目的 探讨血清骨钙素在老年2型糖尿病(T2DM)合并认知功能障碍患者中的意义,为老年T2DM合并认知功能障碍患者早期干预提供依据.方法 选取上海交通大学附属第六人民医院临港院区就诊的150例患者作为研究对象,分为三组:①健康对照组(NC组);②2型糖尿病非认知障碍组(T2DM组);③2型糖尿病合并认知障碍组(CI-T2DM组),三组各50例,比较三组间患者血清骨钙素水平、一般生化指标和认知功能评分情况,并分析影响认知功能的相关因素,采用单因素和多元回归方法分析骨钙素与糖脂代谢及认知功能之间的关系.结果 与T2DM组比较,CI-T2DM组中腰围、糖化血红蛋白、内脏脂肪面积均升高,而骨钙素水平与简易精神状态检查量表(MMSE)评分下降;NC组、T2DM组、CI-T2DM组血清骨钙素水平逐渐下降,且组间差异有统计学意义;在老年T2DM人群中,MMSE评分与年龄、腰围、糖化血红蛋白及内脏脂肪面积呈负相关(P＜0.05),而与骨钙素水平呈正相关(r=0.374,P＜0.001);以骨钙素作为因变量,经多元线性回归分析发现,糖化血红蛋白、内脏脂肪面积、MMSE仍与骨钙素水平相关(P＜0.05).结论 骨钙素可能为糖尿病合并认知功能障碍的保护因素.

目的 探讨2型糖尿病(T2DM)合并骨质疏松的中老年患者血清骨钙素与糖脂代谢及骨密度的关系.方法 选取2019年6月至2020年12月在上海市第六人民医院住院的179例50岁以上T2DM患者,根据双能X线(DXA)测量的骨密度结果将患者分为3组:①T2DM骨质正常组;②T2DM骨质减少组;③T2DM骨质疏松组.对3组患者间性别、年龄、糖尿病病程、体重指数(BMI)、腰围(WC)、臀围(HC)、内脏脂肪面积(VFA)、皮下脂肪面积(SFA),空腹血糖(FPG)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、骨钙素(OCN)、腰椎、左髋关节骨密度等进行统计学分析.结果 3组间糖尿病病程、糖脂代谢指标差异均无统计学意义(P>0.05);与骨质正常组和骨质减少组比较,骨质疏松组年龄和OCN水平均升高,而BMI、WC、HC、VFA、SFA及骨密度均降低(P<0.05).以OCN作为因变量进行相关性分析:在骨质正常组中,OCN仅与HbA1c呈负相关(r=-0.348,P=0.009);而在骨质异常组(骨质减少+骨质疏松)中,OCN与BMI、WC、HC、VFA、HbA1c、T值(L1～L4)均呈负相关(P<0.05);且在骨质异常组中,OCN与VFA、HbA1c、L3有线性回归关系.以OCN≥12.53μg/L为影响因素,分析OCN与骨质疏松的关系,发现血清OCN水平高的糖尿病患者,骨质疏松的患病风险升高(OR=0.363,P=0.003).结论 中老年T2DM合并骨质疏松患者的骨转换率升高,OCN的测定可为糖尿病骨质疏松患者的发病机制提供参考依据.

Peripheral artery disease (PAD) is a common syndrome in elderly people. Recently, artificial intelligence (AI) algorithms, in particular machine-learning algorithms, have been increasingly used in disease diagnosis. In this study, we designed an effective diagnostic model of PAD in the elderly patients using artificial intelligence. The study was performed with 539 participants, all over 80 years in age, who underwent the measurements of Doppler ultrasonography and ankle–brachial pressure index (ABI). Blood samples were collected. ABI and two machine-learning algorithms (MLAs)—logistic regression and a random forest (RF) model—were established to diagnose PAD. The sensitivity and specificity of the models were analyzed. An additional RF model was designed based on the most significant features of the original RF model and a prospective study was conducted to demonstrate its external validity. Thirteen of the 28 features introduced to the MLAs differed significantly between PAD and non-PAD participants. The respective sensitivities and specificities of logistic regression, RF, and ABI were as follows: logistic regression (81.5%, 83.8%), RF (89.3%, 91.6%) and ABI (85.1%, 84.5%). In the prospective study, the newly designed RF model based on the most significant seven features exhibited an acceptable performance rate for the diagnosis of PAD with 100.0% sensitivity and 90.3% specificity. An RF model was a more effective method than the logistic regression and ABI for the diagnosis of PAD in an elderly cohort.

目的 探讨影响泛耐药鲍曼不动杆菌(Extensively Drug resistance Acinetobacter baumannii,XDRAB)感染预后的危险因素.方法 回顾性收集2011年1月至2016年12月在上海市第六人民医院住院且发生XDRAB感染的患者的临床资料,应用单因素分析及多因素logistic回归分析影响XDRAB感染预后的危险因素.结果 157例XDRAB感染患者中存活90例,死亡67例,死亡率42.68％,logistic多因素回归分析发现,年龄≥65岁、合并心功能不全、住院期间有创通气、住院期间联合抗真菌药物、感染时CRP≥184.63 mg/L、住院期间谷丙转氨酶≥141U/L、住院期间尿素氮≥14.3 mmol/L为影响XDRAB感染预后的独立危险因素,感染XDRAB后抗生素使用持续时间≥6天,是XDRAB感染预后的独立保护因素.结论 XDRAB感染死亡率高,高龄、基础疾病重、CRP明显升高、联用抗真菌药物是预后不良的主要因素,减少并发症发生,避免抗真菌药物滥用,适当延长感染XDRAB后抗生素治疗时间,有利于改善预后.

OBJECTIVES: We compared the diagnostic potential of cancer ratio (CR, serum lactate dehydrogenase [LDH]/pleural fluid adenosine deaminase [pfADA]), cancer ratio plus (CR plus, cancer ratio/pleural lymphocyte percentage), and age/pfADA ratio with pfADA in malignant pleural effusion. METHODS: Data from 100 patients with malignant pleural effusion (MPE) and 119 patients with tuberculous pleural effusion (TPE) were retrospectively collected. PfADA, age/pfADA ratio, CR, and CR plus were compared between patients with MPE and those with TPE in two age groups (≤50 and >50 years). The best cut-off value was determined, and the diagnostic performance was evaluated according to the receiver operating characteristic curve. RESULTS: PfADA was statistically significantly lower while age/pfADA ratio, CR, and CR plus were significantly higher in the MPE group than in the TPE group in both age groups (p<0.05). For patients aged ≤50 years, the differential diagnostic value of pfADA for MPE was better than those of age/pfADA ratio, CR, and CR plus. At a cut-off value of 13.0 U/L, the sensitivity, specificity, and accuracy were 88.9%, 100.0%, and 98.9%, respectively. For patients aged >50 years, the diagnostic performance of CR plus was superior to those of pfADA, age/pfADA ratio, and CR. At a cut-off value of 22.6, the sensitivity, specificity, and accuracy of CR plus for the diagnosis of MPE were 86.8%, 84.6%, and 86.2%, respectively. CONCLUSIONS: The best parameter for diagnosing MPE was different for patients aged ≤50 years and >50 years. For patients aged >50 years, CR plus was a good parameter for the differential diagnosis of MPE. For patients aged ≤50 years, pfADA was better.

目的 建立区分呼吸系统泛耐药鲍曼不动杆菌(XDRAB)感染与定植的评分系统.方法 选择2011年1月至2016年12月在上海市第六人民医院呼吸道标本培养出XDRAB的患者272例(定植142例,感染130例).利用单因素分析进行筛选,然后使用多因素logistic回归分析发现感染的独立预测因素并建立评分系统,采用ROC曲线评价该评分系统,并进行准确性验证.结果 通过建模样本建立评分系统:Z=42×培养出XDRAB时最高体温(≥38℃为1分,<38℃为0分)+18×新出现症状或原有症状加重(是为1分,否为0分)+32×白细胞数(≥10.6×109/L为1分,反之为0分)+43×胸部影像学变化(新出现炎性浸润影或炎性浸润影加重为1分,否则为0分),该评分系统ROC曲线下面积为0.973(95％CI:0.954～0.992).当Z<75分时考虑为定植,≥75分时考虑为感染.在测试样本中该评分系统对XDRAB感染和定植的预测与实际相符率为85.56％,阳性预测值为0.930,阴性预测值为0.787.结论 该评分系统能较准确地区分呼吸系统XDRAB的感染和定植,从而为治疗提供依据.

Background Tuberculous pleural effusion (TPE) is usually characterized by lymphocytic predominance and high pleural fluid adenosine deaminase (pfADA), while parapneumonic pleural effusion (PPE) is usually characterized by neutrophilic predominance. However, in some cases, neutrophils can be predominant in TPE. In such cases, the differential diagnosis between TPE and PPE is challenging and has been rarely investigated. The aim of this study was to evaluate the accuracy of pfADA, pleural fluid lactate dehydrogenase (pfLDH) and other parameters, such as age/pfADA in the differential diagnosis of neutrophil-predominant TPE (NP-TPE) and PPE. Methods Between January 2003 and August 2018, 19 patients with NP-TPE and 54 patients with PPE at Shanghai Jiao Tong University Affiliated Sixth People's Hospital were retrospectively reviewed. Age, blood and pleural fluid findings, and eight ratios that consisted of routine biomarkers were compared between the two groups in ≤50 and >50 years old groups. ROC curve analysis was used to evaluate diagnostic performance. Results The three parameters with the largest AUC were age/pfADA, pfADA and pfLDH in ≤ 50 years old group, and pfADA, age/pfADA and the percentage of neutrophils in pleural fluid (pfN%) in >50 years old group. For patients ≤ 50 years old, pfADA combined with pfLDH or age/pfADA combined with pfLDH could increase the specificity to 100%, while the sensitivity of the former was high (84.6% vs 76.9%). For patients >50 years old, both pfADA combined with pfN% and age/pfADA combined with pfN% could increase the specificity to 90.3% with the same sensitivity. Conclusions Although pfADA played an important role in the discrimination of NP-TPE from PPE, combining pfADA with pfLDH for patients ≤50 years old or combining pfADA with pfN% for patients >50 years old might improve diagnostic performance.

Background The novel coronavirus diseases (COVID-19) has led to a pandemic and affected people's lives greatly, including their health seeking behavior. We aimed to evaluate the impact of the current COVID-19 pandemic on characteristics and trends of emergency department (ED) visits in Shanghai, China.Methods This was a retrospective observational study using medical record databases from the Shanghai Sixth People's Hospital (East Campus) for years 2016 through 2020. All the patients referred to the ED between January 2016 and June 2020 were retrospectively reviewed. January 1, 2020, was chosen as the cutoff date for the statistical analysis and data of January and February in 2020 was compared with the same period of 2019.Results During the first two months of 2020, there was a 60.9% decline in ED visits when compared with the same period of 2019 (9,904 vs. 25,316, respectively), and the waiting time in ED has been greatly reduced correspondingly (12±4 vs. 66±19 min, p < 0.001); ED visits for acute ischemic stroke (AIS) and acute coronary syndrome(ACS) decreased by 53.9% and 41.2% respectively; proportion of intravenous thrombolysis for AIS has dropped(42.1% vs. 11.4%, p = 0.003), and percutaneous coronary intervention for ACS was similar (70.6% vs. 63.3%, p = 0.668); and onset-to-door time (ODT) of these patients increased significantly (AIS: 217(136-374) vs. 378(260-510)min, ACS: 135(85-195) vs. 226(155-368)min, all p < 0.001).Conclusion The outbreak of COVID-19 pandemic was correlated with a significant decline in the number of ED visits including AIS and ACS patients when compared to the pre-COVID-19 period. ODT of AIS and ACS patients increased significantly. Raising public awareness is necessary to avoid serious healthcare and economic consequences of undiagnosed and untreated stroke and myocardial infarction attack.

目的 探讨影响结核性胸腔积液(tuberculous pleural effusion,TPE)腺苷脱氨酶(adenosine deaminase,ADA)水平的因素,并制定诊断TPE的最佳ADA界值.方法 对2003年1月至2018年8月在上海交通大学附属第六人民医院住院治疗的443例胸腔积液患者的相关临床与实验室检查资料进行回顾性分析,其中包括192例TPE,54例肺炎旁胸腔积液(parapneumonic pleural effusion,PPE)和197例恶性胸腔积液(malignant pleural effusion,MPE).采用多元Logistic回归分析探讨影响TPE患者ADA水平的独立因素.以50岁为界将研究人群分为两组(≤50岁和>50岁组).应用受试者工作特征(receiver operating characteristic,ROC)曲线制定诊断TPE的最佳ADA界值.结果 年龄和胸水中性粒细胞百分比是影响TPE患者ADA水平的独立因素,尤其是年龄.胸水ADA水平在≤50岁组显著高于>50岁组(P<0.001).两个年龄组中,胸水ADA诊断TPE的最佳临界值分别为17.5和9.5 U/L,灵敏度和特异度分别为94.4％、80.5％和94.1％、67.1％.结论 年龄是影响TPE患者胸水ADA水平的重要因素,对于年龄较大患者,使用较低的ADA界值诊断TPE可减少假阴性.

Background The differential diagnosis of tuberculous pleural effusion (TPE) is challenging. In recent years, artificial intelligence (AI) machine learning algorithms have started being used to an increasing extent in disease diagnosis due to the high level of efficiency, objectivity, and accuracy that they offer. Methods Data samples on 192 patients with TPE, 54 patients with parapneumonic pleural effusion (PPE), and 197 patients with malignant pleural effusion (MPE) were retrospectively collected. Based on 28 different features obtained via statistical analysis, TPE diagnostic models using four machine learning algorithms (MLAs), namely logistic regression, k-nearest neighbors (KNN), support vector machine (SVM) and random forest (RF) were established and their respective diagnostic performances were calculated. The respective diagnostic performances of each of the four algorithmic models were compared with that of pleural fluid adenosine deaminase (pfADA). Based on 12 features with the most significant impacts on the accuracy of the RF model, a new RF model was designed for clinical application. To demonstrate its external validity, a prospective study was conducted and the diagnostic performance of the RF model was calculated. Results The respective sensitivity and specificity of each of the four TPE diagnostic models were as follows: logistic regression – 80.5 and 84.8%; KNN– 78.6 and 86.6%; SVM – 83.2 and 85.9%; and RF – 89.1 and 93.6%. The sensitivity and specificity of pfADA were 85.4 and 84.1%, respectively, at the best cut-off value of 17.5 U/L. RF was the superior method among the four MLAs, and was also superior to pfADA. The newly designed RF model (based on 12 out of 28 features) exhibited an acceptable performance rate for the diagnosis of TPE with a sensitivity and specificity of 90.6 and 92.3%, respectively. In the prospective study, its sensitivity and specificity were 100.0 and 90.0%, respectively. Conclusions Establishing a model for the diagnosis of TPE using RF resulted in a more effective, economical, and faster diagnostic method. This method could enable clinicians to diagnose and treat TPE more effectively.

Herein, gefitinib-loaded nanoparticles are prepared based on the flash nanoprecipitation (FNP) approach, which lead to kinetically frozen nanoparticles featuring good size control and stability over time. Folic acid-modified amphiphilic Dex-b-PLA is applied as the protective copolymer, and the formed nanoparticles (NPs) display decent biocompatibility and efficient cellular uptake rate due to the presence of the dextran blocks and target groups, respectively. Our study demonstrates a novel method for preparing lung cancer drug-loaded NPs that show potential for further therapeutic applications.

侵袭性曲霉菌病(invasive aspergillosis,IA)是免疫功能低下患者最常见的侵袭性真菌感染,致死率高.由于曲霉菌孢子飘浮于空气中而易被吸入,IA中以侵袭性肺曲霉菌病(invasive pulmonary aspergillosis,IPA)最常见.然而,由于临床表现不典型,诊断金标准即病理学依据获得困难,IPA的诊断仍具挑战性,尤其是在疾病早期阶段.因此,寻找简便、快速、准确性高的诊断方法具有重要意义.本文就目前IPA的诊断进展作一综述.