两种药物性肝炎诊断评分标准的临床应用分析

目的:比较Maria药物性肝损害(1997年)诊断标准和我国常用诊断标准对药物性肝损害的效价。方法:回顾性分析我院2005年1月至2006年4月期间经肝穿病理诊断为药物性肝损害的54例病例,分别按照上述两个标准评分。评价每一标准的准确性。结果:符合Maria药物性肝损害(1997年)诊断标准的(>10分)有45例,占83%;符合我国常用诊断标准的有39例,占72%。结论:两个诊断标准符合率较高,均可做为药物性肝损害的诊断标准,但仍有部分病例不能准确诊断,需进一步完善。     

超声检查参数联合血清VEGF、Tg、Gal-1对甲状腺癌的诊断价值及其与淋巴结转移的关系

摘要 目的：探讨超声检查参数联合血清血管内皮生长因子（VEGF）、甲状腺球蛋白（Tg）、半乳糖血凝素-1（Gal-1）对于甲状腺癌的临床诊断价值及其与淋巴结转移的关系。方法：回顾性分析2017年6月至2020年6月入我院就诊的158例甲状腺肿瘤患者的临床资料。77例甲状腺癌患者纳入恶性组,81例甲状腺腺瘤患者纳入良性组,比较两组的超声检查参数及血清VEGF、Tg、Gal-1水平;此外,恶性组患者亚分组为淋巴结转移组（n=51）和无淋巴结转移组（n=26）,比较两组超声检查参数及血清VEGF、Tg、Gal-1水平。以受试者工作特征（ROC）曲线分析超声检查参数联合血清VEGF、Tg、Gal-1对甲状腺癌的诊断效能。采用Sprearman相关系数分析各指标水平变化与甲状腺癌患者发生淋巴结转移的相关性。结果：恶性组患者的血管化指数（VI）、血流指数（FI）及血清VEGF、Tg、Gal-1水平均高于良性组患者（P＜0.05）;淋巴转移组患者的VI、FI及血清VEGF、Tg、Gal-1水平均高于无淋巴结转移组患者（P＜0.05）;超声检查参数VI、FI联合血清VEGF、Tg、Gal-1诊断甲状腺癌的曲线下面积为0.933、敏感度为85.50%、特异度为80.00%,均明显高于五项指标单独检测。Spearman相关性分析结果显示,超声检查参数VI、FI以及血清VEGF、Tg、Gal-1与甲状腺癌患者淋巴结转移均呈正相关（P＜0.05）。结论：联合检测超声检查参数VI、FI及血清VEGF、Tg、Gal-1对甲状腺癌有较高的早期诊断价值,且上述指标均与患者淋巴结转移密切相关。     

Design of a polytopic construct of LACK,TSA and GP63 proteins for the diagnosis of cutaneous leishmaniasis: An in silico strategy

Cutaneous leishmaniasis (CL), which is caused by different species of the genus Leishmania, including L. major, is a significant parasitic disease worldwide. Commercial leishmaniasis diagnostic kits frequently target the entire parasite antigen, although this approach can reduce the specificity of the tests. The present study sought to increase the specificity of antigen detection tests by identifying the B-cell epitopes on the surface of the protozoa and developing an antigenic multiepitope construct to react with the system of B-cell epitopes unique to L. major. More specifically, the linear and conformational B-cell epitopes for three L. major proteins, namely, GP63, LACK, and TSA, were predicted using the ABCprd, IEDB, LBtope, CBTOPE, and DiscoTope servers. The three-dimensional structures of these proteins, as well as of the complete multiepitope, were predicted using the I-TASSER server. The multiepitope structure models were validated by means of Ramachandran plots and the Prosa and Verify3D servers. The multiepitope construct was evaluated using the ProtParam and SOLpro servers. The synthesized multiepitope was then successfully expressed into a pET28a plasmid. The expression was confirmed using SDS-PAGE and dot blot techniques. Moreover, the expressed protein was evaluated by means of Western blotting. A band of approximately 39 kDa was observed by SDS-PAGE. The rGLT-pET-28a showed a high response with the 1:1000 dilution of the anti-His-tag monoclonal antibody by Western blot. The results of this study indicated that the integrated GP63, LACK, and TSA multiepitope antigens of L. major represent a potential target for a novel diagnostic kit for CL.     

Meta‐Analysis of Diagnostic Test Accuracy Studies with Multiple Thresholds using Survival Methods

Diagnostic tests play an important role in clinical practice. The objective of a diagnostic test accuracy study is to compare an experimental diagnostic test with a reference standard. The majority of these studies dichotomize test results into two categories: negative and positive. But often the underlying test results may be categorized into more than two, ordered, categories. This article concerns the situation where multiple studies have evaluated the same diagnostic test with the same multiple thresholds in a population of non‐diseased and diseased individuals. Recently, bivariate meta‐analysis has been proposed for the pooling of sensitivity and specificity, which are likely to be negatively correlated within studies. These ideas have been extended to the situation of diagnostic tests with multiple thresholds, leading to a multinomial model with multivariate normal between‐study variation. This approach is efficient, but computer‐intensive and its convergence is highly dependent on starting values. Moreover, monotonicity of the sensitivities/specificities for increasing thresholds is not guaranteed. Here, we propose a Poisson‐correlated gamma frailty model, previously applied to a seemingly quite different situation, meta‐analysis of paired survival curves. Since the approach is based on hazards, it guarantees monotonicity of the sensitivities/specificities for increasing thresholds. The approach is less efficient than the multinomial/normal approach. On the other hand, the Poisson‐correlated gamma frailty model makes no assumptions on the relationship between sensitivity and specificity, gives consistent results, appears to be quite robust against different between‐study variation models, and is computationally very fast and reliable with regard to the overall sensitivities/specificities.     

Life cycle assessment of lightweight and end-of-life scenarios for generic compact class passenger vehicles

Goal, Scope and Background  The automotive industry has a long history in improving the environmental performance of vehicles - fuel economy and emission improvements, introduction of recycled and renewable materials, etc. The European Union also aims at improving the environmental performance of products by reducing, in particular, waste resulting from End-of-Life Vehicles (ELVs) for example. The European Commission estimates that ELVs contribute to approximately 1 % of the total waste in Europe [9]. Other European Union strategies are considering more life cycle aspects, as well as other impacts including resource or climate change. This article is summarizing the results of a European Commission funded project (LIRECAR) that aims at identifying the environmental impacts and relevance for combinations of recycling / recovery and lightweight vehicle design options over the whole life cycle of a vehicle - i.e. manufacturing, use and recycling/recovery. Three, independent and scientific LCA experts reviewed the study according to ISO 14040. From the beginning, representatives of all Life Cycle Stakeholders have been involved (European materials & supplier associations, an environmental Non-Governmental Organization, recycler’s association). Model and System Definition  The study compared 3 sets of theoretical vehicle weight scenarios: 1000 kg reference (material range of today’s end-of-life, mid-sized vehicles produced in the early 1990’s) and 2 lightweight scenarios for 100 kg and 250 kg less weight based on reference functions (in terms of comfort, safety, etc.) and a vehicle concept. The scenarios are represented by their material range of a broad range of lightweight strategies of most European car manufacturers. In parallel, three End-of-Life (EOL) scenarios are considered: EOL today and two theoretical extreme scenarios (100% recycling, respectively, 100% recovery of shredder residue fractions that are disposed of today). The technical and economical feasibility of the studied scenarios is not taken into consideration (e.g. 100% recycling is not possible). Results and Discussion  Significant differences between the various, studied weight scenarios were determined in several scenarios for the environmental categories of global warming, ozone depletion, photochemical oxidant creation (summer smog), abiotic resource depletion, and hazardous waste. However, these improvement potentials can be only realized under well defined conditions (e.g. material compositions, specific fuel reduction values and EOL credits) based on case-by-case assessments for improvements over the course of the life cycle. Looking at the studied scenarios, the relative contribution of the EOL phase represents 5% or less of the total life cycle impact for most selected impact categories and scenarios. The EOL technology variations studied do not impact significantly the considered environmental impacts. Exceptions include total waste, as long as stockpile goods (overburden, tailings and ore/coal processing residues) and EOL credits are considered. Conclusions and Recommendations  LIRECAR focuses only on lightweight/recycling, questions whereas other measures (changes in safety or comfort standards, propulsion improvements for CO₂, user behavior) are beyond the scope of the study. The conclusions are also not necessarily transferable to other vehicle concepts. However, for the question of end-of-life options, it can be concluded that LIRECAR cannot support any general recommendation and/or mandatory actions to improve recycling if lightweight is affected. Also, looking at each vehicle, no justification could be found for the general assumption that lightweight and recycling greatly influence the affected environmental dimension (Global Warming Potential or resource depletion and waste, respectively). LIRECAR showed that this general assumption is not true under all analyzed circumstances and not as significant as suggested. Further discussions and product development targets shall not focus on generic targets that define the approach/technology concerned with how to achieve environmental improvement (weight reduction [kg], recycling quota [%]), but on overall life cycle improvement). To enable this case-by-case assessment, exchanges of necessary information with suppliers are especially relevant.     

Database searching by flexible protein structure alignment

We have recently developed a flexible protein structure alignment program (FATCAT) that identifies structural similarity, at the same time accounting for flexibility of protein structures. One of the most important applications of a structure alignment method is to aid in functional annotations by identifying similar structures in large structural databases. However, none of the flexible structure alignment methods were applied in this task because of a lack of significance estimation of flexible alignments. In this paper, we developed an estimate of the statistical significance of FATCAT alignment score, allowing us to use it as a database-searching tool. The results reported here show that (1) the distribution of the similarity score of FATCAT alignment between two unrelated protein structures follows the extreme value distribution (EVD), adding one more example to the current collection of EVDs of sequence and structure similarities; (2) introducing flexibility into structure comparison only slightly influences the sensitivity and specificity of identifying similar structures; and (3) the overall performance of FATCAT as a database searching tool is comparable to that of the widely used rigid-body structure comparison programs DALI and CE. Two examples illustrating the advantages of using flexible structure alignments in database searching are also presented. The conformational flexibilities that were detected in the first example may be involved with substrate specificity, and the conformational flexibilities detected in the second example may reflect the evolution of structures by block building.     

Genetic assignment methods for the direct, real-time estimation of migration rate: a simulation-based exploration of accuracy and power

Genetic assignment methods use genotype likelihoods to draw inference about where individuals were or were not born, potentially allowing direct, real-time estimates of dispersal. We used simulated data sets to test the power and accuracy of Monte Carlo resampling methods in generating statistical thresholds for identifying F0 immigrants in populations with ongoing gene flow, and hence for providing direct, real-time estimates of migration rates. The identification of accurate critical values required that resampling methods preserved the linkage disequilibrium deriving from recent generations of immigrants and reflected the sampling variance present in the data set being analysed. A novel Monte Carlo resampling method taking into account these aspects was proposed and its efficiency was evaluated. Power and error were relatively insensitive to the frequency assumed for missing alleles. Power to identify F0 immigrants was improved by using large sample size (up to about 50 individuals) and by sampling all populations from which migrants may have originated. A combination of plotting genotype likelihoods and calculating mean genotype likelihood ratios (DLR) appeared to be an effective way to predict whether F0 immigrants could be identified for a particular pair of populations using a given set of markers.     

Meta-analysis of diagnostic test accuracy assessment studies with varying number of thresholds

Current meta-analytic methods for diagnostic test accuracy are generally applicable to a selection of studies reporting only estimates of sensitivity and specificity, or at most, to studies whose results are reported using an equal number of ordered categories. In this article, we propose a new meta-analytic method to evaluate test accuracy and arrive at a summary receiver operating characteristic (ROC) curve for a collection of studies evaluating diagnostic tests, even when test results are reported in an unequal number of nonnested ordered categories. We discuss both non-Bayesian and Bayesian formulations of the approach. In the Bayesian setting, we propose several ways to construct summary ROC curves and their credible bands. We illustrate our approach with data from a recently published meta-analysis evaluating a single serum progesterone test for diagnosing pregnancy failure.