BACKGROUND: There is little literature describing the artificial intelligence (AI)-aided diagnosis of severe pneumonia (SP) subphenotypes and the association of the subphenotypes with the ventilatory treatment efficacy. The aim of our study is to illustrate whether clinical and biological heterogeneity, such as ventilation and gas-exchange, exists among patients with SP using chest computed tomography (CT)-based AI-aided latent class analysis (LCA). METHODS: This retrospective study included 413 patients hospitalized at Xinhua Hospital diagnosed with SP from June 1, 2015 to May 30, 2020. AI quantification results of chest CT and their combination with additional clinical variables were used to develop LCA models in an SP population. The optimal subphenotypes were determined though evaluating statistical indicators of all the LCA models, and clinical implications of them such as guiding ventilation strategies were further explored by statistical methods. RESULTS: The two-class LCA model based on AI quantification results of chest CT can describe the biological characteristics of the SP population well and hence yielded the two clinical subphenotypes. Patients with subphenotype-1 had milder infections ( P <0.001) than patients with subphenotype-2 and had lower 30-day ( P <0.001) and 90-day ( P <0.001) mortality, and lower in-hospital ( P = 0.001) and 2-year ( P <0.001) mortality. Patients with subphenotype-1 showed a better match between the percentage of non-infected lung volume (used to quantify ventilation) and oxygen saturation (used to reflect gas exchange), compared with patients with subphenotype-2. There were significant differences in the matching degree of lung ventilation and gas exchange between the two subphenotypes ( P <0.001). Compared with patients with subphenotype-2, those with subphenotype-1 showed a relatively better match between CT-based AI metrics of the non-infected region and oxygenation, and their clinical outcomes were effectively improved after receiving invasive ventilation treatment. CONCLUSIONS A two-class LCA model based on AI quantification results of chest CT in the SP population particularly revealed clinical heterogeneity of lung function. Identifying the degree of match between ventilation and gas-exchange may help guide decisions about assisted ventilation.
Humans ; Tomography, X-Ray Computed/methods* ; Male ; Female ; Retrospective Studies ; Middle Aged ; Artificial Intelligence ; Aged ; Pneumonia/diagnosis* ; Latent Class Analysis ; Adult

【Objective】 To investigate the development of adaptability in children aged 2 - 6, and to explore its influencing factors, so as to provide reference for promoting the development of adaptability in young children. 【Methods】 Data were from the National Nutrition and Health Systematic Survey for Children in China, and 3 319 children aged 2 - 6 and their parents from 28 sites across 14 provinces were recruited in this study.The Development Scale for Children Aged 0 - 6 years (WS/T 580-2017) was used to measure the developmental quotient of children′s adaptive ability, and a survey questionnaire was used to collect relevant information about children and their parents. 【Results】 Among 3 319 children aged 2 - 6, the proportion of slightly low or low level of adaptability, moderate adaptability development, good and excellent adaptability development was 7.68%,66.25% and 26.06%, respectively.The proportion of children aged 5 - 6 with good and excellent adaptability was lower in 3-year-old and 4-year-old groups (χ²=59.29, P<0.05).Multiple stepwise linear regression showed that children′s gender (β=0.06), gestational age of birth (β=-0.05), only child (β=-0.04), left-behind child (β=-0.04), the main caregiver (β=-0.06), and the education level of parents (β=0.09, 0.10), whether parents actively pay attention to children′s emotions (β=-0.06) and whether children play with homemade toys (β=-0.04) were the influencing factors of children′s adaptive development quotient.Girls, full-term children, only children, non-left-behind children, children with parents as main caregivers, parents with a high level of education, parents who often take the initiative to pay attention to children′s emotions, and children who play with homemade toys had a higher level of adaptability development quotient. 【Conclusions】 The development level of adaptability in children aged 2 - 6 in China is mostly above the average level and is related to multiple factors.Targeted intervention work can be carried out on relevant factors in order to promote the development of children′s adaptability.

Objective To investigate the effect of Xuebijing injection on the inflammatory and coagulation response of complicated intra-abdominal infection by sepsis.Methods A retrospective study was conducted.A total of 274 patients with complicated intra-abdominal infection by sepsis admitted to Yidu Central Hospital of Weifang from June 2020 to July 2023 were enrolled.According to whether Xuebijing was used or not,the patients were divided into an observation group(141 cases)and a control group(133 cases).The patients in both groups were treated with conventional western medicine,and those in the observation group were additionally given Xuebijing(Xuebijing injection 100 mL in 0.9%NaCl solution 100 mL via intravenous infusion,twice per day for a continuous application of 5 days).The differences of clinical prognosis and the serum levels of inflammatory indicators[interleukin-6(IL-6),procalcitonin(PCT),C-reactive protein(CRP)and endotoxin]and coagulation indexes[D-dimer,fibrinogen(FIB),prothrombin time(PT)and activated partial thromboplastin time(APTT)before treatment and on the 2nd,3rd,5th day respectively after treatment were compared,and the clinical prognosis was observed.Results There were no significant differences in the indexes of inflammation and coagulation function between the two groups before treatment.With the extension of therapy duration,following treatment in two groups,the serum levels of inflammatory indicators and coagulation indexes(D-dimer,FIB)decreased,as did coagulation indexes(PT,APTT),reaching the lowest levels on the 5th day.The inflammatory markers and coagulation indexes of observation group were significantly lower than those of control group[IL-6(ng/L):18.89±8.22 vs.24.59±10.39,PCT(μg/L):0.30±0.16 vs.0.52±0.20,CRP(mg/L):13.13±6.54 vs.28.87±8.66,endotoxin(kEU/L):0.17±0.06 vs.0.22±0.08,D-dimer(mg/L):1.75±0.61 vs.1.96±0.77,FIB(g/L):2.50±0.78 vs.3.10±0.94,PT(s):14.16±1.90 vs.15.05±1.46,APTT(s):34.52±5.40 vs.36.21±4.72,both P<0.05].The intensive care unit(ICU)stay time and total hospitalization time were shortened in the observation group than those in the control group[ICU stay time(days):5.71±2.22 vs.6.86±2.99,hospitalization time(days):15.50±6.39 vs.17.02±5.70,both P<0.05];the mortality was significantly lower in the observation group than that in the control group[21.27%(30/141)vs.32.33%(43/133),P<0.05].Conclusion The treatment of complicated intra-abdominal infection by sepsis with Xuebijing injection while receiving conventional western medicine treatment can effectively decrease inflammatory and coagulation response,have high efficacy of inflammatory and coagulation co-treatment,and have some important clinical values.

OBJECTIVE: To prepare customized porous silicone orbital implants using embedded 3D printing and assess the effect of surface modification on the properties of the implants. METHODS: The transparency, fluidity and rheological properties of the supporting media were tested to determine the optimal printing parameters of silicone. The morphological changes of silicone after modification were analyzed by scanning electron microscopy, and the hydrophilicity and hydrophobicity of silicone surface were evaluated by measuring the water contact angle. The compression modulus of porous silicone was measured using compression test. Porcine aortic endothelial cells (PAOECs) were co-cultured with porous silicone scaffolds for 1, 3 and 5 days to test the biocompatibility of silicone. The local inflammatory response to subcutaneous porous silicone implants was evaluated in rats. RESULTS: The optimal printing parameters of silicone orbital implants were determined as the following: supporting medium 4% (mass ratio), printing pressure 1.0 bar and printing speed 6 mm/s. Scanning electron microscopy showed that the silicone surface was successfully modified with polydopamine and collagen, which significantly improved hydrophilicity of the silicone surface (P < 0.05) without causing significant changes in the compression modulus (P > 0.05). The modified porous silicone scaffold had no obvious cytotoxicity and obviously promoted adhesion and proliferation of PAOECs (P < 0.05). In rats bearing the subcutaneous implants, no obvious inflammation was observed in the local tissue. CONCLUSION Poprous silicone orbital implants with uniform pores can be prepared using embedded 3D printing technology, and surface modification obviously improves hydrophilicity and biocompatibility of the silicone implants for potential clinical application.
Animals ; Rats ; Swine ; Silicon ; Orbital Implants ; Endothelial Cells ; Porosity ; Silicones ; Printing, Three-Dimensional

OBJECTIVE To provide reference for clarifying improvement effects of Anemarrhena asphodeloides on sepsis- induced myocardial injury and potential material basis. METHODS Water extract of A. asphodeloides was extracted by thermal reflux method. Total xanthone and total saponins in A. asphodeloides were separated by macroporous adsorption resin. The mice model of sepsis-induced myocardial injury was established by intraperitoneal injection of lipopolysaccharide. The effects of the location of three extraction fractions and the monomers of A. asphodeloides as mangiferin， timosaponin AⅢ and timosaponin BⅡ on the survival rate of the model mice were explored. HE staining was used to observe the effects of mangiferin， timosaponin AⅢ and timosaponin BⅡ on myocardial morphology in model mice. The effects of mangiferin on mRNA expressions of inflammatory cytokines [interleukin-6 （IL-6）， IL-1β and tumor necrosis factor-α （TNF-α）] and the level of reactive oxygen species （ROS） in myocardial tissue of model mice were detected. RESULTS Compared with the model group， the survival rate of mice in the intervention group of total xanthone， total saponins and water extract was increased to different extents， especially total xanthone fraction. Mangiferin， timosaponin AⅢ and timosaponin BⅡcould improve the degree of myocardial cell swelling and muscle bundle arrangement disorder in model mice， especially mangiferin. Compared with model group， mRNA expressions of IL-6， IL- 1β and TNF- α， ROS level in myocardium of mice after mangiferin intervention were decreased to different extents. CONCLUSIONS The different extraction fractions of A. asphodeloides can improve survival rate of mice with sepsis-induced myocardial injury， especially total xanthone fraction. Mangiferin is the best among the three monomers of A. asphodeloides to improve sepsis-induced myocardial injury， which may play a role in anti-sepsis myocardial injury by anti-inflammation and antioxidantion.

Objective:To investigate whether peritoneal dialysis can replace hemodialysis as an option for urgent-start dialysis for elderly patients with end-stage renal disease who need emergency initial dialysis.Methods:This was a retrospective cohort study, with enrolment of patients ≥65 years with end-stage renal disease who started hemodialysis or peritoneal dialysis for the first time at the nephrology department of our hospital between January 1, 2013 and June 1, 2019 and were followed up regularly.All patients started dialysis within 5 days of catheterization.According to different dialysis methods, patients were divided into the urgent-start hemodialysis(USHD)group and the urgent-start peritoneal dialysis(USPD)group, and were followed up until December 31, 2019.Short-term(30 days after the procedure)dialysis-related complications and survival were compared between the two groups.Results:A total of 89 elderly patients with end-stage renal disease receiving urgent-start dialysis were included, with 40 cases in the USPD group and 49 cases in the USHD group.There was no significant difference in the incidences of infection-related complications(0.0% vs.2.5%), non-infection-related complications(2.0% vs.2.5%), re-catheterization(0 vs.0)and bacteremia(0 vs.0)between the two groups( P> 0.05). The Kaplan-Meier survival curve showed that the median survival times of patients with USHD and with USPD were 63.0 months and 38.0 months, respectively, with no statistical significance(Log Rank, χ2=0.025, P=0.88). The Charlson comorbidity index( HR: 1.205, 95% CI: 1.026-1.415, P=0.023)and albumin level( HR: 0.949, 95% CI: 0.903-0.997, P=0.037)were independent risk factors for the survival and prognosis of elderly patients with urgent-start dialysis.Furthermore, we stratified and made an interactive analysis of the albumin level and the comorbidity index of elderly patients with urgent-start dialysis and found that there was no significant difference between the two modes of dialysis in the survival rate of elderly patients with end-stage renal disease( P>0.05). Conclusions:It is safe and effective to start dialysis within 5 days after peritoneal dialysis catheterization.For elderly patients with end-stage renal disease, peritoneal dialysis can replace hemodialysis as an option for urgent-start dialysis.

OBJECTIVE: To analyze the clinical characteristics and treatment outcomes of the first episode of peritoneal dialysis-associated peritonitis (PDAP) in patients receiving long-term peritoneal dialysis. METHODS: The clinical data of patients with the first episode of PDAP in 4 general hospitals in Jilin Province from 2013 to 2019 were collected retrospectively. According to the duration of dialysis, the patients were divided into long-term (≥36 months) and short-term (< 36 months) dialysis groups for comparison of the clinical data, treatment outcomes and long-term prognostic events. RESULTS: A total of 625 patients with PDAP were enrolled, including 93 on long-term and 532 on short-term dialysis. Compared with those on short-term dialysis, the patients on long-term dialysis had significantly higher hemoglobin levels and lower glomerular filtration rates when the first episode of PDAP occurred ( CONCLUSIONS Compared with those on short-term dialysis, patients on long-term dialysis are prone to gram-negative bacterial infection when the first episode of PDAP occurs with worse treatment outcomes but similar long-term outcomes. Long-term dialysis is an independent risk factor of extubation and treatment failure for the first episode of PDAP, and fungal and mixed bacterial infections are independent risk factors for treatment failure of the first PDAP in patients with long-term dialysis.
Humans ; Kidney Failure, Chronic/therapy* ; Peritoneal Dialysis/adverse effects* ; Peritonitis/etiology* ; Retrospective Studies ; Treatment Outcome

The relationship between the conformation of interferon-α (IFN-α) and its anti-viral activity were analyzed by circular dichroism (CD) and flow cytometry (FCM) techniques. The recombinant human IFN-α (rIFN-α2b and rIFN-α2a) were used. CD spectra from 190 nm to 240 nm indicated that two the IFN-α showed stable secondary structure at 65 degrees C, but unstable when the temperature was above 65 degrees C, and the change was irreversible. FCM data of the anti-viral activity of IFN-α indicated that the change of its secondary structures partly weakened its anti-viral activity. The rIFN-α2b and rIFN-α2a showed the same phenomenon. These data indicated that the conformation of IFN-α is one of the factors to influence its anti-viral activity and the combination of CD and FCM is a good method to analyze the relationship between the conformation of protein drugs and their biological activities in single cell level.
Antiviral Agents ; chemistry ; Circular Dichroism ; Flow Cytometry ; Humans ; Interferon-alpha ; chemistry ; Protein Structure, Secondary ; Recombinant Proteins ; chemistry

BACKGROUNDVascular endothelial growth factor (VEGF) is a major mediator of angiogenesis, and plays a key role in the pathogenesis of diabetic retinopathy (DR). This study was designed to identify the possible role of VEGF gene polymorphisms in the development of DR in type 2 diabetic patients in Chinese and clarify the relationship between VEGF serum levels and the risk of DR.

METHODSThis cross-sectional study included 1 040 Chinese subjects with type 2 diabetes mellitus. There were 372 patients diagnosed with DR in the case group and 668 patients without DR in the control group. DNA from each patient was analyzed for VEGF polymorphisms of -2578A/C (rs699947), -1154G/A (rs1570360), -460C/T (rs833061), +405C/G (rs2010963), and +936C/T (rs3025039) using MassARRAY compact analyzer. The VEGF serum levels were quantified by enzyme-linked immunosorbent assay (ELISA).

RESULTSNo evidence of association was observed between -2578 A/C (rs699947), +405C/G (rs2010963), +936C/T (rs3025039), and DR risk under stringent Bonferroni's correction. However, VEGF serum levels were significantly higher in DR patients than those of control group. The genetic variation of VEGF polymorphisms influenced VEGF serum levels; subjects carrying the VEGF -2578 C/C (rs699947) genotype had greater VEGF serum levels than those carrying the C/A genotype and VEGF serum levels were significantly higher in CC genotype of the +405C/G (rs2010963) compared with those of the other genotypes.

CONCLUSIONSThe data did not suggest significant association between the VEGF polymorphisms and DR risk under stringent Bonferroni's correction. However, our study indicated that DR patients have higher VEGF levels than diabetic patients without retinopathy, and -2578A/C (rs699947) and +405C/G (rs2010963) may be important factors in determining serum VEGF levels.

Aged ; Asian Continental Ancestry Group ; genetics ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2 ; complications ; Diabetic Retinopathy ; blood ; genetics ; Female ; Humans ; Male ; Polymorphism, Genetic ; Vascular Endothelial Growth Factor A ; blood ; genetics

China Partner Network (CPN) training project would train professionals for better management of children rehabilitation, including advanced theory and manipulation in treatment and functional assessment of children with cerebral palsy, psychological education,and orthotics as well as operation and non-operation protocols. Domestic status quo in this area and some other relevant experiences were also compared with CPN.