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Objective:To explore solutions to the "grey zone" of activated partial thromboplastin time (APTT) mixing study, and establish the clinical application pathway of it.Methods:Patients treated in West China Hospital of Sichuan University from January 1, 2018, to December 31, 2019, with a prolonged APTT were included in this study. The ROC curve was used to analyze the"cut-off"of different methods and explore solutions to the "grey zone" by combination of the 1∶1 and 4∶1 mixing study. Similar samples from January 1, 2020 to December 31, 2020 were included to verify the diagnostic efficiency of the clinical application pathway.Results:The traditional Rosner index criterion had a low diagnostic accuracy in differentiating factor deficiencies from inhibitors. A total of 49 cases (15%) in the establishment group and validation group were located in the "grey zone". The optimal cut-off value of the Rosner index in our 1∶1 mixing study for determining factor deficiency was 5.0%, and inhibitor was 9.1%. The sample between 5.0% and 9.0% needed 4∶1 mixing studies, which could significantly improve the detection sensitivity of inhibitors. The percentage of extended time after incubation-P (1∶1 mixing>10.8% and 4∶1 mixing>13.5%) was better than the traditional criterion mentioned by"consensus"in determining whether the inhibitor was time-dependent. The sensitivity, specificity, positive predictive value and negative predictive value of combined the 1∶1 and 4∶1 mixing study in differentiating factor deficiencies from inhibitors all attained more than 90%. Only 7% (3/43)of inhibitors were incorrectly classified into the factor deficiency group by the combination, which was 20.9% (9/43) by traditional criterion. The specificity for detecting time-dependent inhibitor was increased from 54.2% to 100%, and accuracy was increased from 63.3% to 97.4%.Conclusions:The combination of 1∶1 and 4∶1 mixing study can better resolve the "grey zone". The established clinical application pathway is beneficial for the further promotion and clinical application of APTT mixing study.
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@#Objective To investigate the effect of different administration methods of tranexamic acid on postoperative pulmonary inflammation response during cardiopulmonary bypass (CPB). Methods A total of 64 SD rats were included in the study. They were randomly divided into eight different groups. CPB model was established for the operation groups. The rats in the operation groups were given tranexamic acid at low (25 mg/kg), medium (50 mg/kg) or high (100 mg/kg) concentrations before or after the CPB. Blood cells count and coagulation function were assessed 1 hour after surgery. The concentration of interleukin (IL)-1β、IL-6 and tumor necrosis factor (TNF)-α in blood and lung lavage fluid were measured. The infiltration of inflammatory cells in lungs was observed by hematoxylin-eosin (HE) staining. Results The concentration of inflammatory cells in the operation groups was higher than that in the control group (P<0.05). The use of tranexamic acid inhibited the increase of IL-6 and TNF-α in whole blood and lung lavage fluid due to CPB (P<0.05), but there was no significant difference among the experimental groups (P>0.05). Tranexamic acid could reduce the exudation of inflammatory cells in the lungs. Conclusion The use of tranexamic acid can effectively reduce the release of inflammatory factors and reduce acute lung injury caused by CPB in rat models. But simply increasing the dose or changing the timing of administration is not more effective in reducing the intensity of the inflammatory response.
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This study was aimed to discover the knowledge of urination formula-syndrome in theTreatise on Exogenous Febrile Diseasebased on the Sunshine diagram of multi-layer complex concept network express. A total of 39 items about urination formula-syndrome in theTreatise on Exogenous Febrile Diseasewere collected, and then regulated into standard expression. The database was established and the multi-layer complex concept network express was constructed. The Sunshine diagram was drawn and the connotation rules on urination formula-syndrome in theTreatise on Exogenous Febrile Diseasewere summarized through mode development of the diagram. The results showed that the Sunshine diagram collected 44 objects (i.e., formulas) and 191 properties (i.e. syndromes), which expressed the urination formula-syndrome visually. It was concluded that the application of Sunshine diagram in the formula-syndrome knowledge based on multi-layer complex concept network express provided certain references on the inheritance and development of classics in traditional Chinese medicine (TCM).
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Based on formal concept analysis theory, formal context of formulae, herbs and their relationship was cre-ated in this article first. Then, the created formal context would be divided and optimized according to classification method in Shang Han Lun Lei Fang written by Xu Lingtai, such as Guizhi Tang category, Chaihu Tang category, Xiexin Tang category, and etc. Multilayer complex concept network was used in the description of the universality and particularity of things. The multilayer complex concept network figure of key-formula-classified formulae was completed on the subgroup structure and visualized express of formulae, herbs and their relationship in the Treatise on Exogenous Febrile Disease. This is a new attempt of integrated information technology with diseases harmed by cold in traditional Chinese medicine. It will bring great benefit in relearning traditional classification methods and promoting inheritance and innovation of study on the Treatise on Exogenous Febrile Disease.