Prognostic factors and evaluation methods of acute kidney injury among sepsis patients with pulmonary infection.

OBJECTIVE: Acute kidney injury (AKI) is difficult to detect in the early stages, yet is commonly associated with sepsis and infectious shock, with pulmonary infection being the most frequent culprit. This study aimed to estimate risk factors and their effects on 28-day survival among sepsis patients with pulmonary infection complicated by AKI and assessed the prognostic values of some detection indicators. PATIENTS AND METHODS: From February 2019 to July 2021, the data of 151 patients admitted to the emergency intensive care unit (EICU) of Nanjing First Hospital with pulmonary infection complicated with sepsis were collected in this retrospective study. The patients were categorized into two groups (survivors and non-survivors) depending on the 28-day survival, compared their clinical characteristics, and analyzed the predictors of survival. RESULTS: Cox regression analysis revealed that serum cystatin-C level, serum lactate level, and the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system were independent risk factors for 28-day survival. In predicting 28-day survival, the area under the receiver operating characteristic curve (ROC) for serum Cystatin-C level, serum lactate level, APACHE II score, and the three combinations was 0.74, 0.67, 0.71, and 0.86, respectively. Accordingly, the sensitivity and specificity of the three indicators of 28-day survival were 87.50% and 66.67%, respectively, which were superior to individual indicators. CONCLUSIONS: Sepsis patients with pulmonary infection have a high risk of AKI, and multiple risk factors contribute to this risk. AKI patients may also be adversely affected by a variety of factors, including APACHE II scores, serum Cystatin-C levels, and serum lactate levels, all of which are commonly used to assess the outcomes.

[Clinical pathological characteristics of resectable papillary thyroid microcarcinoma].

Objective: To investigate the difference of prognostic factors and recurrence rates between papillary thyroid microcarcinoma (PTMC) and lager papillary thyroid carcinoma (PTC) and analyze the clinical pathological characteristics of PTMC suitable for surgery. Methods: A retrospective analysis on the clinicopathological features, expression level of of v-raf murine sarcoma viral oncogene homolog B1 (BRAF) V600E gene mutation and pigment epithelium-derived factor (PEDF), and postoperative follow-up results of the 251 PTC patients who underwent surgical treatment from October 2011 to October 2013, including 169 cases with PTMC and 82 with lager PTC (Tumor diameter>1 cm). Results: The BRAF V600E mutation rates of PTMC and lager PTC patients are 65.1%(110/169)and 78.0% (64/82) respectively, and the difference is statistically significant (P<0.05). The prevalence of extrathyroidal invasion (7.1%) and lymph nodes metastasis (27.2%) of the patients with PTMC were significantly lower than those of the patients with larger PTC (15.9% and 46.3%, respectively)(P<0.01). The follow-up durations for PTMC and lager PTC were (45.6±3.6) months and (45.0±3.4) months, respectively (P>0.05). There was no statistic significance for the difference in age, gender, coexistent hashimoto's thyroiditis, PEDF expression, and recurrence rate between the patients with PTMC and with larger PTC (P>0.05). The recurrence rate of the patients who have the high risk factors of PTMC was 1.6%(2/122)and that of larger PTC was 4.9% (4/82). Conclusions: Extrathyroid invasion, lymph node metastases and BRAF V600E gene mutation are the high risk factors of recurrent PTMC. The same treatment strategy should be considered for PTMC with coexistent high risk factors as that for larger PTC. For PTMC with BRAF V600E gene mutation, earlier surgical treatment is suggested. PTMC patients with BRAF V600E gene mutation and high cell subtype are suggested to undergo total thyroidectomy for the first operation in order to reduce the potential risk of recurrence.

Correlation between the BRAF V600E mutation status and the clinicopathologic features of papillary thyroid carcinoma.

This study sought to investigate the correlations of V-raf murine sarcoma viral oncogene homolog B1 (BRAF) gene mutations with the clinicopathologic features of papillary thyroid carcinoma and central lymph node metastasis. We retrospectively analyzed the 2-year medical records of patients who underwent surgery for papillary thyroid carcinoma. After screening, the records of 126 patients who met the study requirements were used to assess the characteristics associated with the BRAF V600E gene mutation. The BRAF mutation incidence rate among patients with papillary thyroid carcinoma was 69.0% (87/126). Univariate analysis revealed that the BRAF mutation status was correlated significantly with both tumor size and lymph node metastasis (P < 0.05). Multivariate analysis revealed a significant correlation between lymph node metastasis and BRAF mutation status (P < 0.05). When the tumor diameter was ≤10 mm, the BRAF mutation status had no effect on lymph node metastasis (P > 0.05). When the tumor diameter was >10 mm, the incidence of lymph node metastasis was significantly higher among BRAF mutation-positive patients than among BRAF mutation-negative patients (P < 0.05). BRAF gene mutations independently predicted central lymph node metastasis in patients with papillary thyroid carcinoma. For patients preoperatively diagnosed to be BRAF mutation-positive, the importance of central lymph node dissection should be emphasized because the tumor diameter increases; regional lymphatic and adipose tissue dissection should be routinely conducted. However, in mutation-negative patients with tumor diameters of ≤5 mm, the need for central lymph node dissection should be re-examined.