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Objective:To compare the predictive value of Oxford acute severity of illness score (OASIS) and simplified acute physiology score Ⅱ (SAPSⅡ) for in-hospital mortality in intensive care unit (ICU) patients with sepsis.Methods:A retrospective cohort study was conducted using the data in the Medical Information Mart for Intensive Care-Ⅳ0.4 (MIMIC-Ⅳ 0.4). Based on Sepsis-3 diagnostic criteria, the basic information of ICU adult sepsis patients with infection and sequential organ failure assessment (SOFA) score ≥ 2 within 24 hours of ICU admission admitted for the first time in the database was extracted, including gender, age, vasopressor drugs, sedative drugs, mechanical ventilation, renal replacement therapy, length of ICU stay, OASIS, SAPSⅡ scores, etc. The primary outcome was in-hospital mortality. A receiver operator characteristic curve (ROC curve) was drawn, and the area under the ROC curve (AUC) was calculated to compare the prognostic value of OASIS score and SAPSⅡ score.Results:A total of 11 098 adult ICU sepsis patients were enrolled in the final analysis, of which 2 320 died and 8 778 survived in hospital, with a mortality of 20.90%. Compared with the survivors, the non-survivors were older [years old: 71 (60, 81) vs. 67 (56, 78)], had longer length of ICU stay [days: 6.95 (3.39, 13.07) vs. 4.23 (2.19, 9.73)] and higher proportions of using vasopressor drugs, sedative drugs, mechanical ventilation and renal replacement therapy [vasopressor drugs: 50.65% (1 175/2 320) vs. 33.05% (2 901/8 778), sedative drugs: 58.53% (1 358/2 320) vs. 48.41% (4 249/8 778), mechanical ventilation: 89.57% (2 078/2 320) vs. 81.66% (7 168/8 778), renal replacement therapy: 11.98% (278/2 320) vs. 6.57% (577/8 778), all P < 0.01]. Moreover, the non-survivors had higher OASIS score [43 (36, 49) vs. 35 (29, 41), P < 0.01] and SAPSⅡ score [49 (40, 60) vs. 38 (31, 47), P < 0.01] as compared with the survivors. ROC curve analysis showed that the AUC of OASIS score and SAPSⅡ score for predicting in-hospital death of ICU patients with sepsis was 0.713 [95% confidence interval (95% CI) was 0.701-0.725] and 0.716 (95% CI was 0.704-0.728), respectively, and the Delong test showed no significant difference in AUC between the two scoring systems ( P > 0.05). Conclusions:OASIS score has a good predictive value for in-hospital mortality in sepsis patients, which is similar to SAPSⅡ score. OASIS score is simpler and has a broader clinical application prospect than SAPSⅡ score.
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Traditional total cranial vault reconstruction for craniosynostosisis traumatic with long operative time and many serious complication. A brand new surgery technique, spring-assisted surgery(SAS), has been invented and performed for 20 years. It showed that SAS has the advantages of less invasive and good result. It has gradually become one of the important methods to treat early craniosynostosis. This article reviewed the SAS related literatures in the past 20 years, focusing on various surgical methods of SAS and possible surgical complications. The osteogenesis principle, prognosis and development of SAS were also summerized.
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Objective To evaluate the effect of CYP3A5 genetic polymorphisms on tacrolimus (Tac) concentration/dosing and other clinical outcomes in a pilot cohort of 113 Chinese HTx recipients.Methods Association between CYP3A5 genetic variants and blood dose-adjusted trough concentrations (C0/D) of Tac at 1st month at the beginning of the immunosuppressive therapy was evaluated in cohorts of 113 patients,then at 1st,3rd,6th,and 12th months after transplantation in 41 patients who received Tac-based immunosuppressive therapy and never changed within one year after transplantation,respectively.In addition,we also evaluated the association between CYP3A5 genetic variants and other clinical outcomes,such as the classifications of endomyocardial biopsy and longterm prognosis.Results The CYP3A5 wild homozygote (* 1/* 1),mutant homozygote (* 3/* 3),and mutant heterozygote (* 1/* 3) occurred in 5,34 and 74 recipients respectively.The gene mutation rate of CYP3A5 in this cohort of Chinese HTx recipients was 80.5 ％ and the homozygous proportion was 65.5％.Compared with CYP3A5 expressors (* 1/* 1 or * 1/* 3),CYP3A5 nonexpressors (* 3/* 3) had a higher Tac C0/D at 1st month (47.34 ± 11.40 vs.116.11 ± 42.40 vs.293.70 ± 171.20,P =0.000),as well as other studied time points (3rd month:98.32 ± 39.43 vs.292.07 ± 141.08,P=0.003;6th month:90.00 ± 21.31 vs.341.68 ± 165.02,P =0.002;and 12th month:96.02 ± 29.33 vs.339.23 ± 162.30,P =0.018);and might have a lower classification of endomyocardial biopsy at 1st month (1.43 ± 0.73 vs.1.50 ± 0.58,P =0.867),3rd month (1.55 ±1.00 vs.2.00 ± 1.73,P =0.512),and 6th month (1.36 ± 0.84 vs.2.33 ± 1.53,P =0.132);as well as a higher mortality due to acute organ rejection (10％ vs.0,P =0.244) and all-cause mortality (20％ vs.9.7％,P =0.580).Conclusion In Chinese HTx recipients,the frequency of this * 3 allele is lower than that has been reported in the white population.The determinations of CYP3A5 genetypes in heart transplant recipients are helpful to guide the individualized Tac regimens.
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Objective This study aimed to identify high?risk groups for metabolic syndrome(MS)among Chinese children and adolescents by calculating the cutoff values of adiposity measures and insulin resistance(IR). Methods From December 2010 to January 2011,data from 933 Chinese subjects(492 boys and 436 girls,aged 11?16 years)from Liaoyang City,China,were included. Questionnaires were administered,and da?ta such as anthropometric parameters(height,waist circumference,and hip circumference),blood pressure,fasting blood glucose level,blood lip?id level,serum uric acid level,and fasting insulin level were collected. Receiver?operating characteristic(ROC)curve analysis was used to deter?mine the optimal cutoff waist?to?height ratio(WHtR),waist?to?hip ratio(WHR),homeostasis model assessment?insulin resistance(HOMA?IR) index,triglyceride level,glucose index(TyG index),and serum uric acid(SUA)level for identification of children and adolescents with MS. Results The AUC of WHtR,WHR,TyG index,HOMA?IR index,and SUA level were larger than 0.5,with P values of<0.01. The optimal cutoff WHtR and WHR derived from the ROC analysis were respectively 0.48(87.0%,84.1%)and 0.84(83.3%,70.3%)for boys and 0.46(95.1%, 81.8%)and 0.80(90.5%,71.8%)for girls. Conclusion This study demonstrated that WHtR and WHR are useful predictive markers of MS , while HOMA?IR,TyG index,and SUA level are not. The usefulness of these criteria needs to be verified by further evaluation.
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Objective To investigate the relationship between Livin and Ki-67 proteins, and the expres-sion and clinical significance of Livin and Ki-67 proteins in cholangiocarcinoma. Methods Fifty-five samples of cholangiocarcinoma tissue were collected in Shengjing Hospital from January 2002 to December 2003. The expres-sion of Livin and Ki-67 proteins in the 55 samples of cholangiocarcinoma tissue and 12 samples of chronic cholan-gitis tissue were detected by immunohistochemical assay. The relationship between the expression of Livin and Ki-67 proteins and the clinicopathological parameters of cholangiocarcinoma was analyzed. The results were analyzed by Spearman rank correlation coefficient, chi-square test and t test. Results The positive expression rate of Livin protein in cholangiocarcinoma was 71% (39/55), which was significantly higher than 0 (0/12)in chronic cholan-girls tissue (χ2=20.361, P<0.01). The expression of Livin protein was influenced by the differentiation of cholangiocarcinoma and the lymph node metastasis (χ2=4.193, 4.245, P <0.05). The positive expression rate of Ki-67 protein was 96% (53/55) in cholangiocarcinoma. The label index of Ki-67 in patients in clinical stage Ⅰ,Ⅱ,Ⅲ,Ⅳ,were 22%±16%, 33%±12%, 43%±15%, and 49%±10%, respectively. There was signifi-cant difference in the label index of Ki-67 between patients in clinical stage Ⅰ and those in clinical stages Ⅱ, Ⅲ,Ⅳ(t=2.307, 2.871, 3.957, P<0.05). The label index of Ki-67 was 43%±13 % in patients with local lymph node metastasis, and 34%±16% in patients without local lymph node metastasis, with statistical difference between the 2 groups (t=2.334, P<0.05). The expression of Livin protein in cholangiocarcinoma was positively correlated with the label index of Ki-67 (r=0.502, P<0.01). Conclusions Livin protein plays an important role in the pathogenesis and development of eholangiocarcinoma, and it also has correlation with the proliferating activity of cholangiocarcinoma cells. Combined detection of the expression of Livin and Ki-67 proteins may be helpful in judging the malignancy of cholangiocarcinoma and determining the prognosis of patients.
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Objective To investigate the effect of hepatocyte growth factor(HGF)on the proliferation of human hepatocellualr carcinoma cells,and the mechanism of HGF-induced proliferation inhibition.Methods Human hepatocellualr carcinoma cell line HepG2 were treated with different concentrations of HGF for different time periods,and the proliferation of these cells was examined by colorimetric BrdU cell proliferation enzyme-linked immunosorbent assay.The expression of S-phase kinase associated protein 2(Skp2)was examined using Western blot and RT-PCR.Plasmids pcDNASkp2 was introduced into HepG2 cells,then the clones showing up-regulation of Skp2 were selected,and the effect of HGF on the proliferation in these clones was investigated.Results HGF inhibited the proliferation of hepatoma cells in a dose and time dependent manner.The expression of Skp2 was significantly suppressed by HGF.Furthermore,HGF did not suppress the proliferation of HepG2 cells transfected with Skp2.Conclusions This study suggests that HGF could inhibit HepG2 cell proliferation,and the down-regulation of Skp2 could be closely related to this suppressed proliferation.