ObjectiveTo achieve high-dimensional prediction of class imbalanced of adverse drug reaction（ADR） of traditional Chinese medicine（TCM） and to classify and identify risk factors affecting the occurrence of ADR based on the post-marketing safety data of TCM monitored centrally in real world hospitals. MethodThe ensemble clustering resampling combined with regularized Group Lasso regression was used to perform high-dimensional balancing of ADR class-imbalanced data， and then to integrate the balanced datasets to achieve ADR prediction and the risk factor identification by category. ResultA practical example study of the proposed method on a monitoring data of TCM injection performed that the accuracy of the ADR prediction， the prediction sensitivity， the prediction specificity and the area under receiver operating characteristic curve（AUC） were all above 0.8 on the test set. Meanwhile， 40 risk factors affecting the occurrence of ADR were screened out from total 600 high-dimensional variables. And the effect of risk factors on the occurrence of ADR was identified by classification weighting. The important risk factors were classified as follows：past history， medication information， name of combined drugs， disease status， number of combined drugs and personal data. ConclusionIn the real world data of rare ADR with a large amount of clinical variables， this paper realized accurate ADR prediction on high-dimensional and class imbalanced condition， and classified and identified the key risk factors and their clinical significance of categories， so as to provide risk early warning for clinical rational drug use and combined drug use， as well as scientific basis for reevaluation of safety of post-marketing TCM.

Objective:To summarize and analyze the clinical data of Chinese patients with colony-stimulating factor 1 receptor (CSF1R)-related leukoencephalopathy, and clarify the phenotypic and genetic characteristics of Chinese patients.Methods:Medical history of patients with CSF1R-related leukoencephalopathy diagnosed from April 1, 2018 to January 31, 2021 in the department of neurology of 22 hospitals in China was collected, and scores of Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment Scale (MoCA), magnetic resonance severity scale were evaluated. Group comparison was performed between male and female patients.Results:A total of 62 patients were included, and the male-female ratio was 1∶1.95. The age of onset was (40.35±8.42) years. Cognitive impairment (82.3%, 51/62) and motor symptoms (77.4%,48/62) were the most common symptoms. The MMSE and MoCA scores were 18.79±7.16 and 13.96±7.23, respectively, and the scores of two scales in male patients (22.06±5.31 and 18.08±5.60) were significantly higher than those in females (15.53±7.41 , t=2.954, P=0.006; 10.15±6.26, t=3.328 , P=0.003). The most common radiographic feature was bilateral asymmetric white matter changes (100.0%), and the magnetic resonance imaging severity scale score was 27.42±11.40, while the white matter lesion score of females (22.94±8.39) was significantly higher than that of males (17.62±8.74 , t=-2.221, P<0.05). A total of 36 CSF1R gene mutations were found in this study, among which c.2381T>C/p.I794T was the hotspot mutation that carried by 17.9% (10/56) of the probands. Conclusions:The core phenotypic characteristics of CSF1R-related leukoencephalopathy in China are progressive motor and cognitive impairment, with bilateral asymmetrical white matter changes. In addition, there exist gender differences clinically, with severer cognitive impairment and imaging changes in female patients. Thirty-six CSF1R gene mutations were found in this study, and c.2381T>C/p. I794T was the hotspot mutation.

Objective:To analyze the characteristics of malaria epidemic situation before and after malaria elimination in Qiandongnan Prefecture, and to provide the basis for establishment of effective strategies and measures to consolidate the achievements of malaria prevention and control.Methods:The data of malaria cases in 16 counties (cities) of Qiandongnan Prefecture from 2005 to 2018 were collected, and descriptive epidemiological method was used to analyze the infection rate of Plasmodium among local residents and floating population before (2005-2011) and after (2012-2018) elimination of malaria, and the characteristics of population distribution, seasonal distribution, species of Plasmodium and types of malaria vectors were analyzed. Results:Before elimination of malaria, total of 1 412 cases of malaria were reported, among those cases, 1 361 cases were local cases, accounting for 96.39% of the total cases. After elimination of malaria, total of 17 cases were reported, all of them were imported cases. After comparison of malaria cases before and after the elimination, the proportion of people aged from 18 to 60 was 70.54% (996/1 412) before the elimination, all 17 imported cases were 18-60 years old after the elimination, and the proportion of children/students decreased from 24.65% (348/1 412) before the elimination to 0 after the elimination. The peak incidence of malaria cases before the elimination was from June to October, and cases occurred every month. After the elimination, the imported cases were sporadic. Plasmodium vivax was the main species of Plasmodium before the elimination (98.58%, 1 392/1 412), and Plasmodium falciparum was mainly imported after the elimination (70.59%, 12/17). Before and after the elimination, Anopheles sinensis, the malaria vector, was the dominant population, but no distribution of Anopheles minimus and Anopheles anthropophagus was found after 2015. Conclusions:After the elimination of malaria in Qiandongnan Prefecture, there is a risk of local malaria cases caused by imported cases. It is suggested that local authorities should focus on the treatment of suspected malaria cases and vector surveillance of overseas returnees in the future.

Objective:To investigate the clinical and electrophysiological characteristics of tremor in patients with epilepsy, and explore the related factors affecting the occurrence of tremor.Methods:A cross-sectional survey was conducted to collect 80 patients with epilepsy in the Department of Neurology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from September 2018 to September 2019. Patients were divided into tremor group and non-tremor group according to clinical evaluation. All patients with epilepsy were evaluated by the Clinical Rating Scale for Tremor and were examined by electromyography (EMG).Results:There were 22 (27.5%, 22/80) patients who were found with tremor by self-reported complaint and (or) physical examination by clinicians, mainly manifested as postural tremor in the upper limbs, and 7.5% (6/80) patients also showed resting tremor. The EMG examination revealed that 51 patients (63.8%, 51/80) had tremor in the upper limbs. The incidence was 2.3 times as much as clinical evaluation. Among them, 42 patients (82.3%, 42/51) manifested postural tremor in upper limbs, 32 patients (62.7%, 32/51) manifested resting tremor. The peak frequency of postural tremor was (7.2±4.1) Hz, and synchronous burst pattern was mainly showed. The peak frequency of resting tremor was (5.3±2.2) Hz, and alternating burst pattern was mainly showed. Multivariate analysis showed that large number of medications and long duration of taking valproate acid were significantly related to the occurrence of tremor in patients with epilepsy.Conclusions:Tremor is mainly manifested as postural tremor in the upper limbs in patients with epilepsy. The EMG is a more sensitive and objective examination, which can detect tremor that was not yet noticed. Large number of medications and long duration of taking valproate acid might be the mainly associated factors for occurrence of tremor in patients with epilepsy.

A 53-year-old female patient received an IV infusion of nivolumab 140 mg once daily 20 months after the operation of intrahepatic cholangiocarcinomas. The drug was used on the first and 20th days of the treatment. On day 3 of the second injection of the drug, the patient developed weakness in both lower limbs, which was aggravated on day 14, accompanied by symptoms such as blurred vision, ptosis, chest tightness, short of breath, and palpitation. On day 24 of the second injection of the drug, her condition became worse, the patient raved, then developed no response to voice stimuli. The patient′s consciousness recovered after mechanical ventilation with nasotracheal intubation and symptomatic and supportive treatments. The patient was diagnosed as drug-induced myasthenia gravis crisis combined with heart failure and respiratory failure. After 19 days of treatments with hormone and human immune globulin, her ptosis and palpitation were improved. However, her respiratory failure was not improved. She was unable to breathe spontaneously.

A 53-year-old female patient received an IV infusion of nivolumab 140 mg once daily 20 months after the operation of intrahepatic cholangiocarcinomas. The drug was used on the first and 20th days of the treatment. On day 3 of the second injection of the drug, the patient developed weakness in both lower limbs, which was aggravated on day 14, accompanied by symptoms such as blurred vision, ptosis, chest tightness, short of breath, and palpitation. On day 24 of the second injection of the drug, her condition became worse, the patient raved, then developed no response to voice stimuli. The patient′s consciousness recovered after mechanical ventilation with nasotracheal intubation and symptomatic and supportive treatments. The patient was diagnosed as drug-induced myasthenia gravis crisis combined with heart failure and respiratory failure. After 19 days of treatments with hormone and human immune globulin, her ptosis and palpitation were improved. However, her respiratory failure was not improved. She was unable to breathe spontaneously.

OBJECTIVE: To assess the effects of iterative model reconstruction (IMR) on image quality for demonstrating non-calcific high-risk plaque characteristics of coronary arteries. MATERIALS AND METHODS: This study included 66 patients (53 men and 13 women; aged 39–76 years; mean age, 55 ± 13 years) having single-vessel disease with predominantly non-calcified plaques evaluated using prospective electrocardiogram-gated 256-slice CT angiography. Paired image sets were created using two types of reconstruction: hybrid iterative reconstruction (HIR) and IMR. Plaque characteristics were compared using the two algorithms. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the images and the CNR between the plaque and adjacent adipose tissue were also compared between the two reformatted methods. RESULTS: Seventy-seven predominantly non-calcified plaques were detected. Forty plaques showed napkin-ring sign with the IMR reformatted method, while nineteen plaques demonstrated napkin-ring sign with HIR. There was no statistically significant difference in the presentation of positive remodeling, low attenuation plaque, and spotty calcification between the HIR and IMR reconstructed methods (all p > 0.5); however, there was a statistically significant difference in the ability to discern the napkin-ring sign between the two algorithms (χ2 = 12.12, p < 0.001). The image noise of IMR was lower than that of HIR (10 ± 2 HU versus 12 ± 2 HU; p < 0.01), and the SNR and CNR of the images and the CNR between plaques and surrounding adipose tissues on IMR were better than those on HIR (p < 0.01). CONCLUSION: IMR can significantly improve image quality compared with HIR for the demonstration of coronary artery and atherosclerotic plaques using a 256-slice CT.
Adipose Tissue ; Angiography ; Atherosclerosis ; Coronary Artery Disease ; Coronary Vessels ; Female ; Humans ; Image Processing, Computer-Assisted ; Male ; Methods ; Multidetector Computed Tomography ; Noise ; Plaque, Atherosclerotic ; Prospective Studies ; Signal-To-Noise Ratio

Multidrug resistance (MDR) in human cancer is one of greatest challenges in cancer therapy. Natural products, especially the alkaloids, exert reversed effects on MDR with low toxicity, by interacting with various targets. In this review article, we summarize the recent progress made in the research of the main alkaloids, including classification, function, mechanism, research status, and application in reversing MDR.
Alkaloids ; administration & dosage ; chemistry ; Animals ; Biological Products ; administration & dosage ; chemistry ; Drug Antagonism ; Drug Resistance, Multiple ; Drug Resistance, Neoplasm ; Humans ; Neoplasms ; drug therapy

Objective To develop a clinical nomogram for predicting the probability of bladder outlet obstruction (BOO) in male LUTS/BPH using the most common and noninvasive parameters in clinical practice , with the hope of detecting BOO individually and precisely. Methods Retrospectively analyze the outpatients and inpatients of male LUTS/BPH from November 2003 to November 2015 in Guangzhou First People′s Hospital. Collect the Pressure-flow study parameters and other clinical parameters including Qmax , PV, TZV, TZI, PSA, and PVR. Find out the best independent predictors on the diagnosis of BOO and develop the nomogram for pre-dicting BOO. Results The data from 1 599 patients were analyzed. The areas under the ROC curve (AUCs)of PV, TZV, TZI, PSA, Qmax, and PVR were 0.803, 0.807, 0.698, 0.775, 0.742, and 0.641, respectively. Qmax, PV, and PSA were selected as the best clinical parameters to predict BOO. The Logistic regression equa-tion is Log(p)=0.332 4 - 0.201 8*Qmax + 0.026 6*PV + 1.135 1*PSA. Finally, a nomogram model was developed by R statistical software. This nomogram showed a concordance index of 0.854 according to the inter-nal validation of the model. Conclusions The clinical nomogram presented a high accuracy (85.4%) in de-tecting BOO, which would help predicting BOO in male LUTS/BPH noninvasively, individually, accurately, and providing valuable reference and guidance in clinical decision.

Objective To evaluate the additional efficacy of local anesthetic injection (LAI) as a part of multimodal anal?gesia in patients undergoing total knee arthroplasty (TKA) with respect to pain, narcotic use, knee function and complications. Methods A multicenter randomized, controlled, double blind study was performed. A total of 101 patients undergoing unilateral TKA in two centers were randomly divided into injection group and control group. Injection group (50 cases) received local anes?thetic injection of ropivacaine (200 mg), fentanyl (1μg) and epinephrine (1∶1 000, 0.25 mg) in operation and control group (51 cas?es) did not. All patients received standardized general anesthesia and postoperative intravenous patient controlled analgesia (PCA). Preoperative baseline data, surgery?related conditions, postoperative pain (on a 0 to 10 scale), knee function, time of open?ing PCA, narcotic dosage in PCA and complications were compared respectively. Results The time of opening PCA in injection group (4-10 h, M=8 h) was longer than that in control group (2-5 h, M=4 h) (P<0.05). The 12 h, 24 h and total narcotic use of PCA in injection group (8.62±3.601 ml, 21.22±9.220 ml, 38.52±7.764 ml) was less than that in control group (18.43±9.671 ml, 35.30± 11.414 ml, 55.52±12.405 ml) (P<0.05). At post anesthesia care unit the mean VAS in injection group (2.40±1.927) was lower than that in control group (3.06 ± 2.073) (P<0.05). There was no difference in mean VAS at other time points, knee function, length of stay between two groups (P>0.05). Conclusion LIA in TKA can relieve pain early after TKA, prolong the time of opening PCA and reduce narcotic use compared with patients without it. It is simple and safe to use.