Association between peripheral lymphocyte count and the mortality risk of COVID-19 inpatients.

BACKGROUND: To explore the relationship between peripheral lymphocyte counts (PLCs) and the mortality risk of coronavirus disease 2019 (COVID-19), as well as the potential of PLC for predicting COVID-19 hospitalized patients death. METHODS: Baseline characteristics, laboratory tests, imaging examinations, and outcomes of 134 consecutive COVID-19 hospitalized patients were collected from a tertiary hospital in Wuhan city from January 25 to February 24, 2020. Multiple regression analysis was used to analyze the relationship between the PLC at admission and mortality risk in COVID-19 patients and to establish a model for predicting death in COVID-19 hospitalized patients based on PLC. RESULTS: After adjusting for potential confounding factors, we found a non-linear relationship and threshold saturation effect between PLC and mortality risk in COVID-19 patients (infection point of PLC: 0.95 × 109/L). Multiple regression analysis showed that when PLCs of COVID-19 patients were lower than 0.95 × 109/L, the patients had a significantly higher mortality risk as compared to COVID-19 patient with PLCs > 0.95 × 109/L (OR 7.27; 95% CI 1.10-48.25). The predictive power of PLC for death in COVID-19 patients (presented as area under the curve) was 0.78. The decision curve analysis showed that PLC had clinical utility for the prediction of death in COVID-19 inpatients. CONCLUSIONS: PLC had a non-linear relationship with mortality risk in COVID-19 inpatients. Reduced PLCs (< 0.95 × 109/L) were associated with an increased mortality risk in COVID-19 inpatients. PLCs also had a potential predictive value for the death of COVID-19 inpatients.

Nomogram to predict multidrug-resistant tuberculosis.

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) is burgeoning globally, and has been a serious challenge in TB management. Clinically, the ability to identify MDR-TB is still limited, especially in smear-negative TB. The aim of this study was to develop a nomogram for predicting MDR-TB. METHODS: Demographics and clinical characteristics of both MDR-TB and drug-susceptible TB patients were utilized to develop a nomogram for predicting MDR-TB. The LASSO regression method was applied to filter variables and select predictors, and multivariate logistic regression was used to construct a nomogram. The discriminatory ability of the model was determined by calculating the area under the curve (AUC). Moreover, calibration analysis and decision curve analysis (DCA) of the model were performed. This study involved a second analysis of a completed prospective cohort study conducted in a country with a high TB burden. RESULTS: Five variables of TB patients were selected through the LASSO regression method, and a nomogram was built based on these variables. The predictive model yielded an AUC of 0.759 (95% CI, 0.719-0.799), and in the internal validation, the AUC was 0.757 (95% CI, 0.715-0.793). The predictive model was well-calibrated, and DCA showed that if the threshold probability of MDR-TB was between 70 and 90%, using the proposed nomogram to predict MDR-TB would obtain a net benefit. CONCLUSIONS: In this study, a nomogram was constructed that incorporated five demographic and clinical characteristics of TB patients. The nomogram may be of great value for the prediction of MDR-TB in patients with sputum-free or smear-negative TB.

Curcumin protects against hypertension aggravated retinal ischemia/reperfusion in a rat stroke model.

The pathogenesis of visual dysfunction in stroke remains unclear. The objective of this study was to explore retinal damage in stroke spontaneously hypertensive rats (SHR) and evaluate the role of curcumin in the retinal injury after stroke. Mature male SHR were used as the animal model for hypertension and age-matched male Wistar-Kyoto (WKY) rats as the normotensive controls. The rat model of stroke was made by bilateral vertebral artery electrocoagulation combined with transient bilateral common carotid artery ligation. The animals were randomly divided into sham group, ischemia/reperfusion group, solvent control group, and curcumin treatment group. Each group was subdivided into 2 h, 6 h, 24 h, 72 h, and 7 day after reperfusion. Blood pressure was measured in SHR and WKY rats. Eye fundus was examined in living animals, and then, tissue specimens were collected for histologic examination, terminal deoxynucleotidyl transferase-mediated 2'-deoxyuridine 5'-triphosphate nick end labeling, and immunohistochemistry. Retinopathy, induced by I/R, was more serious in rats with hypertension than that in normotensive rats (retinal thickness index, p = 0.004). The number of apoptosis in retinal capillary cells and neurons reduced significantly in the curcumin-treated groups. Curcumin treatment inhibited phosphorylated c-Jun N-terminal kinase (JNK) expression in SHR after retinal I/R injury. Thus, hypertension aggravated retinal I/R injury after stroke. Curcumin, a specific inhibitor of JNK, can prevent the development of hypertensive retinopathy after I/R injury by inhibiting apoptosis in retinal capillary cells and neurons.

Malignant glomus tumor of the lung with multiple metastasis: a rare case report.

Malignant glomus tumor, or glomangiosarcoma, is a very rare mesenchymal neoplasm that, when seen, occurs in visceral organs. Despite having histologic features of malignancy, these tumors usually do not metastasize. However, when metastasis occurs, this disease is often fatal. Our report presents the case of a 59-year-old female patient with a highly aggressive and widely metastatic glomus tumor of the lung.

rs833061 and rs699947 on promoter gene of vascular endothelial growth factor (VEGF) and associated lung cancer susceptibility and survival: a meta-analysis.

BACKGROUND: As 2 important SNPs located in the promoter region of VEGF gene, the roles of rs833061 (-460C>T) and rs699947 (-2578C>A) in lung cancer susceptibility and survival remain inconclusive and controversial. MATERIAL/METHODS: For better understanding of these 2 SNPs in lung cancer risk and survival, a meta-analysis was performed to pool findings of previous studies and to generate large-scale evidence. RESULTS: Based on the 10 eligible studies included, this study observed that the -460C>T polymorphism generally had no significant effect on lung cancer risk. However, subgroup analysis found that -460TT homozygote variant might confer significantly increased cancer risk for Asians (TT vs. CC: OR=1.69, 95% CI 1.08-2.63, p=0.02), but not in Caucasians. Similar results were observed in -2578C>A in Asians (AA vs. CC: OR=3.00, 95% CI 1.51-5.95, p=0.002; AA vs. AC: OR=3.15, 95% CI 1.00-9.91, p=0.05; AA vs. (AC+CC): OR=2.92, 95% CI 1.51-5.65, p=0.001). In lung cancer survival, 4 trials included had conflicting results. One found -460C>T polymorphism had no effect on survival, 1 observed risk increasing, while the remaining 2 observed risk decreasing. This inconsistency was closely related to the different therapeutic practices applied in different studies, the effects of which were significantly affected by VEGF expression. CONCLUSIONS: -460TT and -2578AA homozygote might lead to significantly increased cancer risk for Asians, but the effects on survival remain to be explored. These 2 SNPs might be potential indicators of lung cancer risk for Asians and should be considered when planning chemotherapy and radiotherapy for lung cancer patients.

Endobronchial ultrasound-guided transbronchial needle aspiration in peripheral pulmonary lesions: a systematic review and meta-analysis.

The diagnosis of peripheral pulmonary lesions (PPLs) remains a challenge for physicians. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been applied in the diagnosis of PPLs, but its diagnostic rate varies widely. The systematic review and meta-analysis was conducted to figure out the accuracy and safety of EBUS-TBNA in the diagnosis of PPLs. We searched the PubMed and Embase databases for relevant studies published from January 1, 2000 to December 30, 2021 and used PICO (Participants, Intervention, Comparison, and Outcome) to worked out the diagnostic rate of EBUS-TBNA in PPLs. Two reviewers independently performed the data extraction and assessed study quality. Statistical analysis was carried out via R software. In 7 studies of totally 510 patients of PPLs, the overall EBUS-TBNA diagnosis yield is 0.75 (95% CI 0.67-0.84) by the random effect model. EBUS-TBNA showed a higher accuracy of 0.64 (95% CI 0.53-0.74) compared to 0.46 (95% CI 0.19-0.72) of endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB) when EBUS probe is adjacent to lesions. In the case of malignant lesions, the diagnostic rate of EBUS-TBNA is 0.79 (95% CI 0.72-0.88). Combined EBUS-TBNA with conventional bronchoscopy procedures showed the highest diagnostic yield (0.83 (95% CI 0.79-0.87)). Collectively, EBUS-TBNA should be performed firstly in patients with PPLs suspected to lung cancer especially when the EBUS probe was adjacent to the lesions. No serious procedure-related complications were observed.

Development and Validation of a Prediction Pneumothorax Model in CT-Guided Transthoracic Needle Biopsy for Solitary Pulmonary Nodule.

Computed tomography-guided transthoracic needle biopsy (CT-TNB) is widely used in the diagnosis of solitary pulmonary nodule (SPN). However, CT-TNB-induced pneumothorax occurs frequently. This study aimed to establish a predictive model for pneumothorax following CT-TNB for SPN. The prediction model was developed in a cohort that consisted of 311 patients with SPN who underwent CT-TNB. An independent external validation cohort contained 227 consecutive patients. The least absolute shrinkage and selection operator (Lasso) regression analysis was used for data dimension reduction and predictors selection. Multivariable logistic regression was used to develop the predictive model, which was presented with a nomogram. Area under the curve (AUC) was used to determine the discrimination of the proposed model. The calibration was used to test the goodness-of-fit of the model, and decision curve analysis (DCA) was used for evaluating its clinical usefulness. Five variables (age, diagnosis of nodule, puncture times, puncture distance, and puncture position) were filtered by Lasso regression. AUC of the predictive model and the validation were 0.801 (95% CI, 0.738-0.865) and 0.738 (95% CI, 0.656-0.820), respectively. The model was well-calibrated (P > 0.05), and DCA demonstrated its clinical usefulness. Thus, this predictive model might facilitate the individualized preoperative prediction of pneumothorax in CT-TNB for SPN.

Nomogram to predict postoperative PR in patients undergoing CT-guided transthoracic lung biopsy.

BACKGROUND: Pleural reaction (PR) frequently occurs following computed tomography-guided transthoracic needle biopsy (CT-TNB). The purpose of this study was to establish a predictive model for PR following CT-TNB. METHODS: In this study, a total of 436 patients who underwent CT-TNB between June 2016 and December 2017 at a tertiary hospital were consecutively included. Patient demographics, lesion features, laboratory tests, and biopsy parameters were collected. The least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analyses were performed to establish a prediction model for post-CT-TNB PR, presented by a nomogram. Discrimination and calibration were assessed. For internal validation, a bootstrap resampling method was applied, and decision curve analysis (DCA) was used to evaluate its clinical utility. RESULTS: PR occurred in 7.8% (34/436) of patients. Four non-zero coefficient variables (gender, age, lesion location, and puncture position) were filtered by LASSO regression analysis and were used to establish a predictive model. The area under the curve in the derivation and validation was 0.840 (95% CI, 0.767-0.913) and 0.841 (95% CI, 0.769-0.912), respectively. The model was well-calibrated (P>0.05), and DCA indicated clinical efficacy. CONCLUSIONS: In this study, we established a nomogram, including as parameters gender, age, lesion location, and puncture position, which may have great significance for individualized prediction of post-CT-TNB PR.

Threshold Effects in the Relationship Between Serum Non-High-Density Lipoprotein Cholesterol and Metabolic Syndrome.

BACKGROUND: Previous studies have suggested that the non-high-density lipoprotein cholesterol (non-HDL-C) is strongly associated with metabolic syndrome (MetS); however, the explicit relationship between them has not yet been clarified. The aim of this study was to reveal the explicit association between the non-HDL-C with MetS. METHODS: The present study was based on a cross-sectional study, which was carried out in Spain. A total of 60,799 workers were recruited between 2012 and 2016. Anthropometric parameters and blood indices (lipid profile and fasting blood glucose) were collected. Participants were divided into the MetS group or the non-MetS group based on the criteria of the National Cholesterol Education Program Adult Treatment Panel III. The relationship between serum non-HDL-C and the risk of MetS was evaluated using multivariate regression analysis, piece-wise linear regression analysis, smooth curve fitting and threshold saturation effect analysis after adjustment of potential confounders. RESULTS: The risk of developing MetS increased with increasing non-HDL-C level. However, this association was only presented in the range of the non-HDL-C concentrations from 118 mg/dl to 247 mg/dl after adjusting for potential confounders. When compared to lower non-HDL-C level (<118 mg/dl), higher levels of non-HDL-C (118-247 mg/dl and >247 mg/dl) were related to higher incidence of MetS, with adjusted odds ratio (95% confidence interval) of 3.08 (2.77, 3.42) and 17.18 (14.29, 20.65), respectively (P for trend <0.05). CONCLUSION: Higher serum non-HDL-C level was associated with increased MetS incidence; however, significant threshold saturation effects were observed when the non-HDL-C level <118 mg/dl or >247 mg/dl.

Evaluation of retinal injury in a rat model of transient ischemic stroke.

Stroke-associated ocular disorders are vision-threatening. This study was designed to evaluate in vivo retinal injury induced by transient global cerebral ischemia/reperfusion (I/R). A stroke-induced retinal injury model in Wistar rats was established by electrocoagulation of bilateral vertebral arteries, combined with transient ligation of the bilateral common carotid arteries. Rats were randomly divided into groups based on the time post cerebral perfusion (3 h, 24 h, 48 h, 72 h, and 7 days). Retinal injury was evaluated by histological analysis, examination of eye fundus, and TUNEL staining. The expression of protein kinase C-alpha (PKCα) and fibrillary acidic protein (GFAP) was determined using qRT-PCR and immunofluorescence analysis. Both retinal neurons and the vasculature underwent significant damage in the cerebral-I/R groups when compared to rats in the sham group. Moreover, when compared to non-stroke rats, TUNEL staining revealed signs of apoptosis in the retina after transient ischemic stroke was induced (P<0.001). In these rats, the expression of PKCα and GFAP in the retinas was enhanced and peaked at 72 h after induction of cerebral-I/R (P<0.001). In this study, we found that retinas are very susceptible to transient global cerebral-I/R injury. The expression of PKCα and GFAP may be implicated in the pathogenesis of ischemic stroke-induced retinal injury.

The effect of night shift on sleep quality and depressive symptoms among Chinese nurses.

PURPOSE: Night shift is associated with adverse physical and psychological health outcomes such as poor sleep quality and depressive symptoms. We aimed to compare sleep quality as well as depressive symptoms in nurses working night shifts to those working day shifts only and explore the association between sleep quality and depressive symptoms among nurses. PATIENTS AND METHODS: Eight hundred sixty-five nurses were enrolled in the current study. Sleep quality and depressive symptoms among nurses were evaluated by the Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depressive Disorders Rating Scale (HADS), respectively. RESULTS: PSQI and HADS scores were both significantly higher in the nurses working night shifts (P<0.05) than in those working day shifts only. Besides, there was a positive correlation between PSQI and HADS scores. Binary logistic regression showed that night shift and poor sleep quality were independent risk factors of depressive symptoms among nurses. CONCLUSION: Higher rates of depression among Chinese nurses working night shifts may be associated with poor sleep quality induced by night shift.

Evaluation of pulmonary reexpansion in a porcine model of bronchial foreign body.

OBJECTIVES: This study was designed to establish a porcine model of reversible obstruction of endobronchial foreign body (FB) and to assess the natural pulmonary reexpansion process using radiology and histopathology after removal of the bronchial FB. METHODS: A metal stent was placed in the right lower lobe bronchial lumen of 15 pigs by bronchoscopy and removed after 2 weeks of stent retention. Animals were divided into two groups (group I and II), based on when they were sacrificed (week 2 or week 4) after stent removal. Pigs underwent computerized tomography scan to document pulmonary radiological changes. The lungs were harvested for electron microscopy examination, and the expression of pulmonary surfactant-associated protein A (SPA) was determined by immunohistochemistry. RESULTS: Thirteen (86.7%) animals successfully responded to the intervention. Atelectasis was formed by stent implantation within 2 weeks. The ratio of the residual atelectasis area was smaller in group II compared to that in group I (P < 0.01). The histological manifestations of experimental lungs were significantly improved in group II. Moreover, the expression of SPA in group II was higher compared to that in group I (P < 0.01). CONCLUSIONS: We have established a model of reversible bronchial FB obstruction in pigs that is both feasible and appropriate for evaluating the long-term process of pulmonary reexpansion after removal of FB. Bronchial metal FB retention for a period of 2 weeks could form atelectasis, and a natural pulmonary recovery process related to atelectasis takes approximately 4 weeks after removal of metal FB.

A 63-Year-Old Man With Recurrent Dyspnea.

CASE PRESENTATION: A 63-year-old man presented with a 12-month history of recurrent dyspnea, dry cough, fatigue, and weight loss. He denied chest pain, fever, or chills. Chest radiographs during those months revealed bilateral pleural effusions, and he was subjected to serial thoracenteses. Pleural fluid analyses suggested invariably a transudate, and he had received an empirical antiheart failure regimen for several months. However, his symptoms did not improve. He reported no smoking or alcohol use and his medical history was unremarkable.

The location, histologic type, and stage of lung cancer are associated with bleeding during endobronchial biopsy.

BACKGROUND: Several risk factors have been proposed for bleeding during bronchoscopy, including immunosuppression, thrombocytopenia, pulmonary arterial hypertension, and mechanical ventilation. However, research on bronchoscopic biopsy-induced bleeding in the population of lung cancer without these "proposed risk factors" remains lacking. PATIENTS AND METHODS: A total of 531 lung cancer patients with endobronchial biopsy (EBB) were enrolled in this retrospective observational study. Patients were divided into biopsy-induced bleeding group (n=162) and non-bleeding group (n=369). Using multiple logistic regression, independent risk factors for EBB bleeding were identified. RESULTS: The location, histologic type, and stage of lung cancer were independently associated with EBB bleeding, as assessed by multiple logistic regression (p<0.05) in patients with lung cancer. Moreover, during EBB, the risk of bleeding of endobronchial lesions located in the central airways was significantly higher when compared to that in peripheral bronchi (odds ratio [OR], 2.211; 95% CI, 1.276-3.830; p=0.005). In addition, squamous cell carcinoma and small-cell lung carcinoma were more susceptible to bleeding during biopsy when compared with adenocarcinoma (OR, 3.107, 2.389; 95% CI, 1.832-5.271, 1.271-4.489; p=0.000, p=0.007, respectively). Patients with advanced lung cancer were more prone to EBB bleeding compared to patients in the early stages of disease (OR, 1.583; 95% CI, 1.065-2.354; p=0.023). CONCLUSION: Lesions located in the central airways, histologic types of squamous cell carcinoma and small-cell lung carcinoma, and stages of advanced lung cancer were the independent risk factors for hemorrhage in EBB.

Transient cerebral ischemia/reperfusion-induced acute lung injury in rats associated with protein kinase C alpha expression.

OBJECTIVE: The pathogenesis and development timing of acute lung injury (ALI) following cerebral ischemia/reperfusion (I/R) are not fully understood. In this study, the development timing of ALI induced by transient global cerebral I/R as well as the underlying mechanisms of action were investigated. METHODS: A cerebral I/R-induced ALI model in Wistar rats was established by electrocoagulation of bilateral vertebral arteries combined with ligation of the transient bilateral common carotid arteries. Rats were randomly divided into control and cerebral I/R groups. The latter was subdivided into 3 h, 24 h, 48 h and 72 h post reperfusion. Lung injury was assessed by histological examination. The mRNA and protein expression of protein kinase C alpha (PKCα) were determined using qRT-PCR and immunofluorescence analysis, respectively. RESULTS: Lung histological injury could be detected as early as 3 h after global cerebral I/R, and was significant between groups at 48 h and 72 h. Compared with the control group, mRNA expression of PKCα in the lung was enhanced in rats in the cerebral I/R groups (P<0.001), and the highest expression was observed at 48 h (P<0.001). The intensity of PKCα reactivity gradually increased starting at 3 h, and peaked at 72 h after cerebral I/R (P<0.05). CONCLUSIONS: The lung is very susceptible to transient global cerebral I/R injury in vivo. Lung histological injury occurred within hours of cerebral I/R induction and aggregated in a very short period after cerebral I/R. Moreover, PKCα expression was implicated in the pathogenesis of cerebral I/R-induced ALI.

A meta-analysis of the relationship between environmental tobacco smoke and lung cancer risk of nonsmoker in China.

BACKGROUND: To investigate the association between exposure to environmental tobacco smoke (EVT) and the incidence of lung cancer (LC) in nonsmoking adults. METHOD: PubMed, Cochrane, Embase, Wanfang, CNKI, and VIP database were searched by the index words to identify the qualified case-control studies, and relevant literature sources were also searched. The latest research was done in June 2017. Odds radio (OR) along with 95% confidence interval (95% CI) were used to analyze the main outcomes. RESULT: Twenty RCTs were involved in the meta-analysis with 13,004 adults in the case group and 11,199 adults in the control group. The results indicated that compared with the nonexposure population, the risk of LC incidence was significantly higher in EVT exposure (OR: 1.64, 95% CI: 1.34-2.01), EVT male exposure (OR: 1.62, 95% CI: 1.16-2.28), EVT female exposure (OR: 1.57, 95% CI: 1.43-1.72), EVT exposure at workplace (OR: 1.78, 95% CI: 1.29-2.44), EVT exposure at home (OR: 1.53, 95% CI: 1.01-2.33), and EVT female exposure at home (OR: 1.55, 95% CI: 1.34-1.79). However, there is still no significant difference among the risk of LC incidence in EVT male exposure at workplace (OR: 1.51, 95% CI: 0.74-3.06), EVT female exposure at workplace (OR: 1.23, 95% CI: 0.99-1.53), and EVT male exposure at home (OR: 1.24, 95% CI: 0.68-2.26). CONCLUSION: EVT exposure is prospectively associated with a significantly increased risk of LC incidence. More high quality studies are required to address the association between EVT exposure and LC incidence.

[The clinical significance of inspiratory capacity measurement in patients with stable chronic obstructive pulmonary disease].

OBJECTIVE: To study the clinical significance of inspiratory capacity (IC) in the evaluation of airflow obstruction and chronic dyspnea in patients with stable chronic obstruction pulmonary disease (COPD). METHODS: Sixty-one moderate COPD patients underwent pulmonary function test. Borg Scales (BS) was used for the degree of exertional dyspnea. Measurements of pulmonary function and BS were also performed after salbutamol inhalation (400 microg) in 61 COPD patients and after 6-minute walk test (6MWT) in 36 COPD patients. RESULTS: After salbutamol administration, the patients showed a significant increase in IC [(1.6+/-0.5) L vs (1.4+/-0.5) L] and in FEV1 [(1.3+/-0.4) L vs (1.1+/-0.4) L]. The reversibility in IC was significantly higher than that in FEV1 [(20+/-16)% vs (11+/-4)%]. A reversibility greater or equal to 10% in IC was found in 75.4% (46/61) of the patients, but in FEV1 was found in 39.3% (24/61); the difference was significant (chi2=16.190, P<0.01). BS was significantly decreased after salbutamol administration (3.0+/-0.7 vs 3.9+/-0.8, P<0.01). After 6MWT, the 36 COPD patients showed a significant decrease in IC [(1.1+/-0.4) L vs (1.4+/-0.5) L] and in FEV1 [(1.0+/-0.4) L vs (1.1+/-0.4) L]. The decrease in IC was significantly greater than that in FEV1 [(26+/-8)% vs (14+/-6)%]. A decrease greater or equal to 10% in IC was found in 100% (36/36) of the patients and in FEV1 was found in 72.2% (26/36); the difference was significant (chi2=11.613, P<0.01). BS was significantly higher after 6MWT (5.6+/-1.0 vs 3.9+/-0.9, P<0.01). In the multiple regression analysis, the change of IC after and before therapy (DeltaICthe) with the change of BS after and before therapy (DeltaBSthe), and the change of IC after and before exercise (DeltaICexe) with the change of BS after and before exercise (DeltaBSexe), were significantly correlated (regression coefficient was 0.314 and 0.329, respectively, all P<0.05). In Pearson correlation analysis, IC with functional residual capacity (FRC), DeltaICthe with DeltaFRCthe and DeltaIC with DeltaFRC were negatively correlated (r=-0.416 and -0.826 and -0.778, respectively, all P<0.05 or P<0.01). CONCLUSION: IC may be more sensitive than FEV1 in evaluation of change of airflow obstruction and dyspnea in stable COPD patients.

Diffuse cystic lung adenocarcinoma: a case report and literature review.

Lung adenocarcinoma can exhibit a variety of radiological manifestations. However, the presence of diffuse cystic lesions in both lungs is extremely rare. Here, we report a case of a middle-aged woman with a primary lung adenocarcinoma that manifested as diffuse cystic lesions in bilateral lungs. Histopathological examination ultimately confirmed the lung adenocarcinoma. The patient was treated with the epidermal growth factor receptor (EGFR) inhibitor Gefitinib and remained stable during 18 months of follow-up. Knowledge of uncommon radiological performances of lung adenocarcinoma characterized by diffuse cystic imaging is important in suggesting the diagnosis and preventing misinterpretation.

[Clinical characteristics and prognosis in patients with high plasma level of procalcitonin: an analysis in 188 patients].

OBJECTIVE: To investigate the clinical characteristics and prognosis of patients with high level of plasma procalcitonin (PCT > 100 µg/L), and to improve the clinician's understanding, diagnosis and treatment of this kind of patients. METHODS: A retrospective study was conducted. The clinical data of patients with plasma PCT over 100 µg/L within 48 hours of admission admitted to Second Affiliated Hospital of Zhejiang University School of Medicine from February 2013 to December 2016 were collected, and the clinical characteristics were analyzed. The patients were divided into survival and death groups according to 28-day prognosis. The general data and laboratory parameters including vital signs, 24-hour urine output, routine blood test, blood biochemical tests, coagulation parameters, myocardial enzymes and arterial blood gas analysis were collected. The risk factors of mortality were analyzed using multi-logistic regression analysis. RESULTS: 188 patients with high level of plasma PCT were enrolled. There were 128 male patients (68.1%) with the average age of 62 (49, 75) years. Most patients were admitted in intensive care unit (ICU, 70.7%, 133/188). Major diagnosis was sepsis (91.0%), followed by multiple organ dysfunction syndrome (MODS, 57.4%), post large operation of thorax and abdomen (20.7%), trauma/burns (13.8%) and post-cardiopulmonary resuscitation (CPR, 6.4%). Of all the 188 patients, 115 patients survived and 73 died with a mortality of 38.8%. The parameters in the death group, including the percentages of MODS (84.9% vs. 40.0%), trauma/burns (26.0% vs. 6.1%), post-CPR (13.7% vs. 1.7%), ventilator support (82.2% vs. 40.9%) and shock (100.0% vs. 60.0%), the numbers of principal diagnosis [2.0 (2.0, 3.0) vs. 2.0 (1.0, 2.0)], acute physiology and chronic health evaluation II score [APACHE II score: 24 (19, 28) vs. 14 (10, 16)] and sequential organ failure assessment (SOFA) score [16.0 (12.5, 18.0) vs. 9.0 (6.0, 12.0)], as well as liver function, coagulation parameters, myocardial enzymes and lactic acid (Lac) levels were significantly higher than those in the survival group, but the platelet (PLT) count in the death group was significantly lower than that in the survival group [×109/L: 62.00 (21.50, 111.00) vs. 93.00 (53.00, 136.00), all P < 0.05]. The parameters with statistical significance in the univariate analysis were enrolled in the multiple factor logistic regression analysis, which showed that patient with a high score of APACHE II [odds ratio (OR) = 1.290, 95% confidence interval (95%CI) = 1.121-1.484, P = 0.000] or the occurrence of MODS (OR = 7.264, 95%CI = 1.762-29.941, P = 0.006) at admission had a poor prognosis. CONCLUSIONS: The primary patients with high levels of plasma PCT (> 100 µg/L) were diagnosed with sepsis, MODS, trauma and post-CPR, complicated with respiratory and circulatory insufficiency. These factors of trauma, MODS and cardiac arrest, and some laboratory parameters including PLT, Lac, liver function, coagulation spectrum, and cardiac enzymes were correlated with the prognosis of the patients with high levels of plasma PCT. High APACHE II score and the incidence of MODS might be independent predictors of poor prognosis in the patients with high levels of plasma PCT.