Assessment of Optimal Selected Prognostic Factors

The identification and assessment of prognostic factors is one of the major tasks in clinical research. The assessment of one single prognostic factor can be done by recently established methods for using optimal cutpoints. Here, we suggest a method to consider an optimal selected prognostic factor from a set of prognostic factors of interest. This can be viewed as a variable selection method and is the underlying decision problem at each node of various tree building algorithms. We propose to use maximally selected statistics where the selection is defined over the set of prognostic factors and over all cutpoints in each prognostic factor. We demonstrate that it is feasible to compute the approximate null distribution. We illustrate the new variable selection test with data of the German Breast Cancer Study Group and of a small study on patients with diffuse large B‐cell lymphoma. Using the null distribution for a p‐value adjusted regression trees algorithm, we adjust for the number of variables analysed at each node as well. (© 2004 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)     

Immunotoxins up to the present day

Immunotoxins consist of monoclonal or polyclonal antibodies conjugated to bacterial or plant toxins. The toxins used are typically of the A-B type in which a toxic A chain is coupled to a B chain responsible for cell binding and facilitation of A chain entry into the cytosol. Two broad strategies have been followed: coupling intact toxins, or A chains alone, to antibodies. This review examines current progress inin vitro andin vivo research, including recent clinical studies, concentrating principally on ricin or ricin A chain conjugates. The future role of conjugates using membrane-acting toxins, immunolysins, is also discussed.     

Biosynthesis of a ubiouitin-related peptide in rat brain and in human and mouse pituitary tumors

A biosynthetic labeled peptide structurally related to the thymic peptide ubiquitin was first identified fortuitously in bovine pars intermedia cells in regard to its partial NH₂ terminal amino acid sequence (Met 1, Leu 8, 15 and Lys 6, 11, 27, 29, 33) after a protein segment data bank search. A peptide with the same behavior on carboxymethylcellulose chromatography and polyacrylamide gel electrophoresis has been purified after labeling experiments in two areas of rat brain, hypothalamus and striatum, and in a mouse and a human ACTH-secreting pituitary tumors. It represents about 1 to 10% of the total labeled proteins in the various experiments. Its identity with the above mentioned bovine pituitary peptide was confirmed by microsequence analysis with respect to Met 1, Lys 6, 11 in hypothalmus, Met 1 in striatum, and Lys 6, 11, 27, 29, 33 in the two pituitary tumors. The availability of standard purified ubiquitin allowed us to show that labeled and cold peptides have the same electrophoretic mobility and elution volume on Sephadex G-50 chromatography this further confirms their identity. Possible interests of such a biosynthetic characterization of a ubiquitin-related peptide are discussed, particularly in view of the structural relationship of ubiquitin to the non histone component of nuclear protein A-24, and as a test of tissue viability and biosynthetic efficiency in our in vitro biosynthetic systems.     

新型疫苗佐剂的研究进展

与传统的灭活或活体疫苗相比,由基因工程重组抗原或化学合成多肽组成的现代疫苗往往存在免疫原性弱等问题,需要新型的免疫佐剂来增强其作用。尽管传统的铝盐佐剂是目前唯一全球公认的人用佐剂,但存在激发细胞免疫应答能力差等不足,因此,需要研发更为安全有效的人用新型佐剂,尤其是安全无毒、能够刺激较强细胞免疫应答的佐剂,以及适合粘膜疫苗、DNA疫苗和癌症疫苗的免疫佐剂。分析阐述了新型佐剂研究状况和佐剂发展方向,并进一步对新型佐剂的临床前和临床试验研究以及已批准上市的新型疫苗佐剂进行了综述。     

全球寡核苷酸类药物开发现状与趋势

从产品开发角度分析寡核苷酸类药物的发展现状和未来趋势。     

脓毒症患者发生凝血功能紊乱的临床特征及预后影响因素分析

摘要 目的：探究脓毒症患者发生凝血功能紊乱的临床特征及预后影响因素。方法：选择2019年9月~2023年1月本院收治的80例脓毒症患者为本次研究对象,对所有患者开展凝血功能检验,并依据检验结果,将患者分为凝血功能异常组（n=60）及正常组（n=20）,分析凝血功能障碍异常及正常患者临床特征、凝血功能障碍异常及正常患者病情严重程度,并依据脓毒症患者预后,将其分为存活组（n=64）及死亡组（n=16）脓毒症患者预后的单因素与多因素Logistic回归分析。结果：凝血功能正常组及异常组平均动脉压、体温、白细胞计数（WBC）、纤维蛋白原（FIB）、凝血酶时间（TT）指标水平无较大差异（P＞0.05）,与凝血功能正常组比较,凝血功能异常组患者呼吸、脉率、降钙素原（PCT）、C反应蛋白（CRP）指标水平相对较高,部分凝血活酶时间（APTT）、凝血酶原时间（PT）指标水平相对较长,PLT指标水平相对较高（P＜0.05）;与凝血功能正常的脓毒症患者相比较,凝血功能异常患者急性肾损伤（AKI）及急性呼吸窘迫综合征（ARDS）发生率、急性生理与慢性健康评分（APACHE Ⅱ）及急性生理功能评分（SOFA）评分更高,住ICU时间均相对较长（P＜0.05）,机械通气及住院时间比较（P＞0.05）;脓毒症患者预后影响因素分析中,结果显示,年龄、体质量指数（BMI）、性别、糖尿病史、高血压病史均未对脓毒症患者预后产生较大影响（P＞0.05）,PT、PCT、APTT、CRP、SOFA评分及APACHE Ⅱ评分对脓毒症预后产生严重影响,死亡组患者各指标水平均高于存活组（P＜0.05）;将影响脓毒症患者预后的单因素予以赋值,纳入Logistic回归分析,以PCT、PT、APTT、CRP、SOFA、APACHE Ⅱ 评分为自变量,结果显示,PCT、PT、CRP、SOFA、APACHE Ⅱ 评分是影响脓毒症患者预后的独立危险因素（P＜0.05）。结论：脓毒症患者发生凝血功能紊乱会对临床相关指标产生影响,从而增加疾病严重程度,依据脓毒症患者预后,研究结果显示,PT、PCT、CRP、SOFA及APACHE Ⅱ评分均会对脓毒症患者预后产生不良影响,检验上述指标水平,可为临床评估脓毒症预后提供一定参考价值。     

基于经会阴实时三维超声评估生物反馈电刺激联合盆底肌锻炼治疗产后盆底功能障碍的临床疗效

摘要 目的：探讨经会阴实时三维超声评估生物反馈电刺激联合盆底肌锻炼治疗产后盆底功能障碍的临床疗效。方法：选择2020年9月至2022年9月我院收治的96例产后盆底功能障碍患者,根据随机数字表法将患者分为两组,对照组（48例）采用盆底肌锻炼治疗,研究组（48例）采用生物反馈电刺激联合盆底肌锻炼治疗。治疗前后采用经会阴实时三维超声检查,对比两组治疗前后的盆底功能障碍调查表（PFDI-20）、盆底障碍影响简易问卷7（PFIQ-7）评分、静息和Valsalva动作状态下的肛提肌超声参数。分析肛提肌超声参数与PFDI-20、PFIQ-7评分的相关性。结果：两组治疗后PFDI-20、PFIQ-7评分,静息和Valsalva动作状态下肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积较治疗前降低（P＜0.05）,静息时肛提肌厚度较治疗前增加（P＜0.05）。研究组治疗后PFDI-20、PFIQ-7评分,静息和Valsalva动作状态下肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积低于对照组（P＜0.05）,静息时肛提肌厚度大于对照组（P＜0.05）。静息和Valsalva状态下肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积与PFDI-20、PFIQ-7评分呈正相关（P＜0.05）,静息状态肛提肌厚度与PFDI-20、PFIQ-7评分呈负相关（P＜0.05）。结论：经生物反馈电刺激联合盆底肌锻炼治疗后肛提肌裂孔大小较治疗前降低,肛提肌厚度较治疗前增加,且与PFDI-20、PFIQ-7评分改善有关,经会阴实时三维超声可客观、有效评价产后盆底功能障碍患者的治疗效果。