The U-shaped association between serum osmolality and 28-day mortality in patients with sepsis: a retrospective cohort study.

BACKGROUND: Sepsis is a recognized global health challenge that places a considerable disease burden on countries. Although there has been some progress in the study of sepsis, the mortality rate of sepsis remains high. The relationship between serum osmolality and the prognosis of patients with sepsis is unclear. METHOD: Patients with sepsis who met the criteria in the Medical Information Mart for Intensive Care IV database were included in the study. Hazard ratios (HRs) and 95% confidence intervals (CIs) were determined using multivariable Cox regression. The relationship between serum osmolality and the 28-day mortality risk in patients with sepsis was investigated using curve fitting, and inflection points were calculated. RESULTS: A total of 13,219 patients with sepsis were enrolled in the study; the mean age was 65.1 years, 56.9 % were male, and the 28-day mortality rate was 18.8 %. After adjusting for covariates, the risk of 28-day mortality was elevated by 99% (HR 1.99, 95%CI 1.74-2.28) in the highest quintile of serum osmolality (Q5 >303.21) and by 59% (HR 1.59, 95%CI 1.39-1.83) in the lowest quintile (Q1 ≤285.80), as compared to the reference quintile (Q3 291.38-296.29). The results of the curve fitting showed a U-shaped relationship between serum osmolality and the risk of 28-day mortality, with an inflection point of 286.9 mmol/L. CONCLUSION: There is a U-shaped relationship between serum osmolality and the 28-day mortality risk in patients with sepsis. Higher or lower serum osmolality is associated with an increased risk of mortality in patients with sepsis. Patients with sepsis have a lower risk of mortality when their osmolality is 285.80-296.29 mmol/L.

The association between lactate dehydrogenase to serum albumin ratio and the 28-day mortality in patients with sepsis-associated acute kidney injury in intensive care: a retrospective cohort study.

BACKGROUND: The mortality rate of patients with sepsis-associated acute kidney injury (SA-AKI) in the intensive care unit (ICU) is high, and there is a need for early identification of SA-AKI patients with poor prognoses. This study investigated the relationship between the lactate dehydrogenase to serum albumin ratio (LAR) and prognosis in patients with SA-AKI. METHODS: We performed a retrospective cohort study of patients with SA-AKI who are represented in the Medical Information Mart for Intensive Care IV (MIMIC-IV). We used multivariable Cox regression analysis to determine adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Subgroup analysis, survival curves, and curve fitting were used to evaluate a connection between the LAR and prognosis in patients with SA-AKI. RESULTS: There were a total of 6453 participants in this research. The average age of the participants was 63.9 ± 16.1 years, and the average LAR was 11.0 (7.6, 17.7)/IU/g. After controlling for variables, the HRs for 28-day mortality were 1.20 (HR: 1.20, 95% CI: 1.05-1.38, p = 0.008) and 1.61 (HR: 1.61, 95% CI: 1.41-1.84, p < 0.001) for Tertile 2 (T2, 8.59≤ LAR< 14.66) and Tertile 3 (T3, LAR ≥ 14.66), respectively, compared to Tertile 1 (T1, LAR < 8.59). The outcomes for 90-day mortality and in-hospital death rate were comparable. The Kaplan-Meier (KM) analysis revealed that the group with greater LAR had higher 28-day and 90-day death rates. CONCLUSION: Our study shows that LAR is associated with poor prognosis in patients with SA-AKI. Higher LAR is associated with higher 28-day, 90-day, and in-hospital mortality.

[Clinical Analysis of Elderly Patients with AML/High-Risk MDS].

OBJECTIVE: To analyze the clinical features of acute myeloid leukemia (AML)/high-risk myelodysplastic syndrome (MDS) patients aged over 60 years old. METHODS: The clinical data of 61 elderly newly diagnosed patients with AML and high-risk MDS who submitted to the Department of Hematology/Oncology of the First Affiliated Hospital of Tsinghua University from January 2009 to April 16, 2021 were retrospectively analyzed. These patients were divided into chemotherapy group (45 cases) and supportive treatment group (16 cases). The overall survival (OS) was analyzed by Kaplan-Meier method, and the prognostic factors of survival were analyzed by multivariate Cox regression. RESULTS: After 2 cycles of induction chemotherapy, the complete remission (CR) rate was 37.8% (17/45), and overall response rate was 62.2% (28/45) in the chemotherapy group. The median OS in the chemotherapy group and supportive treatment group was 11.3 (0.07-43) and 1.6 (0.33-7.72) months, respectively (P<0.001). The median OS in patients who reached CR or did not reach after 1 cycle of induction chemotherapy was 19.8 (10-30.63) and 8.17 (0.07-43) months, respectively (P<0.05), while after 2 cycles was 22.7 (4.2-43) and 7.26 (0.07-26) months, respectively (P<0.001). Univariate analysis showed that age > 80 years old, CCI score > 2, PS score > 2 and supportive treatment were the adverse prognostic factors for OS. Further multivariate analysis suggested that chemotherapy was the only independent prognostic factor for OS (HR=0.140, 95%CI: 0.048-0.409, P<0.001). In the chemotherapy group, univariate analysis showed that CCI score > 2 and failure to reach CR after induction chemotherapy were poor prognostic factors. Multivariate analysis showed that CCI score > 2 (HR=0.139, 95%CI: 0.050-0.384, P<0.001) and failure to achieve CR after induction chemotherapy (HR=0.103, 95%CI: 0.041-0.259, P<0.001) were the adverse prognostic factors for OS. The patients were tolerant to side-effect of chemotherapy. CONCLUSION: Appropriate chemotherapy can prolong the survival of elderly patients with AML and high-risk MDS.

Chinese expert consensus on the nursing management of the totally implantable venous access device.

The totally implantable venous access device (TIVAD) has been widely used in clinical nursing work in China. The use of TIVAD has significantly improved the safety of venous access and reduced the pain caused by a repeated puncture; however, it may also bring with it varying degrees of complications associated with the long-term insertion of TIVAD and the maintenance quality of the venous access. Standard maintenance of the venous access for TIVAD is very important for reducing complications and improving the efficacy and patient's quality of life. This consensus briefly describes the fundamental knowledge and operating procedures of TIVAD while focusing on the evaluation and management of perioperative nursing, the observation and treatment of complications, the operation methods, and precautions for maintenance of venous access, as well as health education. This agreement seeks to standardize the nursing care of TIVAD patients in China.

Low dose of homoharringtonine and cytarabine-based priming induction regimens for patients with de novo acute myeloid leukemia and high-risk myelodysplastic syndrome aged over 70 years.

OBJECTIVES: Our objective is to retrospectively analyze the response to low dose of homoharringtonine (HHT) and cytarabine-based priming induction regimens in patients above 70 years with de novo acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS). PATIENTS AND METHODS: We retrospectively analyzed these very elderly newly diagnosed patients with AML and high-risk MDS, who received low dose of HHT and cytarabine-based priming induction regimens between March 2006 and September 2019. RESULTS: Of the 24 patients, 11 patients (47.8%) achieved complete remission (CR) and 3 (13%) partial remission, and the overall response rate was 60.9%. The estimated median overall survival (OS) time was 12 months and the 1-year OS rate was 47.8%. Patients without CR and Charlson's Comorbidity Index > 2 may be the two independent prognostic factors. The median OS was significantly higher for patients with CR after induction chemotherapy than those without CR (22.93 vs. 8.5 months, p < .01). CONCLUSION: Our study provides a hint of the efficacy of low dose of HHT and cytarabine-based priming induction regimens for patients aged over 70 years with de novo AML and high-risk MDS should be further studied.

The incidence risk of programmed cell death-1/programmed cell death ligand 1 inhibitor-related alopecia for cancer patients: A systematic review and meta-analysis.

PURPOSE: To evaluate the incidence risk of programmed cell death-1/programmed cell death ligand 1 (PD-1/PD-L1) inhibitor-related alopecia for cancer patients, the meta-analysis was put into practice. METHOD: The meta-analysis was designed and put into practice according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. RESULTS: After rigorous screening and verification, 22 clinical trials involving PD-1/PD-L1 inhibitors were collected for the final comprehensive analysis. The incidence risk of alopecia for all-grade in the PD-1/PD-L1 group was significantly lower than that in the control chemotherapy group (odds ratio [OR] = 0.01, 95% confidence interval [CI]: [0.01, 0.04], I = 86%, Z = 8.73 [P < .00001]). Similar to the above, the incidence risk of alopecia for grade 3-5 related to PD-1/PD-L1 was obvious lower than the control group (OR = 0.17, 95% CI:[0.05, 0.55], I = 0%, Z = 2.97 [P = .003]). When 7 clinical trials (PD-1/PD-L1 + Chemotherapy vs Chemotherapy) were taken to evaluate the risk of alopecia for all-grade and grade 3-5, no statistically significant results were found. CONCLUSION: The incidence risk of alopecia caused by PD-1/PD-L1 is significantly lower than chemotherapy, and there is no statistical significant evidence that PD-1/PD-L1 combined with chemotherapy would increase the incidence risk of alopecia.

The Association of Circulating T Follicular Helper Cells and Regulatory Cells with Acute Myeloid Leukemia Patients.

OBJECTIVE: This study aims to investigate the association of circulating T follicular helper (cTfh) cells and T follicular regulatory (cTfr) cells with acute myeloid leukemia (AML) patients. METHODS: A total of 22 newly diagnosed, untreated AML patients as well as 26 healthy controls were enrolled. Percentages of cTfh and cTfr cells were detected using flow cytometry. RESULTS: Compared to healthy controls, a significantly higher percentage of cTfr cells was observed in AML patients (4.10 ± 11.18 vs. 0.63 ± 0.38%) (p < 0.05). In addition, a significantly lower cTfh/cTfr ratio was found in the AML patients' group when compared to the control group (9.04 ± 9.19 vs. 11.66 ± 5.68) (p < 0.05). A lower level of plasma IL-2 and TGF-ß1 was found in AML patients. Based on the complete remission (CR) response after one cycle of inductive chemotherapy, patients were divided into two groups at sample collection: AML with and without CR. Significantly lower percentages of cTfr cells and a higher cTfh/cTfr ratio were found in the group of AML patients with CR than in the AML patients without CR. CONCLUSION: There was a significantly higher percentage of cTfr cells in AML patients. cTfr cells may have a potential association with the pathogenesis of AML patients.

[Survival Analysis of 148 Patients with Primary Diffuse Large B Cell Lymphoma].

OBJECTIVE: To investigate the clinical outcome of the patients with primary diffuse large B-cell lymphoma（DLBCL）. METHODS: Clinical data of 148 patients with DLBCL in our hospital and cancer hospital from March 2006 to April 2016 were retrospectively analyzed. Kaplan-Meier analysis was used to estimate progression-free survival（PFS）and overall survival（OS）. RESULTS: 5-year OS and PFS rates were 85% and 69%，respectively. The survival analysis showed that 5-year OS rate of R-CHOP group was significantly higher than that of CHOP alone group（89% vs. 70%，P<0.05）. In univariate analysis，several clinical factors，such as older age（>60 years），poor ECOG score（≥2），advanced stage（Ⅲ-Ⅳ），higher IPI score（≥3），CHOP alone and absence of radiotherapy related with poor survival rate. Furthermore，multivariate analysis showed that age>60 year significantly related with the worse OS. CONCLUSION: Age >60 year is an important independent prognostic factor to predict worse OS or PFS.

[Clinical Analysis of Priming Regimen for Treatment of Acute Myeloid Leukemia (Non-APL) Patients Aged over 70 Years].

OBJECTIVE: To explore the therapeutic efficacy for patients aged over 70 years with acute myeloid leukemia(non-APL). METHODS: Clinical data of 19 acute myeloid leukemia patients aged over 70 years admitted in our hospital from March 2006 to April 2016 years were analyzed retrospectively. Among them 15 patients received priming regimen and 4 patients received best supportive treatment. The overall survival time between patients with priming regimen and patients with best supportine treatment was compared by Kaplan-Meier analysis. The prognostic factors were evaluated by using multivariate analysis. Out of the 19 patients, 9 were males and 10 were females, with median age of 75 years (70-84). RESULTS: After 2 cycles of induction chemotherapy, the complete response rate was (7/15)46.6% and overall response rate was (11/15) 73%. Significant longer median survival time was observed in priming regimen group, compared with that in best supportive treatment group (11 months vs 2 months)(χ2=17.077, P<0.001). The patients were well tolerant to side-effect of chemotherapy. Multivariate analysis showed that only receiving induction chemotherapy or not was the independent prognostic factor of the survival time(P<0.05), while the sex, age, ECOG index, CD34, HLA-DR, WBC count and ratio of blast cells in bone marrow were factor affecting the prognosis. CONCLUSION: The priming regimen may be practicable and effective for the treatment of patients with acute myeloid leukemia aged over 70 years (non-APL) and prolong the survival time of these patients.