Association of procalcitonin levels with the progression and prognosis of hospitalized patients with COVID-19.

Rationale: Coronavirus disease 2019 (COVID-19) was first announced in Wuhan, and has rapidly evolved into a pandemic. However, the risk factors associated with the severity and mortality of COVID-19 are yet to be described in detail. Methods: We retrospectively reviewed the information of 1525 cases from the Leishenshan Hospital in Wuhan. Univariate and multivariate Cox regression analyses were generated to explore the relationship between procalcitonin (PCT) level and the progression and prognosis of COVID-19. Univariate and multivariate logistic regression analyses were performed to explore the relationship between disease severity in hospitalized patients and their PCT levels. Survival curves and the cumulative hazard function for COVID-19 progression were conducted in the two groups. To further detect the relationship between the computed tomography score and survival days, curve-fitting analyses were performed. Results: Patients in the elevated PCT group had a higher incidence of severe and critical severity conditions (P < 0.001), death, and higher computed tomography (CT) scores. There was an association between elevated PCT levels and mortality in the univariate ((hazard ratio [1], 3.377; 95% confidence interval [2], 1.012-10.344; P = 0.033) and multivariate Cox regression analysis (HR, 4.933; 95% CI, 1.170-20.788; P = 0.030). Similarly, patients with elevated PCT were more likely to have critically severe disease conditions in the univariate (odds ratio [2], 7.247; 95% CI, 3.559-14.757; P < 0.001) and multivariate logistic regression analysis (OR, 10.679; 95% CI, 4.562-25.000; P < 0.001). Kaplan-Meier curves showed poorer prognosis for patients with elevated PCT (P = 0.024). The CT score 1 for patients with elevated PCT peaked at day 40 following the onset of symptoms then decreased gradually, while their total CT score was relatively stable. Conclusion: PCT level was shown as an independent risk factor of in-hospital mortality among COVID-19 patients. Compared with inpatients with normal PCT levels, inpatients with elevated PCT levels had a higher risk for overall mortality and critically severe disease. These findings may provide guidance for improving the prognosis of patients with critically severe COVID-19.

Surgical treatment of thoracolumbar fracture with incomplete lower limb paralysis in a patient with COVID-19.

Since December 2019, COVID-19, an acute infectious disease, has gradually become a global threat. We report a case of thoracolumbar fractures (T12 and L1) and incomplete lower limb paralysis in a patient with COVID-19. After a series of conservative treatment which did not work at all, posterior open reduction and pedicle screw internal fixation of the thoracolumbar fracture were performed in Wuhan Union Hospital. Three weeks later, the patient could stand up and the pneumonia is almost cured. We successfully performed a surgery in a COVID-19 patient, and to our knowledge it is the first operation for a COVID-19 patient ever reported.

Risk Factors for Intraoperative Periprosthetic Femoral Fractures in Patients with Hip Dysplasia Undergoing Total Hip Arthroplasty with Uncemented Prostheses.

OBJECTIVES: To determine the potential risk factors for intraoperative periprosthetic femoral fractures in patients with developmental dysplasia of the hip (DDH) undergoing total hip arthroplasty (THA). METHODS: This was a retrospective study. Patients who were diagnosed with DDH and undergoing THA (by artificial joint replacement) at our hospital from January 1999 to December 2019 were included in this study. Clinical and radiological factors were obtained from their medical records, such as age, sex, Crowe classification, morphological features of proximal femur, and features of surgical procedure. The outcome of interest was the occurrence of intraoperative periprosthetic femoral fracture, which was recorded and classified according to the Vancouver classification system. According to the fracture status, the patients were divided into two groups: the fracture group and the non-fracture group. Multivariate logistic regression model was built to identify the risk factors for these fractures. RESULTS: A total of 1252 hips were finally included. Intraoperative periprosthetic femoral fractures were identified in 62 hips. The incidence of intraoperative periprosthetic femoral fractures in patients with DDH undergoing THA was 4.95%. There were 22 patients (proportion = 35.48%, incidence = 1.76%) with Type A fractures, 38 (proportion = 61.29%, incidence = 3.04%) with Type B fractures, and two (proportion = 3.23%, incidence = 0.16%) with Type C fractures. Six independent risk factors for intraoperative periprosthetic femoral fractures were identified: osteoporosis (OR = 3.434; 95% CI, 1.963-6.007), previous surgical history (OR = 4.797; 95% CI, 2.446-9.410), Dorr Type A canal (OR = 3.025; 95% CI, 1.594-5.738), retained femoral neck length (OR = 1.121; 95% CI, 1.043-1.204), implanted metaphyseal-diaphyseal fixation stems (OR = 3.208; 95% CI, 1.562-6.591), and implanted stem with anteversion design (OR = 2.916; 95% CI, 1.473-5.770). CONCLUSIONS: The overall incidence of intraoperative periprosthetic femoral fractures in patients with DDH undergoing THA was 4.95%, which was at a moderate level compared to patients with other diseases undergoing THA. Six independent risk factors were identified: osteoporosis, previous surgical history, Dorr Type A canal, insufficient neck osteotomy level, implantation of metaphyseal-diaphyseal fixation stem, and implantation of a stem with an anteversion design. Comprehending these risk factors might help surgeons prevent the occurrence of these intraoperative periprosthetic femoral fractures in patients with DDH.

The effect of metastasis patterns on survival in male patients with different breast cancer subtypes: results from the Surveillance, Epidemiology, and End Results (SEER) database.

BACKGROUND: Metastasis sites and breast cancer subtypes are important for breast cancer patients. This study aimed to assess possible relationships between them and their influence on prognosis in male breast cancer (MBC) patients. METHODS: We collected data on 2,983 patients with MBC from the Surveillance, Epidemiology, and End Results database, including 250 patients with M1 stage disease. Information on metastatic patterns was provided for bone, brain, liver, and lung metastases. MBC was classified into four subtypes: Her2-/HR+, Her2+/HR+, Her2+/HR-, and triple negative (TN). Univariate and multivariate logistic regression analysis were used to analyze the association, and Cox regression analyses were used to analyze prognosis. RESULTS: The bone was the most common metastatic site and the brain was the least common metastatic site. Patients with the Her2-/HR+ subtype had the highest proportion of metastatic disease, and Her2+/HR- patients had the lowest proportion. Univariate and multivariate logistic regression analyses showed that there were significant differences in distant metastasis patterns in patients with different subtypes. Men with the Her2+/HR+ or Her2-/HR+ subtypes with bone metastasis had better cancer specific survival (CSS), and those with the TN subtype had the worst CSS in all metastatic patterns. CONCLUSIONS: MBC subtypes are associated with different metastasis patterns and can have different effects on prognosis. This study might provide insights into a better understanding of MBC.

Small Cell Carcinoma: a Rare Subtype of Thyroid Cancer with Unanticipated Prognosis.

The prognosis of small cell thyroid carcinoma (SCTC) in a large cohort has not been well reported in the literature. In this study, we analyzed the mortality of SCTC, in comparison to medullary thyroid cancer (MTC) and anaplastic thyroid cancer (ATC), based on the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute, to determine the prognosis of SCTC. Information regarding patients with a diagnosis of MTC, ATC, or SCTC, between 2004 and 2013, was acquired from the SEER database. Patient survival curves were assessed by Cox proportional hazards regression analyses, Kaplan-Meier analyses, and log-rank tests. In a Kaplan-Meier analysis of the entire cohort of thyroid cancer patients, cancer-specific survival declined sharply for patients with SCTC, but it declined more modestly for patients with MTC. The cancer-specific survival was not significantly different between SCTC and ATC. Unadjusted Cox regression analysis showed that SCTC had a higher cancer-specific mortality than MTC but a similar prognosis as ATC. SCTC showed a higher cancer-specific mortality than MTC and ATC after adjustments for various confounding factors. SCTC was found to have a more highly lethal clinical course than MTC and had a similar death rate to ATC. Therefore, we recommend that aggressive, radical treatment like surgery or radiation should be performed for these patients.

[A component of earthworm fibrinolytic enzyme having higher thrombolytic activity than total components in vivo].

AIM: To select higher thrombolytic and lower toxic single component of earthworm fibrinolytic enzymes (EFE). METHODS: EFE containing total components were obtained by affinity chromatography from Eisenia fetida. Using ion-exchange chromatography to separate three main components EfP-0-2, EfP-I-1 and EfP-I-2 from EFE, their thrombolytic activity and toxicity were compared with EFE. RESULTS: Among these components, EfP-I-1 had higher thrombolytic activity in vitro. When 4.5 mg x kg(-1) of these components were injected, the contents of fibrinogen in rat serum were not affected, but only EfP-I-1 exhibited distinct thrombolytic activity. When 6.0 mg x kg(-1) of them were injected intravenously, the bleeding time was not evidently delayed only by EfP-I-1. The acute toxicity test showed that the LD50 of EfP-I-1 was higher than EFE by 2. 17 times. CONCLUSION: Because of distinct thrombolytic activity, lower toxicity in vivo, higher content in EFE and easy to purify, EfP-I-1 was adapted to be developed as a single component medicine for treating thrombus.

Microstructural evolution and electrical properties of base-metal electroded BaTi4O9 materials with B-Si-Ba-Zn-O glass system.

Barium titanate-based microwave dielectrics usually require relatively high temperatures to sinter, which prevents the use of base metals such as copper for electrodes. In this work, BaTi(4)O(9) microwave dielectric ceramics co-fired with copper electrodes are made possible by adding B-Si-Ba- Zn-O glass to induce liquid-phase sintering at sufficiently low temperature and in reduced atmosphere. The microstructures and electric properties of the BaTi(4)O(9) ceramics thus obtained are carefully examined and studied. Proper glass composition may significantly facilitate mass transportation in the low-temperature co-fired ceramic (LTCC) material, resulting in better densification without serious degradation of electric properties. Although the B2O3/SiO2 ratio enhances the glass mobility during sintering, the BaO/ZnO ratio contributes to the chemical affinity of glass to BaTi(4)O(9) ceramics. In addition, various Ba-Ti-O phases with different Ba/Ti ratios may be found in the specimen through the X-ray diffraction patterns when the BaO/ZnO ratio is varied. If the BaO/ZnO ratio is high and the glass flows easily in the material, the Ba(4)Ti(13)O(30) phase is formed. If the BaO/ZnO ratio is low and the glass flows easily in the material, the BaTi(6)O(13) phase appears. We find that glass-induced Ba(4)Ti(13)O(30) transformation may significantly decrease Qxf values in the BT4-BSBZ materials. Therefore, the appropriate glass composition must be selected to ensure the phase stability of dielectrics to achieve the best performance possible.