Evaluation value of Karnofsky performance score for prognosis of elderly patients with sepsis / 中华急诊医学杂志

Objective:To evaluate the prognostic value of Karnofsky performance scores (KPS) in elderly patients with sepsis, so as provide a basis for clinical evaluation of the condition, prognosis and corresponding treatment measures.Methods:A retrospective cohort study was conducted to collect the general information, clinical data, and follow-up data of limb motor function status and self-care ability of elderly patients with sepsis who were hospitalized in the Intensive Care Unit of our hospital from January 2018 to June 2021. Patients were divided into the survival group and death group according to whether they survived the hospitalization. Statistical analysis was performed using t-test, chi-square test, and Mann-Whitney test. The KPS score before admission, disease severity scores (APACHEⅡ and SOFA), serum procalcitonin (PCT), N-terminal pro-brain natriuretic peptide (NT-proBNP), and arterial blood lactate level on admission were compared between the two groups. Then, the factors with significance in univariate analysis were analyzed by Logistic regression method, the independent risk factors for predicting in-hospital mortality were determined, and the receiver operating characteristic (ROC) curve was drawn to evaluate the prognostic value of KPS score in elderly patients with sepsis.Results:A total of 135 patients were collected. There were 85 males and 50 females, 60 died and 75 survived during hospitalization, with a mortality rate of 44.4%. The preadmission KPS score of elderly patients with sepsis in the death group was significantly lower than that in the survival group [30 (30, 40) vs. 70 (50, 90), P<0.001]. Multivariate logistic regression analysis showed that KPS score ( OR=0.938, 95% CI: 0.914-0.963, P<0.001), SOFA score ( OR=1.255, 95% CI: 1.066-1.451, P=0.002) and arterial blood lactate ( OR=1.219, 95% CI: 1.059-1.404, P=0.006) were independent risk factors for predicting the prognosis during hospitalization. ROC curve analysis of mortality showed that compared with SOFA score and blood lactate, the area under the curve of KPS score was the largest, with AUC of 0.830 (95% CI: 0.756-0.890, P<0.001). In addition, the combination of KPS, SOFA and blood lactate had a greater predictive value for the prognosis of elderly patients with sepsis than that of the single index, with an AUC of 0.883 (95% CI: 0.826-0.940, P<0.001). Conclusions:The lower the KPS score, the worse the prognosis of elderly patients with sepsis. The KPS score can be used as a clinical indicator to predict the prognosis of elderly patients with sepsis.

Advances in Radiomics of Cerebral Metastases / 中国医学科学院学报

Cerebral metastases are the most common intracranial tumors in adults,with an increasing incidence in recent years.Radiomics can quantitatively analyze and process medical images to guide clinical practice.In recent years,CT and MRI-based radiomics has been gradually applied to the precise diagnosis and treatment of cerebral metastases,such as the precise detection and segmentation of tumors,the differential diagnosis with other cerebral tumors,the identification of primary tumors,the evaluation of treatment efficacy,and the prediction of prognosis.This article reviews the advances in radiomics of cerebral metastases.

Expression of Wip1 in serum of patients with small cell lung cancer and its clinical significance / 中国肿瘤生物治疗杂志

@#[Abstract] Objective: To investigate the expression of wild type p53 induced phosphatase 1 (Wip1) in small cell lung cancer (SCLC) cells and the serum of SCLC patient and its relationship with clinical prognosis. Methods: Real time quantitative PCR (qPCR) was used to detect the expression of Wip1 in SCLC cells and serum samples. Results: The expression of Wip1 in drug-resistant SCLC cells was significantly higher than that in sensitive cell lines (P<0.01). The expression of Wip1 in serum of SCLC group was significantly higher than that of normal control group (P<0.05); the expression of Wip1 in serum of patients with chemotherapy resistance was significantly higher than that in patients with chemotherapy sensitivity (all P<0.05); the serum Wip1 level was correlated with disease stage, chemotherapy sensitivity and survival status of SCLC patients (all P<0.05). The area under ROC curve of Wip1 predicting the prognosis of SCLC was 0.836 (95%CI:0.8230-0.9600, P<0.01); the expression lever of Wip1 was significantly correlated with progression free survival and overall survival time of SCLC patients (all P<0.05). Disease stage, chemosensitivity and Wip1 expression were independent prognostic factors for SCLC patients (all P<0.05). Conclusion: The expression of Wip1 in serum of SCLC patients may be related to chemotherapy sensitivity and prognosis. Wip1 may be a potential biomarker for therapeutic efficacy and prognosis evaluation of SCLC patients.

Dynamic changes of serum COR and PCT levels in patients with sepsis after burn and analysis of its clinical application / 国际检验医学杂志

Objective To explore the clinical value of Dynamic testing of serum cortisol (COR) and procalcitonin (PCT) in the prediction and prognosis of sepsis after burn.Methods 122adult patients with severe burns who were treated by our unit from September 2014to November 2017were selected and retrospective analyzed.According to the diagnosis criteria of sepsis and the prognosis, the patients were divided into nonsepsis group, sepsis survival group and sepsis death group.The serum COR and PCT level in 1-20days after burn were continuously and dynamically monitored and measured using an automated electrochemical method and immunofluorescence method respectively.Results The serum COR levels in sepsis patients were significantly higher than those in non-sepsis group from the sixth day after burns (P<0.05) , and the serum PCT levels were significantly higher than those in the non-sepsis group from the 7th day after burn (P<0.05) .From the 11th day after burn, the serum COR and PCT levels in the sepsis death group were significantly higher than those in the sepsis survival group (P<0.05);the serum PCT levels in the sepsis death group were significantly higher than those in the sepsis survival group from the 15th day after the burn (P<0.05) .The serum COR levels in the sepsis-dead group decreased linearly, and the serum COR levels were significantly lower than those in the sepsis survival group (P<0.05) .Conclusion The combined testing of serum COR and PCT can be used as an early predictor of post burn sepsis, The Dynamic testing of serum COR and PCT levels in the important clinical application value in the evaluation of prognosis of sepsis after burn.

Clinical management and prognosis evaluation of pulp regeneration therapy / 中华口腔医学杂志

Pulp regeneration in a tooth with pulp necrosis is the research hotspot in current clinical treatment of endodontic diseases. Up to now, the revascularization therapy, which is one of the regenerative endodontic treatment, and the most extensive and effective method in clinical practice, can partially achieve the goal of pulp regeneration and root development in young permanent immature teeth. In order to standardize the technique and improve the curative effect, this atticle discusses the indications, pre-treatment preparation, treatment procedure and the rapeutic evaluation of pulp revascularization therapy.

Mutation analysis of FLT3-ITD gene in acute myeloid leukemia / 中国病理生理杂志

AIM:To investigate the mutation of FLT3-ITD gene in the patients with newly diagnosed acute myeloid leukemia (AML). METHODS:From March 1, 2015 to June 1, 2017, 207 patients with AML admitted to de-partment of hematology, sichuan provincial people′s hospital were enrolled in this study. The bone marrow samples were collected from the patients. PCR was used to detect the mutation of FLT3-ITD gene. After the corresponding chromosome was obtained by R-banding, the cells were made into strips and banding. Twenty karyotypes with relatively cleavage were automatically selected from each specimen to complete karyotyping. By analysis of the clinical data and following-up the prognosis, the FLT3-ITD gene mutation in diagnostic and evaluative values for AML were performed. RESULTS:FLT3-ITD gene mutation was found in 42 cases of 207 AML patients, the positive rate was 20. 29 % . FLT3-ITD positive patients showed 3 bands. FLT3-ITD gene mutation in 42 patients with positive results showed that FLT3-ITD gene mutations in turn met the end to end, and insert a number of nucleotides, but all the mutations were in-frame mutations. According to the FAB and WHO standard, in 42 cases of FLT3-ITD positive positive patients, M0 accounted for 0.00% , M1 accounted for 2.38% (1/42), M2 accounted for 23.81% (10/42), M3 accounted for 0.00% , M4 accounted for 2.38% (1/42), M5 accounted for 69.05% (29/42), M6 accounted for 0.00% , M7 accounted for 2.38% (1/42). The white blood cell ( WBC) level and complete response (CR) rate in FLT3-ITD positive patients were lower than those in FLT3-ITD negative patients (P<0.05). CONCLUSION:The WBC level and CR rate, which are lower in FLT3-ITD positive patients than those in negative patients, are the clinical risk factors. It will be helpful to determine the prognosis evaluation for AML pa-tients.

Research status and progress on exosomes in the diagnosis and treatment of malignant glioma / 中华放射肿瘤学杂志

In recent years,exosomes has gradually captivated widespread attention.It plays a crucial role in the proliferation,differentiation and metastasis of malignant tumors.As nanosized vesicles,exosomes can penetrate through the blood-brain barrier.Thus,exosomes may be a novel tool for the diagnosis and treatment of malignant glioma.In this paper,57 relevant literatures were reviewed to summarize the research status and progress on the role of exosomes in the incidence,progression,liquid biopsy,prognosis evaluation and clinical therapy of malignant glioma.

Second generation sequencing detection breast cancer susceptibility gene variants for risk prediction and clinical treatment / 中国肿瘤临床

Objective:To investigate the function of breast cancer susceptibility gene variants in predicting breast cancer risk and guid-ing clinical treatment through DNA sequencing. Methods:This study involved 146 patients, 71 high-risk cases, and 55 healthy people, totaling 272 cases. The subjects were treated in Tianjin Medical University Cancer Institute and Hospital from November 2013 to July 2015. Genomic DNA was sequenced by a second generation sequencing platform. All exon areas of six common breast cancer suscepti-bility genes (BRCA1, BRCA2, PTEN, STK11, TP53, and RAP1) were sequenced through amplicon sequencing method. Meaningful vari-ants including single nucleotide variants (SNVs), insertion-deletions (InDels) and nonsense mutations were selected and statistical methods, such as t test andχ2 test, were used to analyze the statistical differences in incidence rates among three groups. Results:A total of 177 meaningful variants were confirmed, including 50 SNVs, 8 nonsense mutations, and 9 InDels. Among the variants, 31 were recorded in the Exome Aggregation Consortium (ExAC), 40 were noted in ClinVar database, and 21 were not encoded in the present da-tabase, which were defined as new variants in this study. Conversely, 57 variants (85.1%) were found in breast cancer patients and high-risk cases, and the incidence of axillary lymph node metastasis (P=0.010) and pathological stages (P=0.002) in mutation positive patients were both higher than mutation negative patients. Moreover, the percentage of family history of cancer (P=0.005) and triple negative breast cancer (P=0.009) were both higher in patients carrying pathogenic mutations than in nonpathogenic patients. Conclu-sion:Breast cancer susceptibility gene variants may not only be a tool used to predict the risk of getting breast cancer but also a mean-ingful guideline for the clinical treatment and prognosis evaluation.

Prenatal prognosis evaluation and research advances of congenital diaphragmatic hernia complicated with pulmonary hypertension / 中华实用儿科临床杂志

Congenital diaphragmatic hernia (CDH) is one of the most common congenital malformations and the most deadly types of congenital disease.Pulmonary hypertension (PH) and pulmonary hypoplasia are the most important causes of determining the prognosis of CDH.The prenatal evaluation indicators and management of PH is a difficult point and hot issue of present international study.This article reviewed the new progress of pathogenesis,prenatal evaluation predictor,clinical diagnosis and treatment of CDH complicated with PH.

The value of serum soluble cluster differentiation CD163 to the prognosis of patients with stroke associated pneumonia / 中国中西医结合急救杂志

ObjectiveTo estimate the value of serum soluble scavenger receptor CD163 (sCD163) to the prognosis of patients with stroke associated pneumonia (SAP).Methods A prospective study was conducted. The clinically suspected SAP patients admitted to Department of Intensive Care Unit (ICU) and Emergency ICU (EICU) in Zhejiang Province Zhuji City Chinese Medicine Hospital from February 2014 to January 2015 were all enrolled. According to clinical pneumonia severity index (PSI), they were divided into SAP group and non SAP group according to the presence or absence of SAP, the patients of SAP group were subdivided into mild SAP group (PSI grade Ⅰ-Ⅲgrade) and severe SAP groups (PSI grade Ⅳ-Ⅴ grade) and according to the 28-day prognosis, the patients were subdivided into hospitalized death group and survival group. The clinical data were collected, including gender, age, history of stroke presence or absence, present stroke pattern, National Institutes of Health Stroke Scale score (NIHSS) on the day of stroke suspect diagnosis, Glasgow coma scale (GCS) score, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score, clinical pulmonary infection score (CPIS), PSI score, body temperature, result of chest X-ray film, oxygenation index (PaO2/FiO2), result of sputum culture, serum levels of white blood cell (WBC) and C-reactive protein (CRP) in a period of 7 days after the suspected diagnosis, PCT, sCDl63 levels on days 1, 3, 5, 7 days, length of stay in ICU, the total time of hospitalization and 28-day survival situation, etc. The ability of each index to evaluate the prognosis of SAP was analyzed by the receiver operating characteristic curve (ROC curve). The risk factors influencing the prognosis of SAP patients were analyzed by multivariate logistic regression analysis.Results ① Seventy-eight patients were finally enrolled in the study, 44 patients were diagnosed as SAP, 34 were non SAP. In 44 patients with SAP, there were 28 cases of severe SAP and 16 cases of mild SAP. On the first day of the suspected diagnosis, the NIHSS score [13 (7, 22) vs. 8 (4, 17), the CPIS score [6 (4, 9) vs. 4 (3, 5), sCD163 [mg/L: 0.80 (0.59, 1.32) vs. 0.33 (0.22, 0.46)], CRP [mg/L: 84.2 (50.8, 114.9) vs. 51.4 (26.2, 79.9)] and 28-day mortality [38.6% (17/44) vs. 11.8% (4/34)] in SAP group were significantly higher than those in non SAP group (allP 0.05). ② The levels of sCD163 reached the peak value on the third day after the suspected diagnosis among SAP group and non SAP group, mild SAP group and severe SAP group, survival group and death group and then began to fall; the levels of sCD163, WBC, CRP, PCT within 7 days in SAP, severe SAP and death groups were higher than those in non SAP, mild SAP and survival groups (allP < 0.05). ③ROC curve analysis indicated: sCDl63 showed a better capacity for evaluating the 28-day prognosis of SAP [ROC curve (AUC) =0.673, 95% confidence interval (95%CI) = 0.515-0.807, sensitivity and specificity were 41.2% and 96.3% respectively and the cut-off was 2.65 mg/L]. However, the levels of other inflammatory indexes and scores on the first day after the suspected diagnosis had no value for early prognosis of SAP. The multiple logistic regression analysis showed that the level of sCD163 on the first day after the suspected diagnosis was the independent risk factor of death in hospital of SAP patients [dominance ratio (OR = 1.27, 95%CI = 1.06-1.52,P < 0.05]. Age (OR = 1.04, 95%CI = 1.01-1.06,P = 0.015), NIHSS score (OR = 2.86, 95%CI = 1.64-4.92,P = 0.010), CPIS score (OR = 1.52,95%CI = 1.28-1.90,P < 0.001) and APACHEⅡ score (OR = 2.06, 95%CI = 1.53-3.07,P < 0.001) were also the risk factors of influencing the death of patients with SAP.Conclusions Early sCD163 level is an independent risk factor in predicting the 28-day mortality of patients with SAP, and it has a certain value for the prognosis of SAP.

Analysis of correlations between blood lactic acid, lactate clearance rate and emergency stratification as well as prognosis in patients / 中华危重病急救医学

Objective To investigate the correlations between the level of blood lactic acid (Lac),lactate clearance rate (LCR) and emergency stratification Ⅰ or Ⅱ as well as the prognosis in patients.Methods A retrospective analysis was conducted.The clinical data of 370 critically ill patients with emergency stratification Ⅰ or Ⅱ accompanying with hyperlactacidemia admitted to emergency center of People's Hospital of Wuwei City during January 2013 to April 2015 were analyzed.The patients were allocated into two groups:Lac ≥ 10 mmol/L (n =181) and Lac 4-10 mmol/L (n =189).Base excess (BE),acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and hospital mortality were compared between the two groups.The differences in initial Lac,6-hour LCR and APACHE Ⅱ score were compared between survival group and death group as well as emergency stratification Ⅰ and Ⅱ groups.The correlation between initial Lac,6-hour LCR and APACHE]Ⅱ score was analyzed by Pearson correlation method.Results ① With the increase in Lac level,the negative deviation extent of BE and APACHE Ⅱ score in critical patients were gradually increased [BE (mmol/L):-16.74 ± 8.21 vs.-5.98 ± 8.43,APACHE Ⅱ score:27.6 ± 5.6 vs.20.1 ± 4.8],and hospital mortality was increased [76.79％ (139/181) vs.43.39％ (82/189),all P ＜ 0.01].② The initial Lac and APACHE Ⅱ score of the death group were significantly higher than those of the survival group [initial Lac (mmol/L):8.81 ± 4.71 vs.4.43 ± 2.82,APACHE Ⅱ score:23.6 ± 5.6 vs.17.3 ± 3.7],and 6-hour LCR was significantly decreased [(12.26 ± 6.47)％ vs.(35.16± 10.63)％,all P ＜ 0.01].③ Patients in emergency stratification Ⅰ group had a higher initial Lac and a higher APACHE Ⅱ score but a lower 6-hour LCR level than those in emergency stratification Ⅱ group [initial Lac (mmol/L):8.7±2.6 vs.6.8±2.0,APACHE Ⅱ score:25.2±6.3 vs.16.3±4.7,6-hour LCR:(14.8±4.7)％ vs.(33.5±5.8)％,both P ＜ 0.01].④ It was shown by correlation analysis that initial Lac was significantly positively correlated with APACHE Ⅱ score (r =0.731,P =0.017) in 370 emergency critical ill patients,while 6-hour LCR was negatively correlated with APACHE Ⅱ score (r =-0.694,P =0.010).Conclusions The early arterial blood Lac of patients with emergency stratification Ⅰ was significantly higher than emergency stratification Ⅱ,and the 6-hour LCR in patients with emergency stratification Ⅱ was significantly higher than emergency stratification Ⅰ.Furthermore,the Lac level and LCR were simple and easy to implement as compared with APACHE Ⅱ score in emergency critical ill patients.

Evaluation of serum tumor markers in diagnosis and monitoring prognosis of patients with gastric cancer / 肿瘤研究与临床

Objective To investigate the serum CEA,CA199,CA242,CA724,AFP levels as tumor markers for diagnosis and prognosis of gastric cancer.Methods The serum concentrations of CEA,CA199,CA724,AFP were detected in 108 patients with gastric cancer by ECLIA (electrochemiluminescence immunoassay) method.CA242 by ELISA method.The survival analysis was performed by the Kaplan-Meier method,Cox' s proportional hazards model was used for multivariate analysis of prognosis.Results Using healthy subjects group as control,the ROC-AUC of CEA,CA199,CA242,CA724 were 0.735,0.714,0.598,0.576.The sensitivity,specificity and Youden index were 40.2 ％,97.7 ％,0.379; 43.0 ％,91.3 ％,0.343;35.2 ％,94.8 ％,0.300 and 31.3 ％,95.3 ％,0.266,respectively.For combined detection of CEA,CA199,CA242,CA724,the sensitivity,specificity and Youden Index were 76.8 ％,82.3 ％,0.585.The levels of CEA,CA724 were closely related to lymph node status (both P ＜ 0.05).The concentrations of CEA,CA199,CA242 were significantly related to vascular embolization,distant metastases and ascites (all P ＜ 0.05).The patients of lump and catheter had significantly higher of AFP compared with patients of invasion and anabrosis (P ＜ 0.05).In gastric cancer patients,the size of the primary tumors was closely related to the preoperative serum levels of CEA,AFP,CA724 (P ＜ 0.05).During follow-up,there were 34 cases of death in 59 patients,and the median survival time were 18.1,10.9 months for the patients with CEA negative and positive (P ＜ 0.005).Conclusions Combing detection of CEA,CA199,CA242,CA72 can improve sensitivity of gastric cancer,and play an important role in forecasting the recurrence,metastasis,curing and prognosis evaluation.CEA is an important predictor of recurrence and prognosis of gastric cancer.

Analysis of the karyotype in patients with myelodysplastic syndrome / 白血病·淋巴瘤

Objective To analyze clonal chromosomal abnormalities of patients with MDS and evaluate prognosis combining with complete blood counts and blast counts. Methods The chromosomes were prepared with direct method, brief culture of cells and R-banding techniques, and then the karyotypie analysis was performed. Results Abnormal chromosomes were detected 44.9%, including the numeral abnormalities of chromosomes and structural alterations.The most common chromosomal aberrations were -7,+8.The rate of abnormal karotype in refractory anemia with erythroblasts (RAEB1 and RAEB2) was much higher than in refractory anemia (RA) and refractory anemia with ringed sideroblasts (RAILS). Chromosomal abnormalities correlated positively with bone marrow blasts. Conclusion Karyotype analysis is very useful for the diagnosis, treatment and prognosis evaluation in MDS.