AIM： To study the effect of combined indwelling catheter, hemofiltration, respiration support and traditional Chinese medicine （e.g. Dahuang） in treating abdominal compartment syndrome of fulminant acute pancreatit...AIM： To study the effect of combined indwelling catheter, hemofiltration, respiration support and traditional Chinese medicine （e.g. Dahuang） in treating abdominal compartment syndrome of fulminant acute pancreatitis. METHODS： Patients with fulminant acute pancreatitis were divided randomly into 2 groups of combined indwelling catheter celiac drainage and intra-abdominal pressure monitoring and routine conservative measures group （group 1） and control group （group 2）. Routine non-operative conservative treatments including hemofiltration, respiration support, gastrointestinal TCM ablution were also applied in control group patients. Effectiveness of the two groups was observed, and APACHE Ⅱ scores were applied for analysis. RESULTS： On the second and fifth days after treatment, APACHE Ⅱ scores of group 1 and 2 patients were significantly different. Comparison of effectiveness （abdominalgia and burbulence relief time, hospitalization time） between groups 1 and 2 showed significant difference, as well as incidence rates of cysts formation. Mortality rates of groups 1 and 2 were 10.0% and 20.7%, respectively. For patients in group 1, celiac drainage quantity and intra-abdominal pressure, and hospitalization time were positively correlated （r = 0.552, 0.748, 0.923, P 〈 0.01） with APACHE Ⅱ scores. CONCLUSION： Combined indwelling catheter celiac drainage and intra-abdominal pressure monitoring, short veno-venous hemofiltration （SVVH）, gastrointestinal TCM ablution, respiration support have preventive and treatment effects on abdominal compartment syndrome of fulminant acute pancreatitis.展开更多
BACKGROUND It has been theorized that 75%-80%of febrile neutropenia(FN)is caused by endogenous pathogens,while up to 20%of cases are thought to be caused by a viral infection.It is unknown if precautions such as maski...BACKGROUND It has been theorized that 75%-80%of febrile neutropenia(FN)is caused by endogenous pathogens,while up to 20%of cases are thought to be caused by a viral infection.It is unknown if precautions such as masking and social distancing reduce the risk of FN in susceptible populations.AIM To determine whether coronavirus disease 2019(COVID-19)infection mitigation efforts,namely masking and social distancing,were associated with a reduction in the incidence of FN.METHODS This was a retrospective population based cohort study comparing the incidence of FN in the 13 mo prior to(Year 0)and 13 mo following(Year 1)the public health executive orders(PHEO)in Michigan.Data was queried for all emergency department(ED)visits from April 1,2019 to March 31,2021 from the National Syndromic Surveillance Program,a program which collects data that is voluntarily submitted by approximately 89%of Michigan EDs.The primary study outcome was the incidence of FN as a proportion of ED visits in the 13-mo before and 13-mo after COVID-19 mitigations efforts,namely masking and social distancing.We hypothesized that there would be a significant decrease in the incidence of FN in the period following the PHEO aimed at reducing the spread of the severe acute respiratory syndrome coronavirus 2 virus.RESULTS There was a total of 8979221 total ED visits captured during the study period.In Year 0 there were 5073081 recorded ED visits and 3906140 in Year 1.There was a significant reduction in the proportion of total ED visits with a diagnosis of FN,decreasing 13.3%across periods(0.15%vs 0.13%,P=0.036).In patients with a hematologic malignancy a more impressive reduction in the incidence of FN was evident following PHEO(22%vs 17%,P=0.02).CONCLUSION We found a significant association between social distancing and mask guidelines implemented on a large public scale with decreased rates of FN,particularly in those with a hematologic malignancy.These findings may be useful in the design of future research and recommendations regarding the prevention of FN.展开更多
An improved method for estimation of causal effects from observational data is demonstrated. Applications in medicine have been few, and the purpose of the present study is to contribute new clinical insight by means ...An improved method for estimation of causal effects from observational data is demonstrated. Applications in medicine have been few, and the purpose of the present study is to contribute new clinical insight by means of this new and more sophisticated analysis. Long term effect of medication for adult ADHD patients is not resolved. A model with causal parameters to represent effect of medication was formulated, which accounts for time-varying confounding and selection-bias from loss to follow-up. The popular marginal structural model (MSM) for causal inference, of Robins et al., adjusts for time-varying confounding, but suffers from lack of robustness for misspecification in the weights. Recent work by Imai and Ratkovic?[1][2] achieves robustness in the MSM, through improved covariate balance (CBMSM). The CBMSM (freely available software) was compared with a standard fit of a MSM and a naive regression model, to give a robust estimate of the true treatment effect in 250 previously non-medicated adults, treated for one year, in a specialized ADHD outpatient clinic in Norway. Covariate balance was greatly improved, resulting in a stronger treatment effect than without this improvement. In terms of treatment effect per week, early stages seemed to have the strongest influence. An estimated average reduction of 4 units on the symptom scale assessed at 12 weeks, for hypothetical medication in the 9 - 12 weeks period compared to no medication in this period, was found. The treatment effect persisted throughout the whole year, with an estimated average reduction of 0.7 units per week on symptoms assessed at one year, for hypothetical medication in the last 13 weeks of the year, compared to no medication in this period. The present findings support a strong and causal direct and indirect effect of pharmacological treatment of adults with ADHD on improvement in symptoms, and with a stronger treatment effect than has been reported.展开更多
Reporter genes produce a protein product in transfected cells that can be easily measured in intact or lysed cells and they have been extensively used in numerous basic and applied research applications.Over the past ...Reporter genes produce a protein product in transfected cells that can be easily measured in intact or lysed cells and they have been extensively used in numerous basic and applied research applications.Over the past 10 years,reporter gene assays have been widely accepted and used for analysis of 2,3,7,8-tetrachlorodibenzo-p-dioxin and related dioxin-like compounds in various types of matrices,such as biological,environmental,food and feed samples,given that high-resolution instrumental analysis techniques are impractical for large-scale screening analysis.The most sensitive cell-based reporter gene bioassay systems developed are the mechanism-based CALUX(Chemically Activated Luciferase Expression) and CAFLUX(Chemically Activated Fluorescent Expression) bioassays,which utilize recombinant cell lines containing stably transfected dioxin(AhR) responsive firefly luciferase or enhanced green fluorescent protein(EGFP) reporter genes,respectively.While the current CALUX and CAFLUX bioassays are very sensitive,increasing their lower limit of sensitivity,magnitude of response and dynamic range for chemical detection would significantly increase their utility,particularly for those samples that contain low levels of dioxin-like HAHs(i.e.,serum) .In this study,we report that the addition of modulators of cell signaling pathways or modification of cell culture conditions results in significant improvement in the magnitude and overall responsiveness of the existing CALUX and CAFLUX cell bioassays.展开更多
文摘AIM： To study the effect of combined indwelling catheter, hemofiltration, respiration support and traditional Chinese medicine （e.g. Dahuang） in treating abdominal compartment syndrome of fulminant acute pancreatitis. METHODS： Patients with fulminant acute pancreatitis were divided randomly into 2 groups of combined indwelling catheter celiac drainage and intra-abdominal pressure monitoring and routine conservative measures group （group 1） and control group （group 2）. Routine non-operative conservative treatments including hemofiltration, respiration support, gastrointestinal TCM ablution were also applied in control group patients. Effectiveness of the two groups was observed, and APACHE Ⅱ scores were applied for analysis. RESULTS： On the second and fifth days after treatment, APACHE Ⅱ scores of group 1 and 2 patients were significantly different. Comparison of effectiveness （abdominalgia and burbulence relief time, hospitalization time） between groups 1 and 2 showed significant difference, as well as incidence rates of cysts formation. Mortality rates of groups 1 and 2 were 10.0% and 20.7%, respectively. For patients in group 1, celiac drainage quantity and intra-abdominal pressure, and hospitalization time were positively correlated （r = 0.552, 0.748, 0.923, P 〈 0.01） with APACHE Ⅱ scores. CONCLUSION： Combined indwelling catheter celiac drainage and intra-abdominal pressure monitoring, short veno-venous hemofiltration （SVVH）, gastrointestinal TCM ablution, respiration support have preventive and treatment effects on abdominal compartment syndrome of fulminant acute pancreatitis.
文摘BACKGROUND It has been theorized that 75%-80%of febrile neutropenia(FN)is caused by endogenous pathogens,while up to 20%of cases are thought to be caused by a viral infection.It is unknown if precautions such as masking and social distancing reduce the risk of FN in susceptible populations.AIM To determine whether coronavirus disease 2019(COVID-19)infection mitigation efforts,namely masking and social distancing,were associated with a reduction in the incidence of FN.METHODS This was a retrospective population based cohort study comparing the incidence of FN in the 13 mo prior to(Year 0)and 13 mo following(Year 1)the public health executive orders(PHEO)in Michigan.Data was queried for all emergency department(ED)visits from April 1,2019 to March 31,2021 from the National Syndromic Surveillance Program,a program which collects data that is voluntarily submitted by approximately 89%of Michigan EDs.The primary study outcome was the incidence of FN as a proportion of ED visits in the 13-mo before and 13-mo after COVID-19 mitigations efforts,namely masking and social distancing.We hypothesized that there would be a significant decrease in the incidence of FN in the period following the PHEO aimed at reducing the spread of the severe acute respiratory syndrome coronavirus 2 virus.RESULTS There was a total of 8979221 total ED visits captured during the study period.In Year 0 there were 5073081 recorded ED visits and 3906140 in Year 1.There was a significant reduction in the proportion of total ED visits with a diagnosis of FN,decreasing 13.3%across periods(0.15%vs 0.13%,P=0.036).In patients with a hematologic malignancy a more impressive reduction in the incidence of FN was evident following PHEO(22%vs 17%,P=0.02).CONCLUSION We found a significant association between social distancing and mask guidelines implemented on a large public scale with decreased rates of FN,particularly in those with a hematologic malignancy.These findings may be useful in the design of future research and recommendations regarding the prevention of FN.
文摘An improved method for estimation of causal effects from observational data is demonstrated. Applications in medicine have been few, and the purpose of the present study is to contribute new clinical insight by means of this new and more sophisticated analysis. Long term effect of medication for adult ADHD patients is not resolved. A model with causal parameters to represent effect of medication was formulated, which accounts for time-varying confounding and selection-bias from loss to follow-up. The popular marginal structural model (MSM) for causal inference, of Robins et al., adjusts for time-varying confounding, but suffers from lack of robustness for misspecification in the weights. Recent work by Imai and Ratkovic?[1][2] achieves robustness in the MSM, through improved covariate balance (CBMSM). The CBMSM (freely available software) was compared with a standard fit of a MSM and a naive regression model, to give a robust estimate of the true treatment effect in 250 previously non-medicated adults, treated for one year, in a specialized ADHD outpatient clinic in Norway. Covariate balance was greatly improved, resulting in a stronger treatment effect than without this improvement. In terms of treatment effect per week, early stages seemed to have the strongest influence. An estimated average reduction of 4 units on the symptom scale assessed at 12 weeks, for hypothetical medication in the 9 - 12 weeks period compared to no medication in this period, was found. The treatment effect persisted throughout the whole year, with an estimated average reduction of 0.7 units per week on symptoms assessed at one year, for hypothetical medication in the last 13 weeks of the year, compared to no medication in this period. The present findings support a strong and causal direct and indirect effect of pharmacological treatment of adults with ADHD on improvement in symptoms, and with a stronger treatment effect than has been reported.
基金support from the National Institutes of Environmental Health Sciences Superfund Basic Research Grant(ES004699(MSD))the California Agricultural Experiment Station,the Startup Fund of 100 Talents Program of Chinese Academy of Sciences+1 种基金the National Natural Science Foundation of China (20921063)the National Basic Research Program(2010CB933500)
文摘Reporter genes produce a protein product in transfected cells that can be easily measured in intact or lysed cells and they have been extensively used in numerous basic and applied research applications.Over the past 10 years,reporter gene assays have been widely accepted and used for analysis of 2,3,7,8-tetrachlorodibenzo-p-dioxin and related dioxin-like compounds in various types of matrices,such as biological,environmental,food and feed samples,given that high-resolution instrumental analysis techniques are impractical for large-scale screening analysis.The most sensitive cell-based reporter gene bioassay systems developed are the mechanism-based CALUX(Chemically Activated Luciferase Expression) and CAFLUX(Chemically Activated Fluorescent Expression) bioassays,which utilize recombinant cell lines containing stably transfected dioxin(AhR) responsive firefly luciferase or enhanced green fluorescent protein(EGFP) reporter genes,respectively.While the current CALUX and CAFLUX bioassays are very sensitive,increasing their lower limit of sensitivity,magnitude of response and dynamic range for chemical detection would significantly increase their utility,particularly for those samples that contain low levels of dioxin-like HAHs(i.e.,serum) .In this study,we report that the addition of modulators of cell signaling pathways or modification of cell culture conditions results in significant improvement in the magnitude and overall responsiveness of the existing CALUX and CAFLUX cell bioassays.
