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Cancer is the second-leading cause of death worldwide. Cancer mortality is largely caused by the absence of recognizable early signs and a poor prognosis. Therefore, developing efficient diagnostic and prognostic biomarkers is crucial to reducing the incidence of cancer and improving its prognostic accuracy. tRNA-derived fragments are a new class of non-coding RNAs with important regulatory roles in cancer biology. In this paper, the research progress of tRNA-derived fragments as biomarkers in tumorigenesis, development, and prognosis was reviewed to provide a theoretical basis for cancer diagnosis and prognostic assessment.
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@#Root fracture is a kind of dental trauma involving dentin, cementum, pulp tissue, periodontal membrane ligament and even the surrounding alveolar bone. It occurs frequently between the ages of 10-20, mostly in the area of the maxillary anterior teeth with high aesthetic requirements. The treatment goal for root fracture in permanent teeth is to maintain the physiological and functional integrity of the tooth as much as possible and to reduce the incidence of complications. Clinicians usually classify the affected teeth according to the position of the root fracture, including the apical, mid-root, cervical-mid-root and cervical segments, since it determines the treatment plan and the prognosis of the affected teeth. CBCT examination can avoid misdiagnosis and missed diagnosis of root fracture to the greatest extent. The sequential treatment plan of root fracture after permanent anterior tooth trauma includes initial emergency treatment, pulp vitality monitoring and complication management during follow-up. Emergency treatment mainly includes local anesthesia and repositioning, if displaced, the coronal segment of the tooth as soon as possible. Then, after checking its position radiographically, adjustment occlusion and flexible splinting for 4 weeks (4 months for cervical root fracture). The process of root fracture repair includes many tissues and is affected by many clinical factors. Timely and standardized treatment and close follow-up according to the Dental Trauma Guideline guarantee a good prognosis of root fracture. The closer the root fracture line is to the apex, the higher the survival rate is. In addition to the location of the root fracture line, the prognosis is affected by many other clinical factors, such as the displacement of the coronal fragment of the root fracture, the pathological state of the dental pulp, patient age, developmental stage of the root, timely and good replacement of the root fracture, splinting method, and the presence of other dental trauma complications. Pulp vitality should be monitored regularly, and root canal therapy of the coronal segment should be carried out only when infection of the pulp is established. This article reviews the classification, diagnosis, emergency treatment, sequential follow-up treatment, and prognostic assessment of root fracture trauma to provide suggestions for clinicians to manage root fracture trauma in permanent teeth.
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Objective To investigate the prognostic value of microRNA-122 (miR-122) combined with acute physiology and chronic health evaluationⅡ(APACHEⅡ) score in patient with acute respiratory distress syndrome (ARDS), and to provide evidence for the diagnosis and treatment of ARDS. Methods ARDS patients admitted to the Third People's Hospital of Haikou City from January 2016 to December 2018 were enrolled. The general data, serum miR-122 expression level and APACHEⅡ score within 24 hours were collected. The patients were divided into survival group and death group according to the survival status of ARDS patients. ARDS patients were divided into low-risk group ( < 10 scores), medium-risk group (10-20 scores) and high-risk group ( > 20 scores) according to APACHEⅡ score. Predictive values of miR-122 and APACHEⅡ scores on prognosis in ARDS patients were evaluated by the receiver operating characteristic (ROC) curve. The correlation between the serum miR-122 expression and APACHEⅡscore in patients with ARDS was calculated by Pearson correlation analysis. Results A total of 142 ARDS patients were selected, 94 male and 48 female; with age (56.80±11.30) years old; 55 deaths and 87 survivors; 67 of high-risk, 48 of medium-risk and 27 of low-risk. The expression of serum miR-122 and APACHEⅡ score in the death group were significantly higher than those in the survival group [miR-122 (2-ΔΔCt): 0.26±0.12 vs. 0.07±0.03, APACHEⅡ:31.84±4.25 vs. 15.30±2.60, both P < 0.01]. With the severity increase of the disease, the serum miR-122 expression level, APACHEⅡ score, and mortality rate of ARDS patients gradually elevated, and the difference between the two groups was significant in the low-risk group, medium-risk group, and high-risk group [miR-122 (2-ΔΔCt):0.05±0.02, 0.14±0.06, 0.23±0.09; APACHEⅡ: 12.30±2.15, 20.62±3.40, 28.90±3.60; mortality rate: 11.1%, 31.2%, 55.2%, respectively, all P < 0.05]. ROC curve analysis showed that miR-122 and APACHEⅡ score could predict the death of ARDS patients, and the area under the ROC curve (AUC) was 0.835 [95% confidence interval (95%CI) = 0.776-0.893] and 0.790 (95%CI = 0.732-0.854); the predicted value of the miR-122 combined with APACHEⅡscore (AUC = 0.918, 95%CI = 0.857-0.972) was higher than the single miR-122 and APACHEⅡscore (both P < 0.05), with sensitivity and specificity were 91.3% and 86.4% respectively. The correlation analysis showed that the expression of serum miR-122 was positively correlated with APACHEⅡscore in death patient with ARDS (r = 0.825, P < 0.01). Conclusion Elevated serum miR-122 expression level is associated with disease severity and prognosis of ARDS patients; miR-122 combination with APACHEⅡ score has a high evaluation value on prognosis of ARDS patients.
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BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) patients with spinal metastasis (SM) show heterogeneous lengths of survival. In this study, we develop and propose a graded prognostic assessment for HCC patients with SM (HCC-SM GPA). METHODS: We previously reported the outcomes of 192 HCC patients with SM who received radiotherapy from April 1992 to February 2012. Prognostic factors that significantly affected survival in that study were used to establish the HCC-SM GPA. Validation was performed using an independent cohort of 63 patients recruited from September 2011 to March 2016. RESULTS: We developed the HCC-SM GPA using the following factors: Eastern Cooperative Oncology Group performance status (0–2, 0 point; 3–4, 1 point), controlled primary HCC (yes, 0 point; no, 2 points), and extrahepatic metastases other than bone (no, 0 point; yes, 1 point). Patients were stratified into low (GPA=0), intermediate (GPA=1 to 2), and high risk (GPA=3 to 4). When applied to the validation cohort, the HCC-SM GPA determined median survival durations of 13.6, 4.8, and 2.6 months and 1-year overall survival rates of 58.3%, 17.8%, and 7.3% for the low-, intermediate-, and high-risk patient groups, respectively (p<0.001). CONCLUSIONS: Our newly proposed HCC-SM GPA successfully predicted survival outcomes.
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Humans , Carcinoma, Hepatocellular , Cohort Studies , Neoplasm Metastasis , Radiotherapy , Survival RateABSTRACT
Cuidados Paliativos devem ser prestados a todos os pacientes críticos, sendo ideal que haja integração entre médicos intensivistas e paliativistas. Para a otimização dos Cuidados Paliativos em Unidades de Terapia Intensiva é apontada a necessidade da identificação de pacientes com risco de má evolução. Este trabalho visou identificar quais pacientes internados na Unidade de Terapia Intensiva do Hospital Universitário Polydoro Ernani de São Thiago seriam elegíveis à avaliação paliativista e comparar o perfil desses pacientes com o daqueles que foram efetivamente discutidos pela equipe de Cuidados Paliativos. Durante três meses foram avaliados semanalmente os prontuários dos pacientes internados, sendo identificados como elegíveis para avaliação paliativista aqueles com tempo de internação ≥ 5 dias associado à idade ≥ 80 anos, readmissão na unidade, necessidade de gastrostomia/traqueostomia/hemodiálise não programada ou presença de condições de base ameaçadoras da vida. Posteriormente, foram comparados os dados dos pacientes elegíveis com os dos pacientes discutidos pela equipe. Dos 103 pacientes internados, foram identificados 53 (51,4%) para avaliação paliativista. Não houve diferença demográfica entre os selecionados ou não. Quinze doentes (14,5%) foram discutidos pela equipe. Esses eram mais comumente do sexo masculino, tinham um quadro mais grave, sendo mais comum o diagnóstico de insuficiência respiratória (p=NS). As doenças mais frequentemente relacionadas à discussão paliativista foram: doença pulmonar obstrutiva crônica, insulto neurológico, neoplasia e demência (p<0.05). Houve maior prevalência de traqueostomia no grupo discutido pela equipe e de hemodiálise não programada no grupo não discutido (p<0.05).
Palliative Care must be provided to all critically ill patients, being ideal integration between palliative and critical care physicians. For the optimization of Palliative Care in Intensive Care Units, it is necessary to identify patients at risk for poor outcome. This study aimed to identify which patients admitted at the Polydoro Ernani de São Thiago University Hospital Intensive Care Unit would be eligible for palliative assessment, and compare the profile of these patients with those who were actually discussed by the Palliative Care team. For three months, weekly, the charts of hospitalized patients were evaluated, being identified as eligible for Palliative Care assessment those with length of stay ≥ 5 days associated with age ≥ 80 years, readmission to the unit, unplanned need for gastrostomy / tracheostomy / hemodialysis, or baseline condition that threatens life. Later, the data from those eligible patients and those discussed by the team patients were compared. Of the 103 hospitalized patients, 53 (51,4%) were identified for palliative assessment. There were no demographic differences between the groups. Fifteen patients (14,5%) were discussed by the Palliative Care team. These were more commonly male, had a more serious conditions, and the most common diagnosis was respiratory failure (p=NS). The most common diseases related to palliative discussion were: chronic obstructive pulmonary disease, neurological insult, cancer and dementia (p<0.05). There was a higher prevalence of tracheostomy on the discussed group and unplanned hemodialysis on the not discussed group (p <0.05).