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1.
Sci Rep ; 11(1): 22096, 2021 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-34764382

RESUMO

Autologous liver transplantation (ALT) to cure end-stage hepatic alveolar echinococcosis (HAE) requires that hepatobiliary surgeons understand the invasion of intrahepatic structure and adjacent tissues or organs. Triphase contrast-enhanced CT of the liver has been widely used for diagnosis and preoperative evaluation of HAE. Three-dimensional (3D) reconstruction allows for accurate measurement of remnant liver volume (RLV). The objective of the study was to evaluate value of triphase contrast-enhanced CT together with 3D reconstruction in preoperative evaluation of indications for ALT in patients with end-stage HAE. This cohort include twenty-one consecutive patients with end-stage HAE, who preoperatively underwent triphase enhanced CT together with 3D reconstruction for ALT. To depict the indications, the 2D image data were reviewed statistically focusing on porta hepatis invasion, retrohepatic vena cava (RHVC) involvement and degrees of intrahepatic vessel invasion, and the 3D reconstruction was performed to obtain ratio of RLV to standard liver volume (SLV). The results showed that 95.24% patients (20/21) had porta hepatis invasion. When lesions located in right liver lobe, porta hepatis invasion occurred most commonly in the second and third porta hepatis (7/10), whereas the first, second and third porta hepatis were most commonly invaded by lesions in the right and caudate / left medial liver lobes (7/11) (P < 0.05). The mean value of longitudinal invasion of RHVC was 8.0 cm, and 95.2% (20/21) of patients had RHVC invasion with ≥ 180° circumferential invasion. As for the important vascular events, moderate and severe invasion occurred most commonly in the right hepatic vein, right branch of portal vein and RHVC each in 95.2% (20/21) patients (P < 0.05). We also found that preoperative CT had a good agreement with intraoperative findings in assessing intrahepatic vascular involvement by HAE (kappa index = 0.77). The estimated average ratio of RLV to SLV was 0.95 (range, 0.43-1.62). In conclusion, the 2D contrast-enhanced CT could well depict anatomic location and size of HAE, and invasion of porta hepatis and vascular by this disease, and involvement of other adjacent organs and tissues. Above all, 3D reconstruction could accurately measure RLV in patients with end-stage HAE for ALT.

2.
J Hepatol ; 2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34793865

RESUMO

BACKGROUND & AIMS: To investigate the prognostic value and relevant mechanisms of tertiary lymphoid structures (TLSs) in intrahepatic cholangiocarcinoma (iCCA). METHODS: We retrospectively included 962 patients from three cancer centers across China. The TLSs at different anatomic subregions were quantified and correlated with overall survival (OS) by Cox regression and Kaplan-Meier analyses. Multiplex immunohistochemistry (mIHC) was applied to characterize the composition of TLSs in 39 iCCA samples. RESULTS: A quaternary TLS scoring system was established for intra-tumor region (T score) and peri-tumor region (P score) respectively. T score positively correlated with favorable prognosis (P<0.001), whereas a high P score signified a worse survival (P<0.001). Then, mIHC demonstrated that both Tfh and Treg cells were significantly increased in intra-tumor TLSs than peri-tumor counterparts (P<0.05), and Treg cell frequencies within intra-tumor TLSs were positively associated with P score (P<0.05) rather than T score. Collectively, the combination of T and P scores stratified iCCAs into four Immune Classes with distinct prognosis (P<0.001) that differed in the abundance and distribution pattern of TLSs. Patients displayed an immune active pattern had the lowest risk, with 5-year OS rates of 68.8%, whereas only 3.4% of patients with immune excluded pattern survived at 5 years (P<0.001). The C-index of the Immune Class was statistically higher than the TNM staging system (0.73 vs 0.63, P<0.001). These results were validated in an internal and two external cohorts. CONCLUSIONS: The spatial distribution and abundance of TLSs significantly correlated with prognosis and provided a useful immune classification for iCCA. Tfh and Treg cells may play a critical role in determining the functional orientation of spatially different TLSs. LAY SUMMARY: Tertiary lymphoid structures (TLSs) have been attracting extensive attentions as they are associated with favorable prognosis through activating endogenous anti-tumor immune response. However, their role in intrahepatic cholangiocarcinoma (iCCA) remains elusive. Herein, we comprehensively evaluated the spatial distribution, abundance, and cellular composition of TLSs in iCCA, and revealed opposite prognostic impacts of TLSs located within or outside tumor region. The heterogeneous distribution of Tfh and Treg cells within the spatially different TLSs might be determinant of their functional state. Successfully, the integrated analysis of TLSs stratified iCCAs into four immune subclasses with distinct clinical outcomes.

3.
Front Oncol ; 11: 753797, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34745986

RESUMO

Objective: To investigate relationship of tumor stage-based gross tumor volume (GTV) of esophageal squamous cell carcinoma (ESCC) measured on computed tomography (CT) with early recurrence (ER) after esophagectomy. Materials and Methods: Two hundred and four consecutive patients with resectable ESCC including 159 patients enrolled in the training cohort (TC) and 45 patients in validation cohort (VC) underwent contrast-enhanced CT less than 2 weeks before esophagectomy. GTV was retrospectively measured by multiplying sums of all tumor areas by section thickness. For the TC, univariate and multivariate analyses were performed to determine factors associated with ER. Mann-Whitney U test was conducted to compare GTV in patients with and without ER. Receiver operating characteristic (ROC) analysis was performed to determine if tumor stage-based GTV could predict ER. For the VC, unweighted Cohen's Kappa tests were used to evaluate the performances of the previous ROC predictive models. Results: ER occurred in 63 of 159 patients (39.6%) in the TC. According to the univariate analysis, histologic differentiation, cT stage, cN stage, and GTV were associated with ER after esophagectomy (all P-values < 0.05). Multivariate analysis revealed that cT stage and GTV were independent risk factors with hazard ratios of 3.382 [95% confidence interval (CI): 1.533-7.459] and 1.222 (95% CI: 1.125-1.327), respectively (all P-values < 0.05). Mann-Whitney U tests showed that GTV could help differentiate between ESCC with and without ER in stages cT1-4a, cT2, and cT3 (all P-values < 0.001), and the ROC analysis demonstrated the corresponding cutoffs of 13.31, 17.22, and 17.83 cm3 with areas under the curve of more than 0.8, respectively. In the VC, the Kappa tests validated that the ROC predictive models had good performances for differentiating between ESCC with and without ER in stages cT1-4a, cT2, and cT3 with Cohen k of 0.696 (95% CI, 0.498-0.894), 0.733 (95% CI, 0.386-1.080), and 0.862 (95% CI, 0.603-1.121), respectively. Conclusion: GTV and cT stage can be independent risk factors of ER in ESCC after esophagectomy, and tumor stage-based GTV measured on CT can help predict ER.

4.
Front Oncol ; 11: 698373, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34616673

RESUMO

Background: Hepatocellular carcinoma (HCC) is the sixth most common cancer in the world and the third leading cause of cancer-related death. Although the diagnostic scheme of HCC is currently undergoing refinement, the prognosis of HCC is still not satisfactory. In addition to certain factors, such as tumor size and number and vascular invasion displayed on traditional imaging, some histopathological features and gene expression parameters are also important for the prognosis of HCC patients. However, most parameters are based on postoperative pathological examinations, which cannot help with preoperative decision-making. As a new field, radiomics extracts high-throughput imaging data from different types of images to build models and predict clinical outcomes noninvasively before surgery, rendering it a powerful aid for making personalized treatment decisions preoperatively. Objective: This study reviewed the workflow of radiomics and the research progress on magnetic resonance imaging (MRI) radiomics in the diagnosis and treatment of HCC. Methods: A literature review was conducted by searching PubMed for search of relevant peer-reviewed articles published from May 2017 to June 2021.The search keywords included HCC, MRI, radiomics, deep learning, artificial intelligence, machine learning, neural network, texture analysis, diagnosis, histopathology, microvascular invasion, surgical resection, radiofrequency, recurrence, relapse, transarterial chemoembolization, targeted therapy, immunotherapy, therapeutic response, and prognosis. Results: Radiomics features on MRI can be used as biomarkers to determine the differential diagnosis, histological grade, microvascular invasion status, gene expression status, local and systemic therapeutic responses, and prognosis of HCC patients. Conclusion: Radiomics is a promising new imaging method. MRI radiomics has high application value in the diagnosis and treatment of HCC.

5.
Metab Brain Dis ; 36(8): 2329-2341, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34665375

RESUMO

Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases among the elderly people. The T2DM increases the risk of cardio-cerebrovascular disease (CCD), and the main pathological change of the CCD is atherosclerosis (AS). Meanwhile, the carbonic anhydrases (CAs) are involved in the formation and progression of plaques in AS. However, the exact physiological mechanism of carbonic anhydrase III (CAIII) has not been clear yet, and there are also no correlation study between CAIII protein and T2DM with CCD. The 8-week old diabetic mice (db/db-/- mice) and wild-type mice (wt mice) were feed by a normal diet till 32 weeks, and detected the carotid artery vascular opening angle using the method of biomechanics; The changes of cerebral cortex and myocardium were watched by the ultrastructure, and the autophagy were observed by electron microscope; The tissue structure, inflammation and cell injury were observed by Hematoxylin and eosin (HE) staining; The apoptosis of cells were observed by TUNEL staining; The protein levels of CAIII, IL-17, p53 were detected by immunohistochemical and Western Blot, and the Beclin-1, LC3, NF-κB were detected by Western Blot. All statistical analysis is performed using PRISM software. Compared with wt mice, db/db-/- mice' carotid artery open angle increased significantly. Electron microscope results indicated that autophagy in db/db-/- mice cerebral cortex and heart tissue decreased and intracellular organelle ultrastructure were damaged. HE staining indicated that, db/db-/- mice' cerebral cortex and heart tissue stained lighter, inflammatory cells infiltration, cell edema were obvious, myocardial fibers were disorder, and myocardial cells showed different degrees of degeneration. Compared with wt mice, TUNEL staining showed that there was obviously increase in db/db-/- mice cortex and heart tissue cell apoptosis. The results of immunohistochemistry and Western Blot indicated that CAIII, Beclin-1 and LC3II/I expression levels conspicuously decreased in cortex and heart tissue of db/db-/- mice, and the expression level of IL-17, NF-κB and p53 obviously increased. The carotid artery' vascular stiffness was increased and which was probably related with formation of AS in diabetic mice. And the autophagy participated in the occurrence and development of diabetic CCD. CAIII protein might somehow be involved in the regulation of autophagy probably through affecting cell apoptosis and inflammation, but the underlying mechanism remains to be further studied.

6.
Chem Commun (Camb) ; 57(85): 11233-11235, 2021 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-34633005

RESUMO

An SPA-triazolium bromide-catalyzed transannular C-acylation of enol lactones is presented. This methodology provides convenient access to a range of enantioenriched spirocyclic 1,3-diketones in moderate to high yields and enantioselectivities and features a broad substrate scope in terms of enol lactones. The catalytic capability of this triazolium salt catalyst is also demonstrated in this enantioselective transformation, which could inspire its further application.

7.
Pest Manag Sci ; 2021 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-34523221

RESUMO

BACKGROUND: The use of chemical insecticides to control Bemisia tabaci Gennadius (Hemiptera: Aleyrodidae) is widespread, although it might exert a sublethal effect on its dominant parasitoid, Encarsia formosa Gahan (Hymenoptera: Aphelinidae). To investigate the sublethal effect of spirotetramat on E. formosa, we observed the ability of E. formosa to locate and handle the host, oviposit and preen after exposure to sublethal concentrations of spirotetramat. RESULTS: After exposure to spirotetramat at LC50 , the response time of E. formosa to the volatile reached 223.40 s and was significantly prolonged. Only 56.44% of the wasps were attracted by the volatile and the insect crawled the slowest among all of the treatments. The averages of oviposition posture adopted and host handled by each E. formosa in 1 h decreased significantly to 1.79 and 1.27, respectively. At the sublethal concentration of LC10 , 94.59% of the wasps were attracted by the volatile and the insect crawled the fastest. The average of host handled by each E. formosa was 3.92, and the frequency of drumming while walking and drumming the host was 12.34 times per second and 12.30 times per second, respectively, demonstrating a significant acceleration in these abilities. CONCLUSION: These findings demonstrate that spirotetramat induced hormesis in E. formosa on exposure to its LC10 concentration and accelerated its host locating, host handling and frequency of antennae drumming. These findings could assist in balancing the chemical and biological control of B. tabaci and enhancing the efficacy of E. formosa as a biocontrol agent.

8.
J Matern Fetal Neonatal Med ; : 1-3, 2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34496712

RESUMO

OBJECTIVE: To assess the efficacy of positive feedback closed-loop management system (PFCMS) protocol in influencing parents' decision about pregnancy continuation in pregnancies diagnosed with omphalocele. METHODS: This was a retrospective cohort study of patients who were diagnosed with fetal omphalocele prior to 20 weeks' gestation by ultrasound and were referred to Fetal Care Center at a mainland Chinese medical center during an 11-year period. Two management strategies were offered during the two stages of the study period: a single consultant with a routine protocol and a multidisciplinary support team with PFCMS, respectively. We analyzed the two protocols influencing parents' decision about pregnancy continuation. RESULTS: Forty-nine patients diagnosed with fetal omphalocele were included in this study. In Group A including 16 patients with routine protocol during the first stage of the study period, the majority opted for termination, and only five continued the pregnancy. In Group B including 33 patients with PFCMS during the second stage of the study period, less than one third chose TOP, and 23 ended in live births. There was a significantly lower TOP rate in patients treated with the PFCMS protocol. CONCLUSION: The PFCMS protocol may be an efficient approach in managing pregnancies complicated by omphalocele, which may help in preventing unnecessary pregnancy terminations.

9.
Angew Chem Int Ed Engl ; 60(42): 22688-22692, 2021 10 11.
Artigo em Inglês | MEDLINE | ID: mdl-34414645

RESUMO

Although copper-nitrene has been extensively studied as a versatile active species in various transformations, asymmetric reactions involving copper-nitrene have been limited to the aziridination of olefins. Herein, we report the novel copper-nitrene-catalyzed desymmetric oxaziridination reaction of cyclic diketones with alkyl azides and the subsequent rearrangement of the resulting highly active intermediate, which produces a synthetically challenging chiral bicyclic lactam containing a quaternary carbon center. This procedure not only enriches the copper-nitrene-catalyzed asymmetric reactions, but also provides an alternative strategy to address the inherent challenges of catalytic asymmetric Schmidt reactions. This unique reaction could inspire the investigation of novel copper-nitrene-catalyzed asymmetric transformations and their reaction mechanisms.

10.
Chem Sci ; 12(27): 9262-9274, 2021 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-34349896

RESUMO

As has been well-recognized, semipinacol rearrangement functions as an exceptionally useful methodology in the synthesis of ß-functionalized ketones, creation of quaternary carbon centers, and construction of challenging carbocycles. Due to their versatile utilities in organic synthesis, development of novel rearrangement reactions has been a vibrant topic that continues to shape the research field. Recent breakthroughs in novel electrophiles, tandem processes, and enantioselective catalytic transformations further enrich the toolbox of this chemistry and spur the strategic applications of this methodology in natural product synthesis. These achievements will be discussed in this minireview.

11.
Chem Sci ; 12(28): 9748-9753, 2021 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-34349947

RESUMO

A versatile silylation of heteroaryl C-H bonds is accomplished under the catalysis of a well-defined spirocyclic NHC Ir(iii) complex (SNIr), generating a variety of heteroarylsilanes. A significant advantage of this catalytic system is that multiple types of intermolecular C-H silylation can be achieved using one catalytic system at α, ß, γ, or δ positions of heteroatoms with excellent regioselectivities. Mechanistic experiments and DFT calculations indicate that the polycyclic ligand of SNIr can form an isolable cyclometalated intermediate, which leaves a phenyl dentate free and provides a hemi-open space for activating substrates. In general, favorable silylations occur at γ or δ positions of chelating heteroatoms, forming 5- or 6-membered C-Ir-N cyclic intermediates. If such an activation mode is prohibited sterically, silylations would take place at the α or ß positions. The mechanistic studies would be helpful for further explaining the reactivity of the SNIr system.

12.
Phys Rev Lett ; 127(4): 040504, 2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34355936

RESUMO

Quantum target detection is an emerging application that utilizes entanglement to enhance the sensing of the presence of an object. Although several experimental demonstrations for certain situations have been reported recently, the single-shot detection limit imposed by the Helstrom limit has not been reached because of the unknown optimum measurements. Here we report an experimental demonstration of quantum target detection, also known as quantum illumination, in the single-photon limit. In our experiment, one photon of the maximally entangled photon pair is employed as the probe signal and the corresponding optimum measurement is implemented at the receiver. We explore the detection problem in different regions of the parameter space and verify that the quantum advantage exists even in a forbidden region of the conventional illumination, where all classical schemes become useless. Our results indicate that quantum illumination breaks the classical limit for up to 40%, while approaching the quantum limit imposed by the Helstrom limit. These results not only demonstrate the advantage of quantum illumination, but also manifest its valuable potential of target detection.

13.
Medicine (Baltimore) ; 100(27): e26557, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34232198

RESUMO

ABSTRACT: Radiomics transforms the medical images into high-dimensional quantitative features and provides potential information about tumor phenotypes and heterogeneity. We conducted a retrospective analysis to explore and validate radiomics model based on contrast-enhanced computed tomography (CECT) to predict recurrence of locally advanced oesophageal squamous cell cancer (SCC) within 2 years after trimodal therapy. This study collected CECT and clinical data of consecutive 220 patients with pathology-confirmed locally advanced oesophageal SCC (154 in the training cohort and 66 in the validation cohort). Univariate statistical test and the least absolute shrinkage and selection operator method were performed to select the optimal radiomics features. Logistic regression was conducted to build radiomics model, clinical model, and combined model of both the radiomics and clinical features. Predictive performance was judged by the area under receiver operating characteristics curve (AUC), accuracy, and F1-score in the training and validation cohorts. Ten optimal radiomics features and/or 7 clinical features were selected to build radiomics model, clinical model, and the combined model. The integrated model of radiomics and clinical features was superior to radiomics model or clinical model in predicting recurrence of locally advanced oesophageal SCC within 2 years in the training (AUC: 0.879 vs 0.815 or 0.763; accuracy: 0.844 vs 0.773 or 0.740; and F1-score: 0.886 vs 0.839 or 0.815, respectively) and validation (AUC: 0.857 vs 0.720 or 0.750; accuracy: 0.788 vs 0.700 or 0.697; and F1-score: 0.851 vs 0.800 or 0.787, respectively) cohorts. The combined model of radiomics and clinical features shows better performance than the radiomics or clinical model to predict the recurrence of locally advanced oesophageal SCC within 2 years after trimodal therapy.


Assuntos
Neoplasias Esofágicas/diagnóstico , Carcinoma de Células Escamosas do Esôfago/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Estadiamento de Neoplasias , Tomografia Computadorizada por Raios X/métodos , Terapia Combinada , Neoplasias Esofágicas/terapia , Carcinoma de Células Escamosas do Esôfago/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Fatores de Tempo
14.
Front Nutr ; 8: 628628, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34268327

RESUMO

Background: The knowledge of the association between low handgrip strength and mortality among older Chinese inpatients is limited. Given China's aging society, a great number of older adults require hospital admission. Objective: To explore the association between low handgrip strength and 90-day mortality, providing evidence for clinicians to predict the risk of mortality and improve clinical outcomes for older inpatients. Materials and Methods: We conducted a national multicenter cohort study with a baseline survey from October 2018 to February 2019 and followed up for 90 days to record mortality outcomes. The assessment of handgrip strength was conducted using a hand dynamometer with the cutoff (handgrip strength < 28 kg for men and < 18 kg for women) to define low handgrip strength. Multivariable logistic regression analysis was applied to explore the association between low handgrip strength and 90-day mortality. Results: A total of 8,910 older Chinese inpatients [mean (SD) age, 72.39 (5.68) years; 3,750 women (42.09%)], with a prevalence of low handgrip strength, at 49.57%, were included. Compared to inpatients with normal handgrip strength, inpatients with low handgrip strength were older, had less education, more were female, had lower activities of daily living (ADL) score, had lower BMI, higher frailty, higher rates of depression, and poorer cognitive function (all p < 0.05). At 90 days, after adjusting for gender, age, education, frailty, depression, ADL score, malnutrition, and diagnosis, low handgrip strength was independently associated with 90-day mortality, compared to normal handgrip strength (OR = 1.64, 95% CI:1.14-2.37; P = 0.008). Additionally, subgroup and interaction analysis showed a significant interaction effect (P = 0.031) between two age groups (65-74 years older vs. ≥ 75 years old), with the OR being 3.19 (95%CI:2.07-4.93) and 1.49 (95%CI:0.87-2.55), respectively. Conclusion: Older Chinese inpatients with low handgrip strength had a 1.64-fold risk of 90-day mortality, compared to those with normal handgrip strength, indicating that clinicians need to screen early for handgrip strength and recommend corresponding interventions, such as resistance training and nutrition, as a priority for older inpatients. Clinical Trial Registration: Chinese Clinical Trial Registry, Identifier: ChiCTR1800017682.

15.
Geriatr Gerontol Int ; 21(9): 810-817, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34318576

RESUMO

AIM: Polypharmacy is prevalent among older adults and has been mainly reported to be associated with falls among community-dwelling or nursing home residents. Our study aimed to investigate the relationship between polypharmacy and falls among older Chinese hospitalized patients. METHODS: A nationwide prospective cohort study included 9062 participants in six hospitals from China aged ≥65 years, with a 1-year follow-up period. Baseline polypharmacy and other health-related variables were collected when older inpatients were recruited on hospital admission. Polypharmacy was defined as patients who have taken five medications or more. Well-trained nurses assessed falls by telephone at follow up. We used multivariate logistic regression analysis to examine the association between polypharmacy and the risk of falls based on cross-sectional analyses and longitudinal analyses. RESULTS: Of 9062 participants, the mean age was 72.42 years (SD= 5.69), and 5228 (57.69%) were men. After fully adjusted for age, sex, education, depression, cognitive impairment, low handgrip strength, frailty, various hospitals, and nutritional status, the cross-sectional and longitudinal analyses showed that inpatients with polypharmacy had an increased risk of falls (OR 1.37, 95%CI 1.17-1.56 for the cross-sectional association; OR 1.43, 95% CI 1.01-2.03 for the longitudinal association, respectively), compared with those without polypharmacy. In addition, subgroup analyses of the association between polypharmacy and 1-year falls, or history of falls was unchanged. CONCLUSIONS: Polypharmacy was prevalent among older Chinese hospitalized patients and was an independent risk factor of 1-year falls, suggesting that clinicians should make a comprehensive assessment of medications, and deprescribing strategies should be implemented to reduce unnecessary medications for decreasing the rate of falls. Geriatr Gerontol Int 2021; 21: 810-817.


Assuntos
Acidentes por Quedas , Polimedicação , Idoso , China/epidemiologia , Estudos de Coortes , Estudos Transversais , Força da Mão , Humanos , Pacientes Internados , Masculino , Estudos Prospectivos
16.
BMC Geriatr ; 21(1): 339, 2021 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078275

RESUMO

BACKGROUND: The evidence of sarcopenia based on CT-scan as an important prognostic factor for critically ill patients has not seen consistent results. To determine the impact of sarcopenia on mortality in critically ill patients, we performed a systematic review and meta-analysis to quantify the association between sarcopenia and mortality. METHODS: We searched studies from the literature of PubMed, EMBASE, and Cochrane Library from database inception to June 15, 2020. All observational studies exploring the relationship between sarcopenia based on CT-scan and mortality in critically ill patients were included. The search and data analysis were independently conducted by two investigators. A meta-analysis was performed using STATA Version 14.0 software using a fixed-effects model. RESULTS: Fourteen studies with a total of 3,249 participants were included in our meta-analysis. The pooled prevalence of sarcopenia among critically ill patients was 41 % (95 % CI:33-49 %). Critically ill patients with sarcopenia in the intensive care unit have an increased risk of mortality compared to critically ill patients without sarcopenia (OR = 2.28, 95 %CI: 1.83-2.83; P < 0.001; I2 = 22.1 %). In addition, a subgroup analysis found that sarcopenia was associated with high risk of mortality when defining sarcopenia by total psoas muscle area (TPA, OR = 3.12,95 %CI:1.71-5.70), skeletal muscle index (SMI, OR = 2.16,95 %CI:1.60-2.90), skeletal muscle area (SMA, OR = 2.29, 95 %CI:1.37-3.83), and masseter muscle(OR = 2.08, 95 %CI:1.15-3.77). Furthermore, critically ill patients with sarcopenia have an increased risk of mortality regardless of mortality types such as in-hospital mortality (OR = 1.99, 95 %CI:1.45-2.73), 30-day mortality(OR = 2.08, 95 %CI:1.36-3.19), and 1-year mortality (OR = 3.23, 95 %CI:2.08 -5.00). CONCLUSIONS: Sarcopenia increases the risk of mortality in critical illness. Identifying the risk factors of sarcopenia should be routine in clinical assessments and offering corresponding interventions may help medical staff achieve good patient outcomes in ICU departments.


Assuntos
Estado Terminal , Sarcopenia , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Músculo Esquelético , Sarcopenia/diagnóstico
17.
Risk Manag Healthc Policy ; 14: 2289-2300, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34104019

RESUMO

Background: Immobile patients often suffer from malnutrition and low calf circumference (CC), a potential surrogate marker of low muscle mass, which has been widely explored as a link with mortality among patients with inconsistent results. In addition, studies comparing CC, BMI, and albumin to predict mortality among immobile patients are limited. The aim of our study was to compare the performance of these three parameters for predicting mortality among immobile patients. Methods: This is a secondary analysis of our previous study consisting of immobile patients, age>18 years. Data were collected between November 2015 and March 2016 by trained nurses through a case report form (CRF) that included clinical data and sociodemographic variables. In addition, anthropometric parameters, including body weight, height and calf circumference, were also measured. The outcome of our study was mortality with follow-up length being 90 days. Multivariate linear and logistic regression analysis were adopted to identify the association between CC and mortality, and a receiver operating characteristic curve analysis was also used to compare the performance of CC, BMI, and albumin. Results: Of the 387 patients who were included (51.42% male), with an average age of 61.22 (SD=15.18), the prevalence of mortality was 5.43%. The results showed that, after full adjustment, calf circumference was a protective factor for reducing the risk of mortality (OR=0.79; 95%CI:0.65-0.96). Meanwhile, immobile patients with low calf circumference had an increased risk of mortality, compared to those whose condition was normal (OR=4.24; 95%CI:1.07-16.74). Receiver operating characteristic curve analysis showed that CC combined with albumin (AUC=0.812; 95% CI=0.733-0.890) had the highest AUC value compared to calf circumference (AUC=0.759; 95%CI:0.662-0.856), BMI (AUC=0.653; 95%CI:0.538-0.767) and albumin (AUC=0.735; 95% CI:0.638-0.832), respectively, in predicting mortality in immobile patients. Conclusion: The relationship between calf circumference and mortality was significantly negative and low calf circumference was associated with a high risk of 90-day mortality, compared to those with normal calf circumference. The combined calf circumference with albumin had good discrimination in predicting mortality among immobile patients. Therefore, it can routinely be used in a clinical setting by medical staff to predict mortality in immobile patients, as it is easy to obtain.

18.
Quant Imaging Med Surg ; 11(5): 1909-1920, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33936974

RESUMO

Background: Although a number of studies have reported on the vascular abnormalities detected by magnetic resonance imaging (MRI) in patients with late-phase acute pancreatitis (AP), few have studied those occurring in the early phase of the disease. The aim of this research was to investigate the MRI findings of early vascular abnormalities in AP and to analyze the correlation of the prevalence of vascular involvement with the severity of AP based on the MR severity index (MRSI) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores. Methods: A retrospective analysis was conducted of 301 consecutive AP patients who were admitted to our institution between March 2013 and June 2019. All patients underwent initial MRI during the early phase of pancreatitis and one or more repeat MRI scans in the late phase. Peripancreatic vascular conditions and pancreatitis were assessed using T1-/T2-weighted imaging and dynamic-enhanced MRI. The association between the prevalence of vascular involvement and AP severity graded according to the MRSI or APACHE II score was analyzed using Spearman's rank correlation. Results: Among 301 AP patients, 75 (24.9%) had at least one MRI-detected vascular abnormality. Overall, vascular involvement on MRI was higher in necrotizing pancreatitis than in edematous pancreatitis [43.2% (54/125) vs. 11.9% (21/176), χ2=38.2, P<0.001]. In the early phase of AP, the prevalence of splenic vein phlebitis, portal vein phlebitis, and splenic arterial arteritis was 24.9% (75/301), 22.3% (67/301), and 19.9% (60/301), respectively. Splenic vein phlebitis was seen on initial MRI in 55.6% (15/27) of patients who had splenic vein thrombosis on repeat MRI. The MRSI scores showed that the prevalence of splenic vein phlebitis, portal vein phlebitis, and splenic arterial arteritis, respectively, was correlated with the severity of pancreatitis (r=0.532, 0.487, and 0.456; all P<0.01). The APACHE II scores showed that the prevalence of MRI-detected vascular involvement was significantly correlated with AP severity (r=0.335, P<0.05). Conclusions: Vascular abnormalities, including splenic vein phlebitis and splenic arterial arteritis, are commonly seen on MRI in patients with early-phase AP, and they may be supplementary indicators that can reflect the severity of pancreatitis.

19.
Neuropsychiatr Dis Treat ; 17: 1267-1277, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33958868

RESUMO

Objective: There have been studies exploring the association between handgrip and depression among community-dwelling adults; however, evidence for this association among hospitalized older adults is scarce. We aimed to use a larger-scale population from multiple centers to explore the association between low handgrip strength and depression. Methods: This was a cross-sectional study that included hospitalized patients aged 65 years or older from different hospitals in China. Depression was assessed by a short-form Chinese Geriatric Depression Scale (GDS-15) with a cutoff value of 5 points or more. Dominant hand handgrip strength was assessed by a dynamometer. A generalized additive model and multivariable regression analysis were conducted. Results: There were 9,368 participants, with an average age of 72.4 (SD=5.7) in the final analysis. The prevalence of low handgrip strength and depressive symptoms among older Chinese hospitalized patients was 50.3% and 16.3%, respectively. There seemed to be a nonlinear relationship between handgrip strength and depression, and curve fitting and threshold analyses indicated that when handgrip strength was less than 35.6 kg, the depression risk decreased significantly with increasing handgrip strength. However, this association between handgrip strength and depression was not significant when the handgrip strength was greater than 35.6 kg. In addition, after adjusting for potential confounders, older patients with low handgrip strength had an increased risk of depression compared to those with normal handgrip strength (OR=1.46; 95% CI=1.27-1.68). The subgroup analysis found the results were unchanged. Conclusion: Our study indicates that low handgrip strength was associated with a higher risk of depression among older Chinese hospitalized patients, implying that early patient screening for handgrip strength and initiating effective intervention programs, such as resistance training and nutritional supplements, could be helpful for older patients.

20.
Sci Rep ; 11(1): 10392, 2021 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-34001962

RESUMO

The present study aimed to investigate the value of intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) in the preoperative prediction of the histologic differentiation of hepatocellular carcinoma (HCC). Seventy HCC patients were scanned with a 3.0 T magnetic resonance scanner. The values of apparent diffusion coefficient (ADC), slow apparent diffusion coefficient (D), fast apparent diffusion coefficient (D*), and the fraction of the fast apparent diffusion coefficient (f) were measured. Analysis of variance was used to compare the differences in parameters between groups with different degrees of histologic differentiation. p < 0.05 was considered statistically significant. Receiver operating characteristic (ROC) curves were used to analyse the efficacy of IVIM-DWI parameters for predicting the histologic differentiation of HCC. The ADC and D values for well, moderately and poorly differentiated HCC were 1.35 ± 0.17 × 10-3 mm2/s, 1.16 ± 0.17 × 10-3 mm2/s, 0.98 ± 0.21 × 10-3 mm2/s, and 1.06 ± 0.15 × 10-3 mm2/s, 0.88 ± 0.16 × 10-3 mm2/s, 0.76 ± 0.18 × 10-3 mm2/s, respectively, and all differences were significant. The D* and f values of the three groups were 32.87 ± 14.70 × 10-3 mm2/s, 41.68 ± 17.90 × 10-3 mm2/s, 34.54 ± 18.60 × 10-3 mm2/s and 0.22 ± 0.07, 0.23 ± 0.08, 0.18 ± 0.07, respectively, with no significant difference. When the cut-off values of ADC and D were 1.25 × 10-3 mm2/s and 0.97 × 10-3 mm2/s, respectively, their diagnostic sensitivities and specificities for distinguishing well differentiated HCC from moderately differentiated and poorly differentiated HCC were 73.3%, 85.5%, 86.7%, and 78.2%, and their areas under the ROC curve were 0.821 and 0.841, respectively. ADC and D values can be used preoperatively to predict the degree of histologic differentiation in HCC, and the D value has better diagnostic value.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Interpretação de Imagem Assistida por Computador , Neoplasias Hepáticas/diagnóstico por imagem , Adulto , Idoso , Carcinoma Hepatocelular/patologia , Feminino , Humanos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Movimento (Física)
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