Predicting Acute Renal Failure after Cardiac Surgery: Validation and Re‐definition of a Risk‐Stratification Algorithm

Background:  Acute renal failure (ARF) after cardiac surgery is associated with significant morbidity and mortality, irrespective of the need for dialysis. Previous studies have attempted to identify predictors of ARF and develop risk stratification algorithms. This study aims to validate the algorithm in an independent cohort of patients that includes a significant proportion of female and black patients and compares two different definitions of renal outcome.
Methods:  A large single center cardiac surgery database was examined (n, 24,660; 1993–2000) which included 29.9% females and 3.7% black patients. Post‐operative ARF was defined as: a) ARF requiring dialysis, b) > 50% reduction in creatinine clearance relative to baseline or requiring dialysis. Clinical variables related to baseline renal function and cardiovascular disease were used in recursive partitioning analysis for both outcome definitions. Chi‐square goodness of fit analysis was performed to validate the algorithm.
Results:  The frequency of post‐operative ARF requiring dialysis ranged between 0.5 and 15.5% based on the risk categories with the area under the receiver operating characteristic (ROC) curve of 0.78. Using the more inclusive definition of ARF, the frequency was significantly higher ranging from 2.6 to 25%(P < 0.001) with an area under ROC curve of 0.65.
Conclusions:  The renal risk stratification algorithm is valid in predicting post‐operative ARF in an independent cohort of patients, well represented by differences in gender and race. Since the need for dialysis remains subjective, a more objective and inclusive definition of ARF may help in identifying a larger number of patients 'at‐risk'.     

冠心病患者循环血中内皮细胞、内皮素和6－酮－前列环素F_（1a）的动态变化及意义

以循环内皮细胞（ＣＥＣ）作为血管内皮细胞（ＶＥＣ）损伤的指示物，以血浆内皮素（ＥＴ）和前列环素（ＰＧＩ２）反映ＶＥＣ的功能变化，对８５例冠心病患者与３０例正常人进行对比研究，并对５０例不稳定型心绞痛及２０例急性心肌梗塞进行了动态观察．结果表明：冠心病外周血中ＣＥＣ、ＥＴ明显升高（Ｐ＜０．００１），ＰＧＩ２明显下降（Ｐ＜０．００１），尤以不稳定型心绞痛和急性心肌梗塞更显著，与病情的严重程度相一致．提示冠心病ＶＥＣ损伤，以及它所分泌的内皮源性舒缩因子失平衡参与了冠心病的病理过程。     

核素心室造影舒张早期功能测定对冠心病估价

用平衡法核素心室造影自动左心室功能测定法检查了２３例正常人、３７例无心肌梗塞（ＣＡＤ－ＮＭＩ）和１４例有心肌梗塞（ＣＡＤ－ＭＩ）冠心病人左心室功能。结果表明，ＰＦＲ反映心肌缺血改变比其他心功能参数敏感。ＣＡＤ－ＮＭＩ组与正常对照组比较，ＰＦＲ的灵敏度为９４．５９％，Ｐ〈０．００１，其他参数的灵敏度依次为ＴＰＦＲ５４．０５％，Ｐ〈０．０１；ＰＥＲ５４．０５，Ｐ〈０．０１；ＴＰＥＲ４９．９５％，Ｐ〈０     

新生牛肝活性肽的制备及其毒性检测

目的制备新生牛肝活性肽并评价其安全性。方法采用膜法分离制备新生牛肝活性肽。将3批制品于37～40℃,75%相对湿度条件下存放3个月,以多肽含量为指标观察其稳定性,并进行急性毒性试验、小鼠骨髓细胞微核试验、Ames试验、小鼠精子畸形试验和大鼠喂养试验。结果制备的3批新生牛肝活性肽存放3个月后,多肽含量无明显下降,质量稳定。小鼠和大鼠经口灌人大于20.0g/kg体重的新生牛肝活性肽,均无急性毒性。3种致突变试验均未显示出致突变性,大鼠喂养试验各项指标均未见明显毒性。结论新生牛肝活性肽未表现出明显毒性。     

一种高效挖掘冠心病医案关联规则的仿真研究

研究中医冠心病医案,高效挖掘有益信息规则问题,由于中医医案数据量大、关联性强,针对传统的关联规则挖掘算法处理中医医案数据时存在效率低、收敛速度慢及漏报规则等问题,提出一种小生境技术和基因表达式编程相结合的挖掘关联规则的方法。通过惩罚函数设置支持度阈值,利用小生境技术执行小生境演化、融合算法,结合基因表达式编程算法操作简单、鲁棒性强的优势搜索强关联规则,有效避免了算法早熟,解决了规则冗余。针对治疗冠心病的中医医案进行了验证性实验,实验结果表明,改进算法在提取有效信息的效率上有较大的提高,挖掘结果对冠心病中医临床诊治具有一定的参考价值。     

α_1-抗胰蛋白酶的制备及其防治急性肺损伤的疗效

目的　以FIV 1为原料 ,制备较高纯度α1 AT制剂 ,用该制剂干预急性肺损伤动物模型作疗效考核。方法　FIV 1抽提液经PEG沉淀 ,离子交换 ,病毒灭活、超滤、除菌、分装 ,冻干制备α1 AT制剂。用急性肺损伤动物模型 ,比较静脉注射与雾化吸入α1 AT的治疗效果。结果　 3批制剂纯度 >70 % ,无菌、热原、安全试验均符合生物制品规程要求。静脉注射或雾化吸入 ,可降低由内毒素诱发急性肺损伤程度。结论　α1 AT制备工艺适合大规模生产。在防治急性肺损伤时有一定效果     

Detection of urinary biomarkers for early diagnosis of acute renal allograft rejection by proteomic analysis

Acute allograft rejection has been recognized as a major impediment to improved success in renal transplantation. Timely detection and control of rejection are very important for the improvement in long-term renal allograft survival. Thus, biomarkers for early diagnosis of acute rejection are required urgently to clinical medication. This study seeks to search for such biomarker candidates by comparing patients' pre-treatment urinary protein profiling with their post-treatment urinary protein profiling. A total of 15 significantly and consistently down-regulated protein candidates were identified. Among them, alpha-1-antichymotrypsin precursor (AACT), tumor rejection antigen gp96 (GP96) and Zn-Alpha-2-Glycoprotein (ZAG) were selected for further analysis. The results indicated that Western Blot assay of AACT, GP96 and ZAG had advanced the diagnosis time of acute renal rejection by 3 days, compared with current standard clinical observation and laboratory examination. Furthermore, the double-blind detection revealed that the accuracy, sensitivity and specificity of the diagnosis of acute renal rejection of AACT, GP96 and ZAG were 66.67%/100%/60%, 83.33%/100%/80% and 66.67%/100%/60%, respectively, and 100%/100%/100% in combination. In conclusion, urinary protein AACT, GP96 and ZAG could be a set of potential biomarkers for early non-invasive diagnosis of the acute rejection after renal transplantation.     

白蚁提取液急性毒性及致突变性研究

本文采用大,小鼠急性经口毒性试验、Ａｍｅｓ试验、小鼠骨髓细胞微核试验及小鼠精子畸变试验对白蚁提取液的毒理学安全性进行了研究,结果表明,白蚁提取液大,小鼠急性经口ＬＤ５０均大于１０ｇ／ｋｇ体重,属“实际无毒”：体内（包括体细胞和生殖细胞）、体外致突变性试验系统均未检出其致突性。     

Ensemble feature selection and classification methods for machine learning-based coronary artery disease diagnosis

Coronary artery disease (CAD) is a condition in which the heart is not fed sufficiently as a result of the accumulation of fatty matter. As reported by the World Health Organization, around 32% of the total deaths in the world are caused by CAD, and it is estimated that approximately 23.6 million people will die from this disease in 2030. CAD develops over time, and the diagnosis of this disease is difficult until a blockage or a heart attack occurs. In order to bypass the side effects and high costs of the current methods, researchers have proposed to diagnose CADs with computer-aided systems, which analyze some physical and biochemical values at a lower cost. In this study, for the CAD diagnosis, (i) seven different computational feature selection (FS) methods, one domain knowledge-based FS method, and different classification algorithms have been evaluated; (ii) an exhaustive ensemble FS method and a probabilistic ensemble FS method have been proposed. The proposed approach is tested on three publicly available CAD data sets using six different classification algorithms and four different variants of voting algorithms. The performance metrics have been comparatively evaluated with numerous combinations of classifiers and FS methods. The multi-layer perceptron classifier obtained satisfactory results on three data sets. Performance evaluations show that the proposed approach resulted in 91.78%, 85.55%, and 85.47% accuracy for the Z-Alizadeh Sani, Statlog, and Cleveland data sets, respectively.     

Evaluation of the tamper-resistant properties of biphasic immediate-release/extended-release oxycodone/acetaminophen tablets

Context: Abuse potential of extended-release (ER) opioid tablets increases if tampering causes rapid opioid release.

Objective: To evaluate the susceptibility to tampering of biphasic immediate-release (IR)/ER oxycodone (OC)/acetaminophen (APAP) tablets compared with IR OC/APAP tablets.

Materials and methods: IR/ER OC/APAP and IR OC/APAP tablets were tested at room temperature and after heating, freezing and microwaving. Resistance to crushing was tested using manual and powered tools (e.g. spoons, mortar and pestle, blender, coffee grinder). Tampered tablets were tested for suitability for snorting, OC extraction in solvents and ease of drawing into a syringe. Dissolution of IR/ER OC/APAP in gastric fluid with and without ethanol was tested to determine the potential for facilitating precipitous release of opioid from the tablet.

Results: IR/ER OC/APAP tablets were more crush resistant than IR OC/APAP tablets. Heating, freezing and microwaving had no effect on crush resistance of IR/ER OC/APAP tablets. Although a mortar and pestle pulverized IR/ER OC/APAP tablets, upon contact with solvent, the powder formed a thick gel judged unsuitable for absorption through the nasal mucosa and could not be drawn into a syringe. In contrast, powder from crushed IR OC/APAP tablets dissolved readily, was judged suitable for snorting, and was easily drawn into a syringe. Dissolution of IR/ER OC/APAP tablets in gastric fluid was slowed by the addition of ethanol.

Discussion: IR/ER OC/APAP tablets are resistant to crushing and dissolution compared with IR OC/APAP tablets.

Conclusion: IR/ER OC/APAP tablets may have less potential for abuse involving tampering compared with IR OC/APAP tablets.