The effect of Shengmai injection in patients with coronary heart disease in real world and its personalized medicine research using machine learning techniques

Objective: Shengmai injection is a common treatment for coronary heart disease. The accurate dose regimen is important to maximize effectiveness and minimize adverse reactions. We aim to explore the effect of Shengmai injection in patients with coronary heart disease based on real-world data and establish a personalized medicine model using machine learning and deep learning techniques. Methods: 211 patients were enrolled. The length of hospital stay was used to explore the effect of Shengmai injection in a case-control study. We applied propensity score matching to reduce bias and Wilcoxon rank sum test to compare results between the experimental group and the control group. Important variables influencing the dose regimen of Shengmai injection were screened by XGBoost. A personalized medicine model of Shengmai injection was established by XGBoost selected from nine algorithm models. SHapley Additive exPlanations and confusion matrix were used to interpret the results clinically. Results: Patients using Shengmai injection had shorter length of hospital stay than those not using Shengmai injection (median 10.00 days vs. 11.00 days, p = 0.006). The personalized medicine model established via XGBoost shows accuracy = 0.81 and AUC = 0.87 in test cohort and accuracy = 0.84 and AUC = 0.84 in external verification. The important variables influencing the dose regimen of Shengmai injection include lipid-lowering drugs, platelet-lowering drugs, levels of GGT, hemoglobin, prealbumin, and cholesterol at admission. Finally, the personalized model shows precision = 75%, recall rate = 83% and F1-score = 79% for predicting 40 mg of Shengmai injection; and precision = 86%, recall rate = 79% and F1-score = 83% for predicting 60 mg of Shengmai injection. Conclusion: This study provides evidence supporting the clinical effectiveness of Shengmai injection, and established its personalized medicine model, which may help clinicians make better decisions.

Vancomycin population pharmacokinetics analysis in Chinese paediatric patients with varying degrees of renal function and ages: development of new practical dosing recommendations

OBJECTIVES

To describe the pharmacokinetics of vancomycin in a large Chinese paediatric cohort with varying degrees of renal function and ages and to develop practical dosing guidelines.

PATIENTS AND METHODS

We conducted a retrospective population pharmacokinetic study using data from paediatric patients who received vancomycin between June 2013 and June 2022. A non-linear mixed-effect modelling approach with a one-compartment model structure was applied. Monte Carlo simulations were used to stimulate an optimal dosage regimen to achieve the target of AUC24/MIC between 400 and 650.

RESULTS

We analysed a total of 673 paediatric patients and 1547 vancomycin serum concentrations. Covariate analysis revealed that physiological maturation, renal function, albumin and cardiothoracic surgery (CTS) significantly affected vancomycin pharmacokinetics. The typical clearance and volume of distribution, standardized to 70 kg, were 7.75 L/h (2.3% relative standard error, RSE) and 36.2 L (1.7% RSE), respectively. Based on the model, we proposed an optimal dosing regimen that considers the patient's age and estimate glomerular filtration rate (eGFR) to achieve a target AUC24/MIC for CTS and non-CTS patients. We also found that a loading dose of 20 mg/kg can help patients with an eGFR of <60 mL/min/1.73 m2 achieve the target AUC on the first day of treatment.

CONCLUSIONS

We established vancomycin pharmacokinetic parameters in Chinese paediatric patients and proposed a dosing guideline integrating eGFR, age and CTS status, potentially improving clinical outcomes and reducing nephrotoxicity risk.

Prediction of Prognosis in Adult Patients With Carbapenem-Resistant Klebsiella pneumoniae Infection

OBJECTIVE

Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections are associated with poor patient outcomes. We aimed to analyze the clinical information of adult patients with CRKP infection in order to establish a nomogram for mortality risk as well as to determine the treatment effectiveness of different antimicrobial regimens.

METHODS

Adult patients diagnosed with CRKP infection in a tertiary hospital in Shanghai between September 2019 and March 2021 were included. The clinical characteristics and clinical outcomes of these patients were analyzed.

RESULTS

A total of 199 cases of CRKP infection were examined. Five factors, namely age ≥65 years, respiratory failure, Sequential Organ Failure Assessment score, serum procalcitonin ≥5 ng/mL, and appropriate treatments in 3 days, were found to be associated with 30-day mortality. Upon incorporating these factors, the nomogram achieved good concordance indexes of 0.85 (95% confidence interval [CI]: 0.80-0.90) and well-fitted calibration curves. Receiver-operating characteristic curves for 7-, 15-, and 30-day survival had areas under the curve of 0.90, 0.87, and 0.88, respectively. Three-drug combination therapy was observed to be associated with lower mortality in the high-risk group (adjusted hazard ratio = 0.24, 95% CI: 0.06-0.99) but not in the low-risk group. Ceftazidime-avibactam, fosfomycin, and amikacin were effective against infections caused by CRKP. Tigecycline improved the treatment efficiency in 7 days, but a trend toward increased mortality was seen (HR, 1.69; 95% CI: 0.98-2.94; P = 0.061).

CONCLUSION

The antimicrobial regimen efficacy data and the predictive nomogram established in this study can help clinicians in identifying high-risk adult patients with CRKP infection, improving the therapeutic effect, and reducing mortality.

The relationship between vancomycin AUC/MIC and trough concentration, age, dose, renal function in Chinese critically ill pediatric patients

To assess the pharmacokinetic parameters of vancomycin in Chinese critically ill pediatric patients, children treated with vancomycin, hospitalized in the intensive care unit were included. Samples to determine peak and trough serum concentrations were obtained on the third day of treatment. Half-life was significantly longer in neonates and showed a decreasing trend in infants and children. In patients aged ≥1 month, AUC24 /MIC ≥400 was achieved in 31.8% at the dose of 40 mg/kg/d, and in 48.7% at the dose of 60 mg/kg/d with an assumed MIC of 1 mg/L. Augmented renal clearance (ARC) was present in 27.3% of children, which was associated with higher vancomycin clearance and lower AUC values. A good correlation was observed between trough concentration and AUC24 , and the trough concentration that correlated with AUC24 of 400 were varied according to the dosage regimens, 8.42 mg/L for 6-hintervals, and 6.63 mg/L for 8-h intervals. To conclude, vancomycin trough concentration that related to the AUC24 of 400 was much lower in critically ill children than that in adults. The dosage of 60 mg/kg/day did not enough for producing AUC24 in the range of 400-600 mg h/L in critically ill children, especially in those with ARC.

An Ensemble Model for Prediction of Vancomycin Trough Concentrations in Pediatric Patients

Purpose

This study aimed to establish an optimal model to predict vancomycin trough concentrations by using machine learning.

Patients and Methods

We enrolled 407 pediatric patients (age < 18 years) who received vancomycin intravenously and underwent therapeutic drug monitoring from June 2013 to April 2020 at Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine. The median (interquartile range) age and weight of the patients were 2 (0.63–5) years and 12 (7.8–19) kg. Vancomycin trough concentrations were considered as the target variable, and eight different algorithms were used for predictive performance comparison. The whole dataset (407 cases) was divided into training group and testing group at the ratio of 80%: 20%, which were 325 and 82 cases, respectively.

Results

Ultimately, five algorithms (XGBoost, GBRT, Bagging, ExtraTree and decision tree) with high R² (0.657, 0.514, 0.468, 0.425 and 0.450, respectively) were selected and further ensembled to establish the final model and achieve an optimal result. For missing data, through filling the missing values and model ensemble, we obtained R²=0.614, MAE=3.32, MSE=24.39, RMSE=4.94 and a prediction accuracy of 51.22% (predicted trough concentration within ±30% of the actual trough concentration). In comparison with the pharmacokinetic models (R²=0.3), the machine learning model works better in model fitting and has better prediction accuracy.

Conclusion

Therefore, the ensemble model is useful for the vancomycin concentration prediction, especially in the population of children with great individual variation. As machine learning methods evolve, the clinical value of the ensemble model will be demonstrated in the clinical practice.

Prediction of vancomycin dose on high-dimensional data using machine learning techniques

OBJECTIVES

Despite therapeutic vancomycin is regularly monitored, its dose requirements vary considerably between individuals. Various innovative vancomycin dosing strategies have been developed for dose optimization; however, the utilization of individual factors and extensibility is insufficient. We aimed to develop an optimal dosing algorithm for vancomycin based on the high-dimensional data using the proposed variable engineering and machine-learning methods.

METHODS

This study proposed a variable engineering process that automatically generates second-order variable interactions. We performed an initial examination of independent variables and interactive variables using eXtreme Gradient Boosting. The vancomycin dose prediction model was established based on the derived variables.

RESULTS

Based on the evaluation of the model performance in the validation cohort, our algorithm accounted for 67.5% of variations in the vancomycin doses. Subgroup analysis showed better performance in patients with medium and high body weight (with the ideal predictive percentage of 72.7% and 73.7%), and low and medium levels of serum creatinine (with the ideal predictive percentage of 77.8% and 73.1%) than in other groups.

CONCLUSION

The new vancomycin dose prediction model is potentially useful for patients whose population profiles are similar to those of our patients and yielded desired reference of clinical indicators with specific breakpoints.

Mussel-inspired nanofibrous sheet for suture-less stomach incision surgery

We report a dopamine-based crosslinker-conjugated gelatin/polycaprolactone nanofibrous sheet. The nanosheet was then employed to treat stomach incisions without sutures during surgery.

Physician-patient-companion communication and decision-making: a systematic review of triadic medical consultations

OBJECTIVE

To systematically review quantitative and qualitative studies exploring physician-adult patient-adult companion (triadic) communication and/or decision-making within all medical encounters.

METHODS

Studies were identified via database searches and reference lists. One author assessed eligibility of studies, verified by two co-authors. Data were extracted by one author and cross-checked for accuracy. Two authors assessed the quality of included articles using standardized criteria.

RESULTS

Of the 8409 titles identified, 52 studies were included. Summary statements and tables were developed for each of five identified themes. Results indicated companions regularly attended consultations, were frequently perceived as helpful, and assumed a variety of roles. However, their involvement often raised challenges. Patients with increased need were more often accompanied. Some companion behaviours were felt to be more helpful (e.g. informational support) and less helpful (e.g. dominating/demanding behaviours), and preferences for involvement varied widely.

CONCLUSION

Triadic communication in medical encounters can be helpful but challenging. Based on analysis of included studies, preliminary strategies for health professionals are proposed.

PRACTICE IMPLICATIONS

Preliminary strategies for health professionals include (i) encourage/involve companions, (ii) highlight helpful companion behaviours, (iii) clarify and agree upon role preferences of patient/companions. Future studies should develop and evaluate specific strategies for optimizing triadic consultations.

Recovery of nickel ions from simulated electroplating rinse water by electrodeionization process

Pure water production and recovery of Ni(2+) from dilute NiSO(4) solution via improved electrodeionization (EDI) process were investigated. It was indicated that, with the feed water containing 50 mg L(-1) Ni(2+), the dilute resistivity of the EDI could achieve 3 MOmega cm which gave a Ni(2+) rejection more than 99.8% while the Ni(2+) was concentrated as high as 1,583 mg L(-1) in the concentrate stream. The current efficiency was as high as 40% and the concentrate factor could reach 31.7. The experiment results demonstrated that, just in a single process, it was feasible to purifying and concentrating dilute nickel wastewater synchronously by the EDI technology.

GroEL-GroES solubilizes abundantly expressed xylulokinase in Escherichia coli

AIMS

The aims of the present work were to solubilize the abundantly expressed recombinant xylulokinase in Escherichia coli and to develop a reliable xylulokinase assay.

METHODS AND RESULTS

Three mutants of xylulokinase of Bacillus megaterium that were expressed at high level but formed insoluble protein in E. coli BL21(DE3)pLysS were selected for solubility study. The solubility of xylulokinase increased eight to 77-fold after introduction of molecular chaperones GroEL-GroES into the host.

CONCLUSION

This investigation reports that GroEL-GroES minimizes the formation of insoluble protein in three highly expressed recombinant xylulokinases and an improved xylulokinase assay.

SIGNIFICANCE AND IMPACT OF THE STUDY

Commercial production of bioethanol is critically dependent on the development of an efficient and low-cost process of enzymatic conversion of xylan, a major component in lignocellulose biomass, to xylulose-5-phosphate, which can then be channelled into pentose phosphate pathway and metabolized to ethanol. The improved intracellular xylulokinase activity is expected to facilitate the xylose degradation.

Control of hyperchaos

A general method for controlling chaotic systems with one or more positive Lyapunov exponents is investigated analytically and numerically. The method retains the formal features of the adaptive adjustment mechanism and can be equally applied to various types of the unstable fixed points. It is shown that the method proposed here neither asks for any prior analytical knowledge of the system, nor any internal or external controlling parameters in advance.

Stabilizing unstable discrete systems

A general method for stabilizing unstable discrete systems to a fixed point or high-period orbit is developed analytically and numerically in this paper. It is shown that the method can be equally applied to the systems with one or more positive Lyapunov exponents. Moreover, the method does not require a prior analytical knowledge of the system under investigation, nor any additional control parameters.

Smad7 mediates apoptosis induced by transforming growth factor beta in prostatic carcinoma cells

Transforming growth factor beta (TGF-beta) is an important regulator of apoptosis in some cell types, but the underlying molecular mechanisms are largely unknown. TGF-beta signals through type I and type II receptors and downstream effector proteins, termed Smads. TGF-beta induces the phosphorylation of Smad2 and Smad3 (receptor-activated Smads) which associate with Smad4 and translocate to the nucleus, where they regulate gene transcription [1]. Smad7 protein is induced by TGF-beta1 and has been classified as an inhibitory Smad. Smad7 prevents phosphorylation of receptor-activated Smads, thereby inhibiting TGF-beta-induced signaling responses [1]. Smad7 expression is increased in rat prostatic epithelial cells undergoing apoptosis as a result of castration [2]. Here we have shown that TGF-beta1 treatment or ectopic expression of Smad7 in human prostatic carcinoma cells (PC-3U) induces apoptosis. Furthermore, TGF-beta1-induced apoptosis was prevented by inhibition of Smad7 expression, by antisense mRNA in stably transfected cell lines or upon transient transfection with antisense oligonucleotides in several investigated cell lines. These findings provide evidence for a new effector function for Smad7 in TGF-beta1 signaling.

Effects of enzyme inducers and inhibitor on the pharmacokinetics of intravenous 2-(allylthio)pyrazine, a new chemoprotective agent, in rats

In order to find what types of hepatic cytochrome P450 (CYP) isozymes are involved in the metabolism of 2-(allylthio)pyrazine (2-AP) in rats, enzyme inducers, such as phenobarbital, 3-methylcholanthrene, dexamethasone, or isoniazid, and an enzyme inhibitor, such as SKF 525-A were pretreated. After 1-min intravenous administration of 2-AP, 50 mg/kg, to rats pretreated with SKF 525-A (a non-specific CYP inhibitor in rats), the plasma concentrations were significantly higher, and the area under plasma concentration-time curve from time zero to time infinity (AUC) was significantly greater (1365 compared with 1034 microg min/mL) as a result of significantly slower total body clearance (Cl) (36.6 compared with 48.3 mL/min/kg) than those in control rats, indicating that 2-AP was metabolized by CYP isozymes. After 1-min intravenous administration of 2-AP, 50 mg/kg, to rats pretreated with dexamethasone (an inducer of CYP3A in rats), phenobarbital (an inducer of CYP2B1/2, 2C6, 2C7, and 3A1/2 in rats), and 3-methylcholanthrene (an inducer of CYP1A1/2 and 2A1 in rats), the plasma concentrations were significantly lower, and AUC was significantly smaller (27, 41 and 60% decrease, respectively, compared with respective control rats) owing to faster Cl [37 (p>0.05), 70 (p<0.001), and 150% (p<0.001) increase, respectively, compared with respective control rats].

[Effect of Saikosaponin-d on up-regulating GR mRNA expression and inhibiting cell growth in human leukemia cells]

OBJECTIVE

To study the effect of Saikosaponin-d (SSd) on the expression of glucocorticoid receptor (GR) mRNA and cell growth in HL60 cells.

METHODS

Antiproliferation effects of SSd on HL60 cells were determined by 3H-thymidine incorporation. Cell cycle analysis was also performed by flow cytometry. GRmRNA was analyzed by northern blot analysis.

RESULTS

After 48 hours treatment with 10 micrograms/ml SSd, 3H-thymidine incorporation decreased in HL60 cells and the effect was time and dose dependent. The flow cytometry analysis showed HL60 cells were arrested at G0/G1 phase. The expression of GR mRNA increased.

CONCLUSION

SSd exhibits the inhibition effects on cell growth in HL60 cells and could up-regulate the expression of GR mRNA in HL60 cells.

[The influence of nerve growth factor on inferior alveolar nerves regeneration in the silicone tubes]

OBJECTIVE

To explore the effect of exogenous nerve growth factor(NGF) in the regeneration of adult white rabbits inferior alveolar nerve within the silicone tubes.

METHODS

In 24 adults white rabbits. A bilateral 8 mm inferior alveolar nerve gaps were created, and the proximal and distal stumps were inserted into a 12 mm silicone tube. The silicone tube of the right side was filled with exogenous NGF(experimental group) and the contralateral side was filled with saline (control group). Regeneration of the nerves was assessed by histological exam and nerve electrophysiological appreciation. Total number of the regenerating myelinated nerve fibers, the conduction velocities of nerves the thickness of myelin sheaths and the cross section area of myelinated nerve fibers between the experimental and the control groups were compared.

RESULTS

The results showed that: 1. The experimental groups demonstrated more myelinated nerve fibers than that of the controls in 12 and 18 weeks. 2. At the same time following surgery, the myelin sheath thickness and the cross section area of myelinated nerves in the experimental groups were significantly greater than that in the controls. 3. In 12 and 18 weeks, the conduction velocities of regenerating nerves in the experimental groups were faster than that of the controls.

CONCLUSION

This study suggested that exogenous NGF can enhance regeneration of inferior alveolar nerve with necovery of its sensory function.

[Saikosaponin-d up-regulates GR mRNA expression and induces apoptosis in HL-60 cells]

OBJECTIVE

To research the effect of saikosaponin-d (SSd) on the expression of glucocorticoid receptor (GR) mRNA and induction of apoptosis in HL-60 cells.

METHODS

Antiproliferation effects of SSd on HL-60 cells were determined by 3H-thymidine incorporation. Apoptosis of the SSd-treated cells was determined by DNA fragmentation analysis and flow cytometry. GR mRNA was analyzed by Northern blot analysis.

RESULTS

After 48 h treatment with 10 micrograms/ml SSd, 3H-thymidine incorporation was decreased in HL-60 cells and the effects were time and dose dependent. DNA ladder appeared after 60 h treatment with SSd. The flow cytometry analysis showed HL-60 cells was arrested at G0/G1 phase and apoptotic peak appeared in sub-G1 phase. The expression of GR mRNA was increased.

CONCLUSION

SSd up-regulates the expression of GR mRNA, inhibits the cell growth and induces apoptosis in HL-60 cells.

[Surgical reconstruction of laryngeal and tracheal stenosis]

OBJECTIVE

Reconstruction of laryngotracheal stenosis.

METHOD

According to the pathologic condition of the larynx and trachea, various surgical procedures were designed for the treatment of laryngotracheal stenosis. These techniques included endoscopic management, laser therapy and laryngotrachoetomy with autogenous tissue and stent.

RESULT

Among 36 patients, 32 were decannulated. The success rate was 88.8%.

CONCLUSION

In order to improve the curation effects of laryngjotrachal stenosis, the choice of surgical procedure must be individualized to the pathologic condition of larynx and trachea, as well as the experience of the surgeon. Learning previous successful experience is also very important for a good result.

[Effect of Gengnianjian on up regulated estrogen receptor mRNA to substance P and beta-endorphin in hypothalamus of aging female rats]

OBJECTIVE

To investigate the effect of Chinese herbal formula Gengnianjian on estrogen receptor (ER), ERmRNA substance P (SP) and beta-endorphin (beta-EP) in the hypothalamus of aging female rats.

METHODS

ER proteins were determined by radioligand binding assay, ER mRNA was analyzed by Northern blot analysis and the levels of beta-EP and SP were detected by immunohistochemistry.

RESULTS

In aging rats, lowered ER and ER mRNA in the hypothalamus were still up-regulated by low serum E2 level, but not in rats of after the age of 21 months; Gengnianjian significantly increased ER protein level and ER mRNA expression, decreased SP and increased the level of beta-EP in the hypothalamus in aging female rats before 21 months of age, without changing of serum E2 level. In EB group, serum E2 and beta-EP levels increased and SP level decreased but ER expression suppressed in the hypothalamus except after 21 months.

CONCLUSION

Enhance estrogen bioactivity can decrease the level of SP and increase the level of beta-EP in hypothalamus of aging female rats. Herbal formula Gengnianjian increase-EP level and decrease SP level by raising the level of ER and ER mRNA.

[Clinical experience of coronal flap approach in surgery of anterior skull base tumor]

Surgery of the anterior skull base tumor has been undertaken in 7 cases by coronal flap approach, of which 4 cases were malignant tumors and 3 cases were benign tumors. The dura became torn in 3 cases and resected in 2 cases due to tumor invasion. The dura and bony defects could be repaired with galea, pericranial flaps and fascia flaps of temporalis. The bigger bony defect was consolidated with scalp flap. Three out of 4 cases with malignant tumors were free of tumors for 6 years, 4 years and 17 months, respectively: 1 case died of tumor recurrence after 18 months. No case had postoperative complications.