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Objective:To evaluate the value of age-adjusted Charlson comorbidity index (aCCI) in the clinical prognosis of sepsis and septic shock in the elderly, and to further explore the role of aCCI in evaluating the timing of Shenfu injection in elderly patients with septic shock.Methods:Clinical data of elderly patients with sepsis and septic shock in Dongzhimen Hospital of Beijing University of Chinese Medicine from January 1, 2019 to January 1, 2022 were retrospectively analyzed. With the median aCCI score of all samples as the cutoff value, the patients were divided into the low aCCI score group and high aCCI score group. The prognosis of elderly patients with septic shock and the application timing of Shenfu injection with aCCI score and sequential organ failure assessment (SOFA) were compared.Results:A total of 61 patients were included, including 31 patients in the high aCCI score group. The proportion of septic shock in elderly sepsis patients was lower in the low aCCI score group ( P < 0.05). The aCCI score (95% CI: 1.229-2.615; P< 0.01) was more valuable than SOFA score (95% CI: 1.035-1.607; P< 0.05) in predicting septic shock in elderly patients with sepsis. The 28-day survival rate in the low aCCI score group was higher than that in the high aCCI score group ( P < 0.05). Both the SOFA score (95% CI: 1.010-1.364) and the aCCI score (95% CI: 1.072-10.501) were independent factors affecting the 28-day survival rate. The use of Shenfu injection was associated with 28-day survival outcome in elderly patients with septic shock (95% CI: 0.012-0.788; P < 0.05). Conclusions:aCCI score is more effective than SOFA score in assessing the risk of shock in elderly patients with septic shock, and has a certain predictive value for the survival and prognosis of elderly patients with sepsis. Shenfu injection may be beneficial to the survival and prognosis of elderly patients with septic shock, but it needs to be further verified by large-scale prospective studies.
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OBJECTIVE@#To investigate the expression of four-jointed box kinase 1 (FJX1) in gastric cancer (GC), its correlation with survival outcomes of the patients, and its role in GC progression.@*METHODS@#The expression level of FJX1 in GC tissues and normal gastric mucosal tissues and its correlation with the survival outcomes of GC patients were analyzed using TCGA and GEO database GC cohort. Immunohistochemistry was used to detect FJX1 expression level in clinical specimens of GC tissue, and its correlations with the patients' clinicopathological parameters and prognosis were analyzed. Bioinformatic analysis was performed to identify the potential pathways of FJX1 in GC. The effects of FJX1 overexpression or FJX1 silencing on GC cell proliferation and expressions of proliferation-related proteins, PI3K, AKT, p-PI3K, and p-AKT were evaluated using CCK-8 assay and Western blotting. The effect of FJX1 overexpression on GC cell tumorigenicity was evaluated in nude mice.@*RESULTS@#GC tissues showed significantly higher expressions of FJX1 mRNA and protein compared with normal gastric mucosa tissues (P < 0.05). The high expression of FJX1 was associated with poor prognosis of GC patients (P < 0.05) and served as an independent risk factor for poor survival outcomes in GC (P < 0.05). FJX1 was expressed mainly in the cytoplasm of GC cells in positive correlation with Ki67 expression (R=0.34, P < 0.05), and was correlated with CA199 levels, depth of tumor infiltration and lymph node metastasis of GC (P < 0.05). In the cell experiment, FJX1 level was shown to regulate the expressions of Ki67 and PCNA and GC cell proliferation (P < 0.05). Gene set enrichment analysis indicated that the PI3K/AKT pathway potentially mediated the effect of FJX1, which regulated the expressions of PI3K and AKT and their phosphorylated proteins. In nude mice, FJX1 overexpression in GC cells significantly promoted the growth of the transplanted tumors (P < 0.05).@*CONCLUSION@#FJX1 is highly expressed in GC tissues and is correlated with poor prognosis of GC patients. FJX1 overexpression promotes GC cell proliferation through the PI3K/AKT signaling pathway, and may serve as a potential prognostic biomarker and therapeutic target for GC.
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Animals , Mice , Humans , Cell Proliferation , Ki-67 Antigen , Mice, Nude , Phosphatidylinositol 3-Kinases , Proto-Oncogene Proteins c-akt , Signal Transduction , Stomach Neoplasms/pathology , Intercellular Signaling Peptides and Proteins/geneticsABSTRACT
Objective To investigate the therapeutic effect and prognostic significance of lateral lymph node dissection (LPLND) in patients with lateral lymph node (LPLN) metastasis. Methods The clinicopathological data of rectal cancer patients who underwent total mesorectal excision (TME) combined with LPLND and pathologically confirmed as LPLN metastasis after operation were retrospectively analyzed. The clinicopathological characteristics and metastasis rules of patients with LPLN metastasis were discussed, and the survival prognosis after LPLND was analyzed. Results A total of 102 rectal cancer patients with pathologically confirmed LPLN metastasis were included. The common sites of LPLN metastasis were internal iliac vessels lymph nodes (n=68, 66.7%), followed by obturator lymph nodes (n=44, 43.1%), and common iliac vessels or external iliac vessels lymph nodes (n=12, 11.8%). There were 10 patients (9.8%) with bilateral LPLN metastases, and the mean number of LPLN metastases was 2.2±2.4, among which 16 patients (15.7%) had LPLN metastases number≥2. The 3-year OS (66.8% vs. 7.7%, P < 0.001) and DFS (39.1% vs. 10.5%, P=0.012) of patients with LPLN metastases to the external iliac or common iliac lymph node were significantly lower than those with metastases to the internal iliac or obturator lymph node. The multivariate analysis showed that LPLN metastasis to external iliac or common iliac lymph node was an independent risk factor both for OS (HR=3.53; 95%CI: 1.50-8.31; P=0.004) and DFS (HR=2.40; 95%CI: 1.05-5.47; P=0.037). Conclusion LPLN mainly metastasizes to the internal iliac or obturator lymph node areas. The survival of patients with metastasis to the external iliac or common iliac lymph node cannot be improved by LPLND, and thus systemic comprehensive treatment is often the optimal treatment option.
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【Objective】 To explore the factors influencing the survival and prognosis of patients with bladder urothelial carcinoma (BUC) after surgical treatment, and to establish an artificial intelligence algorithm to predict the effects of different surgical regimens. 【Methods】 BUC patients treated with surgery during Jan.2007 and Jan.2019 in The Second Hospital of Dalian Medical University and Nanfang Hospital of Southern Medical University were enrolled. The complete clinical and follow-up data were collected. Deep neural network (DNN) was used to establish an artificial intelligence algorithm model. A prediction model of survival and prognosis was established, and the influencing factors of survival were explored and ranked by the artificial intelligence algorithm. 【Results】 A total of 832 patients were involved, including 438 (52.64%) treated in The Second Hospital of Dalian Medical University, and 394 (47.36%) treated in Nanfang Hospital of Southern Medical University. Of all cases, 579 (69.6%) were non-muscle invasive bladder cancer, and 253 (30.4%) were muscle invasive bladder cancer. Transurethral resection of bladder tumor was conducted in 539 (64.8%) cases, partial cystectomy in 66 (7.9%) cases, and total cystectomy in 227 (27.3%) cases. The data of patients treated in Second Hospital of Dalian Medical University were used for DNN modeling, and the data of patients treated in Nanfang Hospital of Southern Medical University were used for external verification after modeling. Finally, it was concluded that the factors affecting survival and prognosis were T stage, pathological grade, hypertension or cardiovascular and cerebrovascular disease, hemoglobin, blood calcium, smoking, albumin, lymphocytes, age, ratio of albumin/globulin, operation method, N stage, and creatinine clearance rate in descending order. The model could be used for preoperative prediction. 【Conclusion】 Through DNN modeling and external verification, the influencing factors of postoperative survival can be predicted for patients with bladder cancer, and the surgical effects can also be predicted before operation. The model can provide artificial intelligence algorithm support for the selection of surgical methods and postoperative follow-up plans.
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With the gradual maturity of renal replacement therapy technology, prolonging life span and improving quality of life of patients with uremia have become the ultimate management goals. In recent years, many studies at home and abroad have suggested that hypomagnesemia has an adverse effect on the prognosis of dialysis patients, which may be related to an increased risk of death. We understand the correlation between blood magnesium and blood pressure, cardiovascular disease, bone metabolism and vascular calcification, point out that blood magnesium may become one of the control indicators to reduce the mortality of dialysis patients, and explore its new clinical application.
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Objective • To detect T cell immunoglobulin mucin 3 (Tim-3) and galectin 9 (Gal-9) expression as well as CD3+ T cells and CD8+ T cells infiltration in the tumor tissues of adenocarcinoma of the esophagogastric junction (AEG), and analyze their correlations with the patients' clinical characteristics and survival prognosis. Methods • A retrospective case study was used to collect clinical data and follow-up data of 116 AEG patients who were admitted to Renji Hospital, Shanghai Jiao Tong University School of Medicine from Dec. 2005 to Dec. 2013. Tim-3, Gal-9, CD3, and CD8 protein expressions were detected by immunohistochemistry in the tumor tissues, and the clinical characteristics and prognosis were compared among the patients with different levels of protein expression and T cells infiltration. Results • The results of immunohistochemistry showed that Tim-3 mainly expressed in the infiltrating immune cells, and Gal-9 mainly expressed in the tumor cells. The analysis on the clinical characteristics revealed that Tim-3 expression level was related to the Siewert classification (P=0.030) and CD8+ T cells infiltration level was related to the tumor TNM stage (P=0.042). The results of survival analysis showed that the patients with high level of CD8+ T cells infiltration had a better survival prognosis (P=0.047). However, there was no difference in the prognosis among the patients with different Tim-3 and/or Gal-9 expression levels or with different CD3+ T cell infiltration levels. Conclusion • AEG patients with high level of CD8+ T cells infiltration usually have earlier TNM stages and better prognosis. There is no significant difference in the prognosis of AEG patients with different Tim-3/Gal-9 expression levels.
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Surgery is currently the most appropriate treatment for early-stage non-small cell lung cancer (NSCLC). Increasing unilateral or bilateral multiple primary lung cancer being found, segmentectomy has attracted wide attention for its unique advantages in the treatment for such tumors. Ground glass opacity dominant early-stage NSCLC is associated with a good prognosis and can be cured by segmentectomy, however, the treatment of solid-dominant NSCLC remains controversial owing to the invasive nature. With the in-depth study on the lymph node metastasis pathway, radiological characteristics and molecular biology of NSCLC, a large part of solid nodules with certain characteristics can also be cured by segmentectomy. This paper reviews the research status and progress about the indication of segmentectomy. .
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OBJECTIVE: To compare the predictive value of Ees/Ea in patients with pulmonary arterial hypertension based on right cardiac catheterization and cardiac magnetic resonance examination. METHODS: A total of 50 pulmonary arterial hypertension patients confirmed by right heart catheterization were retrospectively reviewed and followed up 2 years. The relationship between the baseline clinical data and survival prognosis of patients with pulmonary arterial hypertension were analyzed. The predictive value of baseline Ees/Ea for prognosis in patients with pulmonary arterial hypertension were compared. RESULTS: The Ees/Ea calculated by volume method was significantly correlated with the prognosis of patients with pulmonary arterial hypertension(OR =0.082, 95%CI 0.009-0.814, P=0.032). The two-year survival rate of group Ees/Ea>0.67 was significantly higher than that of Ees/Ea≤0.67(86.7% vs. 50%, P=0.003). Conclution Ees/Ea calculated by volume method is an independent influence factor of the survival prognosis of patients with pulmonary arterial hypertension. When Ees/Ea≤0.67, the patients with pulmonary arterial hypertension is more likely to deteriorate.
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Objective To investigate the safety and efficacy of total thoracoscopic pneumonectomy for malignant lesion from a single-center pneumonectomy database.Methods A retrospectively analysis of 43 cases of malignant lesions in patients underwent total thoracoscopic pneumonectomy from surgical database of Shanghai Pulmonary Hospital from December 2013 to August 2017 was conducted,and then the mortality,complications,and disease recurrence were summarized.Results All lesions in 43 patients were pathologically comfirmed malignant,including 39 non-small cell lung cancers and 3 small cell lung cancers and 1 pulmonary metastasis.Complete thoracoscopic pneumonectomy was pedormed in 43 patients.The average operation time was (181.1 ± 68.0) min,blood loss was (146.5 t 113.6) ml,mean tube length was (8.4 ± 3.4) days.Perioperative mortality was 2.3％ (1/43).The complication rate of grade 3 or above was 16.3％.Median follow-up was 18 months,with 9 cases occuning local recurrence or distant metastasis;6 cases suffered from cancer-related death while non-cancer related death happened in 1 patient.Conclusion For selected locally advanced pulmonary malignant lesion,total thoracoscopic pneumonectomy is an alternative to open thoracic surgery with a better perioperative safety and satisfied mid-term oncologic survival.
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Objective@#To investigate the prognostic value of albumin/globulin ratio on postoperative survival outcomes in patients with hepatocellular carcinoma.@*Methods@#Data of 630 patients with HCC, who underwent surgical resection from February 2009 to July 2013, were retrospectively analyzed. Patients were divided into low-value group (A/G < 1.5, defined as L group) and high-value group (A/G≥1.5, defined as H group), and their distribution characteristics were observed with the normal A/G threshold value. Independent risk factors’ affecting survival and prognosis was analyzed with univariate and multivariate Cox’s regression model. Survival trend of all patients with low-value and high-value groups in A, B and C of Barcelona stage (BCLC stage) were analyzed using the Kaplan-Meier method.@*Results@#Multivariate analysis showed that preoperative A/G ratio (P = 0.007), alpha-fetoprotein (P < 0.001), gamma-glutamyltransferase (P = 0.006), RBC (P = 0.014), international normalized ratio (P = 0.009), preoperative BCLC staging (P < 0.001) and number of tumors (P = 0.003), and intraoperative blood transfusion (P < 0.001) were independent prognostic factors affecting long-term survival in HCC patients. The median overall survival time in-group L was 15 months, significantly lower than that in group H of 42 months (P < 0.001). Stratified analysis showed that the short-term survival advantage of patients with high A / G value was limited to those with Barcelona stage A (P < 0.001), and disappeared in patients with Barcelona stage B and C (P > 0.05). The long-term survival advantage existed in patients with Barcelona stage A (P < 0.001), B (P < 0.05), and disappeared in C (P > 0.05).@*Conclusion@#Preoperative albumin/globulin ratio can predict postoperative prognosis and survival, and direct towards the treatment for early stage of HCC and thus representing as an indicator of high clinical value.
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Objective To systematically evaluate the expression of microvascular invasion (MVI) in predicting the clinical prognosis of patients with non-metastatic renal cell cancer (nmRCC) after surgical operation.Methods The relevant search strategy,including and excluding criteria for the relevant literature were developed by two independent researchers.Pubmed,EMBASE,China National Knowledge Infrastructure (CNKI),and Wanfang databases were searched from the inception to May 2018 for the study of tumor prognosis in the patients of nmRCC with MVI following surgical resection.The search language was English and Chinese.The methodological quality of the included studies was assessed by the NOS.Stata 12.0 software and Review Manager 5.3 were used to perform a clinical meta-analysis of relevant literature data.Results A total of 25 related clinical studies were included,published from 2004 to 2018.There were 6 741 patients with nmRCC,of which 1 768 cases of MVI,with a proportion rate of 26.2％.The results showed that the patients with MVI in pathological sections had a lower cancer-specific survival rate (CSS) [HR =1.51,95％ CI(1.41-1.62),P ＜0.001],recurrence-free survival rate(RFS) [HR =1.47,95％ CI (1.26-1.71),P＜0.001] and overall survival rate(OS) [HR=1.37,95％C1(1.19-1.57),P＜ 0.001].Egger's publication bias analysis showed no significant publication bias in terms of CSS (t =1.43,P=0.176),RFS (t =1.21,P=0.253) and OS(t =0.37,P=0.725).Conclusions MVI had a significant poor outcome in patients with surgical resection of nmRCC.It can be used as an independent risk factor to evaluate the postoperative prognosis of those patients.
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To systematically evaluate the expression of lymphovascular invasion (LVI) in predicting the clinical prognosis of patients after radical cystectomy.Methods The relevant search strategy,including and excluding criteria for the relevant literature were developed by two independent researchers.The study of tumor prognosis in the patients with LVI following radical cystectomy cancer were searched by computerized PubMed,EMBASE,Web of Science,Cochrane library,China National Knowledge Infrastructure (CNKI),Wanfang and VIP citation database.The search period was setted from the beginning of establishment of library until May 2017,and the search language was English and Chinese.The methodological quality of the included studies was assessed by the NOS.Besides,the relationship between LVI and the clinical outcome in patients following radical cystectomy was calculated by RevMan 5.3 and Stata 12.0 software.Results A total of 18 related clinical studies were included,published from 2008 to 2017.There were 12 354 patients with bladder cancer,of which 4 272 cases of LVI,with a proportion rate 34.6％.The results showed that the patients with LVI in pathological sections had a lower overall survival rate (HR =1.26,95％ CI 1.16-1.38,P ＜0.001),recurrence-free survival (HR =1.27,95％ CI 1.06-1.52,P ＜0.001),cancer-specific survival rate (HR =1.30,95％CI 1.18-1.42,P ＜0.001).Egger's publication bias analysis showed no significant publication bias in terms of overall survival(P =0.636),recurrence-free survival (P =0.077),and cancer-specific survival (P =0.342).Conclusions LVI had a significant poor outcome in patients with radical resection of bladder cancer.It can be used as an independent risk factor to evaluate the postoperative prognosis of those patients,but more randomized controlled studies are still needed to make a further conformity in our completion.
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Objective To compare the values of peripheral blood and tumor tissue Annexin A3 protein expressions for predictinge platinum resistance in ovarian epithelial cancer. Methods A total of 72 cases of newly treated ovarian epithelial cancer and undergoing platinum based chemotherapy after surgery,and completely followed up in this hospital from February 2010 to February 2012 were selected and divided into the platinum-sensitive group(54 cases) and platinum-resistant group(18 cases) according to the platinum resistance evaluation criteria. Peripheral blood Annexin A3 level was detected by chemiluminescence immunoassay. Tumor tissue Annexin A3 level was detected by adopting the immunohistochemical staining. The predictive value of peripheral blood and tumor tissue Annexin A3 for predicting platinum resistance was analyzed by drawing the ROC curve. Results The peripheral blood Annexin A3 level in the platinum-sensitive group was significantly lower than that in the platinum-resistant group,the difference was statistically significant(P<0.05), the positive rate of tumor tissue Annexin A3 expression in the platinum sensitivity group was significantly lower than that of platinum-resistant group(P<0.05). The median survival time in peripheral blood Annexin A3 low concentration group was significantly higher than that of high concentration group(31.2 months vs. 20.4 months, P<0.05). The median survival time in tissue Annexin A3 low expression group was significantly higher than that in the high expression group (35.2 months vs. 23.1 months P<0.05). The multivariate analysis showed that the level of Annexin A3 expression in serum and tumor tissue were the independent risk factor for affecting platinum resistance (all P<0.05). The area of curve (AUC) of peripheral blood Annexin A3 in predicting platinum resistance was 0. 821, which of tissue Annexin A3 in predicting platinum was 0. 763, peripheral blood Annexin A3 for predicting platinum resistance was significantly higher than tissue Annexin A3 (P< 0.05). Conclusion The expression levels of Annexin A3 protein in peripheral blood and tumor tissue are significantly increased in the patients with platinum resistant ovarian cancer,the predictive value of Annexin A3 protein in peripheral blood for platinum resistance is better than that of tissue Annexin A3 protein.
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Objective To investigate value of peripheral NLR and PLR for the survival of patients with primary gastric cancer.Methods The clinical data of 132 primary gastric cancer patients and 30 healthy controls were analyzed by the Kaplan-Meier, Log-rank test and multivariate COX regression.Results NLR, PLR levels of the case group were significantly higher than that in the healthy control group (t=6.67, P=0.000;t=13.23, P=0.000); the higher the age, the greater tumor diameter, the higher the degree of differentiation, lymph node metastasis, and not be treated with surgery, NLR and PLR could increase (P<0.05);NLR and PLR showed a significant positive correlation (r=0.3164, P=0.0002);survival time of low NLR group was (57.59 ±2.23) months and high NLR group was (35.22 ±3.09) months(P<0.05);survival time of low PLR group was (54.09 ±2.66) months and high PLR group was (35.22 ±2.75 ) months(P<0.05);age, clinical stage, lymph node metastasis and NLR, PLR levels were independent factors for the overall survival in patients with gastric cancer ( P<0.05 ) .Conclusion NLR and PLR of gastric cancer patients increase significantly and are closely related to tumor size, metastasis, clinical stage, and the deterioration, which showes some predictive value for the survival prognosis of the patients.
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OBJECTIVE: This study was designed to determine the relationship between the VEGF (Vascular Endothelial Growth Factor) expression and histopathologic prognostic factors and 5-year survival rate. METHODS: We examined the expression of the VEGF by immunohistochemical staining in 40 specimens collected from invasive uterine cervix cancer patients. We compared the results of relationship between the VEGF expression and several histopathologic prognostic factors by using Fisher exact test for statistical analysis. RESULTS: All specimens showed low or high immunoreactivity. There was no significant correlation between the expression of the VEGF and histopathologic prognostic factors (p>0.05) except for pathological cell types (p<0.05). Parametrial invasion, the stage and age showed statistically significant correlation with 5 year survival rate (p<0.05). There was no statistically significant correlation between the VEGF expression and 5 year survival rate. CONCLUSION: VEGF expression had no relation with prognostic factors except for histopathologic cell types. Its expression may not play an important role in the prognosis of the uterine cervix cancer patients.