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2021 2

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治疗推荐；脓毒症；自监督学习；强化学习；电子病历 1

纳米海绵 1

纳米颗粒 1

细菌毒素 1

血小板 1

败血症 1

金黄色葡萄球菌 1

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Review of recent guidelines for the management of severe sepsis and septic shock

Jin-Nong ZHANG MD, Bo PENG BA, Jamile WOODS MD, Wei PENG MD, PhD,

《医学前沿（英文）》 2010年第4卷第1期页码 54-58 doi: 10.1007/s11684-010-0008-7

摘要： Severe sepsis and septic shock affect millions of patients and are major causes of mortality worldwide. Advancements in treatment and disease management led to a decline in in-hospital mortality from 27.8% (1979–1984) to 17.9% (1995 to 2000). In this article, we systemically review recent guidelines for the management of severe sepsis and septic shock published in 2008 by the International Surviving Sepsis Campaign Guidelines Committee. The 2008 Surviving Sepsis guidelines recommend protocolized resuscitation with goals to maintain central venous pressure≥8–12mmHg, mean arterial pressure≥65mmHg, urine output≥0.5mL·kg·h and central venous oxygen saturation≥70% (or mixed venous≥65%). Further fluid administration, transfusion of packed red blood cells to achieve a hematocrit of≥30% and/or infusion of dobutamine max 20µg·kg·min are advised if venous O saturations remain below 70%. In patients with decreased ventricular compliance or mechanical ventilation, a target central venous pressure of 12–15mmHg is recommended. Intravenous antibiotic administration within the first hour of recognizing severe sepsis and septic shock is essential, while use of corticosteroids in sepsis is controversial. The mechanisms by which activated protein C improves clinical outcomes in sepsis are unknown. Therapy with activated protein C is approved for patients with severe sepsis and an increased risk of death [Acute Physiology and Chronic Health Evaluation II (APACHE II)>25]. Bicarbonate therapy is discouraged. Intravenous insulin should be used to control hyperglycemia in patients with severe sepsis following stabilization in the intensive care unit.

关键词： sepsis septic shock hemodynamics guidelines

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Sepsis biomarkers: an omics perspective

null

《医学前沿（英文）》 2014年第8卷第1期页码 58-67 doi: 10.1007/s11684-014-0318-2

摘要：

Sepsis is a common cause of death in hospitalized patients worldwide. The early detection of sepsis remains a great challenge for clinicians, and delayed diagnosis frequently undermines treatment efforts, thereby contributing to high mortality. Omics technologies allow high-throughput screening of sepsis biomarkers. This review describes currently available and novel sepsis biomarkers in the context of genomics, transcriptomics, proteomics, and metabolomics. The combination of these technologies can help refine the diagnosis of sepsis. This review paper serves as a reference for future studies that employ an integrated, multi-omics approach to disease identification.

关键词： sepsis biomarker genomics transcriptomics proteomics metabolomics

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自监督脓毒症治疗推荐算法 Research Articles

朱思涵1,浦剑2

《信息与电子工程前沿（英文）》 2021年第22卷第7期页码 926-939 doi: 10.1631/FITEE.2000127

摘要：由于每个脓毒症患者治疗反应可能不同，为病人提供量身定制的治疗建议来帮助医生有效、准确地做出决定，并采取有效治疗方案，是降低医院重症监护病房死亡率的一项极具挑战性的工作。本文将强化学习应用于个人治疗推荐，采用对样本不确定性进行建模并评估的方法，根据患者对治疗的反应和状态，将患者样本分为两个域，然后使用辅助迁移学习任务重建两个域的样本，使用特权学习的蒸馏方法与用于迁移学习的变分自动编码器框架关联低质量域和高质量域间的任务。通过结合自监督方式获得更好的状态和动作表示，本文提出一种针对引起较高风险的不确定性进行控制的深度强化学习方法；模型提供一定的灵活性使之可以在不同场景对模糊样本做出保守预测或明确判断，并降低预期死亡率。在大规模公开可用的真实医疗数据集MIMIC-III上的实验表明，所提模型将总体估计死亡率降低了2.3%，并将主要估计死亡率降低到9.5%。

关键词：治疗推荐；脓毒症；自监督学习；强化学习；电子病历

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工程化仿生血小板膜包覆纳米颗粒阻断金黄色葡萄球菌的细胞毒性并防止致命的全身感染 Article

Jwa-Kyung Kim, Satoshi Uchiyama, Hua Gong, Alexandra Stream, Liangfang Zhang, Victor Nizet

《工程（英文）》 2021年第7卷第8期页码 1149-1156 doi: 10.1016/j.eng.2020.09.013

摘要：

金黄色葡萄球菌（S. aureus）是一种常见的人类病原体，它可以引发严重的侵袭性感染，如菌血症、败血症和心内膜炎，具有较高的发病率和死亡率。然而由于细菌的抗生素耐药性增强，如耐甲氧西林金黄色葡萄球菌（MRSA），加剧了此类细菌的发病率和死亡率。金黄色葡萄球菌的发病机制是由毒素的分泌推动的，如膜损伤孔α毒素，它有不同的细胞靶点，包括上皮细胞、内皮细胞、白细胞和血小板。本文采用人体血小板膜包覆纳米颗粒（PNP）作为一种仿生诱饵策略，来中和金黄色葡萄球菌的毒素，并维持宿主细胞的防御功能。血小板膜包覆纳米颗粒保护血小板免受由金黄色葡萄球菌毒素带来的损伤，维持血小板活化和杀菌活性。血小板膜包覆纳米颗粒也同样保护巨噬细胞免受由金黄色葡萄球菌毒素带来的损伤，支持巨噬细胞进行氧化迸发、产生一氧化氮和维持其杀菌活性，并减少耐甲氧西林金黄色葡萄球菌诱导的中性粒细胞胞外杀菌网络。在感染系统性耐甲氧西林金黄色葡萄球菌的小鼠模型中，血小板膜包覆纳米颗粒制剂减少了血液中的细菌数量并防止小鼠发生死亡。总之，目前的研究结果证明了血小板膜包覆纳米颗粒的治疗优点，如中和毒素、保护细胞和增加宿主对侵袭性金黄色葡萄球菌感染的抵抗力。

关键词：纳米颗粒纳米海绵血小板金黄色葡萄球菌细菌毒素败血症