Predictors of mortality in patients with isolated gastrointestinal perforation.

Gastrointestinal (GI) perforation is common in the emergency department and has a high mortality rate. The present study aimed to identify risk factors for mortality in patients with GI perforation. The objective was to assess and prognosticate the surgical outcomes of patients, aiming to ascertain the efficacy of the procedure for individual patients. A retrospective cohort study of patients with GI perforation who underwent surgery in a public tertiary hospital in China from January 2012 to June 2022 was performed. Demographics, clinical characteristics, laboratory and imaging results, and outcomes were collected from electronic medical records. The primary outcome measure was in-hospital mortality, and patients were divided into survivor and non-survivor groups based on this measure. Univariate and multivariable logistic regression analyses were performed to obtain independent factors associated with mortality. A total of 529 patients with GI perforation were eligible for inclusion. The in-hospital mortality rate after emergency surgery was 10.59%. The median age of the patients was 60 years (interquartile range, 44-72 years). Multivariable logistic regression analysis indicated that age, shock on admission, elevated serum creatinine (sCr) and white blood cell (WBC) count <3.5x109 or >20x109 cells/l were predictors of in-hospital mortality. In conclusion, advanced age, shock on admission, elevated sCr levels and significantly abnormal WBC count are associated with higher in-hospital mortality following emergency laparotomy.

Analysis of appendicitis management during COVID-19 pandemic: A study of Chinese adult cohorts.

Background: Healthcare seeking behavior has been widely impacted due to the restricted movements of individuals during the Coronavirus disease-19 (COVID-19) pandemic. This study aims to perform risk stratification in patients requiring timely intervention during the recovery periods. Methods: Operation notes of acute appendicitis (AA) patients within a hospital were analyzed during three six-month periods (23 January-23 July in 2019, 2020, and 2021, respectively). Patient data were collected retrospectively including demographics, pre-emergency status, perioperative information, postoperative outcomes, and follow-up results. Results: 321 patients were included in this study, with 111, 86, and 124 patients in 2019, 2020, and 2021 groups, respectively. The median age of patients decreased by 4 years in 2020 as compared to that in 2019. The proportion of pre-hospitalization symptoms duration of more than 48 h in the 2020 group was higher (36.05% in 2020 vs. 22.52% in 2019). Length of hospital stay (LOS) in 2020 was shorter than it was during the same period in 2019 (4.77 vs. 5.64) and LOS in 2021 was shorter than in 2019 (4.13 vs. 5.64). Compared to the lockdown period, the proportion of patients with recurrent AA was higher in the post-lockdown period (15.1% vs. 27.4%). The median age was 34 years (vaccinated) vs. 37 years (unvaccinated). Logistic regression suggests that elevated C-reactive protein (CRP) (OR = 1.018, CI = 1.010-1.028), white cell count (WBC) (OR = 1.207, CI = 1.079-1.350), female (OR = 2.958, CI = 1.286-6.802), recurrent (OR = 3.865, CI = 1.149-12.997), and fecalith (OR = 2.308, CI = 1.007-5.289) were associated with complicated appendicitis (CA). Conclusion: The lockdown measures during the COVID-19 epidemic are shown to be correlated with a reduction in the proportion of AA patients who underwent surgery, particularly in older adults. Risk factors for CA include elevated CRP, WBC, female, recurrent, and fecalith.

Loss of ID3 drives papillary thyroid cancer metastasis by targeting E47-mediated epithelial to mesenchymal transition.

Papillary thyroid cancer (PTC) is the main histological type of thyroid cancer and accounts for almost all increased cases worldwide. Patients with PTC exhibit a favorable prognosis, but the fact that PTC is often accompanied by a high prevalence of lymph node metastasis (LNM) means that the overall recurrence-free survival rate in PTC patients is relatively low. Herein, we identified that ID3 expression is subdued in PTC tissues and closely associated with LNM and a poor disease-free survival outcome in PTC patients. The main contributor to this gene repression is the hypermethylation of the CpG island at the promoter of ID3. Besides, we uncovered that a loss of ID3 promotes invasion and migration of PTC cells, while an ectopic overexpression of ID3 inhibits invasion and migration. Mechanistically, ID3 exhibits tumor suppressor functions in PTC cells by interacting with E47 to form heterodimers that prevent E47 binding to CDH1 promoter and maintaining CDH1 transcription and epithelial phenotype in PTC cells. Taken together, our study demonstrates that ID3 plays a tumor suppressor role in PTC and impedes metastasis by inhibiting E47-mediated epithelial to mesenchymal transition.

Delphian lymph node metastasis is a novel indicator of tumor aggressiveness and poor prognosis in papillary thyroid cancer.

BACKGROUND AND OBJECTIVES: Although the significance of Delphian lymph nodes (DLNs) in patients with papillary thyroid carcinoma (PTC) has been reported, all studies have been based on a small sample size and lack a direct statement concerning prognosis. METHODS: A total of 904 consecutive patients were enrolled in the current study, and all patients were divided into two groups (DLN-positive and DLN-negative) according to the presence of DLN metastasis. RESULTS: DLN was detected in 687 patients (76.0%), and 123 (17.9%) had DLN metastasis. Compared to those in the DLN-negative group, the proportion of other central lymph node (CLN) metastases, mean number of metastatic CLNs, and mean metastatic CLN ratio were higher in the DLN-positive group (86.2 vs. 50.2%, 6.70 ± 5.19 vs. 1.60 ± 2.37, and 0.54 ± 0.25 vs. 0.18 ± 0.26, respectively; p < .001). The same phenomena were observed in the metastatic lateral lymph nodes (LLNs) between the DLN-positive and DLN-negative groups (52.0 vs. 15.4%, 7.28 ± 6.08 vs. 3.38 ± 3.73, and 0.23 ± 0.15 vs. 0.13 ± 0.12, respectively; p < .001). Patients in the DLN-positive group had shorter LLN metastasis-free survival and distant metastasis-free survival than patients in the DLN-negative group (93.5% vs. 98.6% and 95.9% vs. 98.8%, respectively, p < .05). CONCLUSIONS: DLN metastasis in PTC is associated with tumor aggressiveness and a poor prognosis.

Distribution, sources and ecological risks of polycyclic aromatic hydrocarbons in an urban landscape river.

The contents of 16 priority water-borne polycyclic aromatic hydrocarbons (PAHs) in water, potential external pollution sources and sediment from the famous landscape of the Qinghuai River were measured by gas chromatography-mass spectrometry (GC-MS). The distribution, composition, source and ecological risk of PAHs were analyzed. The following results were obtained: (1) Benzo[a]pyrene and benzo[ghi] perylene were not detected in all samples. The total contents of 16 priority PAHs (PAH16) varied from 52.5 to 745.3 ng l(-1) with the average of 174.0 ng l(-1) in water, from 96.0 to 1,064.6 ng l(-1) with the average of 329.2 ng l(-1) in potential sources, from 931.7 to 15,295.5 ng g(-1) with the average of 7,133.6 ng g(-1) in sediments. (2) The concentration of PAH16 in water is lower than in sediment and higher rings are more easily detected in sediment. The percentage of higher ring (four- to six-rings) PAHs accounted for more than 55.6% of PAHs in sediment. (3) The value of FLA/(FLA+Pyr) was higher than 0.5 at most sampling points which illustrated the source was related with petrogenic such as liquid fossil fuel combustion. (4) The potential ecosystem risk of low ring PAH for upstream conflux of external Qinhuai River was less than 10%, while it was 10-50% for other sampling points; The four rings PAH shows lower potential ecosystem risk than other ring PAH in this study area; Dibenzo [ah] anthracene (DahA) shows high potential ecosystem risk at all sampling points.