Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.149
Filtrar
1.
Medicine (Baltimore) ; 100(11): e24861, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33725958

RESUMO

BACKGROUND: Sepsis is a systemic inflammatory response caused by infection, which is a common complication after severe infection, trauma, shock, and surgery, and is also an important factor in inducing septic shock and multiple organ dysfunction syndrome (MODS), and has become one of the important causes of death in critically ill patients. Septic patients with gastrointestinal transport function weakened, are prone to malnutrition, resulting in decreased immune function, thereby affecting the therapeutic effect. Clinical practice shows that the nutritional metabolism and immune response of patients with sepsis can be effectively improved by giving alanyl glutamine nutritional support treatment, but there is no evidence of evidence-based medicine. The study carried out in this protocol aims to evaluate the effectiveness of alanyl glutamine in nutritional support therapy for patients with sepsis. METHODS: The Cochrane Library, PubMed, Embase, Web of Science, WHO International Clinical Trials Registry Platform, CNKI, CBM, VIP, and Wanfang databases were searched by computer, to retrieve all randomized controlled trials (RCTs) on nutritional support for the treatment of sepsis with alanyl glutamine from the date of database establishment to December 2020. Two researchers independently selected the study, extracted and managed the data. RevMan5.3 software was used to analyze the included literature. RESULTS: This study observed the changes of serum albumin (ALB), prealbumin (PAB), hemoglobin (Hb), C-reactive protein (CRP), immunoglobulin (IgG, IgA, and IgM), APACHE II score before and after treatment to evaluate the efficacy of alanyl glutamine in nutritional support therapy for patients with sepsis. CONCLUSION: This study will provide reliable evidence for the application of alanyl glutamine in nutritional support therapy for patients with sepsis. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/VRZPJ.


Assuntos
Dipeptídeos/administração & dosagem , Apoio Nutricional/métodos , Sepse/terapia , APACHE , Proteína C-Reativa/análise , Resultados de Cuidados Críticos , Estado Terminal/terapia , Hemoglobinas/análise , Humanos , Imunoglobulinas/sangue , Metanálise como Assunto , Pré-Albumina/análise , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Sepse/sangue , Albumina Sérica/análise , Revisões Sistemáticas como Assunto , Resultado do Tratamento
2.
Biomed Res Int ; 2021: 3905353, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33521127

RESUMO

Background: The objective of this study was to explore the role of preoperative fibrinogen-to-prealbumin ratio (FPR) in evaluating the prognosis of patients with stage I-III colorectal cancer (CRC). Methods: This retrospective study enrolled 584 stage I-III CRC patients undergoing surgical resection. Logistic regression analysis was used to explore the correlation between FPR and postoperative complications. The Kaplan-Meier curve and Cox proportional hazards model were used to identify the prognostic factors. The nomograms were constructed based on the prognostic factors. The concordance index and calibration curve were used to determine the accuracy of the nomograms. Time-dependent receiver operating characteristic was used to compare the predictive prognostic efficacy of nomograms and TNM stage. Results: FPR was determined to be an independent factor affecting postoperative complications. Patients with a low-FPR had a significantly better prognosis than those with a high-FPR (disease-free survival, p = 0.028; overall survival, p = 0.027), especially patients with stage I CRC (disease-free survival, p = 0.015; overall survival, p = 0.017). The Cox proportional hazards model identified FPR as an independent poor prognostic factor of disease-free survival (hazard ratio (HR) = 1.459, 95% confidence interval (CI) = 1.074-1.954, p = 0.011) and overall survival (HR = 1.405, 95% CI = 1.034-1.909, p = 0.030). The prognostic nomograms had good accuracy and were superior to the traditional TNM stage. Conclusions: FPR is a potential indicator for predicting short- and long-term prognosis of stage I-III CRC patients undergoing surgical resection.


Assuntos
Biomarcadores Tumorais/sangue , Neoplasias Colorretais/sangue , Neoplasias Colorretais/diagnóstico , Fibrinogênio/análise , Pré-Albumina/análise , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/cirurgia , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Período Pós-Operatório , Prognóstico , Modelos de Riscos Proporcionais , Curva ROC , Análise de Regressão , Estudos Retrospectivos , Adulto Jovem
3.
BMC Infect Dis ; 21(1): 67, 2021 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-33441105

RESUMO

BACKGROUND: Recently, many cases of pneumonia in children with Mycoplasma pneumoniae infection have been shown to have varying degrees of intrabronchial mucus plug formation. The clinical, laboratory, radiological characteristics, and treatment of patients with Mycoplasma infection are analyzed in this study. The risk factors for M. pneumoniae pneumonia (MPP) mucus plug formation in children are explored, and a risk factor scoring system is established. METHODS: MPP patients treated with bronchoscopy were retrospectively enrolled in the study from February 2015 to December 2019. The children were divided into a mucus plug group and a control group according to the presence or absence of mucus plug formation. The clinical, laboratory, radiological characteristics, and treatment of the two groups of children were compared. Univariate and multivariate logistic regression models were used to identify the risk factors for MPP mucus plug formation. The receiver operating characteristic (ROC) curve was drawn to evaluate the regression model and establish the MPP mucous plug risk factor scoring system. RESULTS: A univariate analysis showed that the children in the mucous group were older and had a longer fever duration, longer hospital stay, higher fever peak, more cases of wheezing symptoms and allergies, and azithromycin or corticosteroids were administered later. In addition, neutrophil, C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer (DD), sputum MP-DNA copy number, and total immunoglobulin A (IgA) levels were higher, while prealbumin (PA) levels were lower. The ROC curve analysis showed that children with MPP had PA ≤144.5 mg/L, had used corticosteroids during the course of the illness of ≥4.5 days, CRP ≥12.27 mg/L, an LDH ≥ 462.65 U/L, and there was a possibility of intra-airway mucus formation. The independent risk factors were scored according to their odds ratio (OR) value. Among the 255 children with MPP, the high-risk group had 44 (83.02%) mucus plugs out of 53; the middle-risk group had 35 (34.3%) mucus plugs out of 102; and the low-risk group had 11 (11%) mucus plugs out of 100. CONCLUSIONS: PA levels, timing of corticosteroid use (use in the first few days), CRP levels, and LDH levels were independent risk factors for MPP mucus plug formation. This provides a basis for the early identification of MPP in children combined with mucus plug formation.


Assuntos
Brônquios/fisiopatologia , Broncoscopia/métodos , Muco/metabolismo , Mycoplasma pneumoniae/genética , Mycoplasma pneumoniae/imunologia , Pneumonia por Mycoplasma/fisiopatologia , Pneumonia por Mycoplasma/cirurgia , Corticosteroides/uso terapêutico , Proteína C-Reativa/análise , Criança , Pré-Escolar , Feminino , Febre , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Lactente , L-Lactato Desidrogenase/sangue , Tempo de Internação , Modelos Logísticos , Masculino , Neutrófilos/metabolismo , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/tratamento farmacológico , Pré-Albumina/análise , Curva ROC , Estudos Retrospectivos , Fatores de Risco
4.
Nutrition ; 78: 110930, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32854020

RESUMO

OBJECTIVES: High-risk patients ≥65 y of age with coronavirus disease 2019 (COVID-19) tended to have lower serum prealbumin concentrations. The aim of this study was to investigate the association of prealbumin at baseline on COVID-19-related mortality in elderly patients (≥65 y of age). METHODS: We non-selectively and consecutively collected participants from Tongji Hospital in Wuhan from January 17 to February 17, 2020. Univariate and multivariate logistic regression models were employed to evaluate the correlation between prealbumin and in-hospital outcomes (in-hospital mortality, admission to the intensive care unit [ICU], and mechanical ventilation) in elderly patients with COVID-19. Linear trend was performed by entering the median value of each category of prealbumin tertile as a continuous variable and was visually confirmed by using generalized additive models. Interaction and stratified analyses were conducted as well. RESULTS: We included 446 elderly patients with COVID-19 in the final analyses. In-hospital mortality was 14.79%. Of the 446 patients, 15.47% were admitted to the ICU and 21.3% required mechanical ventilation. Compared with patients in the highest tertile, the prealbumin of patients in the lowest tertile had a 19.09-fold higher risk for death [odds ratio (OR), 20.09; 95% confidence interval (CI), 3.62-111.64; P = 0.0006], 25.39-fold higher risk for ICU admission (OR, 26.39; 95% CI, 4.04-172.39; P = 0.0006), and 1.8-fold higher risk for mechanical ventilation (OR, 2.8; 95% CI, 1.15-6.78; P = 0.0227) after adjustment for potential confounders. There was a linear trend correlation between serum prealbumin concentration and risk for in-hospital mortality, ICU admission, and mechanical ventilation in elderly patients with COVID-19 infection. CONCLUSION: Prealbumin is an independent risk factor of in-hospital mortality for elderly patients with COVID-19. Assessment of prealbumin may help identify high-risk individuals ≥65 y of age with COVID-19.


Assuntos
Betacoronavirus , Infecções por Coronavirus/sangue , Infecções por Coronavirus/mortalidade , Mortalidade Hospitalar , Pneumonia Viral/sangue , Pneumonia Viral/mortalidade , Pré-Albumina/análise , Idoso , Biomarcadores/sangue , China/epidemiologia , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Modelos Logísticos , Masculino , Análise Multivariada , Razão de Chances , Pandemias , Respiração Artificial/estatística & dados numéricos , Medição de Risco , Fatores de Risco
5.
Rev. esp. med. nucl. imagen mol. (Ed. impr.) ; 39(4): 254-266, jul.-ago. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-198286

RESUMO

La amiloidosis cardíaca relacionada con el depósito de transtirretina (ATTR) ha sido tradicionalmente considerada como una enfermedad rara, de difícil diagnóstico y sin tratamiento. Sin embargo, en la actualidad sabemos que su prevalencia es mayor de la considerada, disponemos de métodos diagnósticos no invasivos y están apareciendo tratamientos eficaces. En este contexto, la gammagrafía cardíaca (GC) con difosfonatos marcados con 99mTc ha alcanzado un inusitado interés al mostrar alta sensibilidad y especificidad para el diagnóstico no invasivo y fiable de la ATTR. Este artículo, a modo de guía, pretende identificar los componentes críticos en la realización de la GC que resulten de utilidad en la práctica clínica diaria y, así, ayudar a los especialistas a utilizar los radiofármacos idóneos, obtener las imágenes más adecuadas, interpretar los resultados de estas y conocer los escenarios clínicos en los que resulta apropiado realizar la GC


Transthyretin cardiac amyloidosis (ATTR) has traditionally been considered a rare, difficult-to-diagnose and untreatable disease. However, its prevalence is known to be greater than what was previously thought, non-invasive diagnostic methods are available, and that effective treatments are emerging. In this context, cardiac scintigraphy (CS) with 99mTc-labelled diphosphonates has aroused a noticeable surge in interest by demonstrating high sensitivity and specificity for the reliable, non-invasive diagnosis of ATTR. By way of a guide, this article aims to identify the critical components in the performance of CS that are useful in everyday clinical practice and, thus, help specialists use optimal radiopharmaceuticals, obtain the most appropriate images, interpret the results thereof, and acquaint themselves with those clinical scenarios in which it is convenient to perform CS


Assuntos
Humanos , Cintilografia/métodos , Pré-Albumina/análise , Placa Amiloide/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , Difosfonatos/administração & dosagem , Tecnécio/administração & dosagem , Marcação por Isótopo/métodos
6.
Epidemiol Infect ; 148: e164, 2020 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-32713370

RESUMO

The emergence of 2019 novel coronavirus disease (COVID-19) is currently a global concern. In this study, our goal was to explore the changing expression levels of acute-phase reaction proteins (APRPs) in the serum of COVID-19 patients and to elucidate the immunological characteristics of COVID-19. In the study design, we recruited 72 COVID-19 patients, including 22 cases of mild degree, 38 cases of moderate degree and 12 cases of severe degree. We also recruited 20 patients with community-acquired pneumonia (CAP) and 20 normal control subjects as a comparison. Fasting venous blood was taken to detect the content of complement 3 (C3), complement 4 (C4), C-reactive protein (CRP), serum amyloid A (SAA) and prealbumin (PA). When compared the COVID-19 group with the CAP and normal control groups, respectively, the mean value of CRP and SAA in the COVID-19 group (including mild, moderate and severe patients) had increased significantly (P < 0.01), whereas the mean values of C3, C4 and PA decreased (P < 0.01). For the asymptomatic or mild symptomatic patients with COVID-19, the actual aggravation of disease may be more advanced than the clinical appearances. Meanwhile, the statistical analyses indicated that the development of COVID-19 brought about a significant increase in the content of CRP and SAA (P < 0.01), and a decline in the content of C3, C4 and PA (P < 0.01). These findings suggested that the changes in the level of APRPs could be used as indicators to identify the degree and progression of COVID-19, and the significant changes might demonstrate the aggravation of disease. This study provided a new approach to improve the clinical management plan and prognosis of COVID-19.


Assuntos
Proteínas da Fase Aguda/análise , Proteínas da Fase Aguda/biossíntese , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Adulto , Idoso , Proteína C-Reativa/análise , Proteína C-Reativa/biossíntese , Estudos de Casos e Controles , Infecções Comunitárias Adquiridas/sangue , Infecções Comunitárias Adquiridas/imunologia , Complemento C3/análise , Complemento C3/biossíntese , Complemento C4/análise , Complemento C4/biossíntese , Infecções por Coronavirus/sangue , Infecções por Coronavirus/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia/sangue , Pneumonia/imunologia , Pneumonia Viral/sangue , Pneumonia Viral/imunologia , Pré-Albumina/análise , Pré-Albumina/biossíntese , Prognóstico , Proteína Amiloide A Sérica/análise , Proteína Amiloide A Sérica/biossíntese , Índice de Gravidade de Doença , Adulto Jovem
8.
J Chromatogr A ; 1622: 461097, 2020 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-32381302

RESUMO

In this study, polymeric monoliths with gold nanoparticles (AuNP@monolith) were investigated as microcartridges for the analysis of protein biomarkers by on-line solid-phase extraction capillary electrophoresis-mass spectrometry (SPE-CE-MS). "Plug-and-play" microcartridges (7 mm) were prepared from a glycidyl methacrylate (GMA)-based monolithic capillary column (5 cm x 250 µm i.d.), which was modified with ammonia and subsequently functionalized with gold nanoparticles (AuNPs). The performance of these novel microcartridges was evaluated with human transthyretin (TTR), which is a protein related to different types of familial amyloidotic polyneuropathies (FAP). Protein retention depended on the isoelectric point of the protein (TTR pI~5.4) and elution was achieved with a basic phosphate solution. Under the optimized conditions, limits of detection (LODs) for TTR by AuNP@monolith-SPE-CE-MS were 50 times lower than by CE-MS (5 vs 250 mg•L-1, with an ion trap (IT) mass spectrometer). The sensitivity enhancement was similar compared to SPE-CE-MS using immunoaffinity (IA) microcartridges with intact antibodies against TTR. Linearity, repeatability in migration times and peak areas, reusability, reproducibility and application to serum samples were also evaluated.


Assuntos
Biomarcadores , Eletroforese Capilar , Ouro , Espectrometria de Massas , Nanopartículas Metálicas , Pré-Albumina , Extração em Fase Sólida , Biomarcadores/análise , Compostos de Epóxi/química , Ouro/química , Humanos , Limite de Detecção , Nanopartículas Metálicas/química , Metacrilatos/química , Polímeros/química , Pré-Albumina/análise , Reprodutibilidade dos Testes
9.
Arch Gynecol Obstet ; 302(2): 329-335, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32451658

RESUMO

BACKGROUND: Transthyretin (TTR) is considered to be associated with insulin resistance in humans. This study aimed to investigate TTR level in gestational diabetes mellitus (GDM) and its association with glucose metabolism. METHODS: Fifty pregnant women with GDM and 47 pregnant women with normal glucose tolerance matched for body mass index and age were enrolled in this study. Their blood samples were collected to detect TTR, retinol-binding protein 4 (RBP4), and their association with glucose and lipid metabolism. RESULTS: Serum TTR levels in the GDM group were significantly higher than those in the control group (median, 93.44 [interquartile range, 73.81, 117.79] µg/ml vs. 80.83 [74.19, 89.38] µg/ml; P = 0.006). GDM subjects had a lower RBP4/TTR ratio than the control subjects (median, 517.57 [interquartile range, 348.38, 685.27] vs. 602.56 [460.28, 730.62]; P = 0.02). The serum TTR concentrations were positively associated with neonatal weight (r = 0.223, P = 0.028), homeostatic model assessment of insulin resistance (r = 0.246, P = 0.015), and fasting blood glucose (FBG) (r = 0.363, P < 0.001). In stepwise multivariate linear regression analysis, FBG (standardized beta = 0.27, P = 0.004) and neonatal weight (standardized beta = 0.345, P < 0.001) were independent predictors of serum TTR concentrations. Additionally, FBG (standardized beta = - 0.306, P = 0.002) and triglyceride (TG) (beta = 0.219, P = 0.025) were independently associated with RBP4/TTR ratio. CONCLUSIONS: Serum TTR concentrations were significantly higher in women with GDM than that in women without GDM, suggesting that elevated TTR level may play a role in the pathogenesis of GDM. Meanwhile, TTR was positively and independently associated with FBG and neonatal weight, while FBG and TG were independent predictors of RBP4/TTR ratio. Moreover, serum TTR levels and RBP4/TTR ratio were considered valuable markers of insulin resistance and GDM.


Assuntos
Aborto Habitual/sangue , Glicemia/metabolismo , Diabetes Gestacional/sangue , Pré-Albumina/metabolismo , Proteínas Plasmáticas de Ligação ao Retinol/metabolismo , Aborto Habitual/epidemiologia , Adulto , Grupo com Ancestrais do Continente Asiático , Biomarcadores/sangue , Índice de Massa Corporal , China/epidemiologia , Diabetes Gestacional/epidemiologia , Feminino , Teste de Tolerância a Glucose , Humanos , Resistência à Insulina , Pré-Albumina/análise , Gravidez , Triglicerídeos/sangue
10.
Dis Markers ; 2020: 7815214, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32025276

RESUMO

The precise pathophysiological mechanisms of preeclampsia (PE) and preventative strategies remain unknown. Laboratory markers which can help in identifying PE patients from pregnant women and assessing the severity of PE during pregnancy are worthy to be explored. In this study, a retrospective case-control study was designed to assess whether the serum levels of albumin (ALB), total protein (TP), prealbumin (PA), alkaline phosphatase (ALP), lactic dehydrogenase (LDH), D-dimer, fibrinogen (Fbg), platelet (PLT) count, mean platelet volume (MPV), and platelet distribution width (PDW) can help in assessing PE and evaluate its severity. 256 pregnant women were enrolled and classified into 3 groups: mild preeclampsia (mPE, n = 85), severe preeclampsia (sPE, n = 78), and healthy normotensive controls (control, n = 93). Our result showed that the serum levels of ALP, LDH, and D-dimer were significantly higher in mild or severe PE patients compared with the healthy controls (66 (52.5-76.5) vs. 168 (141.5-201.25) vs. 182.5 (120-191.5), 152 (139.75-166.25) vs. 183.5 (163.25-307) vs. 282 (215.25-306), 1.05 (0.65-1.57) vs. 3.05 (2.25-4.08) vs. 5.65 (2.29-7.71)), while ALB, TP, and PA are lower (38 (37-42) vs. 31.5 (25.5-34.5) vs. 28.5 (24-33), 65 (63-68.25) vs. 56.5 (52-61) vs. 51.5 (49-58), 219.14 ± 68.25 vs. 167.88 ± 52.21 vs. 143.22 ± 50.46). On the other hand, compared with the mPE group, the sPE group showed significantly lower PLT count but higher level of LDH, D-dimer, and Fbg. No significant differences in MPV or PDW were found between any of the two groups. In conclusion, the above markers except for the MPV and PDW may be correlated with PE severity in this patient cohort, indicating possible values of these potential biomarkers in auxiliary diagnosis and severity assessment of PE.


Assuntos
Pré-Eclâmpsia/sangue , Adulto , Fosfatase Alcalina/sangue , Biomarcadores/sangue , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Fibrinogênio/análise , Humanos , L-Lactato Desidrogenase/sangue , Volume Plaquetário Médio , Contagem de Plaquetas , Pré-Eclâmpsia/diagnóstico , Pré-Albumina/análise , Gravidez
11.
Clin Chim Acta ; 502: 73-83, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31836500

RESUMO

AIMS OF THE STUDY: To evaluate the state-of-the-art of 14 specific proteins measurement; to evaluate the laboratories' performance and the degree of harmonization in reporting results of participants in the External Quality Assessment Program of the Centre of Biomedical Research (CRB). METHODS: Overall and system-related inter-laboratory analytical variability (mean CVs%) and between-system differences (mean bias%) were evaluated from data of six EQA cycles 2013-2018. Moreover, we evaluated the analytical performance of participants as well as the units used to express proteins results. RESULTS: Overall inter-laboratory variability ranged from 3.8% for haptoglobin (HPT) to 12.5% for α1-antitrypsin (AAT) and decreased for IgA, α2-macroglobulin (A2M) and transferrin (TRF). Mean CVs% were generally higher for Siemens BN and Beckman Immage immunonephelometric systems, but <7.0% for all proteins. Mean bias > 7.0% was observed for BN (IgA, C4, AAT, transthyretin TTR), Siemens Vista (IgA, C4) and Immage (C4), whereas mean bias < -7.0% was found for Immage (AAT), Beckman AU (IgM) and Roche Cobas (C4, TTR, C-reactive protein). The laboratories' performance within the limits ranged from 85.1% of albumin (ALB) to 97.2% of HPT. The census of units employed in 2018, demonstrated that ~ 70% of laboratories still express the results in mg/dL. CONCLUSIONS: Despite a reduction in inter-laboratory variability for some proteins, different analytical systems showed both proportional and constant bias between methods. Units used by participants have not been substantially changed and dL is still largely used. The CRB EQA Program, with its performance data sets, is a valuable resource for laboratories and IVD manufacturers and support the goals of harmonization.


Assuntos
Laboratórios/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Albuminas/análise , Proteína C-Reativa/análise , Complemento C3/análise , Haptoglobinas/análise , Humanos , Imunoglobulina A/análise , Imunoglobulina G/análise , Imunoglobulina M/análise , Orosomucoide/análise , Pré-Albumina/análise , alfa 2-Macroglobulinas Associadas à Gravidez/análise , Transferrina/análise , alfa 1-Antitripsina/análise
12.
World J Surg ; 44(1): 115-123, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31637508

RESUMO

BACKGROUND: Transthyretin (TTR) has been described as a predictor for outcomes in medical and surgical patients. However, the association of TTR on admission and over time on outcomes has not yet been prospectively assessed in trauma patients. METHODS: This is a prospective observational study including trauma patients admitted to the intensive care unit (ICU) of a large Level I trauma center 05/2014-05/2015. TTR levels at ICU admission and all subsequent values over time were recorded. Patients were observed for 28 days or until hospital discharge. The association of outcomes and TTR levels at admission and over time was assessed using multivariable regression and generalized estimating equation (GEE) analysis, respectively. RESULTS: A total of 237 patients with TTR obtained at admission were included, 69 of whom had repeated TTR measurements. Median age was 40.0 years and median ISS 16.0; 83.1% were male. Below-normal TTR levels at admission (41.8%) were independently associated with higher in-hospital mortality (p = 0.042), more infectious complications (p = 0.032), longer total hospital length of stay (LOS) (p = 0.013), and ICU LOS (p = 0.041). Higher TTR levels over time were independently associated with lower in-hospital mortality (p = 0.015), fewer infections complications (p = 0.028), shorter total hospital and ICU LOS (both p < 0.001), and fewer ventilator days (0.004). CONCLUSIONS: In critically ill trauma patients, below-normal TTR levels at admission were independently associated with worse outcomes and higher TTR levels over time with better outcomes, including lower in-hospital mortality, less infectious complications, shorter total hospital and ICU LOS, and fewer ventilator days. Based on these results, TTR may be considered as a prognostic marker in this patient population.


Assuntos
Pré-Albumina/análise , Ferimentos e Lesões/sangue , Ferimentos e Lesões/mortalidade , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Criança , Estado Terminal/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
13.
Sci Rep ; 9(1): 18691, 2019 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-31822765

RESUMO

Amnestic mild cognitive impairment (MCI) is a prodromal stage of dementia, with a higher incidence of these patients progressing to Alzheimer's disease (AD) than normal aging people. A biomarker for the early detection and prediction for this progression is important. We recruited MCI subjects in three teaching hospitals and conducted longitudinal follow-up for 5 years at one-year intervals. Cognitively healthy controls were recruited for comparisom at baseline. Plasma transthyretin (TTR) levels were measured by ELISA. Survival analysis with time to AD conversion as an outcome variable was calculated with the multivariable Cox proportional hazards models using TTR as a continuous variable with adjustment for other covariates and bootstrapping resampling analysis. In total, 184 MCI subjects and 40 sex- and age-matched controls were recruited at baseline. At baseline, MCI patients had higher TTR levels compared with the control group. During the longitudinal follow-ups, 135 MCI patients (73.4%) completed follow-up at least once. The TTR level was an independent predictor for MCI conversion to AD when using TTR as a continuous variable (p = 0.023, 95% CI 1.001-1.007). In addition, in MCI converters, the TTR level at the point when they converted to AD was significantly lower than that at baseline (328.6 ± 66.5 vs. 381.9 ± 77.6 ug/ml, p < 0.001). Our study demonstrates the temporal relationship between the plasma TTR level and the conversion from MCI to AD.


Assuntos
Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Pré-Albumina/análise , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/sangue , Doença de Alzheimer/metabolismo , Biomarcadores/sangue , Disfunção Cognitiva/sangue , Disfunção Cognitiva/metabolismo , Demência/sangue , Demência/metabolismo , Progressão da Doença , Diagnóstico Precoce , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Testes Neuropsicológicos , Pré-Albumina/metabolismo , Sintomas Prodrômicos , Prognóstico , Taiwan
14.
Clin Chim Acta ; 499: 70-74, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479652

RESUMO

BACKGROUND: Commercial solutions of human serum albumin (HSA) are administered to critically ill patients for the treatment of shock, restoration of blood volume, and the acute management of burns. Previously, conflicting results on the effects of HSA administration have been reported varying from a favorable increase in total plasma antioxidant capacity to a higher mortality rate in traumatic brain injury (TBI) patients. These results could be partially explained due to the known heterogeneity of HSA solutions. We report the discovery of S-sulfonated human transthyretin (hTTR) in HSA solutions. METHODS: Proteomics was performed on commercially available solutions of 5% HSA by LC-MS analysis. The MS charge envelope for hTTR was deconvolved to the uncharged native hTTR parent mass (13,762 Da). The parent mass was then integrated, and relative proportions of the 2 major species of hTTR, native and S-sulfonated hTTR (13,842 Da), were calculated. RESULTS: The majority of hTTR found in 5% commercial HSA solutions is in the S-sulfonated form regardless of the age of the HSA solution. S-sulfonation of hTTR at the free cysteine residue in position 10 appears to be the result of a mixed disulfide exchange possibly with S-cysteinylated hTTR or S-cysteinylated HSA. hTTR is a tetramer composed of four identical monomers each containing a reduced cysteine residue in position 10. S-sulfonation of hTTR at this cysteine residue can destabilize the hTTR tetramer, an important step in the formation of TTR-related amyloid fibrils. CONCLUSIONS: Administration of a commercial HSA solution that already contains S-sulfonated hTTR could potentially contribute to the development of amyloid-related/polyneuropathy in the critically ill.


Assuntos
Neuropatias Amiloides/metabolismo , Pré-Albumina/análise , Albumina Sérica Humana/química , Soluções/química , Soluções/economia , Neuropatias Amiloides/patologia , Cromatografia Líquida , Cisteína/química , Cisteína/metabolismo , Humanos , Espectrometria de Massas , Oxirredução , Pré-Albumina/metabolismo , Proteômica , Albumina Sérica Humana/metabolismo
15.
PLoS One ; 14(9): e0222032, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31504048

RESUMO

Type 2 diabetes is a metabolic disease with a group of metabolic derangements and inflammatory reactants in the serum. Despite the substantial public health implications, markers of diabetes progression with abdominal obesity are still needed to facilitate early detection and treatment. In this study, we performed a proteomic approach to identify differential target proteins underlying diabetes progression in patients with abdominal obesity. Proteomic differences were investigated in the serum of controls and patients with prediabetes or diabetes with or without abdominal obesity by 2-DE combined with MALDI-TOF-MS. Proteomics data were validated by western blot analyses and major protein-protein interactions were assessed using a network analysis with String database. Among 245 matched protein spots, 36 exhibited marked differences in normal patients with abdominal obesity, prediabetes, and diabetes compared to levels in normal patients without abdominal obesity. Seven (Alpha-1-antichymotrypsin, Alpha-1-antitrypsin, Apolipoprotein A-I, haptoglobin, retinol-binding protein 4, transthyretin, and zinc-alpha2-glycoprotein) of these spots exhibited significant differences between normal and prediabetes/diabetes patients. After a network analysis, functional annotation using Gene Ontology indicated that most of the identified proteins were involved in lipid transport, lipid localization, and the regulation of serum lipoprotein particle levels. Our results indicated that variation in the levels of these identified protein biomarkers has been reported in normal, prediabetes and diabetic Assessment of the levels of these biomarkers may contribute to the development of biomarkers for not only early diagnosis but also in prognosis of diabetes mellitus type 2.


Assuntos
Diabetes Mellitus/sangue , Obesidade Abdominal/complicações , Proteoma/química , Adipocinas , Adulto , Apolipoproteínas/sangue , Biomarcadores/sangue , Proteínas de Transporte/sangue , Diabetes Mellitus/diagnóstico , Feminino , Glicoproteínas/sangue , Haptoglobinas/análise , Humanos , Masculino , Pessoa de Meia-Idade , Pré-Albumina/análise , República da Coreia , Proteínas de Ligação ao Retinol/análise , alfa 1-Antitripsina/sangue
16.
Pediatr Surg Int ; 35(11): 1245-1253, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31535199

RESUMO

PURPOSE: A single-stage pull-through (SSPT) is the most commonly performed procedure for Hirschsprung disease (HSCR) and has been shown to be better than multi-stage procedures. However, performing a SSPT in the neonatal period or early in infancy is a risk factor for an inaccurate diagnosis, post-operative enterocolitis, and a protracted post-operative recovery. The present study was primarily designed to evaluate the feasibility and efficacy of home rectal irrigation in the neonatal period and early in infancy, followed by a delayed and planned SSPT in a prospective cohort with HSCR. METHODS: Between January 2014 and December 2016, a total of 147 neonates diagnosed with HSCR were enrolled in the study. Six patients were excluded as a result of ganglion cells found in second rectal biopsies after the neonatal period. One hundred twenty-two patients successfully underwent 2-4 months of home rectal irrigation during the neonatal period, followed by a SSPT procedure after the neonatal period (group A, n = 122). Nineteen patients were not candidates for home rectal irrigation, and thus, colostomies were performed during the neonatal period followed by multi-stage procedures after the neonatal period (group B, n = 19). One hundred twenty-two healthy children, age- and gender-matched to group A were enrolled as the healthy control group for assessment of nutrition status (group C, n = 122). The birth weight, gender ratio, aganglionic segment, age, and Hirschsprung-associated enterocolitis (HAEC) score at the time of HSCR diagnosis were measured to evaluate the feasibility of home rectal irrigation in neonates and early in infancy. The nutritional indices, including weight, body length, serum albumin, serum prealbumin, serum retinol-binding protein, and incidence of HAEC after 2-4 successful home rectal irrigation, were used to assess the efficacy of home rectal irrigation. Anastomotic strictures or leakage, perianal excoriation, frequency of defecation, and morbidity of post-operative HAEC were recorded to evaluate the beneficial effects to pull through (PT), which were facilitated by home rectal irrigation. RESULTS: Higher HAEC scores and older age at the time of diagnosis of HSCR were associated with group B, compared to group A (4.34 ± 1.25 vs. 11.0 ± 2.56 [t = 18.20, p < 0.05] and 2.8 ± 1.46 days vs. 12.1 ± 5.3 days [t = 16.10, p < 0.05], respectively). The ratio of rectosigmoid HSCR to non-rectosigmoid HSCR was higher in group A than group B (104/18 vs. 4/15 [χ2 = 34.29, p < 0.05]). There were no differences in birth weight, weight at the time of diagnosis of HSCR, and gender ratio between groups A and B. There were no differences in birth weight, birth length, post-home rectal irrigation age, post-home rectal irrigation weight, post-home rectal irrigation length, and post-home rectal irrigation serum albumin between groups A and C (3.47 ± 0.42 kg vs. 3.48 ± 0.40 kg [t = 0.10, p > 0.05], 50.02 ± 0.49 cm vs. 50.05 ± 0.46 cm [t = 0.61, p > 0.05], 98.59 ± 13.34 days vs. 97.83 ± 13.58 days [t = 0.44, p > 0.05], 6.77 ± 0.66 kg vs. 6.97 ± 0.87 kg [t = 1.95, p > 0.05], 61.55 ± 2.14 cm vs. 61.70 ± 2.07 cm [t = 0.59, p > 0.05], and 41.78 ± 2.42 g/L vs. 41.85 ± 2.37 g/L [t = 0.22, p > 0.05], respectively). The rate of HAEC in the period of home rectal irrigation in group A was low; however, the post-home rectal irrigation serum prealbumin level and retinol-binding protein were significantly lower in group A than group C (0.15 ± 0.04 g/L vs. 0.17 ± 0.05 g/L [t = 3.50, p < 0.05] and 22.51 ± 7.53 g/L vs. 30.57 ± 9.26 g/L [t = 7.46, p < 0.05], respectively). There were no anastomotic strictures or leakage after definitive PT performed in group A. The frequency of defecation ranged from 2-6 times per day, 10 patients had perianal excoriation 3 months after PT, and 11 patients had post-operative HAEC during 6 months of follow-up after PT. CONCLUSION: Home rectal irrigation in neonates and early in infancy, followed by a delayed and planned SSPT is feasible and effective in patients with HSCR, and could be beneficial to definitive PT. However, for patients with an extended aganglionic segment, older age, or high HAEC score at the time of diagnosis of HSCR, rectal irrigation maybe not suitable. TRIAL REGISTRATION: This was a prospective comparative study designed to evaluate the effects of home rectal irrigation for facilitating and enhancing recovery after PT, and was registered at Clinical Trials.gov as NCT02776176.


Assuntos
Doença de Hirschsprung/terapia , Reto , Irrigação Terapêutica , Fatores Etários , Enterocolite/etiologia , Estudos de Viabilidade , Feminino , Doença de Hirschsprung/complicações , Humanos , Lactente , Recém-Nascido , Masculino , Pré-Albumina/análise , Estudos Prospectivos , Proteínas de Ligação ao Retinol/análise
17.
Sci Rep ; 9(1): 11583, 2019 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399624

RESUMO

The study aimed to determine whether high sensitivity C-reactive protein to prealbumin (hs-CRP/PAB) ratio could be used to predict in-hospital major adverse cardiac events (MACE) in patients with acute coronary syndrome (ACS). A total of 659 patients with ACS were included in the study. Patients were divided into two groups: high hs-CRP/PAB ratio group (hs-CRP/PAB ≥0.010) and low hs-CRP/PAB ratio group (hs-CRP/PAB <0.010). MACE was defined as death, cardiogenic shock, re-infarction and acute heart failure. Logistic regression was performed and the receiver operating characteristic curve (ROC) was generated to evaluate the correlation of hs-CRP/PAB ratio and MACE in patients with ACS. The occurrence rate of MACE was significantly higher in high hs-CRP/PAB ratio group when compared with that in low hs-CRP/PAB ratio group (P < 0.001). Multivariable analysis determined that hs-CRP/PAB ratio was an independent predictor of MACE (adjusted odds ratio: 1.276, 95% confidence interval: 1.106-1.471, P = 0.001). Moreover, the area under the curve value of hs-CRP/PAB ratio for predicting MACE was higher than hs-CRP and equal to PAB. High hs-CRP/PAB ratio was considered as a prognostic parameter of MACE in ACS patients, with the predictive power equal to PAB but greater than hs-CRP.


Assuntos
Síndrome Coronariana Aguda/sangue , Proteína C-Reativa/análise , Pré-Albumina/análise , Síndrome Coronariana Aguda/diagnóstico , Idoso , Biomarcadores/análise , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Fatores de Risco
19.
Clin Nutr ESPEN ; 33: 183-187, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31451259

RESUMO

BACKGROUND & AIMS: Phase angle (PhA) has been used as a prognostic indicator in several clinical situations. However, the use of PhA as a prognostic tool in bariatric patients is less known. The aim of this study was to evaluate PhA as a prognostic index and its correlation with the prognostic inflammatory and nutritional index (PINI) during follow-up of women subjected to bariatric surgery. METHODS: Twenty female volunteers were studied. Body weight, body mass index (BMI), PhA, and biochemical components of PINI [serum C-reactive protein, alpha-1-acid glycoprotein, albumin, and transthyretin (TTR) concentrations] were evaluated at three time points: before (T0) and approximately 2-3 (T1) and 6 (T2) months after surgery. One-way repeated measures ANOVA or the Friedman test with Tukey's post hoc test was used depending on data normality. The associations between PhA and the other parameters were evaluated using Spearman's (nonparametric data) or Pearson's (parametric data) correlation coefficient. RESULTS: Phase angle reduction was accompanied by a significant decrease in body weight and BMI at T1 (P < 0.05), but not at T2 (P > 0.05). PINI indicated low-risk complications during the preoperative period and no risk during the postoperative period (T1 and T2). No significant correlation was observed between PhA and PINI (P > 0.05). Regarding its association with the biochemical components of PINI, lower PhA values were significantly correlated with lower serum TTR concentrations (r = 0.633, P < 0.001). CONCLUSIONS: Phase angle was not associated with PINI, although lower values were correlated with lower serum TTR, suggesting that PhA reduction is associated with an increased nutritional risk.


Assuntos
Cirurgia Bariátrica , Avaliação Nutricional , Pré-Albumina/análise , Adulto , Índice de Massa Corporal , Peso Corporal , Brasil , Proteína C-Reativa , Feminino , Seguimentos , Humanos , Desnutrição , Pessoa de Meia-Idade , Estado Nutricional , Obesidade , Período Pós-Operatório , Prognóstico , Estudos Prospectivos , Albumina Sérica , Perda de Peso
20.
Dis Markers ; 2019: 7142065, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31275452

RESUMO

Background: Many studies have shown the link between the pretreatment serum transthyretin and prognosis in gastrointestinal (GI) cancers. However, based on the conclusion, the initial findings were inconsistent. Hence, this meta-analysis was performed to identify the prognostic values of the pretreatment serum transthyretin in GI cancers. Methods: Previous studies published before November 2018 were collected from a comprehensive literature search of several databases. The pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were applied in the assessment of the intensity of associations. Also, the publication bias and the robustness of merged data were assessed. All statistical analyses were undertaken using STATA/SE 14.1. Results: The combined data indicated that the pretreatment serum transthyretin level was related to the prognosis in GI cancers. The group with reduced pretreatment transthyretin had a significantly worse overall survival (OS) (HR = 1.71, 95% CI: 1.37-2.05). The subgroup analysis for OS further showed the predictive value of transthyretin. In addition, the low serum transthyretin level could be an unfavorable factor for recurrence-free survival (RFS) or progression-free survival (PFS) (HR = 1.66, 95% CI: 1.14-2.18) in GI cancers. Conclusion: The low pretreatment serum transthyretin level implies an unfavorable prognosis for patients with GI cancers. The monitoring of pretreatment transthyretin level could contribute to the risk stratification and individualized therapy in GI cancers.


Assuntos
Biomarcadores Tumorais/sangue , Neoplasias Gastrointestinais/sangue , Pré-Albumina/análise , Idoso , Humanos , Pessoa de Meia-Idade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...