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1.
Geriatr Gerontol Aging ; 18: e0000061, Apr. 2024.
Article in English | LILACS | ID: biblio-1555618

ABSTRACT

OBJECTIVE: To evaluate frailty and its relationship with prognostic markers in hospitalized patients with acute coronary syndrome. METHODS: This cross-sectional study with a prospective variable analysis (prognostic markers) involved adults of both sexes aged ≥ 50 years with acute coronary syndrome. Patients with ≥ 3 of the following criteria were considered frail: 1) unintentional weight loss; 2) exhaustion (assessed by self-reported fatigue); 3) low handgrip strength; 4) low physical activity level; and 5) low gait speed. The included prognostic markers were: metabolic changes (lipid and glycemic profile), changes in inflammatory status (C-reactive protein), thrombolysis in myocardial infarction risk score, troponin level, angioplasty or surgery, hospitalization in the intensive care unit, length of hospital stay, and hospital outcome. RESULTS: The sample consisted of 125 patients, whose mean age was 65.5 (SD, 8.7) years. The prevalence of frailty was 48.00%, which was higher in women (PR = 1.55; 95%CI 1.08­2.22; p = 0.018) and patients with systemic arterial hypertension (PR = 2.18; 95%CI 1.01­5.24; p = 0.030). Frailty was not associated with age, cardiac diagnosis, or prognostic markers (p > 0.05). CONCLUSIONS: Frailty was highly prevalent in patients with acute coronary syndrome, affecting almost half of the sample, particularly women and patients with hypertension, irrespective of age. However, despite its high prevalence, frailty was not associated with markers of metabolic change or poor prognosis.


Subject(s)
Humans , Middle Aged , Acute Coronary Syndrome/diagnosis
3.
Rev. bras. cir. cardiovasc ; 39(1): e20230012, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1521675

ABSTRACT

ABSTRACT Introduction: The impact of mitral regurgitation (MR) on valve-in-valve transcatheter aortic valve implantation (VIV-TAVI) in patients with failed bioprostheses remains unclear. The purpose of this study was to assess the prognostic impact of residual moderate MR following VIV-TAVI. Methods: We retrospectively analyzed 127 patients who underwent VIV-TAVI between March 2010 and November 2021. At least moderate MR was observed in 51.2% of patients before the procedure, and MR improved in 42.1% of all patients. Patients with postoperative severe MR, previous mitral valve intervention, and patients who died before postoperative echocardiography were excluded from further analyses. The remaining 114 subjects were divided into two groups according to the degree of postprocedural MR: none-mild MR (73.7%) or moderate MR (26.3%). Propensity score matching yielded 23 pairs for final comparison. Results: No significant differences were found between groups before and after matching in early results. In the matched cohort, survival probabilities at one, three, and five years were 95.7% vs. 87.0%, 85.0% vs. 64.5%, and 85.0% vs. 29.0% in the none-mild MR group vs. moderate MR-group, respectively (log-rank P=0.035). Among survivors, patients with moderate MR had worse functional status according to New York Heart Association (NYHA) class at follow-up (P=0.006). Conclusion: MR is common in patients with failed aortic bioprostheses, and improvement in MR-status was observed in over 40% of patients following VIV-TAVI. Residual moderate MR after VIV-TAVI is not associated with worse early outcomes, however, it was associated with increased mortality at five years of follow-up and worse NYHA class among survivors.

4.
Arq. bras. oftalmol ; 87(2): e2021, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1533794

ABSTRACT

ABSTRACT Purpose: This study aimed to analyze the association between magnetic resonance imaging apparent diffusion coefficient map value and histopathological differentiation in patients who underwent eye enucleation due to retinoblastomas. Methods: An observational chart review study of patients with retinoblastoma that had histopathology of the lesion and orbit magnetic resonance imaging with apparent diffusion coefficient analysis at Hospital de Clínicas de Porto Alegre between November 2013 and November 2016 was performed. The histopathology was reviewed after enucleation. To analyze the difference in apparent diffusion coefficient values between the two major histopathological prognostic groups, Student's t-test was used for the two groups. All statistical analyses were performed using SPSS version 19.0 for Microsoft Windows (SPSS, Inc., Chicago, IL, USA). Our institutional review board approved this retrospective study without obtaining informed consent. Results: Thirteen children were evaluated, and only eight underwent eye enucleation and were included in the analysis. The others were treated with photocoagulation, embolization, radiotherapy, and chemotherapy and were excluded due to the lack of histopathological results. When compared with histopathology, magnetic resonance imaging demonstrated 100% accuracy in retinoblastoma diagnosis. Optic nerve invasion detection on magnetic resonance imaging showed a 66.6% sensitivity and 80.0% specificity. Positive and negative predictive values were 66.6% and 80.0%, respectively, with an accuracy of 75%. In addition, the mean apparent diffusion coefficient of the eight eyes was 0.615 × 103 mm2/s. The mean apparent diffusion coefficient value of poorly or undifferentiated retinoblastoma and differentiated tumors were 0.520 × 103 mm2/s and 0.774 × 103 mm2/s, respectively. Conclusion: This study revealed that magnetic resonance imaging is useful in the diagnosis of retinoblastoma and detection of optic nerve infiltration, with a sensitivity of 66.6% and specificity of 80%. Our results also showed lower apparent diffusion coefficient values in poorly differentiated retinoblastomas with a mean of 0.520 × 103 mm2/s, whereas in well and moderately differentiated, the mean was 0.774 × 103 mm2/s.

5.
Arq. neuropsiquiatr ; 82(1): s00441779505, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1533831

ABSTRACT

Abstract Background Understanding the causes of intracerebral hemorrhage (ICH) is crucial for effective treatment and preventing recurrences. The SMASH-U scale is a suggested method for classifying and predicting the outcomes of ICH. Objective To describe the SMASH-U classification and outcomes by etiology in patients admitted to a comprehensive stroke center in São Paulo, Brazil. Methods A retrospective analysis was conducted on patients admitted to the hospital or outpatient clinic between April 2015 and January 2018. Two stroke neurologists evaluated the SMASH-U classification, and patients with incomplete medical records were excluded. Results Out of the 2000 patients with a stroke diagnosis evaluated, 140 were included in the final analysis. The mean age was 57.9 (± 15.5) years, and 54.3% were male. Hypertension was the most frequent etiology, accounting for 41.4% of cases, followed by amyloid angiopathy (18.5%) and structural lesions (14.1%). Structural lesions were more common among women and patients under 45 years old. Favorable outcomes were observed in 61% of patients with structural lesions, compared to 10% of patients with medication-related etiologies. Conclusion This study provides important evidence regarding the etiological classification of Brazilian patients with ICH. Hypertension and amyloid angiopathy were the most frequent causes, while structural lesions and systemic diseases were more common in younger patients.


Resumo Antecedentes Compreender as causas da hemorragia intracerebral (HIC) é crucial para o tratamento eficaz e prevenção de recorrências. A escala SMASH-U é um método sugerido para classificar e prever os resultados da HIC. Objetivo Descrever a classificação SMASH-U e os resultados por etiologia em pacientes admitidos em um centro de acidente vascular cerebral (AVC) em São Paulo, Brasil. Métodos Foi realizada uma análise retrospectiva de pacientes admitidos no hospital ou ambulatório entre abril de 2015 e janeiro de 2018. Dois neurologistas especializados em doenças cerebrovasculares avaliaram a classificação SMASH-U e pacientes com prontuários incompletos foram excluídos. Resultados Dos 2000 pacientes com diagnóstico de AVC avaliados, 140 foram incluídos na análise final. A idade média foi de 57,9 (±15,5) anos e 54,3% eram do sexo masculino. A hipertensão foi a etiologia mais frequente, correspondendo a 41,4% dos casos, seguida pela angiopatia amiloide (18,5%) e lesões estruturais (14,1%). As lesões estruturais foram mais comuns em mulheres e pacientes com menos de 45 anos. Resultados favoráveis foram observados em 61% dos pacientes com lesões estruturais, em comparação com 10% dos pacientes com etiologias relacionadas a medicamentos. Conclusão Este estudo fornece evidências importantes sobre a classificação etiológica de pacientes brasileiros com HIC. A hipertensão e a angiopatia amiloide foram as causas mais frequentes, enquanto lesões estruturais e doenças sistêmicas foram mais comuns em pacientes mais jovens.

6.
Dement. neuropsychol ; 18: e20230034, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1534306

ABSTRACT

ABSTRACT. Autism spectrum disorder (ASD) is expressed with neurobehavioral symptoms of different degrees of intensity. It is estimated that, for every three cases detected, there are two cases that reach adulthood without treatment. Objective: To establish what challenges are still present in the implementation of early intervention (EI) and its effects on the prognosis of ASD. Methods: A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Prisma) methodology was carried out in the PubMed and ScienceDirect databases in January 2023. The search keywords were "autism spectrum disorder", "early intervention" and "prognosis". Results: Sixteen studies were included, two randomized and 14 non-randomized. Knowledge about the signs of ASD, diagnostic and therapeutic methods, age at the start of treatment, and socioeconomic factors were the main challenges encountered in the implementation of the EI. Conclusion: EI is capable of modifying the prognosis of ASD and challenges in its implementation persist, especially in developing regions with low socioeconomic status.


RESUMO. O transtorno do espectro autista (TEA) expressa-se com sintomas neurocomportamentais de diferentes graus de intensidade. Estima-se que, para cada três casos detectados, existam dois casos que atingem a idade adulta sem tratamento. Objetivo: Estabelecer quais são os desafios ainda presentes na implementação efetiva da intervenção precoce (IP) e quais são os seus efeitos no prognóstico do TEA. Métodos: Revisão sistemática com a metodologia Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Prisma) foi realizada nos bancos de dados PubMed e ScienceDirect em janeiro de 2023. As palavras-chave da pesquisa foram "autism spectrum disorder", "early intervention" e "prognosis". Resultados: Dezesseis estudos foram incluídos, sendo dois randomizados e 14 não randomizados. O conhecimento sobre os sinais do TEA, os métodos diagnósticos e terapêuticos, a idade de início de tratamento e os fatores socioeconômicos foram os principais desafios encontrados na implementação da IP. Conclusão: A IP é capaz de modificar o prognóstico do TEA e os desafios em sua implementação ainda afetam, principalmente, regiões em desenvolvimento e de baixo status socioeconômico.

7.
Rev. Soc. Bras. Med. Trop ; 57: e00401, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1535371

ABSTRACT

ABSTRACT Background: Visceral leishmaniasis (VL) is a public health problem and is a relevant cause of death in developing countries. This study aimed to evaluate the 20-year survival and predictors of worse prognosis in patients with VL admitted to a reference hospital for the treatment of infectious diseases between 1995 and 2016 in northern Minas Gerais, an area of high endemicity for VL. Methods: This retrospective cohort study was conducted at a hospital in northern Minas Gerais, Brazil. All patients with VL were evaluated over a 20-year period. The medical records were thoroughly analyzed. Cox regression analysis was performed to estimate factors associated with the probability of survival. Results: The cohort included 972 individuals, mostly male children <10 years old, from urban areas who presented at admission with the classic triad of fever, hepatosplenomegaly, and skin pallor. The mean hemoglobin level was 7.53 mg/dl. The mean interval between symptom onset and hospital admission was 40 days. The instituted therapies ranged from pentavalent antimonates to amphotericin, or both. The probability of survival was reduced to 78% one year after symptom onset. Hemoglobin levels and age were strongly associated with the probability of survival. Conclusions: Regardless of the mechanism underlying the reduction in hemoglobin and the non-modifiable factors of age, early initiation of drug treatment is the most appropriate strategy for increasing survival in patients with VL, which challenges health systems to reduce the interval between the onset of symptoms and hospital admission.

8.
Rev. bras. cir. cardiovasc ; 39(2): e20220185, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1535546

ABSTRACT

ABSTRACT Introduction: Inflammatory and immunological factors play pivotal roles in the prognosis of acute type A aortic dissection. We aimed to evaluate the prognostic values of immune-inflammatory parameters in acute type A aortic dissection patients after surgery. Methods: A total of 127 acute type A aortic dissection patients were included. Perioperative clinical data were collected through the hospital's information system. The outcomes studied were delayed extubation, reintubation, and 30-day mortality. Multivariate logistic regression analysis and receiver operating characteristic analysis were used to screen the risk factors of poor prognosis. Results: Of all participants, 94 were male, and mean age was 51.95±11.89 years. The postoperative prognostic nutritional indexes were lower in delayed extubation patients, reintubation patients, and patients who died within 30 days. After multivariate regression analysis, the postoperative prognostic nutritional index was a protective parameter of poor prognosis. The odds ratios (95% confidence interval) of postoperative prognostic nutritional index were 0.898 (0.815, 0.989) for delayed extubation and 0.792 (0.696, 0.901) for 30-day mortality. Low postoperative fibrinogen could also well predict poor clinical outcomes. The odds ratios (95% confidence interval) of postoperative fibrinogen were 0.487 (0.291, 0.813) for delayed extubation, 0.292 (0.124, 0.687) for reintubation, and 0.249 (0.093, 0.669) for 30-day mortality. Conclusion: Postoperative prognostic nutritional index and postoperative fibrinogen could be two promising markers to identify poor prognosis of acute type A aortic dissection patients after surgery.

9.
Braz. j. med. biol. res ; 57: e13155, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1528104

ABSTRACT

Intracranial hemorrhage (ICH) is a serious medical condition that can lead to significant morbidity and mortality if not diagnosed and treated promptly. Early detection and treatment are essential for improving the outcome in patients with ICH. Near-infrared spectroscopy (NIRS) is a non-invasive imaging technique that has been used to detect changes in brain tissue oxygenation and blood flow in various conditions. The aim of this study was to investigate the predictive potential of NIRS for early diagnosis of ICH in patients presenting to the Emergency Department (ED) triage with headache. A total of 378 patients were included in the study. According to the final diagnosis of the patients, 4 groups were formed: migraine, tension-cluster headache, intracranial hemorrhage and intracranial mass, and control group. Cerebral NIRS values "rSO2" were measured at the first professional medical contact with the patient. The right and left rSO2 (RrSO2, LrSO2) were significantly lower and the rSO2 difference was significantly higher in the intracranial hemorrhage group compared to all other patient groups (P<0.001). The cut-off values determined in the receiver operating characteristics (ROC) analysis were RrSO2 ≤67, LrSO2 ≤67, and ΔrSO2 ≥9. This study found that a difference of more than 9 in cerebral right-left NIRS values can be a non-invasive, easy-to-administer, rapid, and reliable diagnostic test for early detection of intracranial bleeding. NIRS holds promise as an objective method in ED triage for patients with intracranial hemorrhage. However, further research is needed to fully understand the potential benefits and limitations of this method.

10.
Braz. j. infect. dis ; 28(1): 103721, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1550136

ABSTRACT

Abstract Introduction COVID-19 remains an important threat to global health and maintains the challenge of COVID-19 hospital care. To assist decision making regarding COVID-19 hospital care many instruments to predict COVID-19 progression to critical condition were developed and validated. Objective To validate eleven COVID-19 progression prediction scores for critically ill hospitalized patients in a Brazilian population. Methodology Observational study with retrospective follow-up, including 301 adults confirmed for COVID-19 sequentially. Participants were admitted to non-critical units for treatment of the disease, between January and April 2021 and between September 2021 and February 2022. Eleven prognostic scores were applied using demographic, clinical, laboratory and imaging data collected in the first 48 of the hospital admission. The outcomes of greatest interest were as originally defined for each score. The analysis plan was to apply the instruments, estimate the outcome probability reproducing the original development/validation of each score, then to estimate performance measures (discrimination and calibration) and decision thresholds for risk classification. Results The overall outcome prevalence was 41.8 % on 301 participants. There was a greater risk of the occurrence of the outcomes in older and male patients, and a linear trend with increasing comorbidities. Most of the patients studied were not immunized against COVID-19. Presence of concomitant bacterial infection and consolidation on imaging increased the risk of outcomes. College of London COVID-19 severity score and the 4C Mortality Score were the only with reasonable discrimination (ROC AUC 0.647 and 0.798 respectively) and calibration. The risk groups (low, intermediate and high) for 4C score were updated with the following thresholds: 0.239 and 0.318 (https://pedrobrasil.shinyapps.io/INDWELL/). Conclusion The 4C score showed the best discrimination and calibration performance among the tested instruments. We suggest different limits for risk groups. 4C score use could improve decision making and early therapeutic management at hospital care.

11.
Afr. j. prim. health care fam. med. (Online) ; 16(1): 1-6, 2024. figures, tables
Article in English | AIM | ID: biblio-1551635

ABSTRACT

Background: Cancer is the third leading cause of death in Kenya. Yet, little is known about prognostic awareness and preferences for prognostic information. Aim: To assess the prevalence of prognostic awareness and preference for prognostic information among advanced cancer patients in Kenya. Setting: Outpatient medical oncology and palliative care clinics and inpatient medical and surgical wards of Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya. Methods: The authors surveyed 207 adults with advanced solid cancers. The survey comprised validated measures developed for a multi-site study of end-of-life care in advanced cancer patients. Outcome variables included prognostic awareness and preference for prognostic information. Results: More than one-third of participants (36%) were unaware of their prognosis and most (67%) preferred not to receive prognostic information. Increased age (OR = 1.04, 95% CI: 1.02, 1.07) and education level (OR: 1.18, CI: 1.08, 1.30) were associated with a higher likelihood of preference to receive prognostic information, while increased symptom burden (OR= 0.94, CI: 0.90, 0.99) and higher perceived household income levels (lower-middle vs low: OR= 0.19; CI: 0.09, 0.44; and upper middle- or high vs low: OR= 0.22, CI: 0.09, 0.56) were associated with lower odds of preferring prognostic information. Conclusion: Results reveal low levels of prognostic awareness and little interest in receiving prognostic information among advanced cancer patients in Kenya. Contribution: Given the important role of prognostic awareness in providing patient-centred care, efforts to educate patients in Kenya on the value of this information should be a priority, especially among younger patients.


Subject(s)
Humans , Male , Female , Cause of Death , Disease Progression , Neoplasms , Prevalence , Access to Information , Kenya
12.
Chinese Journal of Lung Cancer ; (12): 47-55, 2024.
Article in Chinese | WPRIM | ID: wpr-1010109

ABSTRACT

BACKGROUND@#Invasive mucinous adenocarcinoma (IMA) was a rare and specific type of lung adenocarcinoma, which was often characterized by fewer lymphatic metastases. Therefore, it was difficult to evaluate the prognosis of these tumors based on the existing tumor-node-metastasis (TNM) staging. So, this study aimed to develop Nomograms to predict outcomes of patients with pathologic N0 in resected IMA.@*METHODS@#According to the inclusion criteria and exclusion criteria, IMA patients with pathologic N0 in The Affiliated Lihuili Hospital of Ningbo University (training cohort, n=78) and Ningbo No.2 Hospital (validation cohort, n=66) were reviewed between July 2012 and May 2017. The prognostic value of the clinicopathological features in the training cohort was analyzed and prognostic prediction models were established, and the performances of models were evaluated. Finally, the validation cohort data was put in for external validation.@*RESULTS@#Univariate analysis showed that pneumonic type, larger tumor size, mixed mucinous/non-mucinous component, and higher overall stage were significant influence factors of 5-year progression-free survival (PFS) and overall survival (OS). Multivariate analysis further indicated that type of imaging, tumor size, mucinous component were the independent prognostic factors for poor 5-year PFS and OS. Moreover, the 5-year PFS and OS rates were 62.82% and 75.64%, respectively. In subgroups, the survival analysis also showed that the pneumonic type and mixed mucinous/non-mucinous patients had significantly poorer 5-year PFS and OS compared with solitary type and pure mucinous patients, respectively. The C-index of Nomograms with 5-year PFS and OS were 0.815 (95%CI: 0.741-0.889) and 0.767 (95%CI: 0.669-0.865). The calibration curve and decision curve analysis (DCA) of both models showed good predictive performances in both cohorts.@*CONCLUSIONS@#The Nomograms based on clinicopathological characteristics in a certain extent, can be used as an effective prognostic tool for patients with pathologic N0 after IMA resection.


Subject(s)
Humans , Prognosis , Lung Neoplasms/pathology , Adenocarcinoma, Mucinous/pathology , Adenocarcinoma of Lung/pathology , Neoplasm Staging , Lung/pathology , Retrospective Studies
13.
Chinese Journal of Contemporary Pediatrics ; (12): 81-85, 2024.
Article in Chinese | WPRIM | ID: wpr-1009897

ABSTRACT

Neonatal lupus erythematosus (NLE) is caused by the transmission of maternal anti-Ro/SSA antibodies, anti-La/SSB antibodies, and other autoantibodies to the fetus through the placenta. Usually, with the disappearance of autoantibodies in the children's body, abnormal changes in the mucocutaneous, blood system, and digestive system can spontaneously subside, but the damage to various systems caused by autoantibodies may persist for a long time. This article provides a comprehensive review of the manifestations and prognosis of NLE in various systems, including mucocutaneous, blood system, circulatory system, nervous system, digestive system, respiratory system, aiming to provide reference for clinical work.


Subject(s)
Child , Infant, Newborn , Female , Pregnancy , Humans , Lupus Erythematosus, Systemic/diagnosis , Prognosis , Autoantibodies , Family
14.
Cancer Research on Prevention and Treatment ; (12): 67-72, 2024.
Article in Chinese | WPRIM | ID: wpr-1007231

ABSTRACT

Fanconi anemia (FA) is an inheritable disorder that presents with bone marrow failure, developmental anomalies, and an increased susceptibility to cancer. The etiology of this condition stems from a genetic mutation that disrupts the proper repair of interstrand DNA cross-links (ICLs). The resultant dysregulation of the DNA damage response mechanism can induce genomic instability, thereby elevating the mutation rates and the likelihood of developing cancer. The FA pathway assumes a pivotal role in safeguarding genome stability through its involvement in the repair of DNA cross-links and the maintenance of overall genomic integrity. A mutation in the germ line of any of the genes responsible for encoding the FA protein results in the development of FA. The prevalence of aberrant FA gene expression in somatic cancer, coupled with the identification of a connection between FA pathway activation and resistance to chemotherapy, has solidified the correlation between the FA pathway and cancer. Consequently, targeted therapies that exploit FA pathway gene abnormalities are being progressively developed and implemented. This review critically examines the involvement of the FA protein in the repair of ICLs, the regulation of the FA signaling network, and its implications in cancer pathogenesis and prognosis. Additionally, it explores the potential utility of small-molecule inhibitors that target the FA pathway.

15.
Journal of Clinical Hepatology ; (12): 19-23, 2024.
Article in Chinese | WPRIM | ID: wpr-1006419

ABSTRACT

Porto-sinusoidal vascular disease (PSVD) is a new disease nomenclature proposed in recent years, which is an important supplement to idiopathic non-cirrhotic portal hypertension. PSVD includes the patients with specific pathological conditions, but without portal hypertension symptoms, and the patients with portal vein thrombosis or viral hepatitis. This article elaborates on the naming, epidemiology, etiology, clinical manifestations, prognosis, and treatment of PSVD, in order to improve the understanding of this disease among clinicians.

16.
Journal of Sun Yat-sen University(Medical Sciences) ; (6): 63-68, 2024.
Article in Chinese | WPRIM | ID: wpr-1007275

ABSTRACT

ObjectiveTo analyze the expression of molecular marker affecting the prognosis of acute myeloid leukemia (AML) patients from bioinformatics database, thus providing an experimental basis for further exploration of a novel molecular marker for the prognosis of AML. MethodsThe prognostic data of 179 AML patients from The Cancer Genome Atlas (TCGA) database were examined for differential gene analysis and survival analysis. The bone marrow samples of 74 healthy individuals (HI) and 542 de novo AML patients in the dataset GSE13159 downloaded from the Gene Expression Omnibus (GEO) database were analyzed to detect the difference in the expression levels of differential target genes. Peripheral blood and bone marrow samples were collected from 18 de novo AML patients and 20 age- and gender-matched healthy controls, and real-time fluorescent quantitative PCR was used to validate the expression levels of the differential genes in the AML patients. ResultsBioinformatics data analysis showed that the optimal cut-off value of Homo sapiens NK2 homeobox 3 (NKX2-3) calculated by R language was 0.051. Survival analysis revealed a statistically poorer overall survival in de novo AML patients with high NKX2-3 expression than in those with low NKX2-3 expression (P = 0.0036). NKX2-3 was highly expressed in patients with de novo AML than in HI and the difference was statistically significant (P < 0.001). Real-time fluorescence quantitative PCR verified the expression levels of the NKX2-3 gene in AML patients and confirmed that compared with those in HI, in the de novo AML patients, NKX2-3-1 and NKX2-3-2 were highly expressed and were significantly correlated (P = 0.000, P = 0.000). ConclusionNKX2-3 is highly expressed in de novo AML patients, and the AML patients with high NKX2-3 expression have poor overal survival. NKX2-3 may be closely related to the clinical outcome and prognosis of AML.

17.
Journal of Clinical Hepatology ; (12): 298-305, 2024.
Article in Chinese | WPRIM | ID: wpr-1007244

ABSTRACT

ObjectiveTo investigate the value of platelet-albumin-bilirubin index (PALBI) combined with AIMS65 score in predicting rebleeding and death within 6 weeks after admission in patients with liver cirrhosis and acute upper gastrointestinal bleeding (AUGIB). MethodsA retrospective study was conducted for 238 patients with liver cirrhosis and AUGIB who were hospitalized in The First Affiliated Hospital of Jinzhou Medical University from February 2021 to October 2022, and all patients were followed up for 6 weeks. According to the prognosis, they were divided into death group with 65 patients and survival group with 173 patients, and according to the presence or absence of rebleeding, they were divided into non-rebleeding group with 149 patients and rebleeding group with 89 patients. General data and laboratory markers (including blood routine, liver/renal function, and coagulation), and PALBI, AIMS65 score, Child-Turcotte-Pugh (CTP) score, and Model for End-stage Liver Disease (MELD) score were calculated on admission. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. A multivariate logistic regression model analysis was used to investigate the risk factors for death or rebleeding within 6 weeks after admission in patients with liver cirrhosis and AUGIB. The receiver operating characteristic (ROC) curve and the area under the ROC curve (AUC) were used to investigate the predictive efficacy of each scoring system, and the DeLong test was used for comparison of AUC. ResultsThere were significant differences between the death group and the survival group in hematemesis, past history of varices, albumin (Alb), total bilirubin (TBil), international normalized ratio (INR), creatinine (Cr), prothrombin time (PT), systolic blood pressure, PALBI, AIMS65 score, CTP score, and MELD score (all P<0.05). The multivariate logistic regression analysis showed that hematemesis (odds ratio [OR]=4.34, 95% confidence interval [CI]: 1.88‍ ‍—‍ ‍10.05, P<0.001), past history of varices (OR=3.51, 95%CI: 1.37‍ ‍—‍ ‍8.98, P=0.009), PALBI (OR=4.49, 95%CI: 1.48‍ ‍—‍ ‍13.64, P=0.008), and AIMS65 score (OR=3.85, 95%CI: 2.35‍ ‍—‍ ‍6.30, P<0.001) were independent risk factors for death. The ROC curve analysis of each scoring system in predicting survival showed that CTP score, MELD score, PALBI, AIMS65 score, and PALBI combined with AIMS65 score had an AUC of 0.758, 0.798, 0.789, 0.870, and 0.888, respectively, suggesting that PALBI combined with AIMS65 score had a significantly larger AUC than the four scoring systems used alone (all P<0.05). There were significant differences between the rebleeding group and the non-rebleeding group in hematemesis, history of diabetes, Alb, TBil, INR, Cr, PT, PALBI, AIMS65 score, CTP score, and MELD score (all P<0.05). The multivariate logistic regression analysis showed that PALBI (OR=2.41, 95%CI: 1.17‍ ‍—‍ ‍4.95, P=0.017) and AIMS65 score (OR=1.58, 95%CI: 1.17‍ ‍—‍ ‍2.15, P=0.003) were independent risk factors for rebleeding. The ROC curve analysis of each scoring system in predicting rebleeding showed that CTP score, MELD score, PALBI, AIMS65 score, and PALBI combined with AIMS65 score had an AUC of 0.680, 0.719, 0.709, 0.711, and 0.741, respectively, suggesting that PALBI combined with AIMS65 score had the largest AUC (all P<0.05), but with a relatively low specificity. ConclusionPALBI combined with AIMS65 score has a certain value in predicting death within 6 weeks after admission in patients with liver cirrhosis and AUGIB, with a better value than CTP score and MELD score alone. PALBI combined with AIMS65 score has a relatively low value in predicting rebleeding within 6 weeks, with an acceptable accuracy.

18.
Journal of Clinical Hepatology ; (12): 264-270, 2024.
Article in Chinese | WPRIM | ID: wpr-1007239

ABSTRACT

ObjectiveTo investigate the clinical value of serum creatinine-to-cystatin C ratio (CCR) in evaluating the prognosis of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). MethodsA retrospective analysis was performed for the clinical data of 130 patients with HBV-ACLF (treatment group) who were hospitalized in Department of Infectious Diseases, The First Affiliated Hospital of Soochow University, from January 2021 to November 2022. According to the treatment outcome, they were divided into survival group with 87 patients and death group with 43 patients; according to the presence or absence of infection, they were divided into infection group with 37 patients and non-infection group with 93 patients. A total of 30 individuals who underwent physical examination during the same period of time were enrolled as control group. Routine blood test results were collected on the day of admission, including white blood cell count, platelet count, neutrophil count, and lymphocyte count; serum creatinine, cystatin C, serum albumin (Alb), and prothrombin time (PT) were observed on the day of admission and on days 5, 10, and 15 of hospitalization, and related indicators were calculated, including CCR, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), prognostic nutritional index (PNI), CCR5 (CCR on day 5 after admission), ΔCCR5 (CCR on day 5 after admission minus CCR on the day of admission), CCR10 (CCR on day 10 after admission), ΔCCR10 (CCR on day 10 after admission minus CCR on day 5 after admission), CCR15 (CCR on day 15 after admission), and ΔCCR15 (CCR on day 15 after admission minus CCR on day 10 after admission). The above indicators were compared between the survival group and the death group and between the infection group and the non-infection group. The Mann-Whitney U test was used for comparison of continuous data between two groups, and the Kruskal-Wallis H test was used for comparison between multiple groups. The univariate and multivariate logistic regression analyses were used to investigate the influencing factors for disease prognosis; the receiver operating characteristic (ROC) curve was used to assess the value of CCR in predicting HBV-ACLF death events, and the DeLong test was used for comparison of the area under the ROC curve (AUC). ResultsThere were significant differences in CCR, NLR, PNI, PT, and Alb at baseline between the treatment group and the healthy control group (all P<0.001), and there were significant differences in CCR, NLR, and PT between the survival group and the death group on the day of admission (all P<0.05). Among the 130 patients with HBV-ACLF, there were 25 in the precancerous stage, 48 in the early stage, 32 in the intermediate stage, and 25 in the advanced stage, and there were significant differences in baseline CCR, PLR, and PT between the patients in different stages of HBV-ACLF (all P<0.05). There were significant differences in ΔCCR5 and NLR between the infection group and the non-infection group (P<0.05), and there were significant differences in ΔCCR5, CCR10, and CCR15 between the survival group and the death group (all P<0.05). The multivariate logistic regression analysis showed that ΔCCR5 (odds ratio [OR]=1.175, 95% confidence interval [CI]: 1.098‍ — ‍1.256, P<0.001), NLR (OR=0.921, 95%CI: 0.880‍ — ‍0.964, P<0.001), and PT (OR=0.921, 95%CI: 0.873‍ — ‍0.973, P=0.003) were independent influencing factors for the prognosis of HBV-ACLF patients. ΔCCR5 had an AUC of 0.774, a sensitivity of 0.687, and a specificity of 0.757, and the AUC of ΔCCR5+PT+NLR was 0.824, which was significantly higher than the AUC of ΔCCR5, NLR, or PT alone (all P<0.05). ConclusionΔCCR5, NLR, and PT can reflect the condition and prognosis of patients with HBV-ACLF and are independent predictive indicators for death events in patients with HBV-ACLF. The combination ofΔCCR5, PT, and NLR has the best predictive efficiency.

19.
Chinese Journal of Experimental Traditional Medical Formulae ; (24): 160-169, 2024.
Article in Chinese | WPRIM | ID: wpr-999172

ABSTRACT

ObjectiveTo objectively evaluate the clinical efficacy of multiple therapies of traditional Chinese medicine (TCM) in low-prognosis patients who received antagonist protocol for in vitro fertilization and embryo transfer (IVF-ET) again. MethodA total of 128 patients with kidney Yin deficiency, liver depression, and blood stasis who planned to receive antagonist protocol for IVF-ET in the West China Second Hospital of Sichuan University were enrolled and assigned into two groups by random number table method. The observation group (64 casces) was treated by oral administration of Chinese medicine decoction + enema of kidney-tonifying and blood-activating method + auricular point sticking + oral administration of dehydroepiandrosterone (DHEA), while the control group (64 casces) was treated by only oral administration of DHEA. After treatment for three menstrual cycles, both groups received the antagonist protocol for IVF-ET. The TCM syndrome scores, basic sex hormone levels, antral follicle count (AFC), the usage of gonadotropin (Gn), endometrial receptivity indicators, embryo quality indicators, and pregnancy outcomes were compared between the two groups. ResultAfter treatment, the observation group showed decreased follicle-stimulating hormone (FSH)/luteinizing hormone (LH) ratio, lowered level of estradiol (E2), increased AFC, decreased amount and days of Gn usage, improved endometrial receptivity indicators (endometrial thickness on trigger and ET days, proportion of endometrial type A in endometrial types and the level of E2 on trigger day) and embryo quality indicators (the rates of mature follicles, fertilization, normal fertilization, and premium embryos), and decreased TCM syndrome scores (P<0.05, P<0.01). Moreover, the observation group had lower FSH/LH ratio, E2 level, and amount of Gn usage, higher AFC, poorer endometrial receptivity and embryo quality indicators, and lower TCM syndrome scores than the control group after treatment (P<0.05, P<0.01). In addition, except for 3 cases of natural pregnancy, the observation group outperformed the control group in terms of improving the clinical pregnancy rates during initiation cycle and transplantation cycle and clinical pregnancy rate and decreasing biochemical pregnancy rate and early abortion rate (P<0.05). ConclusionCombined therapies of TCM can alleviate the clinical symptoms, reduce TCM syndrome scores, reduce the Gn usage amount, improve the number and quality of embryos and endometrial receptivity, and coordinate the synchronous development of endometrium and embryo. In this way, they can increase the clinical pregnancy rate and reduce biochemical pregnancy rate and early abortion rate in the low prognosis patients with kidney yin deficiency, liver depression, and blood stasis who are undergoing IVF-ET again.

20.
Journal of Clinical Hepatology ; (12): 767-772, 2024.
Article in Chinese | WPRIM | ID: wpr-1016522

ABSTRACT

ObjectiveTo investigate the clinicopathological features, diagnosis and treatment methods, and prognosis of gallbladder sarcomatoid carcinoma (GBSC). MethodsA retrospective analysis was performed for the clinical data of 16 patients with GBSC who were admitted to The First Affiliated Hospital of Zhengzhou University from January 2015 to April 2023, including general information, clinical manifestations, imaging features, pathological features, and treatment modality, and follow-up was performed for all patients. The Kaplan-Meier method was used to perform the survival analysis and plot the survival curve, and the Log-rank test was used for comparison between groups. ResultsAmong the 16 patients, there were 6 male patients and 10 female patients, with a mean age of 62.9±8.4 years. The main clinical manifestations were right upper abdominal pain in 13 patients (81.3%), nausea in 5 patients (31.3%), abdominal distension in 4 patients (25.0%), poor appetite in 3 patients (18.8%), weakness in 2 patients (12.5%), fever in 2 patients (12.5%), and jaundice in 1 patient (6.3%), and 3 patients were asymptomatic and were found to have this disease by physical examination. Of all patients, 81.3% (13/16) were in the advanced stage (stage Ⅲ/Ⅳ) at the time of initial diagnosis. Histopathological examination showed that some cancer cells were spindle-shaped under the microscope, with marked nuclear division and noticeable heteromorphism. Immunohistochemistry showed a positive expression rate of 100% (16/16) for Vimentin, AE1/AE3, and CK8/18, and Ki-67 proliferation index was highly expressed in 81.3% (13/16) of the patients (≥50%), with a median of 70% (range 20%‍ ‍—‍ ‍90%). All 16 patients underwent surgical treatment, with radical surgery in 11 patients and palliative surgery in 5 patients, among whom 9 received R0 resection, 2 received R1 resection, and 5 received R2 resection, and 7 patients received adjuvant therapy after surgery. Effective follow-up was achieved for all 16 patients, with a follow-up time of 0.5‍ ‍—‍ ‍26.0 months and a median follow-up time of 11.0 months. By the end of follow-up, 2 patients survived and 14 patients died due to tumor recurrence or metastasis, with a median survival time of 10.0 months, and the 1- and 2-year cumulative survival rates after surgery were 31.3% and 8.3%, respectively. The prognostic analysis showed that TNM stage (χ2=6.727, P=0.009), surgical approach (χ2=7.508, P=0.006), margin condition (χ2=7.934, P=0.005), and adjuvant therapy (χ2=4.608, P=0.032) were associated with the prognosis of patients. ConclusionThe clinical manifestations of GBSC lack specificity, and a confirmed diagnosis relies on immunohistochemical analysis. Most patients are in the advanced disease at the time of initial diagnosis and tend to have a poor prognosis. There are currently no targeted therapies for this disease, and radical surgery with negative margins and adjuvant therapy can improve the survival rate of patients.

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