基于多通道的ICU脑血管疾病死亡风险预测模型

死亡风险预测指根据病人临床体征监测数据来预测未来一段时间的死亡风险。对于ICU病患，通过死亡风险预测可以有针对性地对病人做出临床诊断，以及合理安排有限的医疗资源。基于临床使用的MEWS和Glasgow昏迷评分量表，针对ICU病人临床监测的17项生理参数，提出一种基于多通道的ICU脑血管疾病死亡风险预测模型。引入多通道概念应用于BiLSTM模型，用于突出每个生理参数对死亡风险预测的作用。采用Attention机制用于提高模型预测精度。实验数据来自MIMIC [Ⅲ]数据库，从中提取3?080位脑血管疾病患者的16?260条记录用于此次研究，除了六组超参数实验之外，将所提模型与LSTM、Multichannel-BiLSTM、逻辑回归（logistic regression）和支持向量机（support vector machine, SVM）四种模型进行了对比分析，准确率Accuracy、灵敏度Sensitive、特异性Specificity、AUC-ROC和AUC-PRC作为评价指标，实验结果表明，所提模型性能优于其他模型，AUC值达到94.3%。     

Reactive Oxygen and Nitrogen Species in Defense/Stress Responses Activated by Chitosan in Sycamore Cultured Cells

Chitosan (CHT) is a non-toxic and inexpensive compound obtained by deacetylation of chitin, the main component of the exoskeleton of arthropods as well as of the cell walls of many fungi. In agriculture CHT is used to control numerous diseases on various horticultural commodities but, although different mechanisms have been proposed, the exact mode of action of CHT is still unknown. In sycamore (Acer pseudoplatanus L.) cultured cells, CHT induces a set of defense/stress responses that includes production of H₂O₂ and nitric oxide (NO). We investigated the possible signaling role of these reactive molecules in some CHT-induced responses by means of inhibitors of production and/or scavengers. The results show that both reactive nitrogen and oxygen species are not only a mere symptom of stress conditions but are involved in the responses induced by CHT in sycamore cells. In particular, NO appears to be involved in a cell death form induced by CHT that shows apoptotic features like DNA fragmentation, increase in caspase-3-like activity and release of cytochrome c from the mitochondrion. On the contrary, reactive oxygen species (ROS) appear involved in a cell death form induced by CHT that does not show these apoptotic features but presents increase in lipid peroxidation.     

Glibenclamide for the Treatment of Ischemic and Hemorrhagic Stroke

Ischemic and hemorrhagic strokes are associated with severe functional disability and high mortality. Except for recombinant tissue plasminogen activator, therapies targeting the underlying pathophysiology of central nervous system (CNS) ischemia and hemorrhage are strikingly lacking. Sur1-regulated channels play essential roles in necrotic cell death and cerebral edema following ischemic insults, and in neuroinflammation after hemorrhagic injuries. Inhibiting endothelial, neuronal, astrocytic and oligodendroglial sulfonylurea receptor 1–transient receptor potential melastatin 4 (Sur1–Trpm4) channels and, in some cases, microglial K_ATP (Sur1–Kir6.2) channels, with glibenclamide is protective in a variety of contexts. Robust preclinical studies have shown that glibenclamide and other sulfonylurea agents reduce infarct volumes, edema and hemorrhagic conversion, and improve outcomes in rodent models of ischemic stroke. Retrospective studies suggest that diabetic patients on sulfonylurea drugs at stroke presentation fare better if they continue on drug. Additional laboratory investigations have implicated Sur1 in the pathophysiology of hemorrhagic CNS insults. In clinically relevant models of subarachnoid hemorrhage, glibenclamide reduces adverse neuroinflammatory and behavioral outcomes. Here, we provide an overview of the preclinical studies of glibenclamide therapy for CNS ischemia and hemorrhage, discuss the available data from clinical investigations, and conclude with promising preclinical results that suggest glibenclamide may be an effective therapeutic option for ischemic and hemorrhagic stroke.     

心源性猝死一级预防植入心律转复除颤器前非持续室性心动过速与植入后恰当治疗的关系

目的探讨植入型心律转复除颤器(implantable cardioverter defibrillator,ICD)用于心源性猝死一级预防时,植入前发生非持续性室性心动过速(non-sustained ventricular tachycardia,NSVT)与植入后ICD恰当治疗的关系。方法本研究为单中心回顾性队列研究,连续纳入2006年1月至2017年12月在北京协和医院住院植入ICD用于一级预防的心脏病患者,患者在住院期间ICD植入前均完善Holter检查。根据Holter检查是否出现NSVT,将患者分为NSVT组及无NSVT组。门诊或电话随访至2018年8月,随访事件包括全因死亡、植入后ICD放电治疗及抗心动过速起搏(antitachycardia pacing,ATP)治疗情况。结果纳入60例符合入选和排除标准的患者,随访时间37 (14～61)个月,KaplanMeier生存曲线及Log-Rank检验提示,NSVT组与无NSVT组相比,全因死亡率无统计学差异(P=0. 108),NSVT组恰当治疗的风险高于无NSVT组(P=0. 033),NSVT和左心室射血分数与ICD恰当治疗独立相关(NSVT:HR=5. 099,95%CI:1. 399～18. 588,P=0. 014;左心室射血分数:HR=1. 077,95%CI:1. 013～1. 145,P=0. 018)。结论 ICD一级预防患者植入前出现NSVT提示接受ICD恰当治疗的风险增加。     

Update on the Diagnostic Pitfalls of Autopsy and Post-Mortem Genetic Testing in Cardiomyopathies

Inherited cardiomyopathies are frequent causes of sudden cardiac death (SCD), especially in young patients. Despite at the autopsy they usually have distinctive microscopic and/or macroscopic diagnostic features, their phenotypes may be mild or ambiguous, possibly leading to misdiagnoses or missed diagnoses. In this review, the main differential diagnoses of hypertrophic cardiomyopathy (e.g., athlete’s heart, idiopathic left ventricular hypertrophy), arrhythmogenic cardiomyopathy (e.g., adipositas cordis, myocarditis) and dilated cardiomyopathy (e.g., acquired forms of dilated cardiomyopathy, left ventricular noncompaction) are discussed. Moreover, the diagnostic issues in SCD victims affected by phenotype-negative hypertrophic cardiomyopathy and the relationship between myocardial bridging and hypertrophic cardiomyopathy are analyzed. Finally, the applications/limits of virtopsy and post-mortem genetic testing in this field are discussed, with particular attention to the issues related to the assessment of the significance of the genetic variants.     

Cost-minimization analysis of a working vacation queue with N-policy and server breakdowns

This paper investigates the N-policy M/M/1 queueing system with working vacation and server breakdowns. As soon as the system becomes empty, the server begins a working vacation. The server works at a lower service rate rather than completely stopping service during a vacation period. The server may break down with different breakdown rates during the idle, working vacation, and normal busy periods. It is assumed that service times, vacation times, and repair times are all exponentially distributed. We analyze this queueing model as a quasi-birth–death process. Furthermore, the equilibrium condition of the system is derived for the steady state. Using the matrix-geometric method, we find the matrix-form expressions for the stationary probability distribution of the number of customers in the system and system performance measures. The expected cost function per unit time is constructed to determine the optimal values of the system decision variables, including the threshold N and mean service rates. We employ the particle swarm optimization algorithm to solve the optimization problem. Finally, numerical results are provided, and an application example is given to demonstrate the applicability of the queueing model.     

Child Death From Pediatric Illness: Conceptualizing Intervention From a Family/Systems and Public Health Perspective.

Despite the universal and understandable distress associated with the death of a child from pediatric illness, do psychologists help surviving families in ways that match their need for assistance? Many families do not seek psychological help and cope adaptively with their loss. Indications for psychotherapy with bereaved families are based largely on experience with families who engage in treatment and who have greater distress. Other families may not receive sufficient services but are at risk for ongoing difficulties and unlikely to engage in treatment. Suggestions for intervention are made, with attention to the fit of therapeutic approaches with family needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Terminally ill patients and volunteer support: Is it the right intervention?

Comments on the article by K. T. Herbst-Damm and J. A. Kulik (see record 2005-02260-012) entitled Volunteer support, marital status, and the survival times of terminally ill patients. Can a simple and low-cost intervention, such as a visit by a volunteer, extend the life of terminally ill patients? The answer, according to a study by Herbst-Damm and Kulik (2005), is yes. When it comes to quality of life, however, the effects of volunteer visits remain murky. Thus, it is critical that we look beyond effects on longevity and assess how such a program would influence quality of life. Extending the life of terminally ill patients might not always a blessing. Prolonging their life might even cause harm, as it can extend unwanted physical and mental suffering. It may also go against some patients' desire to hasten their death. Despite Herbst-Damm and Kulik's important findings, the current author remains unconvinced as to the merits of implementing volunteer visits as an intervention policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parental Problem Drinking and Children's Adjustment: Attachment and Family Functioning as Moderators and Mediators of Risk.

Children's perceived attachments with parents, and family cohesion and adaptability were examined as predictors, mediators, and moderators in the parental problem drinking-child outcomes link. A total of 216 6- to 12-year-olds (110 boys, 106 girls) participated. Data were obtained from children and their mothers, fathers, and teachers. A higher level of family cohesion and adaptability functioned as (a) a robust protective factor against adjustment and cognitive difficulties otherwise associated with problem drinking and (b) a mediator of adjustment problems. Children's perceptions of attachments to mothers and fathers were consistent predictors of behavioral, social, and cognitive problems and further moderated relations between problem drinking and child functioning. The results support that child-parent and family functioning variables act as either pathways and/or vulnerability and protective factors for children exposed to a high-risk environment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)