Prevalence and treatment of anemia in chronic kidney disease patients based on regional medical big data / 中华流行病学杂志

Objective: To assess the prevalence, risk factors and treatment of anemia in patients with chronic kidney disease (CKD). Methods: A descriptive method was used to analyze the prevalence and treatment of anemia in CKD patients based on regional health data in Yinzhou District of Ningbo during 2012-2018. The multivariate logistic regression analysis was used to identify independent influence factors of anemia in the CKD patients. Results: In 52 619 CKD patients, 15 639 suffered from by anemia (29.72%), in whom 5 461 were men (26.41%) and 10 178 were women (31.87%), and anemia prevalence was higher in women than in men, the difference was significant (P<0.001). The prevalence of anemia increased with stage of CKD (24.77% in stage 1 vs. 69.42% in stage 5, trend χ2 test P<0.001). Multivariate logistic regression analysis revealed that being women (aOR=1.57, 95%CI: 1.50-1.63), CKD stage (stage 2: aOR=1.10, 95%CI: 1.04-1.16;stage 3: aOR=2.28,95%CI: 2.12-2.44;stage 4: aOR=4.49,95%CI :3.79-5.32;stage 5: aOR=6.31,95%CI: 4.74-8.39), age (18-30 years old: aOR=2.40,95%CI: 2.24-2.57, 61-75 years old: aOR=1.35,95%CI:1.28-1.42, ≥76 years old: aOR=2.37,95%CI:2.20-2.55), BMI (<18.5 kg/m2:aOR=1.29,95%CI: 1.18-1.41;23.0-24.9 kg/m2:aOR=0.79,95%CI: 0.75-0.83;≥25.0 kg/m2:aOR=0.70,95%CI: 0.66-0.74), abdominal obesity (aOR=0.91, 95%CI: 0.86-0.96), chronic obstructive pulmonary disease (aOR=1.15, 95%CI: 1.09-1.22), cancer (aOR=3.03, 95%CI: 2.84-3.23), heart failure (aOR=1.44, 95%CI: 1.35-1.54) and myocardial infarction (aOR=1.54, 95%CI:1.16-2.04) were independent risk factors of anemia in CKD patients. Among stage 3-5 CKD patients with anemia, 12.03% received iron therapy, and 4.78% received treatment with erythropoiesis-stimulating agent (ESA) within 12 months after anemia was diagnosed. Conclusions: The prevalence of anemia in CKD patients was high in Yinzhou. However, the treatment rate of iron therapy and ESA were low. More attention should be paid to the anemia management and treatment in CKD patients.

Expression and significance of calcitonin and osteopontin in peripheral blood of patients with atrial fibrillation / 中国综合临床

Objective:To investigate the expression levels of serum calcitonin (CT) and osteoponin (OPN) in peripheral blood of patients with atrial fibrillation (AF) and their relationship with AF.Methods:A case control study was conducted, 160 AF patients treated in Shaanxi Provincial People's Hospital from June 2020 to December 2021 were selected as case group, and 160 healthy people in the same period were selected as control group. The expression levels of serum CT and OPN in the two groups were analyzed retrospectively, and the correlation between them and AF was analyzed. The value of CT and OPN levels in predicting the occurrence of AF was analyzed by receiver operating characteristic (ROC). Kappa consistency test was used to analyze the efficacy of the combination of them in predicting the occurrence of AF.Results:The serum calcitonin level ((13.5±3.2) ng/L) in the case group was lower than that in the control group ((17.3±3.1) ng/L), and the osteopontin level ((53.8±8.2) μg/L) was higher than that of the control group ((44.1±6.8) μg/L), the difference between the two groups was statistically significant ( t=10.79, P<0.001; t=11.50, P<0.001). The results of binary logistic regression analysis showed that serum calcitonin was the protective factor of atrial fibrillation ( OR=0.723, 95% CI: 0.661-0.790, P<0.001), and osteopontin was the risk factor ( OR=1.183, 95% CI: 1.131-1.237, P<0.001). ROC analysis showed that the area under curve (AUC) of CT, OPN and their combination in predicting AF were 0.794, 0.824, and 0.892, respectively. The predictive critical value for serum CT was <15.0 ng/L and >48.5 μg/L for OPN. The sensitivity, specificity of the combination in AF prediction were 67.50% and 93.75% respectively, and Kappa value was 0.613. Conclusion:The expression of serum CT and OPN was abnormal in patients with atrial fibrillation. The prediction of AF by combined examination of the two had a high degree of consistency with the actual results, which could provide reference for early diagnosis and treatment of AF. However, the rate of missed diagnosis was relatively high, which needs attention in clinical application.

Predicting prolonged length of intensive care unit stay via machine learning / 北京大学学报(医学版)

OBJECTIVE@#To construct length of intensive care unit (ICU) stay (LOS-ICU) prediction models for ICU patients, based on three machine learning models support vector machine (SVM), classification and regression tree (CART), and random forest (RF), and to compare the prediction perfor-mance of the three machine learning models with the customized simplified acute physiology score Ⅱ(SAPS-Ⅱ) model.@*METHODS@#We used medical information mart for intensive care (MIMIC)-Ⅲ database for model development and validation. The primary outcome was prolonged LOS-ICU(pLOS-ICU), defined as longer than the third quartile of patients' LOS-ICU in the studied dataset. The recursive feature elimination method was used to do feature selection for three machine learning models. We utilized 5-fold cross validation to evaluate model prediction performance. The Brier value, area under the receiver operation characteristic curve (AUROC), and estimated calibration index (ECI) were used as perfor-mance measures. Performances of the four models were compared, and performance differences between the models were assessed using two-sided t test. The model with the best prediction performance was employed to generate variable importance ranking, and the identified top five important predictors were pre-sented.@*RESULTS@#The final cohort in our study consisted of 40 200 eligible ICU patients, of whom 23.7% were with pLOS-ICU. The proportion of the male patients was 57.6%, and the age of all the ICU patients was (61.9±16.5) years.Results showed that the three machine learning models outperformed the customized SAPS-Ⅱ model in terms of all the performance measures with statistical significance (P < 0.01). Among the three machine learning models, the RF model achieved the best overall performance (Brier value, 0.145), discrimination (AUROC, 0.770) and calibration (ECI, 7.259). The calibration curve showed that the RF model slightly overestimated the risk of pLOS-ICU in high-risk ICU patients, but underestimated the risk of pLOS-ICU in low-risk ICU patients. Top five important predictors for pLOS-ICU identified by the RF model included age, heart rate, systolic blood pressure, body tempe-rature, and ratio of arterial oxygen tension to the fraction of inspired oxygen(PaO2/FiO2).@*CONCLUSION@#The RF algorithm-based pLOS-ICU prediction model had a best prediction performance in this study. It lays a foundation for future application of the RF-based pLOS-ICU prediction model in ICU clinical practice.

Prediction of intensive care unit readmission for critically ill patients based on ensemble learning / 北京大学学报(医学版)

OBJECTIVE@#To develop machine learning models for predicting intensive care unit (ICU) readmission using ensemble learning algorithms.@*METHODS@#A publicly accessible American ICU database, medical information mart for intensive care (MIMIC)-Ⅲ as the data source was used, and the patients were selected by the inclusion and exclusion criteria. A set of variables that had the predictive ability of outcome including demographics, vital signs, laboratory tests, and comorbidities of patients were extracted from the dataset. We built the ICU readmission prediction models based on ensemble learning methods including random forest, adaptive boosting (AdaBoost), and gradient boosting decision tree (GBDT), and compared the prediction performance of the machine learning models with a conventional Logistic regression model. Five-fold cross validation was used to train and validate the prediction models. Average sensitivity, positive prediction value, negative prediction value, false positive rate, false negative rate, area under the receiver operating characteristic curve (AUROC) and Brier score were used as performance measures. After constructing the prediction models, top 10 predictive variables based on importance ranking were identified by the model with the best discrimination.@*RESULTS@#Among these ICU readmission prediction models, GBDT (AUROC=0.858) had better performance than random forest (AUROC=0.827), and was slightly superior to AdaBoost (AUROC=0.851) in terms of AUROC. Compared with Logistic regression (AUROC=0.810), the discrimination of the three ensemble learning models was much better. The feature importance provided by GBDT showed that the top ranking variables included vital signs and laboratory tests. The patients with ICU readmission had higher mean arterial pressure, systolic blood pressure, diastolic blood pressure, and heart rate than the patients without ICU readmission. Meanwhile, the patients readmitted to ICU experienced lower urine output and higher serum creatinine. Overall, the patients having repeated admissions during their hospitalization showed worse heart function and renal function compared with the patients without ICU readmission.@*CONCLUSION@#The ensemble learning based ICU readmission prediction models had better performance than Logistic regression model. Such ensemble learning models have the potential to aid ICU physicians in identifying those patients with high risk of ICU readmission and thus help improve overall clinical outcomes.

Identification of Peripheral Blood and Menstrual Blood Based on the Expression Level of MicroRNAs and Discriminant Analysis / 法医学杂志

Objective To construct a discriminant analysis model based on the differential expression of multiple microRNAs （miRNAs） in two kinds of blood samples （peripheral blood and menstrual blood） and three non-blood samples （saliva, semen and vaginal secretion）, to form an identification solution for peripheral blood and menstrual blood. Methods Six kinds of miRNA （miR-451a, miR-144-3p, miR-144-5p, miR-214-3p, miR-203-3p and miR-205-5p） were selected from literature, the samples of five kinds of body fluids commonly seen in forensic practice （peripheral blood, menstrual blood, saliva, semen, vaginal secretion） were collected, then the samples were divided into training set and testing set and detected by SYBR Green real-time qPCR. A discriminant analysis model was set up based on the expression data of training set and the expression data of testing set was used to examine the accuracy of the model. Results A discriminant analysis statistical model that could distinguish blood samples from non-blood samples and distinguish peripheral blood samples from menstrual blood samples at the same time was successfully constructed. The identification accuracy of the model was over 99%. Conclusion This study provides a scientific and accurate identification strategy for forensic fluid identification of peripheral blood and menstrual blood samples and could be used in forensic practice.

Application of support vector machine in predicting in-hospital mortality risk of patients with acute kidney injury in ICU / 北京大学学报(医学版)

OBJECTIVE@#To construct an in-hospital mortality prediction model for patients with acute kidney injury (AKI) in intensive care unit (ICU) by using support vector machine (SVM), and compare it with the simplified acute physiology score II (SAPS-II) which is commonly used in the ICU.@*METHODS@#We used Medical Information Mart for Intensive Care III (MIMIC-III) database as data source. The AKI patients in the MIMIC-III database were selected according to the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) definition of AKI. We employed the same predictor variable set as used in SAPS-II to construct an SVM model. Meanwhile, we also developed a customized SAPS-II model using MIMIC-III database, and compared performances between the SVM model and the customized SAPS-II model. The performance of each model was evaluated via area under the receiver operation characteristic curve (AUROC), root mean squared error (RMSE), sensitivity, specificity, Youden's index and accuracy based on 5-fold cross-validation. The agreement of the results between the SVM model and the customized SAPS-II model was illustrated using Bland-Altman plots.@*RESULTS@#A total number of 19 044 patients with AKI were included. The observed in-hospital mortality of the AKI patients was 13.58% in MIMIC-III. The results based on the 5-fold cross validation showed that the average AUROC of the SVM model and the customized SAPS-II model was 0.86 and 0.81, respectively (The difference between the two models was statistically significant with t=13.0, P<0.001). The average RMSE of the SVM model and the customized SAPS-II model was 0.29 and 0.31, respectively (The difference was statistically significant with t=-9.6, P<0.001). The SVM model also outperformed the customized SAPS-II model in terms of sensitivity and Youden's index with significant statistical differences (P=0.002 and <0.001, respectively).The Bland-Altman plot showed that the SVM model and the customized SAPS-II model had similar mortality prediction results when the mortality of a patient was certain, but the consistency between the mortality prediction results of the two models was poor when the mortality of a patient was with high uncertainty.@*CONCLUSION@#Compared with the SAPS-II model, the SVM model has a better performance, especially when the mortality of a patient is with high uncertainty. The SVM model is more suitable for predicting the mortality of patients with AKI in ICU and early intervention in patients with AKI in ICU. The SVM model can effectively help ICU clinicians improve the quality of medical treatment, which has high clinical value.

Effects of different anesthesia levels on perioperative cerebral oxygen metabolism and postoperative cogni-tive function in elderly patients / 实用医学杂志

Objective To investigate the effects of different levels of anesthesia on perioperative cerebral oxygen metabolism and postoperative cognitive function in the elderly patients. Methods One hundred elderly pa-tients receiving gastric cancer surgery were divided into two groups:group D(BIS value 30-39) and group L(BIS value 50-59). Blood samples were collected at T0,T1,T2,T3 and T4. Da-jvO2 and CERO2 were calculated at the same time.MMSE score was recorded at the time point of 1,3 and 7 d after operation.Results Compared with the T0,Da-jvO2 and CERO2 were both decreased in the two groups at T2-T4(P<0.05).Compared with the group L, the group D were decreased more obviously(P < 0.05). Compared with preoperative score,MMSE score was de-creased at the time point of 1,3d in the group L as well as 1d in the group D(P<0.05).Compared with the group L,group D was significantly increased at the time point of 1 and 3 d(P < 0.05). Conclusion BIS value was maintained at 30-39 can decrease perioperative cerebral oxygen metabolism and improve postoperative cognitive function in the elderly patients.

Effect of oxycodone pretreatment on renal ischemia-reperfusion injury in rats / 临床麻醉学杂志

Objective To evaluate the effects of oxycodone pretreatment on renal ischemiareperfusion(IR) injury in rats.Methods Thirty adult male Sprague-Dawley rats were randomly divided into 3 groups (n=10 each) using a random number table:sham operation group(group S),group IR,and oxycodone pretreatment +IR group (group O).After removing the right kidney in rats,the renal I/R was built by occlusion of the left renal artery and vein for 45 min with a traumatic microclips followed by 2 h reperfusion in I/R and O group.In group S,the right kidney was performed and the left renal artery,vein and ureter were isolated without occluding blood flow.In group O,oxycodone 2 mg/kg were infused intravenously 5 min before onset of ischemia.At 2 h of reperfusion,blood samples were taken from the abdominal aorta to determine the concentrations of serum blood urea nitrogen(BUN)and creatinine(Cr).After blood sampling,the rats were sacrificed,and the left kidney were removed for determination of malondialdehyde(MDA) content (by thiobarbituric acid method) and superoxide dismutase (SOD) activity (using xan-thine oxidase method).The expression levels of B-cell lymphoma-2 (bcl-2),bcl-2 Assaciated X protein(bax) and cycteinyl aspirate-specific protease-3 (Caspase-3) protein were detected by Western blotting,respectively.Results Compared with group S,the serum BUN and Cr concentrations,and the contents of MDA,bax and Caspase-3 in renal tissues were significantly increased,the content of bcl-2 and SOD activity in renal tissues were significantly decreased in the other two groups(P＜0.05).Compared with group IR,the serum BUN and Cr concentrations,and the contents of MDA,bax and Caspase-3 in renal tissues were significantly decreased,the content of bcl-2 and SOD activity in renal tissues were significantly increased in group O (P＜0.05).Conclusion Oxycodone can alleviate renal I/R injury in rats,and the mechanism is related to inhibition of oxidative stress response and cell apoptosis.

Effect of oxycodone on hemodynamics and stress response in general anesthesia induction / 实用医学杂志

Objective To investigate the effect of oxycodone and sufentanil with equivalent dose on hemo-dynamics and stress response in general anesthesia induction. Methods One hundred and twenty ASA I orⅡpa-tients with abdominal surgery were randomly divided into oxycodone group(group O,n=60)and sufentanil group (group S,n = 60). Anesthesia was induced with iv oxycodone 0.20 mg/kg(group O)or sufentanil 0.25 μg/kg (group S)respectively,together with iv propofol 2.0 ~ 2.5 mg/kg and cisatracurium 0.2 mg/kg. The patients were tracheally intubated using a single-lumen endotracheal tube. Mean arterial pressure(MAP),heart rate(HR),plas-ma levels of epinephrine(E)and norepinephrine(NE),cortisol(Cor)and blood sugar(Glu)and the occurrence of bucking before anesthesia induction(T0),immediately before intubation(T1),at the moment of intubation(T2), 1 min(T3)and 5 min(T4)after intubation were observed. Results Compared with these at T0,MAP and HR in 2 groups were lower at T1(P0.05). MAP and HR were significantly higher at T2 and T3(P 0.05). Plasma levels of E ,NE,Cor and Glu increased obviously at T2 and T3 in 2 groups(P 0.05). Conclusion Compared with sufentanil ,oxycodone of equivalent dose used for general anesthesia induction can effectively keep smooth on hemodynamics and decrease stress response.

Short-term effect of surgery on the health-related quality of life in children with intermittent exotropia / 国际眼科杂志(Guoji Yanke Zazhi)

? AIM: To investigate health - related quality of life ( HRQOL ) state in children with intermittent exotropia using the Intermittent Exotropia Questionnaire ( IXTQ ) and research the effect of strabismus surgeries on HRQOL.?METHODS: In this prospective study, we chose 42 patients with intermittent exotropia ( aged 5-17 years) as case group, and 42 patients ( aged 5-17 years) as control group. The Chinese IXTQ was used to evaluate HRQOL at 1d preoperatively and 3mo postoperatively in the two groups, and the differences of the two groups before and after surgery and the effect of strabismus surgery on HRQOL were analyzed.?RESULTS:The scores of HRQOL in control group were statistically significant higher than that of case group ( P<0. 01 ). Every items showed a statistically significant difference except on “Kids tease me because of my eyes”and “ My eyes make it hard for me to make friends” ( P<0.05). At 3mo postoperatively ,the scores of HRQOL in case group significantly increased than that at 1d preoperatively(P<0. 01). Child IXTQ of case group was lower on every items than those of control group after surgery(P<0. 05).?CONCLUSION:Intermittent exotropia could affect the HRQOL in psychosocial and visual functional. The greatest HRQOL concerns for children with intermittent exotropia were shutting one eye when sunny, waiting for their eyes to clear up instead of taunts and friendship. The surgical treatment could improve HRQOL in children with intermittent exotropia.

Relationship between pathology of concomitant exotropia medial rectus and surgical results / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the relationship between the medial rectus cells counts in concomitant exotropia and surgical results. METHODS: A total of 32 pieces of medial rectus muscle were collected for HE staining in this study, of which 18 pieces were from patients with concomitant exotropia and 14 pieces were from healthy individuals. A method of strabismus score was used to assess the operative effect.RESULTS: The difference of strabismus score before and after the operation in the intermittent exotropia group was significantly higher than that in constant exotropic group (P<0.01). Under light microscope, the loosen muscle fibers and the increased stromal components in the cross sectional area of medial rectus were observed in strabismic group. The muscle cells counts was obviously lower in strabismic group than in control group (P<0.01), which was related to the difference of strabismus score before and after the operation (P<0.05).CONCLUSION: The decreased medial rectus cells counts induce concomitant exotropia directly. It is the crucial causes of the bad surgical results.

Therapeutic effects of two anastomoses of lacrimal passage on canalicular laceration / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the therapeutic effects of two anastomoses (canaliculus-to-lacrimal sac anastomosis and end-to-end anastomosis) on nasolacrimal laceration for over 7 mm from the broken end to the dacryon.</p><p><b>METHODS</b>A total of 71 patients (44 males and 27 females, aged 16-55 years, mean equal to 34.32 years) with fresh canalicular laceration were treated in our hospital from March 2003 to April 2008. Under a microscope, 37 patients were treated with lacrimal sac anastomosis (the treatment group) and 34 with end-to-end anastomosis (the control group), detaining silicone tubes till 3 months later.</p><p><b>RESULTS</b>The cure rate of the treatment group (89.19%) was significantly higher than that of the control group (55.56%). Class I cure rates were 70.27% in the treatment group and 47.06 % in the control group, and the difference between the two groups was significant (P less than 0.05). Postoperative inflammatory reactions had significant influences on the two kinds of anastomosing methods, but no significant difference was found between the two groups (P larger than 0.05).</p><p><b>CONCLUSIONS</b>When the distance from the broken end to the dacryon is over 7 mm, especially when it is necessary to find the paranasal broken end of the lacrimal canaliculus with dacryocystotomy, canaliculus-to-lacrimal sac anastomosis is a better treatment method than end-to-end anastomosis for laceration of lacrimal canaliculus.</p>