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Objective:To evaluate the feasibility and clinical value of pre-treatment non-enhanced chest CT radiomics features and machine learning algorithm to predict the mutation status and subtype (19Del/21L858R) of epidermal growth factor receptor (EGFR) for patients with non-small cell lung cancer (NSCLC).Methods:This retrospective study enrolled 280 NSCLC patients from first and second affiliated hospital of University of South China who were confirmed by biopsy pathology, gene examination, and have pre-treatment non-enhanced CT scans. There are 136 patients were confirmed EGFR mutation. Primary lung gross tumor volume was contoured by two experienced radiologists and oncologists, and 851 radiomics features were subsequently extracted. Then, spearman correlation analysis and RELIEFF algorithm were used to screen predictive features. The two hospitals were training and validation cohort, respectively. Clinical-radiomics model was constructed using selected radiomics and clinical features, and compared with models built by radiomics features or clinical features respectively. In this study, machine learning models were established using support vector machine (SVM) and a sequential modeling procedure to predict the mutation status and subtype of EGFR. The area under receiver operating curve (AUC-ROC) was employed to evaluate the performances of established models.Results:After feature selection, 21 radiomics features were found to be efffective in predicting EGFR mutation status and subtype and were used to establish radiomics models. Three types models were established, including clinical model, radiomics model, and clinical-radiomics model. The clinical-radiomics model showed the best predictive efficacy, AUCs of predicting EGFR mutation status for training dataset and validation dataset were 0.956 (95% CI: 0.952-1.000) and 0.961 (95% CI: 0.924-0.998), respectively. The AUCs of predicting 19Del/L858R mutation subtype for training dataset and validation dataset were 0.926 (95% CI: 0.893-0.959), 0.938 (95% CI: 0.876-1.000), respectively. Conclusions:The constructed sequential models based on integration of CT radiomics, clinical features and machine learning can accurately predict the mutation status and subtype of EGFR.
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AIM To establish the HPLC-ELSD fingerprints of oligosaccharide sites from mycelia of Hericium erinaceum solid cultures and Weilening Tablets.METHODS The analysis of aqueous extract from samples was performed on a 80 ℃ thermostatic Waters XBridge TM Amide column (4.6 mm × 150 mm,3.5 μm),with the mobile phase comprising of acetonitrile-0.2％ ammonium acetate flowing at 1 mL/min in a gradient elution manner.RESULTS There were eight and nine common peaks in two HPLC-ELSD fingerprints with the similarties of 0.994-0.966 and 0.990-0.997,respectively.Three of them were mannitol,lactose and trehalose,which showed good linear relationships within their own ranges (r ≥ 0.999 0),the average recoveries were 95.08％-104.82％ with the RSDs of 1.12％-2.90％.CONCLUSION This simple and accurate method can be used for the rapid quality control of mycelia of Hericium erinaceum solid cultures and Weilening Tablets.
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Objective To investigate the incidence and the species distribution of catheter‐related bloodstream infection(CRBSI) in the intensive care unit(ICU) at our hospital ,and analyze the risk factors for CRBSI .Methods The hospitalized patients microbi‐ologically diagnosed as CRBSl were included in this study from January 2012 to June 2013 .Data were collected retrospectively and analyzed by software SPSS 19 .0 .Results There were 67 patients were diagnosed as nosocomial CRBSI of 987 cases ,in which 24 cases (35 .8% )died in the hospital .Eighty one strains were detected from 67 cases of CRBSI ,including 42 Gram‐positive(G+ ) bac‐teria(51 .9% ) ,36 Gram‐negative(G-)bacteria (44 .4% ) ,and 3 fungi(3 .7% ) .Staphylococcus epidermidis was predominant patho‐genic G+ bacteria ,and Acinetobacter baumannii was predominant G - bacteria .With multiple logistic regressions ,age≥65 ,high A‐PACHEⅡ score and polymicrobial CRBSI were independent predictors of worse outcome .Conclusion Within the latest 18 months , the prevalence of pathogens infection are Staphylococcus epidermidis and Acinetobacter baumannii in CRBSI in ICU .Advanced age , disease severity and polymicrobial CRBSI should be regarded as significant independent risk factor of the CRBSI patients in ICU for mortality .
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Objective To evaluate the effects of modified early goal directed therapy (EGDT )on the prognosis of patients with septic shock .Methods Clinical data of 116 patients with septic shock admitted to ICU during January 2011 to March 2013 were retrospectively analyzed .Patients were divided into modified early goal‐directed therapy group (n=57) and traditional early goal‐di‐rected therapy group (n=59) according to different methods of treatment ,the patients′28‐day survival rates of these 2 groups were compared .Modified early goal‐directed therapy are divided into survival group (n=46) and non‐survival group (n=11) according to 28‐day prognosis .Acute physiology and chronic health evaluation Ⅱ (APACHEⅡ ) score ,sequential organ failure assessment (SOFA) ,multiple organ dysfunction syndrome (MODS) score and other relevant indicators of survival group and non‐survival group were compared .Results The 28‐day survival rate in modified early goal‐directed therapy group had increased approximately 18 .9% higher than that of the traditional early goal‐directed therapy group(P< 0 .05) .The APACH Ⅱ score ,SOFA score and MODS score in non‐survivors were significantly higher than those of survivors in modified EGDT group ,which were[(29 .36 ± 1 .57)d vs .(24 .30 ± 3 .27)d] ,[(13 .45 ± 0 .52)d vs .(12 .78 ± 1 .33)d] ,[(9 .00 ± 0 .00)d vs .(4 .04 ± 1 .94)d]separately .And vaso‐pressors time and mechanical ventilation time was significantly longer in non‐survivors than survivors(P<0 .05) .Conclusion Mod‐ified early goal directed therapy could improve 28‐day survival rate ,and it show s beneficial effects on outcome of critical patients w ith septic shock .
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Objective To investigate the distribution of-6411A/G (rs208679) polymorphism in the 5' region of catalase (CAT) gene among Han population in Chongqing and its correlation with noiseinduced hearing loss (NIHL).Methods A total of 225 healthy volunteers (normal control group) and 237 noise exposure cases (noise exposure group) were collected from the unrelated Han people in Chongqing.The noise exposure group were further divided into non-deaf group (n =170) and deaf group (n =67) according the presence or absence of NIHL.rs208679 polymorphism in the 5' region of CAT gene was identified using the improved multiplex ligation detection reaction (iMLDR) technique.Genotypes,allelic frequencies and clinical deaf incidence were compared among groups.Results Three genotypes (AA,AG,and GG) were detected in the rs208679 locus.Frequencies of A and G alleles in normal control group and noise exposure group were 0.76 and 0.24 respectively.Genotype distribution in normal control group and noise exposure group showed no deviation from the Hardy-Weinberg equilibrium (P ＞0.05).There were no significant differences in gene polymorphism (AA,AG,and GG) and allelic frequencies (A and G) between normal control group and noise exposure group and between deaf group and non-deaf group (P ＞ 0.05).However,significant difference was observed between deaf group and non-deaf group in recessive analysis (GG vs AG + AA,P ＜ 0.05).Conclusion rs208679 is the predisposing gene to NIHL and can be used as the biomarker for NIHL susceptibility.
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<p><b>BACKGROUND</b>The presence of intracellular organisms (ICOs) in polymorphonuclear leukocytes obtained from bronchoalveolar lavage fluid (BALF) is a possible method for rapid diagnosis of ventilator-associated pneumonia (VAP). However, the validity of this diagnostic method remains controversial and the diagnostic thresholds reported by investigators were different. Our objective was to evaluate the accuracy of quantification of ICOs in BALF for the diagnosis of VAP, and to detect the best cutoff percentage of PMNs containing ICOs (PIC) in the microscopic examination of BALF for the diagnosis of VAP.</p><p><b>METHODS</b>This was a prospective multi-center study conducted in 4 ICUs in Wuhan, China, which involved 181 patients suspected of first episode of VAP. BALF was obtained from all enrolled patients. The BALF samples underwent quantitative culture, cytological and bacteriological analysis to detect the culture results, PIC values and the morphological features of microorganisms. Definite diagnosis of VAP was based on pre-set criteria. The receiver-operating characteristic curve was used to detect the best cutoff point for PIC to diagnose VAP, and the diagnostic accuracy was calculated. Moreover, quantitative culture and Gram's stain of BALF were adopted to diagnose VAP, and their diagnostic accuracy was evaluated as well.</p><p><b>RESULTS</b>There were 102 patients definitely diagnosed with VAP (VAP group), and 60 patients definitely diagnosed without VAP (no VAP group). We found that ICOs were present in 96.08% (98 out of 102) of VAP patients and 20.00% (12 out of 60) of no VAP patients. The PICs were significantly higher ((9.53 ± 6.65)% vs. (0.52 ± 1.33)%, P < 0.01) in VAP group. In our study, the best cutoff point for PIC to diagnose VAP was 1.5%,which had a sensitivity of 94.12%, a specificity of 88.33%, a positive predictive value (PPV) of 93.20% and a negative predictive value (NPV) of 89.83%.The area under the receiveroperating characteristic curve was 0.956 (95% confidence interval,0.925-0.986; P < 0.01). When the positive quantitative culture results of BALF were used to diagnose VAP, the sensitivity, specificity, PPV and NPV were 65.69%, 95.00%, 95.71% and 61.96%, respectively. Whereas they were 70.59%, 76.67%, 83.72% and 60.53%, respectively, when the positive Gram's stain results of BALF were used to diagnose VAP. The concordance between the results of Gram's stain and quantitative cultures was poor, only 32.10% (52 out of 162) was totally right, and 17.28% (28 out of 162) was partially right.</p><p><b>CONCLUSIONS</b>PIC>1.5% has good diagnostic performance in the microscopic examination of BALF for the diagnosis of VAP. However, Gram's stain is not reliable for the early application of antibiotic therapy, due to the poor bacteriological predictive value.</p>
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Aged , Female , Humans , Male , Middle Aged , Bronchoalveolar Lavage Fluid , Microbiology , Pneumonia, Ventilator-Associated , Diagnosis , Prospective StudiesABSTRACT
Objective To investigate the curative effect of large dose ambroxol on ventilatorassociated pneumonia(VAP)in the elderly.Methods From January 2009 to January 2011,76patients with VAP treated by ambroxol were randomly divided into general dose group and large dose group(n =38 for each group).General dose group received 60 mg ambroxol in 250 ml normal saline,and large dose group received 500 mg ambroxol in 250 ml normal saline,intravenous drip,twice daily for 14 d.The other therapeutic measures in all patients were accorded to 2005 guidelines for the hospital-acquired pneumonia.Procalcitonin(PCT)and clinical pulmonary infection score(CPIS)were used to detect the degree of pulmonary infection.Treatment effects were described with duration of mechanical ventilation,rates of tracheotomy intubation and second endotracheal intubation.Results PCT concentrations and CPIS in large dose group during treatment of 5 d[(0.79±0.68)mg/L and (5.50±2.08)scores]and 14 d[(0.44 ± 0.36)mg/L and(5.42 ± 2.23)scores]were significantly lower than in general dose group at 5 d[(1.18±0.97)mg/L and(6.61±2.32)scores]and 14 d[(1.11±0.91)mg/L and(6.47±2.17)scores](t =2.065,2.189,4.220 and 2.090,P＜0.05),and the level of PCT in large dose group during treatment of 14 d was decreased as compared with 5 d(P＜0.05).The time of mechanical ventilation,rates of tracheotomy intubation and second endotracheal intubation in large dose group[(6.03± 1.87)d,7.9％ and 10.5％]were declined as compared with general dose group[(7.24±2.72)d,26.3％ and 31.6％](t=2.264,x2 =4.547,5.066,P＜0.05).Conclusions Ambroxol in large dose for the treatment of VAP have better clinical efficacy than in general dose.
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Objective To test plasma levels of uPA,uPAR,D-dimer,IL-6 and TNF-α,and observe the relationships between uPA,uPAR and D-dimer,IL-6,TNF-αin patients with SIRS.Methods A prospective,clinical case-control study was adopted.Cases were collected from our hospital in January 2008 to January 2010,and all were ＞ 55 years of age.Venous blood samples were collected via routine venipuncture.Eighty-five patients were divided into two groups according to diagnostic criteria of SIRS:SIRS group collected from Intensive Care Unit ( n =50) and non SIRS group collected from medical ward ( n =35).The control group comprised 30 unrelated healthy blood donors who visited the General Health Checkup Division at our hospital.Patients with (1) pregnant women; (2) cancer; (3) died after admitted into ICU in 7 days; (4) after cardiopulmonary resuscitation ; ( 5 ) with previous blood system diseases; (6) patients with SIRS before admitted into ICU were excluded from the study.uPA,uPAR,D-D,IL-6 and TNF-α in blood were detected by commercial enzyme-linked immunosorbent assay (ELISA) kits.The data was analyzed using SPSS version17.0.Data accorded with normal distribution of measurement was expressed as mean ± standard,and analyzed by independent-samples t test; non-normal distribution of measurement data,expressed by median,was analyzed with Mann-Whitney test.Relationships between plasma levels of uPA,uPAR and D-dimer,IL-6 TNF-α were analyzed using Spearman rank correlation test.To compare with blood level of uPA,uPAR,IL-6 and TNF-α in SIRS patients in the application of diagnostic value of MODS,we constructed the receiver operating characteristic curve ( ROC curve) for blood levels of uPA,uPAR,IL-6 and TNF-α in 24 h.Results The plasma levels of uPA,uPAR,D-dimer,IL-6 and TNF-αin patients of SIRS were obviously higher compared with non-SIRS and normal controls ( all P ＜ 0.01 ).Correlation analysis showed that there was positive correlation between uPAR level and IL-6 level (r =0.395,P =0.004) ; there was positive correlation between uPAR level and TNF-αlevel ( r =0.606,P ＜0.01 ).There was no correlation between uPAR levd and D-dimer level ( r =- 0.069,P =0.632).There was no correlation between uPA level and D-dimer,IL-6 or TNF-α ( all p ＞ 0.05).There ROC curve were made based on the abilities of uPAR,D-dimer,IL-6 and TNF-αlevels in 24 hours to diagnose MODS,and the ROC areas under the curves were 0.76,0.58,0.86,0.83 respectively.Conclusions These results demonstrate that uPA and uPAR play a major contributory role in patients with SIRS in the process of coagulation disorders,but the mechanism in SIRS is not the same.uPAR may play a central rolein the development of SIRS to MODS.
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OBJECTIVE@#To explore the effects of c-Met-siRNA on the proliferation, movement and invasion of laryngeal carcinoma Hep-2 cells in vitro.@*METHOD@#Firstly, the pSilencer 2.0/c-Met-shRNA recombinant plasmid was transfected into laryngeal carcinoma Hep-2 cells with transfecting agent of cationic liposome Lipofectamine 2000. Secondly,the transfection efficacy was tested by RT-PCR and Western-Blot, then the most inhibitive c-Met-siRNA sequence was elected. Cell proliferation, movement and invasion were detected with MTT, cell migration assay and cell invasion assay, respectively.@*RESULT@#After the transfection of pSilencer 2.0/c-Met-shRNA recombinant plasmid into laryngeal carcinoma Hep-2 cells, the expression of mRNA and protein of c-Met decreased significantly in Hep-2 cells, and ability of the proliferation, movement and invasion of laryngeal carcinoma Hep-2 cells were also inhibited.@*CONCLUSION@#The results indicated that c-Met-siRNA can down-regulated the expression of c-Met and markedly inhibited laryngeal carcinoma Hep-2 cell proliferation, movement and invasion. It may have the potential as a therapeutic modality to treat human laryngeal carcinoma.
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Humans , Apoptosis , Genetics , Carcinoma, Squamous Cell , Genetics , Pathology , Cell Line, Tumor , Cell Proliferation , Laryngeal Neoplasms , Genetics , Pathology , Liposomes , Proto-Oncogene Proteins c-met , Genetics , RNA, Messenger , Genetics , RNA, Small Interfering , Genetics , TransfectionABSTRACT
Objective To evaluate the efficacy and safety of linezolid in the treatment of severe lung infections caused by methicillin-resistant Staphylococcus aureus (MRSA).Methods Fifteen patients admitted to ICU due to severe lung infection caused by MRSA received linezolid treatment. WBC, lactic acid (LAC), IL-1β, IL-6, and TNF-α levels were measured before and after treatment. Results Clinical efficacy rate was 73.3%. The level of WBC, LAC and inflammatory cytokines decreased significantly after linezolid treatment (P<0.01).Conclusions Linezolid shows good efficacy in the treatment of severe lung infections caused by MRSA.
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An enzyme electrode biosensor was used for the amperometric determination of inosine in its tablets by co-immobilizing nucleoside phosporylase and xanthine oxidase on a hydrogen peroxide electrode. As a fundamental electrode the hydrogen peroxide electrode has an advantage of stability in analysis compared with the 02 electrode. The enzyme electrode showed a linear response to inosine in the range of 1-268 mg/L with a response of 60 seconds under a sample injection volume of 25 microL. Based on the enzyme electrode, inosine solutions were determined with an average recover rate of 100.8% and a relative standard deviation (RSD) of les than 0.14% in 20 assays. The lifetime of the enzyme electrode was relative long and could be used continuously at 25 degrees C for 25 days. These results demonstrated that the enzyme electrode biosensor could be used to determine inosine and its derivatives specifically, rapidly, conveniently and economically.