Individualized model for predicting COVID-19 deterioration in patients with cancer: A multicenter retrospective study.

The 2019 novel coronavirus has spread rapidly around the world. Cancer patients seem to be more susceptible to infection and disease deterioration, but the factors affecting the deterioration remain unclear. We aimed to develop an individualized model for prediction of coronavirus disease (COVID-19) deterioration in cancer patients. The clinical data of 276 cancer patients diagnosed with COVID-19 in 33 designated hospitals of Hubei, China from December 21, 2019 to March 18, 2020, were collected and randomly divided into a training and a validation cohort by a ratio of 2:1. Cox stepwise regression analysis was carried out to select prognostic factors. The prediction model was developed in the training cohort. The predictive accuracy of the model was quantified by C-index and time-dependent area under the receiver operating characteristic curve (t-AUC). Internal validation was assessed by the validation cohort. Risk stratification based on the model was carried out. Decision curve analysis (DCA) were used to evaluate the clinical usefulness of the model. We found age, cancer type, computed tomography baseline image features (ground glass opacity and consolidation), laboratory findings (lymphocyte count, serum levels of C-reactive protein, aspartate aminotransferase, direct bilirubin, urea, and d-dimer) were significantly associated with symptomatic deterioration. The C-index of the model was 0.755 in the training cohort and 0.779 in the validation cohort. The t-AUC values were above 0.7 within 8 weeks both in the training and validation cohorts. Patients were divided into two risk groups based on the nomogram: low-risk (total points ≤ 9.98) and high-risk (total points > 9.98) group. The Kaplan-Meier deterioration-free survival of COVID-19 curves presented significant discrimination between the two risk groups in both training and validation cohorts. The model indicated good clinical applicability by DCA curves. This study presents an individualized nomogram model to individually predict the possibility of symptomatic deterioration of COVID-19 in patients with cancer.

EGFR monoclonal antibody panitumumab inhibits chronic proliferative cholangitis by downregulating EGFR.

In hepatolithiasis, chronic proliferative cholangitis (CPC), an active and longstanding inflammation of stone­containing bile ducts with enhanced mucin­producing activity, not only affects the progression of the disease, it can also induce biliary carcinogenesis. The present study aimed to examine the effect of the epidermal growth factor receptor (EGFR) monoclonal antibody panitumumab (Pani) on CPC. Following the establishment of CPC rat models, periodic acid Schiff staining was used to observe the positive rate of EGFR expression. The expression levels of EGFR, mucin 5AC (MUC5AC), Ki­67, type I collagen and mammalian target of rapamycin (mTOR), and the activity of ß­glucuronidase (ß­G), were measured. The rats treated with Pani demonstrated a significantly lower degree of hyperproliferation of the epithelium and submucosal glands of the bile duct and collagen fibers of the bile duct wall, a significantly decreased positive rate of EGFR, reduced phosphorylation of mTOR, decreased expression of EGFR, MUC5AC, Ki­67 and type I collagen, and reduced ß­G activity. The therapeutic effects in rats treated with 4 and 6 mg/kg of Pani were more marked than those in rats treated with 2 mg/kg of Pani. Collectively, the data obtained in the present study suggest that the EGFR monoclonal antibody Pani can effectively inhibit the excessive proliferation and stone­forming potential of bile duct mucosa in CPC with a receptor saturation effect. Therefore, Pani offers promise as a treatment for the prevention and control of intrahepatic choledocholithiasis caused by CPC.

Induction of cell death by pyropheophorbide-α methyl ester-mediated photodynamic therapy in lung cancer A549 cells.

Pyropheophorbide-α methyl ester (MPPa) was a promising photosensitizer with stable chemical structure, strong absorption, higher tissue selectivity and longer activation wavelengths. The present study investigated the effect of MPPa-mediated photodynamic treatment on lung cancer A549 cells as well as the underlying mechanisms. Cell Counting Kit-8 was employed for cell viability assessment. Reactive oxygen species levels were determined by fluorescence microscopy and flow cytometry. Cell morphology was evaluated by Hoechst staining and transmission electron microscopy. Mitochondrial membrane potential, cellular apoptosis and cell cycle distribution were evaluated flow-cytometrically. The protein levels of apoptotic effectors were examined by Western blot. We found that the photocytotoxicity of MPPa showed both drug- and light- dose dependent characteristics in A549 cells. Additionally, MPPa-PDT caused cell apoptosis by reducing mitochondrial membrane potential, increasing reactive oxygen species (ROS) production, inducing caspase-9/caspase-3 signaling activation as well as cell cycle arrest at G0 /G1 phase. These results suggested that MPPa-PDT mainly kills cells by apoptotic mechanisms, with overt curative effects, indicating that MPPa should be considered a potent photosensitizer for lung carcinoma treatment.

[Reduced zinc concentration in expressed prostatic secretion relates to the pain symptoms of types â ¢ and â £ prostatitis].

OBJECTIVE: To determine the zinc levels in the expressed prostatic secretion (EPS) of the patients with different types of chronic nonbacterial prostatitis, and explore the reference value of zinc concentration in EPS in the diagnosis and treatment of prostatitis. METHODS: We collected EPS samples from 35 healthy men and 173 patients with chronic nonbacterial prostatitis, including 65 cases of type ⅢA, 69 cases of type ⅢB, and 39 cases of type Ⅳ, according to the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). We compared the zinc levels in the EPS samples among different groups and analyzed the correlations of zinc concentration with the NIH-CPSI scores, WBC count, pH value, and age of the subjects. RESULTS: The participants were aged 17－65 (32.5±8.5) years. The zinc concentrations in the EPS were significantly lower in the ⅢA (ï¼»162.2±10.8ï¼½ µg/ml) and ⅢB (ï¼»171.2±12.0ï¼½ µg/ml) than in the Ⅳ (ï¼»234.6±17.9ï¼½ µg/ml) (P<0.05 ) and the control group (ï¼»259.5±14.6ï¼½ µg/ml) (P<0.05 ). The zinc level was correlated negatively with the NIH-CPSI pain score (r=－0.248, P<0.01), quality of life score (r=－0.232, P<0.01), severity score (r=－0.270, P<0.01), total NIH-CPSI score (r=－0.281, P<0.01), and the pH value in EPS (r=－0.208, P<0.01), but showed no correlation with the WBC count and age of the subjects. CONCLUSIONS: The reduced zinc concentration in the EPS of the patients with chronic nonbacterial prostatitis may be associated with the pain symptoms of the disease, which suggests the potential reference value of measuring the zinc concentration in EPS in the diagnosis and treatment of prostatitis.

[Changes and significance of T-lymphocytes subsets in severe hepatitis patients].

AIM: To study the changing of blood T-lymphocytes subsets in severe hepatitis patients and its effect. METHODS: The T-lymphocytes subsets of 21 patients with severe hepatitis and 30 healthy volunteer were detected by flow cytometry. From the changes of T lymphocytes subsets we compared their related clinical prognosis of each case. RESULTS: The average CD4(+) CD8(-), CD4(-) CD8(+) lymphocytes counts in severe hepatitis group were lower than the controls groups (P <0.05). And the the CD4(+)/CD8(+) ratios were higher than the control groups (P<0.05). The CD4(+) CD8(-), CD4(-) CD8(+) lymphocytes was lower than severe hepatitis dead group than the surviving group (P<0.05). CONCLUSION: The changes of T - lymphocytes subsets especially the elevation of counts CD4(+), CD8(+) lymphocytes may be one important marker to predict the clinical prognosis.

[Value of Doppler echocardiography derived myocardial energy expenditure measurements in chronic heart failure patients].

OBJECTIVE: To evaluate the relationship between myocardial energy expenditure (MEE) level and cardiac function in chronic heart failure (CHF) patients. METHODS: A total of 99 CHF patients were divided into 3 groups according to the LVEF (HFNEF > or = 50%, n = 37; HFREF1 35.1% - 49.9%, n = 30; HFREF2 < or = 35%, n = 32) or the New York Heart Association (NYHA II, n = 26; III, n = 42; IV, n = 31) criteria. Thirty patients with cardiovascular disease and without CHF served as controls. Routine examinations including serum CRP (ELISA) and plasma NT-proBNP (chemiluminescence sandwich ELISA) were made on the next morning after admission; echocardiography was performed on the third day after admission. LVMW, LVMWI, RWT, LVIDd, LA, LV, LVEF, LVFS, E/A, EDT, IVRT, Tei index and MEE were measured or calculated. RESULTS: MEE was significantly higher in HFREF patients than in controls (P < 0.01) and similar between HFNEF patients and controls (P > 0.05). MEE increased in proportion to decrease of LVEF and increase of NYHA grades in CHF patients (all P < 0.05). Bivariate analysis confirmed that MEE was significant correlated with LVMW, LVMWI, RWT, LVIDd, LA, LV, LVEF (r = -0.540, P < 0.01), LVFS (r = -0.454, P < 0.01), E/A, EDT, IVRT, Tei index, NYHA grades, CRP and NT-proBNP. CONCLUSION: MEE derived from standard echocardiographic measurements is an effective indicator for myocardial bioenergetics and significantly correlated with cardiac function in CHF patients, especially in CHF patients with reduced LVEF.

[Expression of hypoxia-inducible factor-1 alpha and vascular endothelial growth factor in malignant melanoma].

OBJECTIVE: To evaluate the expression of hypoxia-inducible factor-1 alpha (HIF-1 alpha) and vascular endothelial growth factor (VEGF) and their relationship in malignant melanoma. METHODS: 32 cases of malignant melanoma and 11 samples of normal skin were examined for HIF-1 alpha and VEGF expression by immunohistochemistry. RESULTS: The expression rate of HIF-1 alpha and VEGF was 62.5% (20/32) and 84.8% (27/32), respectively, in malignant melanoma, and 9.1% (1/11) and 18.2% (2/11), respectively, in normal skin, showing a significant difference between the two groups. Positive relationship between the expression of HIF-1 alpha and VEGF was found in malignant melanoma (P < 0.05). CONCLUSIONS: 1) The high expression of HIF-1 alpha and VEGF in malignant melanoma indicates that it may play an important role in the generation and development of malignant melanoma. 2) The positive correlation between the expression of HIF-1 alpha and VEGF in malignant melanoma suggests that HIF-1 alpha may be involved in the regulation of VEGF in malignant melanoma.

Value of echocardiography for observing left ventricular hypertrophy in the diagnosis of myocardial microvascular damage in hypertensives.

OBJECTIVE: To investigate the value of the echocardiographic observation of the left ventricular hypertrophy (LVH) in diagnosing myocardial microvascular damage in patients with essential hypertension (EH). METHODS: After intravenous injection with Quanfuxian (a contrast agent consisting of albumin and C3F8 prepared by Nanfang Hospital), the values of A (the maximum number of microbubbles accumulating in the local tissues for assessing the density of local microvessels), beta (the filling velocity of contrast agent for evaluating local blood flow velocity) and A x beta (the product of A and beta for estimating local myocardial blood flow) at rest and after dipyridamole injection were measured by intermittent harmonic imaging with myocardial contrast echocardiography (MCE). The ratios of A and beta along with the microvascular coronary flow velocity reserve (CFVR) were also calculated. RESULTS: Compared with the control group, the rest values of A, beta and A.beta in EH patients were higher, especially in those with LVH. After dipyridamole injection, the values of A, beta, A x beta and the ratios of A and beta, along with CFVR as well, were significantly lowered (P <0.01), and the reductions were especially obvious in LVH cases. As the hypertension exacerbated, the values of A and A x beta tended to increase in positive correlation with systolic and diastolic blood pressure (P <0.01), while the ratio of A and CFVR were decreased, the latter was inversely correlated with diastolic blood pressure (r=-0.55, P <0.01). Positive correlations were noted of the values of A and A x beta with the left ventricular mass and left ventricular mass index (P <0.01). CONCLUSION: EH patients, especially those with LVH, are characterized by increased rest myocardial microvascular blood flow, impaired myocardial microvascular flow reserve and endothelium independent vasodilation relaxing ability, and reduced capillary density, and these conditions tend exacerbate as the disease worsens. Microvascular function impairment should be suspected when complication of LVH arises in the EH patients. As a new important noninvasive technique, MCE can be a promising modality for diagnosing microvascular disease in essential hypertension.

[Echocardiographical features during the rejection free period after heart transplantation: report of one case].

OBJECTIVE: To study the echocardiographic features during the period free of acute allograft rejection after heart transplantation by monitoring one patient within one year after heart transplantation. METHODS: The dimension of atrial and ventricular, interventricular septal and ventricular wall thickness, blood flow pattern through the mitral and tricuspid valves, left ventricular muscle weight (LVMW) and LVMW index during different periods were measured by echocardiography, and all these data were compared with those of the donor before operation. RESULTS: The patient recovered well without any signs of acute rejection. Echocardiography revealed that the dimension of right atrial, left and right ventriculars decreased significantly while left atrial showed significant increase, with obvious increase in the interventricular septal and ventricular wall thickness. LVMW and LVMW index were also significantly increased. The peaks E-and A.wave velocifies of the mitral and tricuspid E peak flow velocity decreased significantly, while the A peak flow velocity of the tricuspid did not undergo any significant changes. Mitral back flow occurred 4 months after the operation and tricuspid back flow persisted after operation. CONCLUSIONS: The changes of morphology, structure and function of the transplanted heart during periods without rejection are to some extent specific to this special phase, when some of these changes are similar to those during early acute rejection, and correct diagnosis relies on endo-myocardial biopsy.

[Clinical value of emergency bedside ultrasonocardiogram in cardiac care unit].

OBJECTIVE: To evaluate the clinical value of application of emergency bedside ultrasound cardiogram (UCG) in cardiac intensive care unit. METHODS: We conducted a retrospective analysis of 116 cases who received examination with emergency bedside UCG within the period from April 2000 to March 2001. RESULTS: The positivity rate of examination with emergency bedside UCG was 100% among these patients. The diseases identified were as follows: acute myocardial infarction in 41 cases, angina pectoris in 16, ventricular aneurysm in 5, perforation of ventricular septum in 2, rheumatic valvular disease in 9, dilated cardiomyopathy in 9 and aortic dissecting aneurysm in 7. CONCLUSION: Emergency bedside UCG has important value in clinical diagnosis of cardiac emergencies.