Polymyxin monotherapy versus polymyxin-based combination therapy against carbapenem-resistant Klebsiella pneumoniae: A systematic review and meta-analysis.

OBJECTIVES: This meta-analysis was performed to compare polymyxin monotherapy and polymyxin-based combination therapy for carbapenem-resistant Klebsiella pneumoniae (CR-KP) infections. METHODS: We conducted searches on MEDLINE, Embase and Cochrane Collaborative database for both observational studies and randomised controlled trials (RCTs) comparing polymyxin monotherapy with polymyxin-based combination therapy in patients with CR-KP infection. The primary outcome was mortality. We divided all included studies into several groups according to different combination-combination and different infection types. The odds ratio (OR) and 95% confidence intervals (CI) were calculated for outcome analysis. RESULTS: Ten studies with 481 patients were included. Polymyxin monotherapy was associated with higher mortality than polymyxin-based combination therapy in treatment of CR-KP bloodstream infections (BSI) (OR 1.93, 95% CI 1.14-3.27, P = 0.01) and ventilator-associated pneumonia (VAP)/hospital-acquired pneumonia (HAP) (OR 3.82, 95% CI 1.15-12.71, P = 0.03). In subgroup analysis of different combinations, mortality was significantly higher with polymyxin monotherapy compared with combination therapy with tigecycline (OR 1.88, 95% CI 1.05-3.37, P = 0.03), or with cabapenem (OR 3.11, 95% CI 1.25-7.74, P = 0.01), but no differences were found in combinations with aminoglycosides (OR 1.29, 95% CI 0.72-2.29, P = 0.38). Three-drug combination therapy including polymyxin was also associated with significant survival benefit (OR 3.86, 95% CI 1.60-9.32, P = 0.003). CONCLUSIONS: Polymyxin-based combination therapy provides significant survival benefit in treatment of CR-KP, which appears to be more pronounced when a carbapenem or tigecycline is included in the regimen.

Prediction of COVID-19 Severity Using Chest Computed Tomography and Laboratory Measurements: Evaluation Using a Machine Learning Approach.

BACKGROUND: Most of the mortality resulting from COVID-19 has been associated with severe disease. Effective treatment of severe cases remains a challenge due to the lack of early detection of the infection. OBJECTIVE: This study aimed to develop an effective prediction model for COVID-19 severity by combining radiological outcome with clinical biochemical indexes. METHODS: A total of 46 patients with COVID-19 (10 severe, 36 nonsevere) were examined. To build the prediction model, a set of 27 severe and 151 nonsevere clinical laboratory records and computerized tomography (CT) records were collected from these patients. We managed to extract specific features from the patients' CT images by using a recently published convolutional neural network. We also trained a machine learning model combining these features with clinical laboratory results. RESULTS: We present a prediction model combining patients' radiological outcomes with their clinical biochemical indexes to identify severe COVID-19 cases. The prediction model yielded a cross-validated area under the receiver operating characteristic (AUROC) score of 0.93 and an F1 score of 0.89, which showed a 6% and 15% improvement, respectively, compared to the models based on laboratory test features only. In addition, we developed a statistical model for forecasting COVID-19 severity based on the results of patients' laboratory tests performed before they were classified as severe cases; this model yielded an AUROC score of 0.81. CONCLUSIONS: To our knowledge, this is the first report predicting the clinical progression of COVID-19, as well as forecasting severity, based on a combined analysis using laboratory tests and CT images.

[Clinical phenotype and genotype analysis of the family with the Usher syndrome].

OBJECTIVE: To detect potential variants in a family affected with Usher syndrome type I, and analyze its genotype-phenotype correlation. METHODS: Clinical data of the family was collected. Potential variants in the proband were detected by high-throughput sequencing. Suspected variants were verified by Sanger sequencing. RESULTS: The proband developed night blindness at 10 year old, in addition with bilateral cataract and retinal degeneration. Hearing loss occurred along with increase of age. High-throughput sequencing and Sanger sequencing revealed that she has carried compound heterozygous variants of the MYO7A gene, namely c.2694+2T>G and c.6028G>A. Her sister carried the same variants with similar clinical phenotypes. Her daughter was heterozygous for the c.6028G>A variant but was phenotypically normal. CONCLUSION: The clinical features and genetic variants were delineated in this family with Usher syndrome type I. The results have enriched the phenotype and genotype data of the disease and provided a basis for genetic counseling.

Efficacy of Xuebijing for coagulopathy in patients with sepsis.

OBJECTIVES: To provide evidence of the clinical efficacy of Xuebijing (XBJ) on blood coagulation in patients with sepsis. METHODS: We conducted this meta-analysis in The People's Hospital of Liaoning Province, Shenyang, China between December 2013 and May 2014. We searched a number of databases for relevant randomized controlled trials (RCTs) published before December 2013 using the keywords 'Xuebijing', 'coagulation' and 'sepsis'. Statistical analysis was performed with Review Manager 5.2 from the Cochrane Collaboration. RESULTS: Fourteen RCTs involving 867 patients were included. Compared with placebo, XBJ injection significantly improved platelets (mean differences [MD] = 42.14, 95% confidence interval [CI]: 22.42 - 61.86, p<0.00001), shortened the activated partial thromboplastin time (MD = -4.81, 95% CI: -7.86 - [-1.76], p=0.002), shortened the prothrombin time (MD = -2.33, 95% CI: -4.15 - [-0.51], p=0.01), and shortened the thrombin time (MD = -2.05, 95% CI: -3.52 - [-0.58], p=0.006). However, no significant difference was found between the XBJ injection and the placebo group for fibrinogen (MD = 0.21, 95% CI: -0.38 - 0.81, p=0.48). CONCLUSION: Xuebijing injection may improve coagulopathy in patients with sepsis. High-quality and large sample clinical trials are needed for confirmation.