价对其勘探和开发有重要意义。本文利用岩石物理实验、测井资料和叠前地震资料计算了准噶尔盆地东南缘二叠系页岩油致密储层脆性指数,对Rickman经典公式法、杨氏模量与泊松比比值法、拉梅系数法和剪切模量法进行了比较、分析与评价。研究认为:1)杨氏模量相对泊松比对岩性有更好的区分度,由拉梅系数表征的泥岩分布率较高;2)根据文献所得测井多参数计算脆性指数的方法应用效果不佳,在Castagna经验公式换算横波速度基础上计算的脆性指数具有较好的应用效果;3)由YPD(Young's modulus-Poisson's ratio-density)式和LMR(拉梅系数-密度)式反演的弹性参数变化率也能较好地指示有利储层,尤以密度变化率为最佳,该属性在扇三角洲前缘及分流河道特征上得到很好的展示;4)岩石物理实验和实际资料应用均表明,ρE/σ为研究区脆性的最佳表征公式,效果好于Rickman经典公式与其他方法。

Predictive model for non-malignant portal vein thrombosis associated with cirrhosis based on inflammatory biomarkers

BACKGROUND Portal vein thrombosis(PVT),a complication of liver cirrhosis,is a major public health concern.PVT prediction is the most effective method for PVT diagnosis and treatment.AIM To develop and validate a nomogram and network calculator based on clinical indicators to predict PVT in patients with cirrhosis.METHODS Patients with cirrhosis hospitalized between January 2016 and December 2021 at the First Hospital of Lanzhou University were screened and 643 patients with cirrhosis who met the eligibility criteria were retrieved.Following a 1:1 propensity score matching 572 patients with cirrhosis were screened,and relevant clinical data were collected.PVT risk factors were identified using the least absolute shrinkage and selection operator(LASSO)and multivariate logistic regression analysis.Variance inflation factors and correlation matrix plots were used to analyze multicollinearity among the variables.A nomogram was constructed to predict the probability of PVT based on independent risk factors for PVT,and its predictive performance was verified using a receiver operating characteristic curve(ROC),calibration curves,and decision curve analysis(DCA).Finally,a network calculator was constructed based on the nomograms.RESULTS This study enrolled 286 cirrhosis patients with PVT and 286 without PVT.LASSO analysis revealed 13 variables as strongly associated with PVT occurrence.Multivariate logistic regression analysis revealed nine indicators as independent PVT risk factors,including etiology,ascites,gastroesophageal varices,platelet count,D-dimer,portal vein diameter,portal vein velocity,aspartate transaminase to neutrophil ratio index,and platelet-to-lymphocyte ratio.LASSO and correlation matrix plot results revealed no significant multicollinearity or correlation among the variables.A nomogram was constructed based on the screened independent risk factors.The nomogram had excellent predictive performance,with an area under the ROC curve of 0.821 and 0.829 in the training and testing groups,respectively.Calibration curves and DCA revealed its good clinical performance.Finally,the optimal cutoff value for the total nomogram score was 0.513.The sensitivity and specificity of the optimal cutoff values were 0.822 and 0.706,respectively.CONCLUSION A nomogram for predicting PVT occurrence was successfully developed and validated,and a network calculator was constructed.This can enable clinicians to rapidly and easily identify high PVT risk groups.

髌股关节痛业余跑者的下肢肌力特征分析

目的:研究髌股关节痛(patellofemoral pain,PFP)业余跑者的下肢肌力特征。方法:招募PFP业余跑者30例(男性20例,女性10例)作为膝痛组,并匹配30例无损伤的业余跑者作为非膝痛组,采集所有受试者的髋关节外展力量、股四头肌力量、腘绳肌力量,并计算腘绳肌/股四头肌比值、双侧肢体力量对称指数等。采用独立样本t检验对不同组别的各项指标进行统计学检测。结果:男性PFP业余跑者的髋关节外展力量及对称指数、股四头肌力量及对称指数显著小于非膝痛组,腘绳肌/股四头肌比值显著大于非膝痛组;女性PFP业余跑者的髋关节外展力量及对称指数显著小于非膝痛组。结论:PFP业余跑者与非膝痛跑者表现出不同的下肢肌力特征,其男性与女性PFP业余跑者下肢力量特点表现并不一致,PFP康复训练中应考虑功能性及性别差异。

基于广义超椭球模型的结构非概率可靠性指标

非概率凸集合模型仅需获知结构不确定性的范围或界限来度量结构可靠性,因而适用于小样本不确定性结构工程问题.针对广义超椭球模型,对其非概率可靠性度量问题进行了研究.首先,提出了基于广义超椭球模型的简单非概率可靠性指标,定义为结构功能函数的均值与离差之比,并讨论了该可靠性指标的不一致性问题.其次,为克服上述不一致性问题,提出了一种比例因子非概率可靠性指标,定义为不确定域向外扩大或向内收缩时,失效面与不确定域接触的最小比例因子.最后,通过3个工程算例分析验证了所提非概率可靠性指标的有效性和可行性.

Improvement of hepatic fibrosis after tenofovir disoproxil fumarate switching to tenofovir alafenamide for three years

BACKGROUND Both tenofovir alafenamide(TAF)and tenofovir disoproxil fumarate(TDF)are the first-line treatments for chronic hepatitis B(CHB).We have showed switching from TDF to TAF for 96 weeks resulted in further alanine aminotransferase(ALT)improvement,but data remain lacking on the long-term benefits of TDF switching to TAF on hepatic fibrosis.AIM To assess the benefits of TDF switching to TAF for 3 years on ALT,aspartate aminotransferase(AST),and hepatic fibrosis improvement in patients with CHB.METHODS A single center retrospective study on 53 patients with CHB who were initially treated with TDF,then switched to TAF to determine dynamic patterns of ALT,AST,AST to platelet ratio index(APRI),fibrosis-4(FIB-4)scores,and shear wave elastography(SWE)reading improvement at switching week 144,and the associated factors.RESULTS The mean age was 55(28-80);45.3%,males;15.1%,clinical cirrhosis;mean baseline ALT,24.8;AST,25.7 U/L;APRI,0.37;and FIB-4,1.66.After 144 weeks TDF switching to TAF,mean ALT and AST were reduced to 19.7 and 21,respectively.From baseline to switching week 144,the rates of ALT and AST<35(male)/25(female)and<30(male)/19(female)were persistently increased;hepatic fibrosis was also improved by APRI<0.5,from 79.2%to 96.2%;FIB-4<1.45,from 52.8%to 58.5%,respectively;mean APRI was reduced to 0.27;FIB-4,to 1.38;and mean SWE reading,from 7.05 to 6.30 kPa after a mean of 109 weeks switching.The renal function was stable and the frequency of patients with glomerular filtration rate>60 mL/min was increased from 86.5%at baseline to 88.2%at switching week 144.CONCLUSION Our data confirmed that switching from TDF to TAF for 3 years results in not only persistent ALT/AST improvement,but also hepatic fibrosis improvement by APRI,FIB-4 scores,as well as SWE reading,the important clinical benefits of long-term hepatitis B virus antiviral treatment with TAF.

非酒精性脂肪性肝病患者C/RL-r、APRI、FIB-4水平与肝纤维化发生的相关性

目的分析非酒精性脂肪性肝病(NAFLD)患者改良肝尾状叶/右叶比值(C/RL-r)、天门冬氨酸氨基转移酶与血小板比值指数(APRI)、基于4因子的纤维化指数(FIB-4)与肝纤维化发生的相关性。方法选择2021年2月至2022年12月在保定市第一中心医院治疗的NAFLD患者153例,根据病理学结果,将患者分为无肝纤维化组81例、肝纤维化组72例。行MRI扫描检测C/RL-r;计算APRI、FIB-4水平;分析NAFLD患者实验室指标、C/RL-r、APRI、FIB-4水平与发生肝纤维化的相关性,发生肝纤维化的独立危险因素及C/RL-r、APRI、FIB-4对NAFLD患者发生肝纤维化的预测价值。结果肝纤维化组ALT、AST、TBil、GGT、TG、C/RL-r、APRI、FIB-4水平显著高于无肝纤维化组,分别为(42.32±10.21)U/L比(36.21±7.78)U/L、(45.36±8.72)U/L比(27.45±5.40)U/L、(13.52±3.65)μmol/L比(12.24±2.16)μmol/L、(60.53±13.41)U/L比(53.69±12.44)U/L、(1.99±0.53)mmol/L比(1.05±0.33)mmol/L、(1.15±0.12)比(0.92±0.09)、(0.52±0.15)比(0.32±0.10)、(1.47±0.47)比(0.94±0.30),高密度脂蛋白胆固醇(HDL-C)水平显著低于无肝纤维化组为(1.03±0.26)mmol/L比(1.32±0.45)mmol/L,(t=4.189、15.453、2.674、3.272、13.322、13.501、4.302、8.405、4.801,均P<0.05);NAFLD患者ALT、AST、TG、C/RL-r、APRI、FIB-4与发生肝纤维化呈正相关(r=0.531、0.435、0.571、0.605、0.771、0.716,均P<0.001);ALT、AST、TG、C/RL-r、APRI、FIB-4水平高是影响NAFLD患者发生肝纤维化的独立危险因素(P<0.05);C/RL-r、APRI、FIB-4、三者联合预测NAFLD患者发生肝纤维化的曲线下面积(AUC)分别为0.767、0.830、0.754、0.936;相较于C/RL-r、APRI、FIB-4单独预测的AUC,三者联合预测的AUC更高(Z=4.495、3.999、4.677,均P<0.001)。结论发生肝纤维化的NAFLD患者C/RL-r、APRI、FIB-4水平较高,三者联合检测对NAFLD患者发生肝纤维化具有较高预测价值。

脑卒中静脉溶栓后早期神经功能恶化诺莫图预测模型的建立与验证

目的探究脑卒中静脉溶栓(IVT)后早期神经功能恶化(END)的危险因素,并构建诺莫图预测模型进行验证。方法回顾性分析2020年5月至2023年5月期间在大连市中心医院就诊的182例脑卒中患者的临床资料,所有患者均接受重组组织型纤溶酶原激活剂(rt-PA)溶栓治疗,根据溶栓后患者发生END的情况分为END组(n=52)和非END组(n=130)。比较两组临床资料,采用二元Logistic回归分析法明确发生END的危险因素,将独立危险因素引入R软件构建风险列线图,采用Bootstrap法验证模型区分度,绘制Calibration曲线和受试者工作特征(ROC)曲线进行拟合度及预测效能评估。结果END组患者既往脑梗死占比、入院时美国国立卫生研究院卒中量表(NIHSS)评分、发病至溶栓时间、溶栓时间、责任血管重度狭窄占比及糖化血红蛋白(HbA1c)、白细胞计数(WBC)、中性粒细胞/淋巴细胞比值(NLR)水平高于非END组,血红蛋白(Hb)、预后营养指数(PNI)水平则低于非END组(P<0.05)。二元Logistic回归模型显示,入院时高NIHSS评分、高HbA1c、责任血管重度狭窄及高NLR和低PNI是脑卒中IVT后发生END的独立危险因素(P<0.05)。根据独立危险因素建立脑卒中IVT后发生END的预测模型方程,采用Bootstrap法对预测模型进行内部验证,结果显示模型区分度良好,Calibration curve显示模型拟合度好,引入独立危险因素构建的诺莫图预测模型的AUC为0.928(95%CI:0.880~0.961,P<0.05),预测效能优于PNI、NLR单独预测(P<0.05)。结论入院NIHSS评分、HbA1c、责任血管狭窄程度及NLR和PNI是患者脑卒中IVT后发生END的影响因素,以此构建诺莫图预测模型区分度、拟合度良好,对发生END具有较高的预测价值。

C反应蛋白/白蛋白比值和系统免疫炎症指数与浆液性卵巢癌患者临床病理特征和预后的关系

目的 探讨术前C反应蛋白(CRP)/白蛋白(Alb)比值(CAR)和系统免疫炎症指数(SII)与浆液性卵巢癌患者临床病理特征和预后的关系。方法 选取2017年1月—2021年1月洛阳市中心医院浆液性卵巢癌患者132例。收集患者一般临床资料和术前血小板(PLT)计数、中性粒细胞(NEUT)计数、淋巴细胞(LY)计数、CRP、Alb检测结果,并计算CAR和SII。根据CAR和SII的中位数,将患者分别分为低CAR组、高CAR组和低SII组、高SII组,分析不同CAR、SII组间临床病理特征、无复发生存期(RFS)和总生存期(OS)的差异。采用单因素和多因素Cox回归分析评估浆液性卵巢癌患者RFS和OS的影响因素。结果 高CAR组和高SII组国际妇产科联盟(FIGO)分期、组织学分级、淋巴转移分别与低CAR组和低SII组比较,差异均有统计学意义(P<0.05)。高CAR组和高SII组术后残留肿瘤直径<1 cm所占比例均分别低于低CAR组和低SII组(P<0.05)。高CAR组和高SII组的RFS和OS均分别显著低于低CAR组和低SII组(P<0.05)。FIGO分期(Ⅲ期+Ⅳ期)、高CAR和高SII是影响浆液性卵巢癌患者术后RFS的独立危险因素[风险比(HR)分别为2.258、2.665、4.432,95%可信区间(CI)分别为1.125~4.534、1.401~5.069、2.227~8.821]。FIGO分期(Ⅲ期+Ⅳ期)、糖链抗原125(CA125)(≥35 U/L)、高CAR和高SII是浆液性卵巢癌患者术后OS的独立危险因素(HR分别为4.574、4.417、3.167、5.500,95%CI分别为1.660~12.607、1.426~13.686、1.392~7.206、2.254~13.424)。结论 浆液性卵巢癌患者CAR和SII与FIGO分期、组织学分级和淋巴转移等临床病理特征有关,且术前高CAR和高SII是患者预后不良的独立危险因素,可作为浆液性卵巢癌患者预后评估的参考指标。

有机醇胺TEA-M-无机盐体系对固硫灰渣活性激发的影响

固硫灰渣的处理以及环保型激发剂材料的开发是防止环境二次污染的有效途径。本文开发了一种有机醇胺TEA-无机激发剂M-无机盐复合激发剂,通过SEM、FTIR、XRD等测试方法对所制备的复合激发剂进行表征,先后探索了M、TEA-M、TEA-M-无机盐三个系列的激发剂对水泥胶砂流动度比和抗压活性指数的影响。结果表明,TEA的助磨作用改善了颗粒的粒径,无机激发剂M能影响参与水化反应的Ca(OH)_(2)含量,无机盐CaSiO_(3)后期会产生C-S-H并提供碱性条件。复合激发剂中的不同材料间的协同作用使水泥胶砂7和28 d的抗压活性指数分别提高了29个和18个百分点(与空白样相比),并且胶砂净浆的流动度比仍然保持在较高水平。本文为固硫灰渣提供了一种环保型的复合激发剂材料,促进了固硫灰渣的绿色化应用。

蛛网膜下腔出血患者外周血NLR、LMR、PLR和SII值变化的临床意义

目的 分析动脉瘤性蛛网膜下腔出血(aSAH)对血液学参数的影响及其与患者临床状态和短期预后的关系。方法 分析2019年3月至2022年5月于四川省科学城医院神经外科治疗的62例颅内动脉瘤(IA)破裂急性期患者和55例正常对照组。采用流式细胞术分析两组患者外周血中白细胞(WBC)与淋巴细胞(LC)计数的变化,计算中性粒细胞/淋巴细胞比(NLR)、淋巴细胞/单核细胞比(LMR)、血小板/淋巴细胞比(PLR)和全身免疫-炎症指数(SII),并分析血液学参数与患者临床状况和短期预后的关系。结果 与正常对照组相比,IA破裂组WBC、中性粒细胞(Ns)计数、NLR以及SII均明显升高,而LC计数和LMR降低。此外相比于临床状态恢复良好的患者,临床状态较差的患者LC计数明显降低,而NLR、PLR和SII值明显升高。格拉斯哥昏迷评分法(GCS)评分较低的患者CD3+、CD4-、CD8-细胞比例减少。此外,LC计数降低和PLR升高与较差的短期预后相关。结论 IA破裂后会导致全身免疫和炎症反应,LC计数、NLR、PLR和SII值可以作为临床状态及预后的标志物。

预后营养指数与尿素/肌酐比值在食管癌放化疗患者营养状态评估中的应用

目的探讨预后营养指数与尿素/肌酐比值在食管癌放化疗患者营养状态评估中的应用价值研究。方法筛选接受放化疗的食管癌患者138例,采用NRS 2002营养筛查为标准,应用患者客观指标的预后营养指数(PNI)及尿素/肌酐比值(UCR)对食管癌放化疗患者营养不良进行评价,分析两种客观性营养筛查工具与各营养指标的相关性,采用ROC曲线评估比较不同营养筛查工具的诊断效能。结果食管癌放化疗患者的生化指标和血液学指标呈现一定特征,其中尿素、肌酐、UCR、白蛋白(ALB)、前白蛋白(PALB)、总蛋白(TP)、TC、TG、HDL和LDL水平均在正常范围内波动。在营养风险筛查方面,NRS 2002评分识别出57.97%的患者存在营养风险,而PNI和UCR预测存在营养风险的患者比例分别为31.16%和40.58%。一致性检验显示,PNI与NRS 2002评分的Kappa值为0.460(P<0.05),UCR与NRS 2002评分的Kappa值为0.522(P<0.05),表明两者与NRS 2002评分在营养风险筛查上具有一定的相关性。相关性分析表明,NRS 2002评分与UCR、ALB、PALB、PBL、Cr、HDL、TP存在显著相关性(P<0.05),PNI与ALB、PALB、PBL、肌酐(Cr)、HDL、TP、尿素(UREA)存在显著相关性(P<0.05),UCR与PALB、UREA、Cr存在显著相关性(P<0.05)。Logistic单因素回归分析进一步证实了这些相关性,并揭示了营养不良与ALB、PALB、TP、淋巴细胞、Cr、BMI指标成负相关,与UREA呈正相关。然而,多因素回归分析未发现这些相关因素与两种客观评价指标之间存在统计学差异。诊断效能评价结果显示,PNI和UCR评估预测放化疗食管癌营养不良的ROC曲线下面积分别为0.779和0.736,差异有统计学意义(P<0.001)。其中,UCR显示出较高的灵敏度,而PNI表现出较高的特异度,但两者在诊断价值上无显著差异。结论PNI和UCR作为营养评估工具在食管癌放化疗患者的营养风险筛查中具有一定的应用价值,但两者与NRS 2002评分在一致性方面有待提高。在评估患者营养状况时,应结合多种指标和方法,以获得更准确的诊断结果。

限购政策对我国房地产上市企业杠杆率的影响

完善住房市场体系是国民经济中的重要议题,限购政策作为政府稳定和调节房地产市场的主要手段,对房地产企业以及住房市场体系建设均有重要而深远的影响.利用2008—2013年与2015—2021年上市房地产上市企业的相关数据,通过构建强度双重差分模型实证分析了两轮限购政策对房地产上市企业杠杆率的影响及其作用路径.结果表明:限购政策显著降低了房地产上市企业的杠杆率,但第二轮限购政策的效果不显著;对债务期限结构进行区分后,发现第一轮限购政策对房地产上市企业短期杠杆率的抑制作用更加明显;异质性分析表明:限购政策显著降低了行政级别最高的直辖市房地产上市企业的杠杆率,且对非国有房地产上市企业的影响更为显著;经济后果检验表明:限购政策推动了房地产上市企业去杠杆的同时,也抑制了房地产上市企业“脱实向虚”,降低了房地产上市企业的债务违约风险.