Establishment and evaluation of a predictive model for early neurological deterioration after intravenous thrombolysis in acute ischemic stroke based on machine learning / 中华危重病急救医学

OBJECTIVE@#To establish a machine learning model to predict the risk of early neurological deterioration (END) based on the clinical and laboratory data of patients with acute ischemic stroke (AIS) before intravenous thrombolysis.@*METHODS@#The clinical data of AIS patients who received intravenous thrombolytic with recombinant tissue plasminogen activator (rt-PA) at the Stroke Center of the First Hospital of Qinhuangdao City from January 2019 to July 2022 were retrospectively analyzed. Patients were divided into END group and non-END group according to whether END appeared after intravenous thrombolytic. Clinical data of patients at admission were collected, including demographic characteristics, clinical evaluation, comorbidification, drug use history, laboratory tests, etc. Univariate and multivariate Logistic regression analysis were performed to screen out the independent predictors of the END of AIS patients after intravenous thrombolytic. The study subjects were randomly divided into a training set and a test set in a 7 : 3 ratio. Four machine learning prediction models, including Logistic regression (LR), K-nearest neighbor (KNN), support vector machine (SVM) and random forest (RF), were established based on independent predictors. The receiver operator characteristic curve (ROC curve) was used to evaluate the predictive ability of each model in END.@*RESULTS@#A total of 704 patients were enrolled, of whom 99 were identified as END and 605 as non-END. Univariate and multivariate Logistic regression analysis was used to screen out the National Institutes of Health stroke scale [NIHSS, odds ratio (OR) = 1.049, 95% confidence interval (95%CI) was 1.015-1.082, P = 0.004], systolic blood pressure (OR = 1.013, 95%CI was 1.004-1.022, P = 0.004), lymphocyte percentage (LYM%, OR = 0.903, 95%CI was 0.853-0.953, P < 0.001), platelet to lymphocyte ratio (PLR, OR = 1.007, 95%CI was 1.002-1.014, P = 0.013) were the independent predictors of END in AIS patients after intravenous thrombolysis. The area under the curve (AUC) of LR, KNN, SVM, and RF machine learning models in the test dataset were 0.789 (95%CI was 0.675-0.902), 0.797 (95%CI was 0.685-0.910), 0.851 (95%CI was 0.751-0.952) and 0.809 (95%CI was 0.699-0.919), respectively. The RF model had the highest sensitivity (95.7%). The accuracy (0.736), specificity (72.0%) and AUC of SVM model were the highest, and its overall prediction ability was better than the other three models.@*CONCLUSIONS@#Machine learning models have a potential role in early predicting the risk of END after intravenous thrombolysis in AIS patients, and can provide help in clinical decision-making for intravenous thrombolysis.

Literature Analysis of Escitalopram Adverse Reactions / 医药导报

Objective To investigate the adverse drug reactions (ADRs) induced by escitalopram and precautions. Methods Wanfang,CNKI,Pubmed databases were searched to retrieve information about escitalopram adverse reactions reported in the literature,focusing on analysis of adverse reactions in patients with age,sex,clinical manifestations,involved systems, etc. Results Totally,31 references were collected,and a total of 31 cases included in the review analysis.The adverse reaction rate was equivalent between the male and the female.The adverse reaction occurred a few hours to 6 months after medication,and it involved several organ systems,including the nervous system,circulatory system,endocrine system,alimentary system,urinary system,kinetic system,etc. Conclusion Escitalopram should be used according to the doctor's advice,and its amount should not be arbitrarily added.Regular monitoring of adverse reactions should be performed to ensure rational use of the drug.

Surgical treatment of adult Dandy-Walker syndrome / 局解手术学杂志

Objective To discuss the surgical method and efficacy of adult Dandy-Walker syndrome ( DWS) through retrospective anal-ysis and literature review .Methods There were 3 cases of adult DWS in our hospital from August 2010 to August 2011.One case of them was given posterior cranial fossa cyst peritoneal shunt , and the surgery adopted ordinary high voltage shunt .Case 2 was given left side of the lateral ventricle peritoneal shunt , and the surgery adopted ordinary high voltage shunt .Case 3 was given posterior cranial fossa cyst peritoneal shunt combined with left side of the lateral ventricle peritoneal shunt , and the surgery adopted double-end high voltage shunt .The two ends of the shunt were respectively linked with the diverter valve and abdominal cavity drainage tube through T -branch pipe .Results Among the 3 patients, there was 1 case failed to ease the headache symptoms , and it was relieved one month later .The preoperative symptoms of the oth-er 2 cases disappeared immediately after the surgery .During the 4 years of follow-up,preoperative symptoms of the 3 patients disappeared , and there was no positive signs .Conclusion For adult patients with symptomatic DWS ,shunt surgery can eliminate symptoms ,relieve the tension of the posterior fossa cyst ,achieve good curative effect , and there was no surgical complication .

Effect of different dose of dexmedetomidine in preventing visceral traction reaction during caesarean sec-tion under spinal anesthesia / 临床麻醉学杂志

Objective To investigate the effect of different dose of dexmedetomidine for pre-venting the visceral traction reaction during caesarean section under spinal anesthesia.Methods Two hundred ASA physical status Ⅰ-Ⅱ patients,full-term primiparas scheduled for elective cesarean sec-tion were enrolled in this randomized,placebo-controlled study.Patients were randomly allocated to receive dexmedetomidine in four groups:group C (0.9% normal saline),group D1(dexmedetomidine 0.6 μg/kg),group D2(dexmedetomidine 0.8 μg/kg),group D3 (dexmedetomidine 1.0 μg/kg),50 cases in each group.Two minutes after cutting umbilical,groups D1,D2,D3 received an intravenous infusion single-dose of 0.6,0.8,1.0 μg/kg dexmedetomidine respectively for 10 minutes.Group C was injected the same dose of saline.Maternal blood pressure (BP),heart rate (HR),Ramsay scores,visceral traction reaction conditions were recorded at three points:before iv (T0 ),10 min af-ter iv (T1 )and abdominal exploration (T2 ).Results As for the inhibition of visceral traction pain, groups D2 and D3 were obviously better than groups D1 and C,and there was no statistically signifi-cant difference between groups D2 and D3 at T2 (P <0.05 ).The effects of slowing down heart rate and increasing blood pressure were weaker in group D2 than that in group D3 at T2 .Ramsay scores were higher in groups D2 and D3 than in groups D1 and C (P <0.05),and there was no significant difference between groups D2 and D3 at T2 .Conclusion Administration of dexmedetomidine 0.8 μg/kg could alleviate the visceral traction reaction and had little effect on maternal hemodynamics.

Cultivation of laboratory physicians in China：current situation and reform measures / 中华医学教育探索杂志

Cultivation of laboratory physicians in accordance with the needs of discipline should be a priority of education on laboratory medicine in China. Unfortunately, the professional career of Chinese laboratory physicians is presently entrapped in a dilemma owing to unfavorable settings, in-cluding the late start of laboratory physician training in this country, unmatched installation between higher school faculty and curriculum, faulty programs of in-hospital training, disparity in management policies, low social esteem, uncertainty in personal intention of employment, and poor knowledge of position awareness. This paper puts forward a lot of measures such as the development trend of the university curriculum, which is in compliance with the subdivision and refinement of clinical medicine, the establishment of a medical degree for a professional laboratory physician, constantly improving the standardization of laboratory physician residency training and continuing education system for the in-spection of doctors , setting up physicians inspection posts and giving a clear mandate to examine physicians inside the hospital, while outside of the hospital continually improving awareness and accep-tance of the laboratory physicians, giving more educational resources to laboratory physicians, so as to improve the overall level of the laboratory medicine.

Double micro-catheter technique embolization for cerebral aneurysm / 局解手术学杂志

Objective To explore the clinical effect of double micro-catheter technique for detachable coil treatment of intracranial an-eurysms. Methods From January 2010 to April 2014,there were a total of 83 patients with cerebral aneurysms treated with double micro-catheters,and the ratio of neck/body was 1/3~1. The double micro-catheters were positioned within aneurysm. The detachable coils were in-troduced to satisfactory position by different ways. There was always one undetached coil to hold the stability of detached coils till aneurysm compactly embolized. Results 83 cases were instantly compactly embolized with double micro-catheter technique. No coils out of aneurysm. There were two cases of ischemic complication during clinical treatment,one of them was died. One case ruptured during operation. Conclu-sion The double micro-catheter technique may be an optional and safe method during embolization of some cerebral aneurysms.

The strategies of endosomal escape for intracellular gene delivery / 药学学报

The intracellular trafficking and subcellular distribution of exogenous gene is very important for gene delivery. A successful gene vehicle should overcome various barriers including endosomal membrane barriers to delivery gene to the target organelle. Traditional nonviral vehicle is unable to avoid endosomal pathway efficiently, so the efficiency of gene delivery is low and the application of gene drugs is limited. In order to achieve efficient nonviral gene delivery, a lot of researches based on endosomal escape have been carried out and some agents with the function of endsomal escape have been found. These agents facilitate the endsomal escape via various mechanisms, such as fusion into the lipid bilayer of endosomes, pore formation in the endosomal membrane, proton sponge effect and photochemical methods to rupture the endosomal membrane. In this review, various reported strategies for endsomal escape are described according to the escape mechanisms, and their applications in intracellular gene delivery are also discussed.

Progress in the vector-mediated drug delivery system to the brain / 中国药理学通报

The blood-brain barrier(BBB) is formed by the brain capillary endothelium and excludes from the brain approximately 100% of large-molecule neurotherapeutics and more than 98% of all small-molecule drugs.There are three routines to increase drug transport into brain,ie,neurosurgical,pharmaceutical chemical,and physiological ways and the later is most hopeful.The receptor-mediated transcytosis system on the brain capillary endothelium could be used as multifunctional vectors for drug active transport into brain.This provides the platform for CNS drug delivery programs.

Recombinant human augmenter of liver regeneration may inhibit gelatinase A gene expression in experimental liver fibrosis / 中华消化杂志

Objective To investigate the influence of recombinant human augmenter of liver regeneration (hALR) on gelatinase A(MMP 2) gene expression in experimental liver fibrosis. Methods Two kinds of animal model of rat experimental liver fibrosis induced by CCl 4 and albumin were established and different dosage of hALR (10,50 ?g?kg -1 ?d -1 )was given during the process of model making. Total RNA of liver tissues was isolated and MMP 2 gene expression levels were measured by reverse transcription polymerase chain reaction (RT PCR). Results In both rat models of experimental liver fibrosis, MMP 2 gene expression levels in two hALR preventing group were significantly lower than those of model group in different periods of model forming. MMP 2 gene expression levels in high dose of hALR treating group were significanfly lower than those of low dose hALR treating group. Conclusion hALR may have an effect on inhibiting gene expression of MMP 2 in experimental liver fibrosis.