Changes of Immunological Indexes and Blood Routine in Treatment of Aplastic Anemia by Yiqi Yangxue Prescription / 中国实验方剂学杂志

ObjectiveTo investigate the immunological characteristics of the patients with aplastic anemia （AA） and elevated hemogram parameters treated with Yiqi Yangxue prescription combined with Western medicine and the predictive effects of immunological indexes on elevated hemogram parameters， thus providing a reference for the prediction of the treatment efficacy and the adjustment of the treatment regimen. MethodA retrospective study was conducted， involving 77 AA patients treated with Yiqi Yangxue prescription combined with Western medicine for 6 months in 19 medical institutions including Xiyuan Hospital， China Academy of Chinese Medical Sciences from September 2018 to March 2021. The patients were assigned into two groups according to the elevations in hemogram parameters ［including hemoglobin （HGB）， white blood cell count （WBC）， platelet （PLT）， and absolute neutrophil count （ANC）］ after 6 months of treatment. One group had the elevation <50%， and the other group had the elevation ≥50% compared with the baseline. The clinical and immunological characteristics were compared between the two groups. Result① Compared with the group with HGB elevation<50%， the group with HGB elevation≥50% showed elevated level of CD3+ human leukocyte antigen-DR （HLA-DR）+ and increased proportion of patients with T-helper cell type 2 （Th2）<5%， CD8+≥50%， and CD3+HLA-DR+≥9% before treatment （P<0.05， P<0.01）. The multivariate Logistic regression analysis showed that CD8+≥50% before treatment was the independent influencing factor for HGB elevation ≥50% ［odds ratio （OR）=12.000， 95% confidence interval （CI） 2.218， 64.928， P<0.01］. ② Compared with the group with WBC elevation<50%， the group with WBC elevation≥50% showed increased proportion of patients with CD3+HLA-DR+<6% and T-box transcription factor （T-bet）≥200% before treatment （P<0.05）. The multivariate Logistic regression analysis showed that CD3+HLA-DR+<6% （OR=2.998， 95%CI 1.036， 8.680， P<0.05） and T-bet≥200% （OR=3.634， 95%CI 1.076， 12.273， P<0.05） before treatment were independent influencing factors for WBC elevation≥50%. ③ Compared with the group with PLT elevation<50%， the group with PLT elevation≥50% presented lowered Th1 and CD3+HLA-DR+ levels and increased proportion of patients with Th1<12%， CD4+≥6%， and CD3+HLA-DR+<5% before treatment （P<0.05， P<0.01）. The multivariate Logistic regression analysis showed that CD3+HLA-DR+<5% before treatment was the independent influencing factor for PLT elevation≥50% （OR=16.190， 95%CI of 3.430 to 76.434， P<0.01）. ④ Compared with the group with ANC elevation<50%， the group with ANC elevation≥50% showed no significant changes in the hemogram parameters before treatment. ConclusionAs for the AA patients with rapid elevation in HGB， Yiqi Yangxue prescription combined with Western medicine demonstrate significant effects in the patients with Th2<5% and CD3+HLA-DR+≥9%， especially those with CD8+≥50%. As for the AA patients with rapid elevation in WBC， the therapy was particularly effective in the patients with CD3+HLA-DR+<6% and T-bet≥200%. As for the AA patients with rapid growth in PLT， the therapy was particularly effective in the patients with Th1<12% and CD4+≥6%， especially those with CD3+HLA-DR+<5%.

Pulmonary manifestations of hemodialysis patients combined with COVID-19 based on computer scan score and blood routine / 基础医学与临床

Objective To investigate the characteristics of blood routine,chest computed tomography(CT)imaging and short-term evolution of hemodialysis patients infected with Omicron variant of severe acute respiratory syndrom coronavirus 2(SARS-CoV-2).Methods A total of 204 patients diagnosed with Omicron variant infection in the First Hospital of Hohhot from September 2022 to September 2023 were retrospectively reviewed.Among them,89 patients with end-stage renal disease(ESRD)who were receiving hemodialysis were included in the hemo-dialysis group.The remaining 115 patients were control group,and the first blood routine results chest com-puted tomography(CT)imaging data were observed.Thirty-four patients in the hemodialysis group and 29 patients in the control group had complete pulmonary CT imaging data on the day of admission,5-6 days and 10-12 days after admission.The characteristics and chest CT scores of all cases were analyzed.Results 1)The percentage of monocytes,neutrophils,neutrophil/lymphocyte ratio and chest CT score of the hemo-dialysis group were higher than those of the control group,while the white blood cells,lymphocytes and lymphocyte percentage were lower than those of the control group.2)The positive rate of first chest CT was 49.4%in hemo-dialysis group and 35.7%in control group.3)The chest CT scores of the hemo-dialysis group and the control group on day 5 and day 6 were higher than those of first check.Chest CT was reexamined on days 10-12,and scores were higher in the hemo-dial-ysis group than in the control group.Conclusions Hemo-dialysis patients with COVID-19 have higher blood routine indexes,higher positive rate of lung CT and slower absorption than non-hemodialysis patients.

Research on establishing gastric cancer lymph node metastasis prediction model based on machine learning and routine laboratory indicators / 实用医学杂志

Objective To establish a prediction model for lymph node metastasis(LNM)of gastric cancer based on routine laboratory indicators using machine learning algorithms.Methods This study collected data of 741 gastric cancer patients at Affiliated Hospital of Nantong University between January 2020 and January 2022 for model training and testing.Additionally,data of 102 gastric cancer patients between January 2023 and October 2023 were collected for model validation.XGBoost algorithm was used to calculate the importance of indicators and filter out a set of important indicators from 66 indicators.Five machine learning algorithms,including K-Nearest Neighbor,Support Vector Machine,Multilayer Perceptron,Random Forest and Adaboost,were constructed and trained for comparative analysis.Furthermore,the stability and accuracy of the model were further validated on the validation set.Results This study selected a set of important indicators composed of 9 routine laboratory indicators and trained the gastric cancer LNM prediction model,named V9.Additionally,through comparative experiments,it was found that the Adaboost algorithm based on the boosting strategy had the best performance,with evaluation metrics such as area under the curve,F1 score,accuracy,sensitivity,and specificity ranging from 0.833 to 0.968.The accuracy of the predictions on the validation set was 94.12%.Conclusion V9 was a gastric cancer LNM prediction model that has auxiliary clinical diagnostic value.It can be used to assess the risk of patients accurately and provide a basis for clinical decision-making.

Clinical significance of detecting group B Streptococcus from midstream urine culture / 中国感染控制杂志

Objective To explore the clinical significance and antimicrobial resistance of group B Streptococcus(GBS)isolated from midstream urine culture,aiming to provide a basis for the diagnosis and treatment of clinical urinary tract infection(UTI).Methods Information about GBS strains isolated from midstream urine culture of in-patients and outpatient in a hospital in Nanjing from February 2020 to December 2022 were retrieved through labora-tory information system,strains with complete data were screened out.Case data,urine routine,and antimicrobial susceptibility testing results were reviewed.Results A total of 9 081 non-repetitive bacterial strains were detected from midstream urine culture,including 425 GBS strains,accounting for 4.7％,ranking sixth.Strains with incom-plete data were excluded,a total of 365 patients were included in the study.169(46.3％)were males and 196(53.7％)were females,with an average age of(55.4±15.2)years.365 patients who were detected GBS were from 17 de-partments,with the highest proportion being department of urology(n=237,64.9％).The underlying diseases of patients mainly included hypertension(n=136),diabetes(n=95),urolithiasis(n=120)and urinary tumors(n=98).211 patients underwent urological surgery,all were treated with antimicrobial agents before surgery,and 205 patients underwent indwelling urinary catheters after surgery;9 patients were detected GBS from urine during the middle and advanced stage of pregnancy.36.4％(n=133),38.9％(n=142)and 24.7％(n=90)patients had GBS colony count ≤104 CFU/mL,104-105 CFU/mL,and ≥105 CFU/mL,respectively.Patients with symptoms of UTI accounted for 24.9％(n=91),and asymptomatic bacteriuria accounted for 75.1％(n=274).The incidence of UTI symptoms in males was lower than that in females(19.5％vs 29.6％,P＜0.05).As the GBS colony count in urine culture increased,the proportion of patients with symptoms of UTI showed an upward trend(P＜0.05).On the day of urine culture,the positive rates of urine routine white blood cells,leukocyte esterase,and nitrite were 53.2％,50.1％,and 3.8％,respectively.The positive rates of urine occult blood,leukocyte esterase,white blood cells,and urine protein in patients with symptomatic UTI were all higher than those with asymptomatic bacteriuria patients(all P＜0.05).No GBS were found to be resistant to penicillin,ampicillin,vancomycin,linezolid,and tigecycline.The resistance rate to levofloxacin and moxifloxacin was about 40％,and resistance rate to tetracycline and clindamycin was over 60％.Conclusion GBS isolated from urine is more common in non-pregnant adults,and only a small percentage have symptoms of UTI.The results of urine culture and urine routine should be comprehen-sively judged based on patient's clinical symptoms and signs.GBS in urine is susceptible to multiple antimicrobial agents,and clinical medication should be adopted rationally based on antimicrobial susceptibility testing result.

Expressions of cytokines and procalcitonin in infective endocarditis / 局解手术学杂志

Objective To investigate the expressions of 12 cytokines(IL-1β,IL-2,IL-4,IL-5,IL-6,IL-8,IL-10,IL-12p70,IL-17,IFN-α,IFN-γ,TNF-α)and procalcitonin in patients with infective endocarditis(IE).Methods Ten IE patients admitted to our hospital from December 2021 to December 2022 were included into the IE group,10 patients with non-infectious and non-rheumatic valvular diseases who were admitted to our hospital at the same period were randomly selected as the control group,and blood sampling of all patients were conducted at admission.The expressions of 12 cytokines and blood routine indexes were detected by flow cytometry,and the level of procalcitonin was detected by ELISA.The correlations among the expression levels of cytokines in IE patients were analyzed by Pearson method and the correlations of IL-8 level and white blood cell count with procalcitonin in IE patients were analyzed by Spearman method.Results Compared with the control group,the levels of cytokines of IL-1β,IL-2,IL-6,IL-10,TNF-α,IFN-α,IFN-γ and IL-12p70 in the IE group were significantly increased(P<0.05),the white blood cell count,neutrophil percentage and procalcitonin were significantly increased(P<0.05).There was no significant difference in the percentage of monocytes between the two groups(P>0.05).IFN-α of IE patients was positively correlated with IL-2,TNF-α,IL-1β and IL-12p70,IL-2 was positively correlated with TNF-α and IL-1β,IL-12p70 was positively correlated with IFN-γ,and procalcitonin was significantly positively correlated with IL-8 and white blood cell count,with statistically significant differences(P<0.05).Conclusion The levels of IL-1β,IL-2,IL-6,IL-10,TNF-α,IFN-α,IFN-γ,IL-12p70 and procalcitonin in IE patients are significantly higher than those in the normal population,and the detections of these indicators are of guiding significance for the early diagnosis of IE and the evaluation of the severity of the disease.

Association between short-term exposure to atmospheric fine particulate matter and ozone and inflammatory indicators in peripheral blood of patients with pneumonia / 上海预防医学

ObjectiveTo explore the association between short-term exposure to atmospheric fine particulate matter （PM2.5） and ozone （O3） and systemic inflammatory indicators in patients with pneumonia， and to identify the susceptible populations. MethodsFrom September 2018 to April 2020， data of 1 480 patients admitted for pneumonia was collected from a tertiary hospital in Taiyuan City. Generalized additive models （GAMs） were used to explore the associations between PM2.5 and O3 exposure and inflammatory indicators of patients with pneumonia； and to explore the susceptibility factors and susceptible populations to PM2.5 and O3 exposures through stratified analyses. ResultsThe short-term exposure to PM2.5 was associated with changes in peripheral blood C-reation protein （CRP）， erythrocyte sedimentation （ESR）， easinophil （EOS）， neutrophil （NEU） and neutrophil-lymphocyte ratio （NLR） in patients with pneumonia， and there were different degrees of hysteresis effects， with the effect values reaching a maximum at lag03， lag03， lag0， lag03， lag03， respectively， which were 4.13% （95%CI： 0.43%‒7.84%）， 3.10% （95%CI： 0.24%‒5.97%）， 5.27% （95%CI： 3.12%‒7.42%）， 1.85% （95%CI： 0.36%‒3.34%）， and 2.53% （95%CI： 0.53%‒4.74%） for every 10 μg·m-3 of PM2.5. The changes in O3 concentration were associated with the elevation of peripheral blood PCT and ESR in patients with pneumonia， and their effect values all reached the maximum at lag01 d， every 1 μg·m-3 of O3 elevation increased by 0.38% （95%CI： 0.04%‒0.73%） and 0.47% （95%CI： 0.19%‒0.76%）， respectively. Stratified analyses showed that the associations of PM2.5 with peripheral blood CRP， ESR， NEU， and NLR in pneumonia patients were more significant in males， the elderly， and those with onset in the cold season； the associations of O3 with peripheral blood PCT and ESR in pneumonia patients were more significant in the elderly and those with onset in the warm season， and the peripheral blood CRP and PCT in female patients with pneumonia were more susceptible to the changes of O3. ConclusionShort-term exposure to atmospheric PM2.5 and O3 are positively associated with changes in inflammatory indicators in patients with pneumonia， and the effects of PM2.5 on patients with pneumonia are more extensive than those of O3， with a longer lag effect. In addition， elderly patients with pneumonia are more sensitive to air pollution， male patients with pneumonia are more sensitive to PM2.5， and female patients with pneumonia are more sensitive to O3. Cold and warm seasons can exacerbate the effects of PM2.5 and O3 on inflammatory indicators in patients with pneumonia， respectively， and the patients must be protected well.

Thromboelastography and routine coagulation tests in the management of coagulation during ECMO therapy: a comparative study / 中国输血杂志

【Objective】 To investigate the correlation and consistency between the parameters of thromboelastography(TEG) and routine coagulation tests, and to evaluate the application value of the two methods in heparin anticoagulation monitoring and coagulation function monitoring in patients receiving extracorporeal membrane oxygenation(ECMO) therapy. 【Methods】 A total of 138 patients who recieved ECMO in the Department of Critical Care Medicine of the People′s Hospital of Guangxi Zhuang Autonomous Region from October 2021 to December 2022 were selected. A total of 317 pairs of ordinary TEG and heparinase-modified TEG(hmTEG) parameters measured simultaneously were analyzed for correlation and consistency with activated partial thromboplastin time(APTT), fibrinogen(Fib), and platelet count(Plt), and the parameters tested when ECMO was established and 24 hours after ECMO operation were compared. 【Results】 The correlation coefficient between R values and APTT of hmTEG(r=0.441, P0.05), while as for hmTEG, the correlation was 0.359(P0.05). 【Conclusion】 The parameters of hmTEG can better reflect the real level of coagulation factors in patients receiving ECMO. The results of hmTEG and APTT are complementary to assess whether heparin in ECMO patients is overdosed, and hmTEG has unique advantages. Routine coagulation tests and TEG cannot replace each other, and the combination of them can achieve better anticoagulation and coagulation management.

A cost-effectiveness analysis of a novel algorithm to sequentially diagnose leprosy based on manufactured tests under the SUS perspective / Análise de custo-efetividade de um novo algoritmo para exame sequencial de hanseníase baseado em testes fabricados sob a perspectiva do SUS / Análisis de costo-efectividad de un nuevo algoritmo para el examen secuencial de lepra basado en pruebas fabricadas bajo la perspectiva del SUS

Abstract: Brazil has the second largest number of leprosy cases (a disease with a significant burden) in the world. Despite global and local efforts to eliminate this public health problem, inadequate or late diagnosis contribute to perpetuate its transmission, especially among household contacts. Tests such as the rapid IgM antibody detection (RT) and real-time polymerase chain reaction (RT-PCR) were developed to overcome the challenges of early diagnosis of leprosy. This study aimed to analyze the cost-effectiveness of a new diagnostic algorithm recommended by the Brazilian government to diagnose leprosy in household contacts of confirmed leprosy cases, which includes the RT and RT-PCR tests. A decision tree model was constructed and the perspective of the Brazilian Unified National Health System (SUS) and a 1-year time horizon were adopted. Only direct medical costs related to diagnostic tests were included. Effectiveness was measured as the number of avoided undiagnosed leprosy cases. Different scenarios were analyzed. The sequential use of RT, slit-skin smear (SSS) microscopy, and RT-PCR as recommended by the Brazilian Ministry of Health was compared to a base case (isolated SSS microscopy), yielding an incremental cost-effectiveness ratio of USD 616.46 per avoided undiagnosed leprosy case. Univariate sensitivity analysis showed that the prevalence of leprosy among household contacts was the variable that influenced the model the most. This is the first economic model to analyze a diagnostic algorithm of leprosy. Results may aid managers to define policies and strategies to eradicate leprosy in Brazil.

Resumo: O Brasil tem o segundo maior número de casos de hanseníase (doença com carga significativa) do mundo. Apesar dos esforços globais e locais para eliminar esse problema de saúde pública, o diagnóstico inadequado ou tardio contribui para perpetuar sua transmissão, especialmente entre contatos intradomiciliares. Exames como o teste rápido de anticorpos IgM (RT) e a reação em cadeia da polimerase em tempo real (RT-PCR) foram desenvolvidos para superar as barreiras do diagnóstico precoce da hanseníase. Este estudo teve como objetivo analisar a relação custo-efetividade de um novo algoritmo de diagnóstico recomendado pelo governo brasileiro para diagnosticar a hanseníase em contatos domiciliares de casos confirmados de hanseníase, que inclui os testes RT e RT-PCR. Foi construído um modelo de árvore de decisão e adotada a perspectiva do Sistema Único de Saúde (SUS) considerando o período de um ano. Foram incluídos apenas os custos médicos diretos relacionados aos exames diagnósticos. A efetividade foi medida considerando o número de casos evitados de hanseníase. Diferentes cenários foram analisados. O uso sequencial de RT, baciloscopia e RT-PCR, conforme recomendado pelo Ministério da Saúde, foi comparado a um caso base (baciloscopia isolada), obtendo-se uma razão de custo-efetividade incremental de USD 616,46 por caso evitado de hanseníase. A análise de sensibilidade univariada mostrou que a prevalência de hanseníase entre contatos intradomiciliares foi a variável que mais influenciou o modelo. Este é o primeiro modelo econômico a analisar um algoritmo diagnóstico da hanseníase. Os resultados poderão auxiliar os gestores na definição de políticas e estratégias para a erradicação da hanseníase no Brasil.

Resumen: Brasil tiene el segundo mayor número de casos de lepra (enfermedad con carga significativa) del mundo. A pesar de los esfuerzos globales y locales para eliminar ese problema de salud pública, el diagnóstico inadecuado o tardío contribuye a perpetuar su transmisión, sobre todo entre contactos intradomiciliarios. Los exámenes como la prueba rápida de anticuerpos IgM (RT) y la reacción en cadena de la polimerasa en tiempo real (RT-PCR) se desarrollaron para superar las barreras del diagnóstico precoz de la lepra. El objetivo de este estudio fue analizar la relación de costo-efectividad de un nuevo algoritmo de diagnóstico recomendado por el gobierno brasileño para diagnosticar la lepra en contactos domiciliarios de casos confirmados de lepra, que incluye las pruebas RT y RT-PCR. Se construyó un modelo de árbol de decisión y se adoptó la perspectiva del Sistema Único de Salud (SUS) teniendo en cuenta el periodo de un año. Solo se incluyeron los costos médicos directos relacionados con los exámenes diagnósticos. Se midió la efectividad teniendo en cuenta el número de casos de lepra evitados. Se analizaron distintos escenarios. Se comparó el uso secuencial de RT, baciloscopia y RT-PCR, conforme el Ministerio de Salud recomienda, con un caso base (baciloscopia aislada), y se obtuvo un cociente de costo-efectividad incremental de USD 616,46 por cada caso de lepra evitado. El análisis de sensibilidad univariante mostró que la prevalencia de lepra entre contactos intradomiciliarios fue la variable que más influyó el modelo. Este es el primer modelo económico que analiza un algoritmo diagnóstico de lepra. Los resultados podrán ayudar los gestores a definir políticas y estrategias para erradicar la lepra en Brasil.

Factors influencing data quality in routine health information systems in Maridi county, South Sudan

Background: Health system planning and monitoring rely on routine data collection, analysis and utilisation. However, underdeveloped countries need more data for decision-making. South Sudan's data management framework only partially functions, with delayed data collection and inaccurate data. The study examined the factors affecting data quality in Maridi County, South Sudan, aiming to improve resource forecasting and equitable health service delivery. Objective: The study sought to identify the obstacles and opportunities for improving data quality in health information systems (HIS) in Maridi County, Western Equatoria State, South Sudan. Methods: A cross-sectional study involving 106 respondents was conducted on 12 healthcare facilities in Maridi County. Statistical Package for the Social Sciences (SPSS) version 25 was used for descriptive, factor and thematic analysis to understand data quality, focussing on behavioural, organisational and technical aspects. Result: The study revealed that insufficient motivation, negative staff attitudes, excessive workloads, a lack of cooperation, personnel insufficiency, inadequate supervision, feedback and training influenced data quality. These factors were interrelated, with over 50% of variables showing weak to strong correlations. Set of standard indicators correlated with the presence of standard data collection tools (r = 0.51). Regular feedback from the County Health Department linked with completeness (r = 0.63) and the training of personnel on health management information systems (HMIS) and completeness resulted in moderate association (r = 0.488). Conclusion: Staff motivation, optimal staffing, training, regular feedback, and continuous supervision are crucial for maintaining the appropriate skill set for data quality. Contribution: Data quality can be achieved when standard tools and human resources are maintained and are evenly distributed.

Abnormalities in preoperative examinations of plastic surgery patients / Anormalidades em exames pré-operatórios de pacientes de cirurgia plástica

Introduction: Preoperative tests (EPO) aim to detect abnormalities and give greater safety to the procedure. However, the request for these tests is still controversial, either because they do not bring about changes in conduct for the procedure or result in some harm to the patient. The objective is to assess the frequency of EPO requests and abnormalities in aesthetic plastic surgery patients, to verify what these abnormalities are, what preoperative management should be done based on the finding, and to associate the data obtained with the patient's profile and the planned surgery. Method: Retrospective study evaluating medical records of aesthetic plastic surgery patients who underwent routine EPO in a plastic surgery hospital in 2019. Results: 978 patients were studied, and 51% had some abnormality in EPO. 93.7% were women, with a mean age of 46.5 years. 12.3 exams were performed per patient, and abnormality was observed in 6.1% of EPO. The exams that had the most abnormalities were the lipidogram (23.8%) and the cardiac evaluation (14.1%). Hypothyroidism was the most common comorbidity (18.4% of patients); 70% of diabetics had a glycemic level above the recommended level. Only 3.4% of the patients suffered a change in preoperative management due to EPO abnormality, and in 57.9% of these cases, the surgery was postponed. Test alterations were more frequent in male patients (p<0.0001). Conclusion: The performance of routine EPO showed a low frequency of altered exams (3.4%) and implied changes in the preoperative conduct of plastic surgery patients.

Introdução: Os exames pré-operatórios (EPO) visam detectar anormalidades e dar maior segurança ao procedimento. No entanto, a solicitação desses exames ainda é controversa, seja por não trazerem mudanças de conduta para o procedimento ou resultar em alguns malefícios para o paciente. O objetivo é avaliar a frequência de solicitações e de anormalidades dos EPO em pacientes de cirurgia plástica estética, verificar quais são estas anormalidades, qual conduta pré-operatória mediante o achado e associar os dados obtidos com o perfil do paciente e cirurgia prevista. Método: Estudo retrospectivo avaliando prontuários de pacientes de cirurgia plástica estética que realizaram EPO de rotina em um hospital de cirurgia plástica durante o ano de 2019. Resultados: Foram estudados 978 pacientes e 51% desses apresentaram alguma anormalidade nos EPO. 93,7% eram mulheres, com média de idade 46,5 anos. Foram realizados 12,3 exames por paciente e observada anormalidade em 6,1% dos EPO. Os exames que mais tiveram anormalidades foram o lipidograma (23,8%) e os da avaliação cardíaca (14,1%). Hipotireoidismo foi a comorbidade mais achada (18,4% dos pacientes); 70% dos diabéticos estavam com o nível glicêmico acima do recomendado. Apenas 3,4% dos pacientes sofreram alteração da conduta pré-operatória devido anormalidade dos EPO e em 57,9% desses casos houve adiamento da cirurgia. Alterações de exames foram mais frequentes em pacientes do sexo masculino (p<0,0001). Conclusão: A realização de EPO de rotina mostrou baixa frequência de exames alterados (3,4%) e implicou em mudanças na conduta pré-operatória em pacientes de cirurgia plástica.