First-trimester complete blood count combined with maternal characteristics as a predictor of gestational diabetes mellitus / 中华内分泌代谢杂志

Objective:To Investigate comprehensive predictive ability of first-trimester complete blood count combined with maternal characteristics for gestational diabetes mellitus (GDM).Methods:From May 2015 to July 2018, 1 412 pregnant women were retrospectively screened at the Fifth People′s Hospital of Shanghai, Fudan University. We recruited 258 women who developed GDM and 1 154 women who had normal glucose level during pregnancy. At the first visit, clinical data and complete blood count result were obtained. GDM prediction models were established through logistic regression analysis of GDM related risk factors and the prediction abilities of each model were compared.Results:Logistic regression analyses identified age, pre-pregnancy body mass index, previous GDM history, family history of diabetes mellitus, the neutrophil-to-lymphocyte ratio, leukocyte, neutrophil, and monocyte counts were significantly independent predictors of GDM. In the entire cohort, the predictive ability of neutrophil and monocyte counts together with maternal basal characteristics model for the development of GDM [areas under the receiver operating characteristic curve (AUC-ROC)=0.809, integrated discrimination improvement (IDI)=0.056, P=0.001] was the best among various models (basal characteristics model, AUC-ROC=0.753; Monocyte count+ basal characteristics model, AUC-ROC=0.764; neutrophil count + basal characteristics model, AUC-ROC=0.775). Similar results obtained by the same way in all pregnant women without previous GDM history. Conclusion:It could improve the prediction of GDM with model incorporated maternal characteristics and first-trimester neutrophil and monocyte counts.

Establishment and Evaluation of A Early Prediction Model for Severe Acute Pancreatitis Complicated With Pancreatic Encephalopathy / 胃肠病学

Background: Pancreatic encephalopathy (PE) is one of the severe systemic complications of severe acute pancreatitis (SAP). In recent years, the incidence of PE was on the rise. There are few tools for early prediction of SAP complicated with PE. Aims: To screen the early independent risk factors of PE from clinical testing indices and scoring system of SAP patients, and then construct an early predictive scoring model of PE and used for intervening in advance. Methods: The clinical data of 130 patients with SAP from Jan. 2016 to Sept. 2020 at Shaanxi Hanzhong 3201 Hospital were analyzed retrospectively. Early independent risk factors of PE was screened by univariate analysis and multivariate Logistic regression analysis. The predictive scoring model was constructed by the weighted least square method. Results: Univariate analysis showed that history of alcohol abuse, lactic acid, intra-abdominal pressure (IAP), CT severity index (CTSI), extrapancreatic inflammation on CT (EPIC) and Glasgow coma scale (GCS) score were correlated to PE (P6), and differences in the incidence of PE in SAP patients among the three groups were statistically significant (P<0.05). Conclusions: The predictive scoring model constructed has the value for early prediction and evaluation of SAP complicated with PE, and risk stratification is helpful for taking intervention measures in advance to reduce the incidence of PE.

Significance of APTT as early predictor of bleeding in comparison to thrombocytopenia in dengue virus infection

Background: Dengue is a systemic viral infection transmitted by mosquitoes such as Aedes aegypti or Aedes albopictus. Dengue Fever (DF) is characterized by fever, headache, muscle or joint pain, and rash. The spectrum of dengue virus infection spreads from an undifferentiated fever and dengue fever (DF) to dengue haemorrhagic fever (DHF) with shock. Factors responsible for bleeding manifestations in dengue are vasculopathy, thrombocytopenia, coagulopathy, and disseminated intravascular coagulation (DIC). Coagulopathy results in derangement of activated partial thromboplastin time (APTT) which is an indicator of impending bleeding risk.Methods: A prospective study was conducted from June to December in 2017 in R L Jalappa Hospital. Patients aged above 18 years with febrile thrombocytopenia who are positive for dengue virus serology (NS1Ag and/ or IgM) were included in the study. Serial daily monitoring of platelet count and analysis of APTT levels were done. APTT was considered abnormal if it was more than 33.8s. Patients were followed up for evidence of leaking and bleeding manifestations.Results: Out of 170 patients 28.1% patients had bleeding manifestations. Bleeding signs were seen on clinical examination in 52.37% of patients. capillary leak was found in the form of Pleural effusion in 35.3%, Ascites in 41.2% and Periorbital edema in 31.2% of patients. Elevated APTT levels were seen in 110(64.7%) patients. Among patients with abnormal APTT platelet transfusion was done in 78.9% of patients, and among those with normal APTT levels platelet transfusion was done in 21.1% of patients.Conclusions: Our study showed significant correlation between bleeding manifestations and prolonged APTT levels as well as thrombocytopenia with abnormal APTT levels. Study concluded that 21.1% of platelet transfusions could have been prevented considering prolonged APTT as a predictor of bleeding manifestation, thus saving the resources and reactions due to platelet concentrate transfusion.

Study on the relationship between CT image texture changes of parotids and acute xerostomia during radiation treatment for head and neck cancer / 中华放射医学与防护杂志

Objective To investigate the relationship between parotid image texture and acute radiation xerostomia (grade) during radiotherapy in patients with head and neck cancer.The mathematical model was established to predict the severity of radiation dry mouth in the early stage.Methods 23 patients with head and neck cancer treated with radiotherapy were observed.The degree of xerostomia was evaluated according to RTOG criteria.The weekly validated CT images of these patients during radiotherapy were collected and transmitted to the MIM system to outline the parotid gland,and an internal analysis program was developed in MATLAB (R2013a).The changes of texture features of weekly parotid CT images during radiotherapy were analyzed,including mean CT value (MCTN),standard deviation (STD),skewness,kurtosis,entropy and volume.The mathematical model was established,and the KNN method was used to optimize the model and predict the level of xerostomia.Results There was no significant correlation among the changes of MCTN,volume and the degree of xerostomia (P ＞ 0.05).However,according to the weekly changes of MCTN and volume,the model was established to predict the grade of xerostomia with an accuracy of 99％.Conclusions The changes of parotid gland MCTN and volume were significantly correlated with acute radiation xerostomia during radiotherapy for head and neck cancer,and the MCTN changes can be used to predict the severity of xerostomia in the early stage.

Role of Uterine Artery Doppler in 11-14 Weeks Scan as a Predictor of Preeclampsia

Background: Preeclampsia (PE) is a disease in pregnancy involving interplay of multiple genetic, immunologic and environmental factors. The primary pathology of PE is related to abnormal placentation. Uterine artery doppler in the first trimester is a promising screening test for prediction of PE. Objective: To study the role of first trimester uterine artery doppler in prediction of preeclampsia. Methods: A prospective study was carried out to evaluate the role of uterine artery doppler in the 11- 14 week scan for prediction of preeclampsia and associated IUGR. A total number of 200 women who met our selection criteria were included in the study. Uterine artery doppler was done as part of the 11-14 weeks scan and mean uterine artery PI was calculated. Results: Among the women in the study, PE was detected in 21 women with incidence of 11 %. The sensitivity, specificity, positive predictive value and negative predictive values of mean uterine artery PI for development of PI were 76%, 86%, 39% and 96% respectively. Conclusions: Early identification of pregnancies at high-risk of early onset PE and undertaking the necessary measures to improve placentation can reduce the burden of the disease by using prophylactic aspirin. Effective screening for early onset PE can be achieved in the first-trimester of pregnancy with maternal history, uterine artery doppler and biochemical markers. Biochemical screening for preeclampsia needs to become cheaper and easily accessible for better prediction of PE in first trimester.

The significance of combined detection of P-selectin, TM and vWF in early prediction of severe acute pancreatitis / 中华内分泌外科杂志

Objective To investigate the value of P-selectin,thrombomodulin (TM) and von Willebrand factor (vWF) in identifying severe acute pancreatitis (SAP) at an early stage of the disease.Methods 80 patients with acute pancreatitis (25 mild,30 moderate and 25 severe) were selected in this study when they were admitted within 24 hours of the onset of symptoms.20 healthy volunteers were collected as the healthy control.Enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of vascular endothelial cell damage markers (P-selectin,TM and vWF) in SAP patients and the control group.Results The levels of 3 markers were significantly higher in SAP patients than in the mild and moderate acute pancreatitis patients and healthy volunteers (P＜0.05).P-selectin,TM and vWF were independent markers for the development of SAP and had higher discriminative powers than conventional marker tumor necrosis factor(TNF-α)(P＜0.05).They were similar to the APACHE-Ⅱ scoring system in distinguishing SAP at an early stage.Conclusions P-selectin,TM and vWF are independent markers to identify the development of SAP at an early stage.They are obviously superior to TNF-α and similar to the APACHE-Ⅱ scoring system.

Level of copeptin for early prediction of cardiorenal syndrome in rats / 中国病理生理杂志

AIM:To study the value of copeptin(CPP)level for the prediction of cardiorenal syndrome (CRS)in the rats with subtotal nephrectomy(SNX)combined with myocardial infarction(MI).METHODS: Male SD rats(n=60)were divided into blank control group(Con group), renal failure group(SNX group), heart failure group (MI group)and heart failure+renal failure group(CRS group).The concentrations of CPP in the serum and urine,hemo-dynamic indexes,blood pressure and renal function indexes were measured 1~5 weeks after modeling.The predictive val-ue of CPP for CRS in the rats was evaluated by the receiver operating characteristic(ROC)curve.RESULTS:Compared with Con group,left ventricular systolic pressure(LVSP)at 9 d in CRS group was significantly decreased(P<0.05),left ventricular end-diastolic pressure(LVEDP)at 9 d in CRS group was significantly increased(P<0.05), and the differ-ence of blood pressure at each time point was not statistically significant.The levels of blood urea nitrogen(BUN)and uri-nary creatinine(Ucr)in CRS group were significantly increased at 1 and 3 weeks(P<0.05).Compared with Con group, serum CPP level was significantly increased at 1,3 and 5 weeks(P<0.05), and urine CPP level was significantly in-creased at 3 weeks in CRS group.Serum brain natriuretic peptide(BNP)level was significantly increased at 1 and 3 weeks,while urine BNP level was significantly increased at 5 weeks after modeling in CRS group(P<0.05).No correla-tion between serum or urine CPP and BNP or BUN levels at 1 week in CRS group was observed.The results of ROC curve analysis indicated that the area under the curve(AUC)of serum CPP was 0.908(95%CI:0.789~1.028),and the cut-off value was 56.59 ng/L(sensitivity 0.875,specificity 0.800).CONCLUSION:The combination of SNX and MI estab-lishes a CRS rat model with both heart and kidney injury,and serum CPP can be used as a sensitive and specific biomarker for early prediction of CRS.

Overview and considerations on MRI research of neonatal punctate white matter lesions / 西安交通大学学报(医学版)

The number of preterm neonates appears to remain high in China in recent years.These subjects are vulnerable to pathogenic factors and have brain lesions easily.Punctate white matter lesions(PWML)are very common(the incidence＞20%).The degeneration in the brain associated with PWML is harmful to the outcomes and hard to be detected.Early diagnosis and prediction of PWML are focuses for pediatric researchers.This paper describes the change patterns and spatial distributions associated with PWML.The factors of individual differences and development during the diagnosis and prognosis are discussed as well.Finally,the paper points out the core problems in developmental brain template construction,individualized diagnosis,and early prediction.

The value of plasma C-peptide levels in early prediction of type 2 diabetes mellitus with peripheral sensory neuropathy / 中国医师进修杂志

Objective To explore the value of plasma C-peptide levels in early prediction of type 2 diabetes mellitus with peripheral sensory neuropathy.Methods The vibration perception threshold,pain,temperature sensation,touch-pressure sensation,ankle reflex was detected in 500 eases of type 2 diabetes mellitus,and the patients were divided into 4 groups according to peripheral sensory nerve test results:normal group (159 cases),mildly abnormal group (120 cases),moderately abnormal group (121 cases) and severely abnormal group (100 cases).Fasting and 2-hour postprandial C-peptide levels were determined and analysed with peripheral sensory nerve changes.The receiver-operating characteristic (ROC) curve was used to find the best critical point for diagnosis of diabetic peripheral sensory neuropathy.Results The fasting C-peptide among 4 groups had no significant difference (F =1.632,P ＞0.05).Two-hour postprandial C-peptide from normal group to mildly abnormal group and then moderately abnormal group gradually increased [(1.110 ± 0.526),(1.324 ± 0.490),(1.573 ± 0.716) μ g/L],while 2-hour postprandial C-peptide in severely abnormal group was significantly decreased and lower than that in normal group,and there were significant differences (P＜ 0.05).The max Youden Index was 0.366 when 2-hour postprandial C-peptide was 1.173 μ g/L.Conclusions The fasting C-peptide might be not related to early diabetic peripheral sensory neuropathy,but 2-hour postprandial C-peptide might be closely related to early diabetic peripheral sensory neuropathy.It is helpful to detect the early diabetic peripheral sensory neuropathy if we can take a dynamical observation of 2-hour postprandial C-peptide.

Prediction value of the early prediction score system of multiple organ dysfunction syndrome in the elderly / 中华急诊医学杂志

Objective To evaluate the prediction value of the early prediction score system of multiple organ dysfunction syndrome in the elderly (MODSE). Method A total of 393 patients with pulmonary infection, who were above60 years old, were divided into non MODSE(n =224) and MODSE group(n = 169) and were scored by the early prediction score system of MODSE. Independent-samples t Test was used to analyze the difference of forecast score between MODSE and non MODSE group. Receiver operating characteristic (ROC) curve was drawn,and the area under the curve was calculated. The prediction accuracy of scores for MODSE was assessed using sen-sitivity and specificity, and the optimal forecast point for MODSE was found. Results The score of MODSE group was higber than that of non MODSE[(19.38±12.049) vs. (45.78±20.257), P <0.001]. The area under the ROC curve was 0.889 (P <0.001) ond 95% (0.857～0.920). As the value of forecast score was 27.5, the sensitivity of the early prediction score system of MODSE was 82.8 %, the specificity of the early prediction score system of MODSE was 80.3 %. Conclusions The early prediction score system of MODSE is valuable in predic-tion of MODSE, which may be used to forecast MODSE and find the high risk population of MODSE.

Clinical Evaluation of Diagnostic Criteria for Early Prediction of Bacterial Infection in Febrile Neonates

PURPOSE: A retrospective study was undertaken to test the hypothesis that febrile neonates, who have bacterial infections, can be accurately predicted early by diagnostic criteria. METHODS: We conducted a retrospective study of 152 infants, 28 days or less of age, whose rectal temperature was at least 38degrees C. Past history, family history, finding on physical examinations and results of CBC, urinalysis, lumbar puncture, CRP, and cultures of blood, urine and CSF were recorded. The diagnostic criteria for bacterial infection were : presence of identifiable fever focus(skin, soft tissue, bone, joint, eyes, ears), presence of maternal risk factors(malnutrition, fever, infection, premature rupture of membrane) & neonatal risk factors(prematurity, SGA), unhealthy condition at physical examinations, neutrophil index(immature neutrophil count/total neutrophil count ratio)> OR =0.15 and CRP> OR =2.0mg/dL, urinalysis-> OR =5 WBC/high-power field, absence of upper respiratory tract illness in parent and contact people. Febrile neonates who meet any of the diagnostic criteria were considered as high risk for bacterial infection. RESULTS: The overall incidence of bacterial infections in the 152 febrile neonates was 13.8%(21 neonates) with urinary tract infections in 8 neonates, bacteremia in 8 neonates and meningitis in 5 neonates. Only 1 neonate, who was classified as low risk for bacterial infection, was identified with a bacterial urinary tract infection. The sensitivity, specificity, positive predictive value and negative predictive value of the diagnostic criteria were 95.2, 92.4, 66.7 and 99.2%, respectively. CONCLUSION: These data show the ability of diagnostic criteria to identify neonates with bacterial infection. Febrile neonates who meet the diagnostic criteria must be treated intensively and those who do not meet the diagnostic criteria can be carefully managed as inpatients or outpatients without administering antimicrobial agents, avoiding iatrogenic complications.

Clinical Evaluation of Diagnostic Criteria for Early Prediction of Bacterial Infection in Febrile Neonates

PURPOSE: A retrospective study was undertaken to test the hypothesis that febrile neonates, who have bacterial infections, can be accurately predicted early by diagnostic criteria. METHODS: We conducted a retrospective study of 152 infants, 28 days or less of age, whose rectal temperature was at least 38degrees C. Past history, family history, finding on physical examinations and results of CBC, urinalysis, lumbar puncture, CRP, and cultures of blood, urine and CSF were recorded. The diagnostic criteria for bacterial infection were : presence of identifiable fever focus(skin, soft tissue, bone, joint, eyes, ears), presence of maternal risk factors(malnutrition, fever, infection, premature rupture of membrane) & neonatal risk factors(prematurity, SGA), unhealthy condition at physical examinations, neutrophil index(immature neutrophil count/total neutrophil count ratio)> OR =0.15 and CRP> OR =2.0mg/dL, urinalysis-> OR =5 WBC/high-power field, absence of upper respiratory tract illness in parent and contact people. Febrile neonates who meet any of the diagnostic criteria were considered as high risk for bacterial infection. RESULTS: The overall incidence of bacterial infections in the 152 febrile neonates was 13.8%(21 neonates) with urinary tract infections in 8 neonates, bacteremia in 8 neonates and meningitis in 5 neonates. Only 1 neonate, who was classified as low risk for bacterial infection, was identified with a bacterial urinary tract infection. The sensitivity, specificity, positive predictive value and negative predictive value of the diagnostic criteria were 95.2, 92.4, 66.7 and 99.2%, respectively. CONCLUSION: These data show the ability of diagnostic criteria to identify neonates with bacterial infection. Febrile neonates who meet the diagnostic criteria must be treated intensively and those who do not meet the diagnostic criteria can be carefully managed as inpatients or outpatients without administering antimicrobial agents, avoiding iatrogenic complications.