双重血浆分子吸附联合低置换量血浆置换术与全量血浆置换术治疗肝衰竭的疗效比较

摘要 目的：探讨双重血浆分子吸附术（DPMAS）联合低置换量血浆置换术（LPE）与全量血浆置换术（PE）治疗肝衰竭的临床疗效差异。方法：回顾性分析2019年6月至2020年10月在空军军医大学第二附属医院感染科治疗的101例肝衰竭患者的临床资料,分为双重血浆分子吸附联合低置换量血浆置换术（DPMAS+ LPE）治疗组51例和全量血浆置换术（PE）治疗组50例。对首次治疗前及治疗后24 h的肝功能、凝血系列、血小板等实验室指标、不良反应等进行对比分析。结果：DPMAS+LPE组与PE组治疗后两组血清总胆红素（TBIL）、谷丙转氨酶（ALT）、谷草转氨酶（AST）较治疗前均明显下降（P<0.05）,DPMAS+LPE组对胆红素清除效果优于PE组,两组TBIL下降率分别为36.5±17.1% vs 25.2±19.5%,差异有统计学意义（P<0.01）。DPMAS+LPE组治疗后凝血酶原时间（PT）、凝血酶原活动度（PTA）、活化部分凝血活酶时间（APTT）较治疗前无明显变化（P>0.05）,纤维蛋白原（FIB）、血浆白蛋白（ALB）较前有所降低（P<0.0001）,PE组治疗后PT、PTA、APTT较治疗前有所改善（P<0.05）,纤维蛋白原（FIB）、血浆白蛋白（ALB）较治疗前无明显变化（P>0.05）。两组血小板计数(PLT)较治疗前均有所降低（P<0.05）,但两组PLT下降率无统计学意义（P>0.05）。两组治疗中及治疗后均未见明显不良反应。结论：双重血浆分子吸附联合低置换量血浆置换术,与全量血浆置换术比较,不仅在清除血清胆红素方面更有优势,且对凝血功能无明显影响,无明显不良反应,可节约血浆用量,是治疗肝衰竭有效、安全的方式,值得推广。     

Exploratory Cumulative Risk Assessment (CRA) Approaches Using Secondary Data

Cumulative risk assessments (CRAs) include the examination of risks posed by multiple stressors and include population-specific vulnerabilities and susceptibilities. In this case study, we assess potential hearing impairment hazard due to joint exposure from noise and volatile organic compounds (VOCs) in order to examine the strengths and limitations of using secondary data on exposure and health effects for a CRA. Block group-level noise categories were estimated using modeled street-level data. A quantile regression model of sociodemographic and personal predictors from the 1999–2000 U.S. National Health and Nutrition Examination Survey VOC dataset was used along with block group-level sociodemographic and personal variables to estimate VOC exposures. Hazard indices (HIs) for potential hearing impairment due to joint noise and VOC exposures were calculated. County-averaged HIs for hearing impairment ranged from 0.8 (10th total VOCs percentile and 45–60 dB) to 1.7 (90th total VOCs percentile and 71–75 dB). Limitations of the exposure and health effects data included issues combining heterogeneous data and a lack of established threshold levels for combined low-level exposures; yet, this case study illustrates that screening-level CRAs, including non-chemical stressors, can be accomplished with publicly available data and existing methods.     

Assessment of Red Core Resistance of Strawberry Using Enzyme-Linked Immunosorbent Assay (ELISA)

There was a strong correlation between measurements of red core disease of strawberry, assessed as percentage lengths of the adventitious roots with red steles, and ELISA values obtained from the same root systems using a polyclonal antiserum raised to Phytophthora fragariae. ELISA grouped twelve host cultivar/pathogen isolate combinations into three categories, highly resistant, partially resistant and susceptible, which agreed with disease incidence after inoculation.     

ORP2 Delivers Cholesterol to the Plasma Membrane in Exchange for Phosphatidylinositol 4, 5-Bisphosphate (PI(4,5)P2)

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Assessment of Noninferiority (and Equivalence) for Simple Crossover Trials Using Bayesian Approach

To assess the noninferiority or equivalence of a general drug to a standard one, researchers generally use the odds ratio of patient response rates to evaluate the relative treatment efficacy. In this paper, we use a logistic random effects model to test noninferiority and equivalence based on the odds ratio of patient response rates for crossover trials with binary data. We use Bayesian sampling algorithm, data augmentation, and scaled mixture of normal representation to implement the approach and improve efficiency. The performance of the proposed approach is assessed via simulation and real data examples.     

常压室温等离子体(ARTP)诱变茂源链霉菌菌株

采用常压室温等离子体（ARTP）诱变技术处理茂源链霉菌（Streptoverticillium mobaraense）菌株HS47的孢子,选育微生物谷氨酰胺转胺酶（MTG）高产菌株。菌株的致死率强度和正突变率高低结果表明,在电源功率为120W,处理距离2mm,工作气流量10slpm时,等离子体氦气对茂源链霉菌HS47孢子的最佳处理时间为30s。将诱变后的孢子液稀释涂布后,利用96孔板高通量筛选方法对单菌落进行初筛,选出高产的突变株进行两轮试管复筛,筛选过程中保持对菌株的分离纯化,最终获得一株高产菌株M-8,其MTG酶活由2.8U/ml提高到5.1U/ml,较出发菌株HS47提高了82%。该菌株的摇瓶发酵实验证明,其酶活的提高是单位菌株分泌的MTG有所增加的结果。经过8次传代,证实该菌株具有良好的遗传稳定性。这为谷氨酰胺转胺酶的工业化生产提供了菌种支持和理论支持。     

The Effect of ATP (Disodium Salt) upon Rotational Streaming

Through the continuous treatment with various solutions of ATP disodium salt the rotational streaming of the cytoplasma in barley root hairs has been stimulated about 1.2–1.7 times. With the concentrations employed the stimulation of the streaming did not depend on the external ATP supply, but on the initial rate of streaming. It is assumed that the main source of energy supporting the protoplasmic streaming is ATP. Therefore, the results obtained may be interpreted on the basis of variations in ATP content and its degradation products. The differences between initial rates of streaming are supposed to be due to variations of the endogenous ATP level. The ATP taken up probably stimulates the rotational streaming both through the supply of delivered energy and by lowering the cytoplasm viscosity. On the contrary, products of ATP hydrolysis increase the cytoplasm viscosity and induce a lowering or even cessation of the streaming.     

Tissue Quality Assessment Using a Novel Direct Elasticity Assessment Device (The E-Finger): A Cadaveric Study of Prostatectomy Dissection

Introduction

Minimally invasive radical prostatectomy (RP) (robotic and laparoscopic), have brought improvements in the outcomes of RP due to improved views and increased degrees of freedom of surgical devices. Robotic and laparoscopic surgeries do not incorporate haptic feedback, which may result in complications secondary to inadequate tissue dissection (causing positive surgical margins, rhabdosphincter damage, etc). We developed a micro-engineered device (6 mm² sized) [E-finger]) capable of quantitative elasticity assessment, with amplitude ratio, mean ratio and phase lag representing this. The aim was to assess the utility of the device in differentiating peri-prostatic tissue types in order to guide prostate dissection.

Material and Methods

Two embalmed and 2 fresh frozen cadavers were used in the study. Baseline elasticity values were assessed in bladder, prostate and rhabdosphincter of pre-dissected embalmed cadavers using the micro-engineered device. A measurement grid was created to span from the bladder, across the prostate and onto the rhabdosphincter of fresh frozen cadavers to enable a systematic quantitative elasticity assessment of the entire area by 2 independent assessors. Tissue was sectioned along each row of elasticity measurement points, and stained with haematoxylin and eosin (H&E). Image analysis was performed with Image Pro Premier to determine the histology at each measurement point.

Results

Statistically significant differences in elasticity were identified between bladder, prostate and sphincter in both embalmed and fresh frozen cadavers (p = <0.001). Intra-class correlation (ICC) reliability tests showed good reliability (average ICC = 0.851). Sensitivity and specificity for tissue identification was 77% and 70% respectively to a resolution of 6 mm².

Conclusions

This cadaveric study has evaluated the ability of our elasticity assessment device to differentiate bladder, prostate and rhabdosphincter to a resolution of 6 mm². The results provide useful data for which to continue to examine the use of elasticity assessment devices for tissue quality assessment with the aim of giving haptic feedback to surgeons performing complex surgery.     

Plasma Jet-Assisted Synthesis of Graphene Using a DC Plasma Torch

Plasma Physics Reports - Conditions of substrate-free syntheses of graphene and graphene-based systems based on conversion of liquid and gaseous carbon precursors in helium, nitrogen, and argon...     

Accurate Quantitation of Water-amide Proton Exchange Rates Using the Phase-Modulated CLEAN Chemical EXchange (CLEANEX-PM) Approach with a Fast-HSQC (FHSQC) Detection Scheme

Measurement of exchange rates between water and NH protons by magnetization transfer methods is often complicated by artifacts, such as intramolecular NOEs, and/or TOCSY transfer from C protons coincident with the water frequency, or exchange-relayed NOEs from fast exchanging hydroxyl or amine protons. By applying the Phase-Modulated CLEAN chemical EXchange (CLEANEX-PM) spin-locking sequence, 135°(x) 120°(-x) 110°(x) 110°(-x) 120°(x) 135°(-x) during the mixing period, these artifacts can be eliminated, revealing an unambiguous water-NH exchange spectrum. In this paper, the CLEANEX-PM mixing scheme is combined with Fast-HSQC (FHSQC) detection and used to obtain accurate chemical exchange rates from the initial slope analysis for a sample of 15N labeled staphylococcal nuclease. The results are compared to rates obtained using Water EXchange filter (WEX) II-FHSQC, and spin-echo-filtered WEX II-FHSQC measurements, and clearly identify the spurious NOE contributions in the exchange system.     

微卫星评价牙鲆雌核发育二倍体纯合性

采用8个微卫星座位分别对牙鲆减数雌核发育二倍体家系和卵裂雌核发育二倍体家系的纯合性进行检验。卵裂雌核发育二倍体在所有检测座位全部纯合。减数雌核发育二倍体在部分座位发生纯合,但未发现在所有座位全部纯合的个体,在Poli9TUF、Poli9-8TUF、Poli11TUF、Poli13TUF、Poli23TUF、Poli30TUF、Poli123TUF和Poli130TUF座位,杂合子比例分别为1·0000、1·0000、0·1944、0·9459、0·8611、1·0000、0·7778和0·8000,平均杂合子比例为0·8224。由此表明,牙鲆除了Poli11TUF外,在其余7个座位均具有很高的重组率。研究结果显示,牙鲆卵裂雌核发育二倍体一代即可形成纯合子;而减数雌核发育二倍体由于具有较高的重组率,使其与母本的遗传同质性较高。     

Environmental Risk Assessment of Dams in Construction Phase Using a Multi-Criteria Decision-Making (MCDM) Method

This study was conducted to identify environmental and human health risks caused by Balarood Dam, in construction phrase. The first step, all risk-generating factors were identified using a Delphi Questionnaire. Afterwards, the identified criteria were prioritized once using the Analytical Hierarchy Process (AHP) method and then by the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS). Due to the complex and uncertain nature of decision-making in times of risk, it was necessary to use more than one weighting method to ensure accuracy of weights. The results from AHP and TOPSIS revealed a mismatch in priorities; therefore, an integration method was presented blending Mean-Rank, Borda, and Copeland methods. According to the TOPSIS results, factors including cut and fill, explosion, and transportation, were first to third highest-priority risk-generating factors, respectively. Considering the results from the AHP method, factors cut and fill, drilling, and explosion were identified as first to third top-priority risk-generating factors, respectively. The results obtained from the integration method suggested that cut and fill, explosion, and drilling are the most important environmental risks at construction phase. As a general conclusion, different weighting methods can lead to different results by which the fate of a decision may be changed and it is essential to control final scores by applying more than one weighting method.     

Assessment of the Influence Factors on Nasal Spray Droplet Velocity Using Phase-Doppler Anemometry (PDA)

Droplet velocity is an important parameter that can be used to characterize nasal spray products. In this study, a phase-Doppler anemometry (PDA) system was used to measure the droplet velocities of nasal sprays. A survey of seven commercial nasal spray products showed a range of droplet velocities from 6.7 to 19.2 m/s, all significantly different from each other. A three-level, four-factor Box–Behnken design of experiments (DOE) methodology were applied to investigate the influences of actuation parameters and formulation properties on nasal spray droplet velocity using a set of placebo formulations. The DOE study shows that all four input factors (stroke length, actuation velocity, concentration of the gelling agent, and concentration of the surfactant) have significant influence on droplet velocity. An optimized quadratic model generated from the DOE results describes the inherent relationships between the input factors and droplet velocity thus providing a better understanding of the input factor influences. Overall, PDA provides a new in vitro characterization method for the evaluation of inhalation drugs through assessment of spray velocity and may assist in product development to meet drug delivery equivalency requirements.     

Visual vs Fully Automatic Histogram-Based Assessment of Idiopathic Pulmonary Fibrosis (IPF) Progression Using Sequential Multidetector Computed Tomography (MDCT)

Objectives

To describe changes over time in extent of idiopathic pulmonary fibrosis (IPF) at multidetector computed tomography (MDCT) assessed by semi-quantitative visual scores (VSs) and fully automatic histogram-based quantitative evaluation and to test the relationship between these two methods of quantification.

Methods

Forty IPF patients (median age: 70 y, interquartile: 62-75 years; M:F, 33:7) that underwent 2 MDCT at different time points with a median interval of 13 months (interquartile: 10-17 months) were retrospectively evaluated. In-house software YACTA quantified automatically lung density histogram (10^th-90^th percentile in 5^th percentile steps). Longitudinal changes in VSs and in the percentiles of attenuation histogram were obtained in 20 untreated patients and 20 patients treated with pirfenidone. Pearson correlation analysis was used to test the relationship between VSs and selected percentiles.

Results

In follow-up MDCT, visual overall extent of parenchymal abnormalities (OE) increased in median by 5 %/year (interquartile: 0 %/y; +11 %/y). Substantial difference was found between treated and untreated patients in HU changes of the 40th and of the 80th percentiles of density histogram. Correlation analysis between VSs and selected percentiles showed higher correlation between the changes (Δ) in OE and Δ 40^th percentile (r=0.69; p<0.001) as compared to Δ 80^th percentile (r=0.58; p<0.001); closer correlation was found between Δ ground-glass extent and Δ 40^th percentile (r=0.66, p<0.001) as compared to Δ 80^th percentile (r=0.47, p=0.002), while the Δ reticulations correlated better with the Δ 80^th percentile (r=0.56, p<0.001) in comparison to Δ 40^th percentile (r=0.43, p=0.003).

Conclusions

There is a relevant and fully automatically measurable difference at MDCT in VSs and in histogram analysis at one year follow-up of IPF patients, whether treated or untreated: Δ 40^th percentile might reflect the change in overall extent of lung abnormalities, notably of ground-glass pattern; furthermore Δ 80^th percentile might reveal the course of reticular opacities.     

Enumeration of Vital and Thermally Stressed Staphylococcus aureus in Foods Using Baird-Parker Pig Plasma Agar (BPP)

Baird-Parker (BP), modified BP medium (egg yolk replaced with pig plasma, BPP) and modified Vogel and Johnson agar (phosphatidyl choline, deoxyribonucleic acid, with catalase added, PCVJ) were equally efficient for enumerating both non-stressed and thermally-stressed populations of Staphylococcus aureus from pure cultures and naturally contaminated foods. Vogel and Johnson agar was inferior. All colonies exhibiting coagulase activity on BPP were subsequently confirmed as Staph. aureus ; this was not the case with presumptive colonies from BP and PCVJ. Based on selectivity, definitive diagnostic characterization of colonies and increased sensitivity (more sample plated), BPP should be considered as the reference method for the routine enumeration of Staph. aureus in foods.     

Plasma platelet activating factor-acetylhydrolase (PAF-AH)

The platelet-activating factor-acetylhydrolase (PAF-AH) is an enzyme which catalyzes the hydrolysis of acetyl ester at the sn-2 position of PAF. The family of PAF-AHs consists of two intracellular isoforms (Ib and II), and one secreted isoform (plasma). These PAF-AHs show different biochemical characteristics and molecular structures. Plasma PAF-AH and intracellular isoform, II degrade not only PAF but also oxidatively fragmented phospholipids with potent biological activities. Among these PAF-AHs, plasma PAF-AH has been the target of many clinical studies in inflammatory diseases, such as asthma, sepsis, and vascular diseases, because the plasma PAF-AH activity in the patients with these diseases is altered when compared with normal individuals. Finding a genetic deficiency in the plasma PAF-AH opened the gate in elucidating the protecting role of this enzyme in inflammatory diseases. The most common loss-of-function mutation, V279F, is found in more than 30% of Japanese subjects (4% homozygous, 27% heterozygous). This single nucleotide polymorphism in plasma PAF-AH and the resulting enzymatic deficiency is thought to be a genetic risk factor in various inflammatory diseases in Japanese subjects. Administration of recombinant plasma PAF-AH or transfer of the plasma PAF-AH gene improves pathology in animal models. Therefore, substitution of plasma PAF-AH would be an effective in the treatment of the patients with the inflammatory diseases and a novel clinical approach. In addition, the detection of polymorphisms in the plasma PAF-AH gene and abnormalities in enzyme activity would be beneficial in the diagnosis of the inflammatory diseases.     

Pathogen Sources Estimation and Scenario Analysis Using the Soil and Water Assessment Tool (SWAT)

Concerns over water quality in Ireland have increased in recent years, in part due to the more frequent contamination of drinking water by pathogens such as Escherichia coli and Cryptosporidium. The objective of this study was to assess the use of SWAT for pathogen source estimation and to analyze the effects of various source scenarios on pathogen outputs in Irish catchments. Two agricultural catchments in Ireland susceptible to pathogen contamination of source water were the center of the SWAT model development with the primary focus on levels of E. coli in surface water. Model simulations used site and source specific information which was analyzed considering the total E. coli count for the simulation period (Fergus: January 2005–October 2006; Kilshanvey: January 2006–July 2007). Pathogen source estimation identified point sources as the most significant contributors to E. coli output with direct deposition the primary contributor (95%) in Kilshanvey and wastewater treatment plant outflow (89%) the main contributor in the Fergus catchment. A scenario analysis evaluated possible situations that may occur in study locations. The analysis indicated that restriction of livestock access to water sources and improved wastewater treatment would represent effective methods of improving water quality in both catchments.