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Objective: To development the prognostic nomogram for malignant pleural mesothelioma (MPM). Methods: Two hundred and ten patients pathologically confirmed as MPM were enrolled in this retrospective study from 2007 to 2020 in the People's Hospital of Chuxiong Yi Autonomous Prefecture, the First and Third Affiliated Hospital of Kunming Medical University, and divided into training (n=112) and test (n=98) sets according to the admission time. The observation factors included demography, symptoms, history, clinical score and stage, blood cell and biochemistry, tumor markers, pathology and treatment. The Cox proportional risk model was used to analyze the prognostic factors of 112 patients in the training set. According to the results of multivariate Cox regression analysis, the prognostic prediction nomogram was established. C-Index and calibration curve were used to evaluate the model's discrimination and consistency in raining and test sets, respectively. Patients were stratified according to the median risk score of nomogram in the training set. Log rank test was performed to compare the survival differences between the high and low risk groups in the two sets. Results: The median overall survival (OS) of 210 MPM patients was 384 days (IQR=472 days), and the 6-month, 1-year, 2-year, and 3-year survival rates were 75.7%, 52.6%, 19.7%, and 13.0%, respectively. Cox multivariate regression analysis showed that residence (HR=2.127, 95% CI: 1.154-3.920), serum albumin (HR=1.583, 95% CI: 1.017-2.464), clinical stage (stage Ⅳ: HR=3.073, 95% CI: 1.366-6.910) and the chemotherapy (HR=0.476, 95% CI: 0.292-0.777) were independent prognostic factors for MPM patients. The C-index of the nomogram established based on the results of Cox multivariate regression analysis in the training and test sets were 0.662 and 0.613, respectively. Calibration curves for both the training and test sets showed moderate consistency between the predicted and actual survival probabilities of MPM patients at 6 months, 1 year, and 2 years. The low-risk group had better outcomes than the high-risk group in both training (P=0.001) and test (P=0.003) sets. Conclusion: The survival prediction nomogram established based on routine clinical indicators of MPM patients provides a reliable tool for prognostic prediction and risk stratification.
Subject(s)
Humans , Mesothelioma, Malignant , Prognosis , Nomograms , Retrospective Studies , Proportional Hazards ModelsABSTRACT
Objective:To explore the risk stratification value of coronary CT angiography (CCTA) in patients with non-obstructive coronary artery disease based on cluster analysis and to identify the high-risk population of cardiovascular adverse events in patients.Methods:Prospective consecutive patients with suspected coronary artery disease who underwent CCTA examination and were confirmed as non-obstructive coronary heart disease were enrolled in the General Hospital of Chinese PLA from January 1, 2015 to December 31, 2017. The clinical characteristics and CCTA diagnosis information of patients were collected, and then follow-up was performed to obtain adverse cardiovascular events. Firstly, the cluster analysis based on CCTA information divided the patients into different groups. Then, the risk of adverse cardiovascular events was compared between different groups. Finally, segment involvement score (SIS) score, Leiden score, SIS score combined with clinical characteristics, Leiden score combined with clinical characteristics, and cluster information combined with clinical characteristics were used to stratify the population, and the concordance index-time curve and net reclassification improvement (NRI) index were described to compare the risk stratification ability of the five different models.Results:A total of 3 402 patients with non-obstructive coronary artery disease were included in the study, of whom 104 had adverse cardiovascular events during the follow-up period. Cluster analysis based on CCTA information classified patients into 3 different groups. There were statistically significant differences in clinical characteristics, CCTA information, and survival outcomes between groups ( P<0.05). The results of the concordance index-time curve showed that the risk stratification ability of CCTA cluster information combined with clinical characteristics was better than the current SIS score, Leiden score, SIS score combined with clinical characteristics, Leiden score combined with clinical characteristics. At the 1-year and 2-year time cutoffs, cluster information combined with clinical characteristics showed a positive increase in INR compared with the first four models (INR was 0.248 and 0.293, 0.316 and 0.293, 0.147 and 0.003, 0.192 and 0.007, respectively). Conclusion:CCTA based on cluster analysis has a good risk stratification value for patients with non-obstructive coronary artery disease and is helpful for individualized intervention.
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Objective:To investigate the clinical value of endoscopic ultrasound elastography versus contrast-enhanced computed tomography in the risk stratification of gastrointestinal stromal tumors (GISTs). Methods:Clinical and imaging data were obtained from 77 patients who were confirmed to have GISTs and underwent endoscopic or surgical treatment at Wenzhou Central Hospital between May 2019 and April 2021. Endoscopic ultrasound elastography based on a five-point scoring system and hypotonic gastrointestinal contrast-enhanced computed tomography were performed for preoperative risk stratification of GISTs. The two techniques were compared in terms of the accuracy of preoperative risk stratification of GISTs. The imaging features of the two techniques were summarized.Results:According to the postoperative pathological results, 13 patients were at high risk, 13 patients were at medium risk, 35 patients were at low risk, and 16 patients were at extremely low risk. These patients were divided into two groups according to postoperative pathological results: a low-risk group (low risk + extremely low risk) and a medium- and high-risk group (high + medium risk). In the low-risk group ( n = 51), 42 patients were identified by endoscopic ultrasound elastography to have low-risk GISTs and were recommended to receive endoscopic treatment, while the rest 9 patients were identified to have medium-risk GISTs. Contrast-enhanced computed tomography findings revealed that 30 patients had low-risk GISTs and were recommended to receive endoscopic treatment, and 21 patients had medium-risk GISTs. In the medium- and high-risk group ( n = 26), 4 patients were identified by endoscopic ultrasound elastography to have low-risk GISTs, and 22 patients had medium- or high-risk GISTs. Contrast-enhanced computed tomography findings revealed that 9 patients were identified to have low-risk GISTs, and 17 patients had medium- or high-risk GISTs. Endoscopic ultrasound elastography yielded an overall diagnostic accuracy of 83.11% (64/77), while contrast-enhanced computed tomography had an overall diagnostic accuracy of 61.04% (47/77). Endoscopic ultrasound elastography outperformed contrast-enhanced computed tomography in accurate risk stratification of GISTs ( χ2 = 4.66, P < 0.05). In terms of predicting high-risk GISTs, endoscopic ultrasound elastography had a sensitivity of 84.62% and a specificity of 82.35%, both were higher than those of contrast-enhanced computed tomography (sensitivity: 65.38%; specificity: 58.82%), but the differences in sensitivity and specificity between the two techniques were not significant (sensitivity: Fisher's exact test P = 0.590, specificity: χ2 = 0.93, P > 0.05). Conclusion:Endoscopic ultrasound elastography appears to have a better overall diagnostic accuracy in the risk stratification of GISTs compared with contrast-enhanced computed tomography. The combined use of these two techniques may offer a better comprehensive understanding of the perilesional structure and organ involvements and distant metastasis than a single technique, thereby providing a reliable reference for the choice of treatment for GISTs.
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Objective:To analyze the clinical characteristics and risk stratification of 182 patients with acute pulmonary embolism (APE), and to investigate the correlation of neutrophil (N)/lymphocyte (L) ratio (NLR) and risk stratification/prognosis.Methods:The clinical data of 182 APE patients admitted to Peking University People’s Hospital from January 2015 to March 2021 were retrospectively collected, including age, sex, symptoms and signs, blood pressure, blood gas analysis, blood routine parameters, cardiac biomarkers, coagulation parameters, and right ventricular imaging parameters. The patients were divided into groups according to the risk stratification at admission and prognosis in hospital. χ2 test, t test or nonparametric test were used to analyze the differences in clinical characteristics, blood routine parameters, blood gas analysis, coagulation parameters and other parameters between the groups. Multivariate logistic regression analysis was used to study the independent risk factors for the prognosis of APE. Results:Among the 182 patients, 79 were male and 103 were female, 23 were in the high-risk group, 51 were in the intermediate-high-risk group, 46 were in the intermediate-low risk group, and 62 were in the low-risk group. There were 27 deaths and 155 survivors. The respiratory rate of the high/intermediate-high-risk group was significantly higher than that of the low/intermediate-low-risk group. Compared with the other three groups, pH, oxygen partial pressure (PO 2) and blood oxygen saturation (SO 2) in the high-risk group were significantly lower ( both P<0.05). There were statistically significant differences in WBC, N, and NLR levels between the high/intermediate-high-risk group and low/intermediate-low-risk group ( both P<0.05). However there were no significant differences in PLT, PLT/MPV, PLT/PDW, and coagulation related parameters PT, FIB, APTT and D-D between groups (all P > 0.05). MPV and PDW were only significantly different between the low-risk group, intermediate-low-risk group and high-risk group ( both P<0.05). Multivariate logistic regression analysis showed that NLR ( OR=1.179,95% CI:1.029-1.410, P=0.039) and PH ( OR=1.156,95% CI:1.031-1.522, P=0.041) were independent predictors of in-hospital mortality. The ROC curve was used to analyze the predictive value of NLR for in-hospital mortality. When the cutoff value of NLR was 8.38, the AUC of NLR was 0.824 (95% CI: 0.829-0.913), the corresponding sensitivity was 0.831, and the specificity was 0.887. Conclusions:NLR is correlated with risk stratification and prognosis of APE, and is an independent risk factor for poor prognosis.
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OBJECTIVE@#To explore the prognostic factors of patients with multiple myeloma (MM) based on nutritional status.@*METHODS@#The Controlling Nutritional Status (CONUT) score and clinical parameters at diagnosis of 203 newly diagnosed MM patients hospitalized in the department of hematology, Wuxi People's Hospital from January 1, 2007 to June 30, 2019 were analyzed retrospectively. The best cut-off value was determined by ROC curve, and the patients were divided into high CONUT group (>6.5 points) and low CONUT group (≤6.5 points); through COX regression multivariate analysis of overall survival (OS) time, CONUT, ISS stage, LDH and treatment response were selected for multiparameter prognostic stratification.@*RESULTS@#The OS of MM patients in high CONUT group was shorter. The low-risk group (≤2 points) of the multiparameter risk stratification had longer OS time and progression-free survival (PFS) time compared with the high-risk group (>2 points), and it was also effective for different age or karyotype subgroups, new drug groups containing bortezomib and transplant-ineligible subgroup.@*CONCLUSION@#The risk stratification of MM patients based on CONUT, ISS stage, LDH and treatment response is worthy of clinical application.
Subject(s)
Humans , Nutritional Status , Prognosis , Multiple Myeloma , Retrospective Studies , Risk FactorsABSTRACT
Introducción. Las eritrocitosis patológicas en la altura afectan al 10 % de la población constituyéndose una causa importante de morbilidad por enfermedades no transmisibles. Suscita emergente categorizar la severidad de estas eritrocitosis para estimar su evolución y tratamientos adecuados. Objetivo. Estratificar el riesgo de las eritrocitosis patológicas en la altura considerando parámetros de severidad que sean de utilidad clínica en el pronóstico y tratamiento. Material y métodos. Estudio transversal retrospectivo de 283 historias clínicas de pacientes con eritrocitosis patológica de altura (EPA) o eritrocitosis secundaria (ES), residentes en altura (>3600 m s. n. m) y diagnosticados entre gestiones 2000 a 2021. Se identificó características clínico-laboratoriales diferenciales respecto del diagnóstico, respuesta al tratamiento y evolución de pacientes. Se planteó 3 niveles de estratificación de riesgo (bajo, intermedio, alto) considerando variaciones en síntomas de hiperviscosidad, eritropoyetina, complicaciones y comorbilidades. Resultados. 194 pacientes correspondieron al grupo de riesgo bajo, 67 al riesgo intermedio y 22 al riesgo alto. Riesgo bajo conllevó Epo 30 mUI/ml (30-100 mUI/ml), tratamiento con atorvastatina-aspirina, respuestas parciales y pronóstico regular, concerniendo pacientes con ES asociada a patologías pulmonares leves. Riesgo alto reflejó Epo >100 mUI/ml, inclusión de hidroxiurea al tratamiento con atorvastatina, menor respuesta y pronóstico desfavorable, incumbiendo pacientes >60 años con ES asociada a patologías pulmonares crónicas severas o complicaciones por eritrocitosis. Conclusiones. Contar con niveles de riesgo para las eritrocitosis patológicas permite conjeturar su pronóstico y optimizar decisiones terapéuticas.
Introduction. Pathological erythrocytoses at altitude affect 10% of the population, representing an important cause of morbidity from non-communicable diseases. Categorizing the severity of such erythrocytoses to estimate their evolution and suitable treatments becomes emergent. Objective. To stratify the risk of the pathological erythrocytoses at high altitude considering severity parameters useful for prognosis and treatment. Material and methods. Retrospective cross-sectional study that included 283 medical records of patients with Chronic Mountain Sickness-erythrocytosis (CMS-e) or Secondary Erythrocytosis (SE), inhabitants at high altitude (>3600 m a. s. l.) diagnosed between 2000 to 2021. Differential clinical-laboratory characteristics regarding the diagnosis, response to treatment and evolution of patients were identified. Three risk groups (low, intermediate, high) were raised, considering variations about hyperviscosity symptoms, erythropoietin levels, complications, and comorbidities. Results. 194 patients corresponded to the low-risk group, 67 to the intermediaterisk and 22 to the high-risk. Low-risk group involved Epo 30 mIU/ml (30-100 mIU/ ml), treatment with atorvastatin-aspirin, partial responses and favorable prognosis, concerning patients with SE attributed to mild lung diseases. High-risk reflected Epo >100 mIU/ml, inclusion of hydroxyurea to the treatment with atorvastatin, poor response and unfavorable prognosis, involving patients >60 years of age with SE attributed to severe and chronic lung diseases or complications due to erythrocytosis. Conclusion. Counting on a risk stratification for pathological erythrocytosis at high altitude allows to assess the prognosis and optimize therapeutic decisions.
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PolycythemiaABSTRACT
Cardiovascular diseases involve hyperlipidemia, inflammation and oxidative stress. Although this relationship is well established, only biomarkers associated with hyperlipidemia and inflammation are currently in clinical practice for diagnosis and evaluation of patient treatment. Our hypothesis is that oxidative stress biomarkers may be an independent risk factor and may assist in cardiovascular risk stratification and contribute to improving current scores. Thus, the objective of this study was to investigate which are the biomarkers and methodologies were used in clinical studies in humans with different health conditions. With the results obtained in the first part, we selected studies conducted in healthy individuals and in individuals under primary and secondary cardiovascular prevention in order to evaluate the most frequent biomarkers, the results obtained according to the individual's profile and the methodology used, and correlate with different health conditions. We observed that malondialdehyde (MDA) was the most frequent lipid biomarker of oxidative stress applied in the studies, but it presented significant variability in the results and a weak correlation with clinical outcomes. The result of this study demonstrates the importance of carrying out a multicentric study to validate the MDA values in individuals with different health conditions and the standardization of the methodology based on high performance liquid chromatographyy (HPLC)
As doenças cardiovasculares envolvem hiperlipidemia, inflamação e estresse oxidativo. Embora essa relação esteja bem estabelecida, apenas biomarcadores associados à hiperlipidemia e inflamação são atuais na prática clínica para diagnóstico e avaliação do tratamento do paciente. Nossa hipótese é que biomarcadores de estresse oxidativo podem ser um fator de risco independente e podem auxiliar na estratificação de risco cardiovascular e contribuir para melhorar os escores atuais. Assim, o objetivo deste estudo foi investigar primeiramente quais são os biomarcadores e metodologias utilizados nos estudos clínicos em humanos em diferentes condições de saúde. Com os resultados obtidos na primeira etapa, selecionamos os estudos conduzidos em indivíduos saudáveis e em prevenção cardiovascular primária e secundária a fim de avaliar os biomarcadores mais utilizados, os resultados obtidos conforme o perfil do indivíduo e a metodologia utilizada e finalmente correlacionar com as diferentes condições de saúde. Observamos que o malondialdeído (MDA) foi o biomarcador lipídico de estresse oxidativo mais frequente nos estudos, porém apresentou importante variabilidade nos resultados e fraca correlação com desfechos clínicos. O resultado desse estudo demonstra a importância da realização de um estudo multicentrico para validação dos valores de MDA nos diferentes perfis de indivíduos e a padronização metodológica baseada na cromatografia líquida de alta eficiência (HPLC)
Subject(s)
Biomarkers/analysis , Oxidative Stress , Patients/classification , Chromatography, High Pressure Liquid/methods , Atherosclerosis/pathologyABSTRACT
Objective:To investigate the association between bone lesions distribution and survival outcome and prognostic risk stratification in renal cell carcinoma bone metastasis (RCC-BM).Methods:The data of 122 RCC-BM patients admitted to Peking University People's Hospital between January 2009 and December 2019 were retrospectively reviewed. There were 100 males and 22 females, with a baseline age of (59.87±11.33) years old. According to the Memorial Sloan-Kettering Cancer Center (MSKCC)/Motzer score, patients were stratified into different risk groups using profiles at first bone metastasis diagnosis, with 20 (16.4%), 74 (60.6%) and 28 (23.0%) patients in favorable, intermediate and poor group, respectively. The spatial distribution of bone metastasis was investigated at the first bone metastasis diagnosis. The overall distribution patterns were as follows: locoregional group (lesions only involved thoracic and/or lumbar vertebrates) in 26 cases (21.3%), stochastic group (bone lesions randomly distributed) in 69 cases (56.6%), extensive group (with concomitant visceral metastasis) in 27 cases (22.1%). Metastatic site involvement was as follows: spine in 48 cases(39.3%), pelvis in 43 cases (35.2%), upper extremities in 22 cases (18.0%), and lower extremities in 20 cases (16.4%). Half (61 cases) of the enrolled patients had synchronous bone metastasis as their first bone metastases were diagnosed simultaneously with their renal tumors. Of all the patients, 99 (81.1%) accepted radical nephrectomy, 6 (4.9%) accepted partial nephrectomy, and the other 17 patients (13.9%) accepted the treatment of ablation or embolization. Eighty-two patients (67.2%) received definitive treatment for bone metastatic lesions, respectively. Forty patients (32.8%) accepted the palliative tumor reduction therapy. Thirty-two patients (26.2%) received tyrosine kinase inhibitor (TKI) or immune checkpoint inhibitor (ICI) medication, and 12 patients (9.8%) received local radiotherapy. Distribution variation and therapeutic strategies throughout the disease course until the last follow-up were recorded. Univariate analysis (chi-squared test, Mantel-Haenszel test), Kaplan-Meier survival analysis, and multivariate ordinal logistic regression were performed for the possible association.Results:Patients from the locoregional group (30.8%, 8/26) were prone to have higher risk stratification at first diagnosis than patients in the stochastic and extensive groups ( 20.8%, 20/96, P=0.107) as the marginal difference was found. At first bone metastasis diagnosis, RCC-BM patients with spinal involvement were more likely to have higher MSKCC risk stratification than those without spinal involvement [20.3%(15/48) vs. 17.6%(13/74), P<0.05]. Multivariate ordinal logistic regression showed that after adjusting for general data, bone metastasis sites, and concomitant visceral metastasis, RCC-BM patients with spinal involvement at first bone metastasis diagnosis were 3.3 times (95% CI 1.195-9.091, P<0.05)more likely to fall into the higher MSKCC risk group than those without spinal involvement.In those 93 cases with follow-up records, 20 (21.5%), 53 (57.0%), and 20 (21.5%) cases were in the locoregional group, stochastic group, and extensive group, respectively. The median overall survival time (mOS) of patients with pelvic involvement (36 cases) throughout the disease course was 32.0 months (95% CI 6.0-58.0), which was shorter than that of patients without pelvic involvement (57 cases, mOS 49.0 months, 95% CI 20.4-77.5, P<0.05). Conclusions:Spinal involvement (especially limited to thoracic and/or lumbar vertebrates) at first bone metastasis diagnosis and pelvic involvement throughout the disease course were associated with poor prognosis.
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Purpose: The aim of this study was to develop a risk stratification system that predicts visual outcomes (uncorrected corrected visual acuity at one week and five weeks postoperative) in patients undergoing cataract surgery. Methods: This was a retrospective analysis in a multitier ophthalmology network. Data from all patients who underwent phacoemulsification or manual small-incision cataract surgery between January 2018 and December 2019 were retrieved from an electronic medical record system. There were 122,911 records; 114,172 (92.9%) had complete data included. Logistic regression analyzed unsatisfactory postoperative outcomes using a main effects model only. The final model was cross-checked using forward stepwise selection. The Hosmer朙emeshow goodness of fit test, the Bayesian information criterion, and Nagelkerke抯 R2 assessed model fit. Dispersion was calculated from deviance and degrees of freedom and C-stat from receiving operating characteristics analysis. Results: The final phacoemulsification model (n = 48,169) had a dispersion of 1.08 with a Hosmer朙emeshow goodness of fit of 0.20, a Nagelkerke R2 of 0.19, and a C-stat of 0.72. The final manual small-incision cataract surgery model (n = 66,003) had a dispersion of 1.05 with a Hosmer朙emeshow goodness of fit of 0.00015, a Nagelkerke R2 of 0.14, and a C-stat of 0.68. Conclusion: The phacoemulsification model had reasonable model fit; the manual small-incision cataract surgery model had poor fit and was likely missing variables. The predictive capability of these models based on a large, real-world cataract surgical dataset was suboptimal to determine which patients could benefit most from sight-restoring surgery. Appropriate patient selection for cataract surgery in developing settings should still rely on clinician thought processes, intuition, and experience, with more complex cases allocated to more experienced surgeons
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Abstract Background: Obesity is a public health problem and has been associated with the development of metabolic disorders that have a strong relationship with the onset of cardiovascular diseases (CVD). Objective: The objective was to analyze the influence of abdominal obesity (AO) on systemic arterial hypertension (SAH) and on the lipid profile in cardiovascular risk stratification in adult women. Methods: Altogether, 91 women participated in the research. Lifestyle information was collected, in addition to the analysis of clinical measures of cardiovascular risk and biochemical parameters. Unpaired Student's t-test, logistic regression, and Pearson's correlation were performed for data analysis, with a value of p <0.05 considered significant. Results: The prevalence of AO was 62.6%. Logistic regression showed that AO increased the chance of developing SAH by 2.9-fold. The same behavior was observed in the TG/HDL-c lipid ratio (3.93 ± 0.3 vs. 2.16 ± 0.2), representing an 82% increase in obese women. The present study also demonstrated that the best anthropometric parameter to analyze cardiovascular risk in the studied population was the waist/height ratio (AUC = 0.707). Conclusions: It can therefore be concluded that AO plays a significant role in the development of SAH and changes in lipid values that predict increased cardiovascular risk, configuring a strong influence factor for CVD.
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Purpose: To evaluate the effectiveness and future implications of COVID?related risk stratification for managing retinopathy of prematurity (ROP). Methods: A prospective study was conducted at a tertiary eye care center from the beginning of the lockdown in India from 23 March 2020 till the end of the first phase of lockdown on 29 May 2020. We evaluated 200 prematurely born infants (< 34 weeks of gestational age) using the new safety guideline protocols for low?risk babies developed in conjunction with the Indian ROP Society for care during the COVID?19 pandemic. Low risk included babies born at more than 30 weeks of gestational age, post menstrual age 34 weeks or above at presentation, more than 1000 grams of birth weight, and stable systemically with good weight gain. Results: New guidelines were implemented in 106 (53%) infants who were low risk while 94 (47%) infants with high risk were followed up as per the old guidelines. Out of the 106 infants (212 eyes) managed by the new guidelines, good outcome (group 1) was seen in 102 (96.2%) infants. Twenty?seven of the 102 infants had some form of ROP and 5 of these infants needed treatment. None of the low?risk babies with no detachment at presentation managed by new guidelines required surgery later (group 2). Two (1.9%) infants came with retinal detachment at presentation and underwent successful surgery (group 3) and two infants (1.9%) were lost to follow up. Conclusion: New risk stratification during the COVID?19 pandemic was an efficient and safe strategy in managing low?risk ROP babies.
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Background: Coronary artery disease (CAD) early diagnosis remains a clinical problem in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), especially in the regional wall motion abnormalities’ absence on presentation by Echo. This study assessed the relationship between ECG changes and speckle Tracking in subjects with acute NSTE-ACS. Methods: This prospective trial was performed on 100 subjects with NSTE-ACS. All subjects were subjected to laboratory tests [complete blood picture, renal function test, liver test profile, lipid profile, RBS and cardiac biomarkers (cardiac troponin, creatinine kinase and CK-MB)], 12 lead ECG, Echocardiography (TTE, speckle tracking), Image analysis and coronary angiography. Results: regarding IVRT, TDI e`, TDI a`, a considerable difference between the two groups were found. DBP was considerably lower in STD group in comparison with TWI group (P value= 0.047). IVRT, TDI a` and GLS were considerably higher in STD group in comparison with TWI group (P value= 0.024, 0.031, 0.003 respectively). Conclusions: Speckle tracking could be used as part of standard echo for the examination of individuals suffering from NSTE-ACS.
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Resumen Introducción: En gestantes con cardiopatía, los modelos de estratificación del riesgo de desenlaces adversos permiten guiar las decisiones clínicas y establecer estrategias de seguimiento y manejo de acuerdo con cada categoría. Objetivo: Validar los modelos de predicción de riesgo de desenlaces cardiacos adversos CARPREG II y OMSm en gestantes con cardiopatía. Materiales y método: Estudio de validación y comparación de dos modelos de predicción de riesgo en una cohorte prospectiva de gestantes con cardiopatía, valoradas por un equipo cardioobstétrico en un país de ingresos medios. Se evaluaron los desenlaces cardiovasculares y perinatales y se determinó la calibración y el nivel de discriminación de estas herramientas. Resultados: Entre 328 gestantes (27 años DE = 7), el 33% (n = 110) tenían cardiopatía congénita, el 30% (n = 98) arritmias, el 14% (n = 46) valvulopatías y el 9% (n = 29) miocardiopatía. Un evento cardiaco ocurrió en el 15% (10% primario y 5% secundario). La discriminación de ambos modelos fue adecuada (AUC-ROC: 0.74; IC 95%: 0.64-0.84 para CARPREG II y 0.77 para OMSm; IC 95%: 0.69-0.86). La calibración también es buena (Hosmer-Lemeshow > 0.05). Las variables numéricas fracción de eyección y presión sistólica de la arteria pulmonar, pueden mejorar la capacidad de predicción del CARPREG II. Conclusiones: Los modelos CARPREG II y OMSm tienen buena capacidad de predicción del riesgo de desenlaces cardiacos adversos y se ajustan a nuestras gestantes con cardiopatía.
Abstract Introduction: In pregnant women with heart disease, risk stratification models for adverse outcomes allow guiding clinical decisions and establish monitoring and management strategies according to each category. Objective: To validate CARPREG II and WHOm adverse cardiac outcome risk prediction models in this population. Materials and methods: Validation and comparison study of two risk prediction models in a prospective cohort of pregnant women with heart disease, assessed by a team cardio-obstetrician in a middle-income country. We assessed cardiovascular and perinatal outcomes and determined the calibration and level of discrimination of these tools. Results: Among 328 pregnant women (27 years SD = 7), 33% (n = 110) had congenital heart disease, 30% (n = 98) arrhythmias, 14% (n = 46) valvular pathologies and 9% (n = 29) cardiomyopathies. A cardiac event occurred in 15% (10% primary and 5% secondary). Discrimination of both models was adequate (AUC-ROC 0.74 CI 95% 0.64-0.84 for CARPREG II and 0.77 for WHOm 95% CI 0.69-0.86). The calibration is also good (Hosmer-Lemeshow >0.05). The Numerical variables of fraction of ejection and systolic pressure of the pulmonary artery can improve the predictive ability of CARPREG II. Conclusions: The CARPREG II and WHOm risk stratification models have good ability to predict the risk of adverse cardiac outcomes and are adjusted to our pregnant women with heart disease.
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@#This clinical pathway for the diagnosis and risk stratification of patients presenting with acute chest pain, including acute coronary syndromes, provides recommendations and algorithms for clinicians to diagnose, risk stratify, and manage acute chest pain in adult patients. The writing committee reviewed existing international and local guidelines. Modifications to the algorithm following face-to-face and virtual meetings resulted in expert decisions written as recommendations and presented in a flow diagram format. The USTH Chest Pain Pathway provides guidance based on current guidelines and recommendations on assessing and evaluating acute chest pain, tailored to local needs and institution-specific facilities. We recommend its use to ensure quality patient care in the hospital.
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Objective:To explore independent risk factors and risk stratification for diagnosis of clinically significant prostate cancer (CsPCa) in biopsy-naive patients with nonsuspicious multiparametric magnetic resonance imaging (mpMRI).Methods:The data of 549 patients who underwent initial systematic biopsy (SB) in the First Affiliated Hospital of Soochow University, the Second Affiliated Hospital of Soochow University and Traditional Chinese Medicine Hospital of Kunshan between October 2015 and January 2021 were retrospectively reviewed. Nonsuspicious mpMRI was defined as Prostate Imaging-Reporting and Data System (PI-RADS)≤2. All patients received systematic 12 core prostate biopsy, 278 of them by transperineal and 271 by transrectal biopsies. The median age of the patients was 67 (62, 73) years, the median prostate specific antigen (PSA) was 9.01 (6.15, 13.64) ng/ml, the median prostate volume was 48.41 (35.85, 64.28) ml, and 54 patients were positive in digital rectal examination (DRE). Taking CsPCa as the outcome index, receiver operating characteristic (ROC) analysis was performed on age, tPSA, f/tPSA and PSA density (PSAD) to obtain the optimal cut-off value, and logistics regression was used to explore the independent risk factor of CsPCa in mpMRI negative patients. The optimal cut-off value when the negative predictive value (NPV) of mpMRI diagnosis of CsPCa was 100%, was taken as the protective factor, and the risk stratification model was finally proposed.Results:Of all 549 cases, 44 were CsPCa, 35 were clinically insignificant prostate cancer and 470 were non-prostate cancer. There were significant differences in age (71 vs. 67 years old), tPSA (11.95 vs. 8.75 ng/ml), PSAD [0.31 vs. 0.18 ng/(ml·cm 3)], f/tPSA (0.12 vs. 0.16) and DRE positive rate (38.6% vs. 7.3%) between CsPCa group and non-CsPCa group ( P<0.01). Cut-off values were taken in ROC analysis when the Youden index was at its maximum. The optimal cut-off values of each continuous variable were: age=65 years, tPSA=10ng/ml, f/tPSA=0.2 and PSAD=0.15 ng/(ml·cm 3). Multivariate analysis showed that ages over 65 years ( OR=3.43, 95% CI 1.55-7.58, P=0.002), f/t PSA ratio<0.2 ( OR=3.84, 95% CI 1.28-11.56, P=0.016), PSAD>0.15 ng/(ml·cm 3) ( OR=3.60, 95% CI 1.13-11.51, P=0.03) and positive DRE ( OR=5.20, 95% CI 2.39-11.32, P<0.001) were independent risk factors of CsPCa. When NPV was 100%, the cut-off values were taken as the protective factors: age≤55 years, f/tPSA≥0.3, PSAD≤0.1 ng/(ml·cm 3). Combined with independent risk factors, preliminary risk stratification was conducted: those with ≥2 high risk factors were considered as high risk group, those with ≥2 protective factors were considered as low risk group, and the middle region was considered as medium risk group. Conclusions:Patients with age>65 years, f/tPSA<0.2, PSAD > 0.15 ng/(ml·cm 3) and DRE positive are independent risk factors of CsPCa in mpMRI negative patients. Patients in the high-risk group were recommended to undergo prostate biopsy, while patients in the low-risk group could be considered to avoid biopsy.
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Objective:To explore the influencing factors of severity of upper gastrointestinal bleeding (UGIB) and to establish the early warning evaluation model in the form of line chart, so as to provide a feasible basis for emergency nurses' triage.Methods:A total of 680 UGIB patients admitted to the Emergency Department of the First Affiliated Hospital of Wenzhou Medical University from January 2019 to January 2020 were retrospectively analyzed. They were divided into a modeling group ( n=510) and a validation group ( n=170) by random number table method, and were divided into a high-risk group and a low-risk group according to the expert Consensus on Emergency Diagnosis and Treatment Procedures for Acute Upper Gastrointestinal Bleeding in 2020. The differences of various indicators between groups were compared, the factors affecting the severity of the disease were analyzed by Logistic regression, and the nomogram was drawn and validated. Results:Multivariate logistic regression analysis showed that hematemesis ( OR=3.875, 95% CI: 2.212-6.79), diabetes ( OR=2.64, 95% CI: 1.184-5.883), syncope ( OR=10.57, 95% CI: 3.675-30.403), heart rate ( OR=3.262, 95% CI: 1.753-6.068), red blood cell distribution width ( OR=3.904, 95% CI: 2.176-7.007), prothrombin time ( OR=3.665, 95% CI: 1.625-8.269), lactic acid ( OR=3.498, 95% CI: 1.926-6.354) and hemoglobin ( OR=4.984, 95% CI: 2.78-8.938) were the influencing factors of the severity of UGIB patients ( P < 0.05). The nomogram model showed good consistency and differentiation (C-index=0.903, 95% CI: 0.875-0.931), and was verified internally (C-index=0.895) and Hosmer-Lemeshow goodness-of-fit test ( P=0.7936). Externally verified C-index was 0.899 (95% CI: 0.846-0.952). The calibration curve prompt warning evaluation model had good stability and the prediction efficiency was better than the modified early warning score ( P < 0.05). Conclusions:The early warning evaluation model has a reliable predictive value, which can provide a reference for emergency medical staff to screen high-risk patients and formulate targeted nursing interventions.
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Objective:To investigate the therapeutic effect and safety of low-dose dexitabine combined with DA/HA chemotherapy regimen in acute myeloid leukemia (AML) patients with moderate or poor prognosis.Methods:The clinical data of 25 initially diagnosed AML patients (non-acute promyelocytic leukemia) in Affiliated Hospital of Southwest Medical University from April 2013 to May 2020 were retrospectively analyzed. According to the National Comprehensive Cancer Network (NCCN) guideline, all patients were divided into moderate prognosis group (5 cases) and poor prognosis group (20 cases), and they were given low-dose decitabine combined with DA/HA regimen (decitabine 10 mg, day 1-10; daunorubicin 60 mg/m 2, day 1-3; homoharringtonine 2.5 mg/m 2, day 1-7; cytarabine 100-200 mg/m 2, day 1-7). The clinical efficacy and adverse reactions of both groups were observed. Results:Among 25 patients, 1 patient gave up during the treatment; 14 patients received 1 cycle of treatment and the complete response (CR) rate was 71.4% (10/14); 10 patients received ≥2 cycles of treatment and the CR rate was 70.0% (7/10); the difference of CR rate in patients with different treatment cycles was not statistically significant ( χ2 = 0.01, P > 0.05). In the moderate prognosis group, 4 cases achieved CR and 1 case had no response (NR), the CR rate was 80.0% (4/5), and the total effective rate was 80.0% (4/5). In poor prognosis group, 13 cases achieved CR, 4 cases achieved partial response (PR), 2 cases had NR, 1 case gave up the treatment, the CR rate was 68.4% (13/20), and the total effective rate was 89.5% (17/20). There were no statistical differences in the CR rate and the total effective rate between the two groups (both P > 0.05). The adverse reactions of all patients were mild and all patients could tolerate. Conclusions:Low-dose dexitabine combined with DA/HA regimen has a high remission rate in treatment of AML patients with moderate or poor prognosis, and the adverse reactions can be tolerated.
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OBJECTIVE@#To analyze the clinical characteristics and prognosis of 40 children with myelodysplastic syndrome (MDS), and provide ideas for clinical diagnosis and treatment.@*METHODS@#The clinical characteristics, risk stratification, and different treatment regimens of 40 cases with MDS admitted in Department of Hematology of Children's Hospital of Soochow University from January 1, 2011 to December 31, 2017 was retrospectively analyzed. Kaplan-Meier survival curve were used to estimate 3-year overall survival (OS) rate and event-free survival (EFS) rate.@*RESULTS@#In 40 cases, the ratio of male to female was 1.4∶1.0, male was more than female, and median age was 6.0 years old. Among them, refractory cytopenia (MDS-RCC) was the most common type, and 11 cases were chromosomal abnormalities, 21 cases genetic abnormalities. Fifteen cases accepted hematopoietic stem cell transplantation (HSCT) treatment, while 25 cases did not but drug therapy alone. The 3-year OS rate of the cases who accepted HSCT or not was (72.2±12.2)% and (35.3±10.2)% (P=0.039), 3-year EFS rate was (65.0±12.9)% and (19.2±8.4)% (P=0.012), respectively. Cox regression analysis showed that age < 7 years old (P=0.0333), initial diagnosed platelet < 50×109/L (P=0.007), presence of complex karyotypes and/or gene mutations (P=0.0002), and treatment without HSCT (P=0.016) were the high-risk factors of prognosis. All the children were classified according to IPSS, WPSS and IPSS-R, while analysis result showed that the above three risk assessment had limitations for risk assessment of MDS in children, they could not comprehensively assess the prognosis of children with MDS.@*CONCLUSION@#MDS-RCC in children is more common. Cox multivariate analysis shows that age < 7 years old, initial diagnosed platelet < 50×109/L, presence of complex karyotypes and/or gene mutation, and treatment without HSCT are the high-risk factors of prognosis in children with MDS. HSCT is the most effective treatment to cure children with MDS at present. The current methods such as IPSS-R commonly used in assessment of prognosis in children with MDS show obvious limitation.
Subject(s)
Child , Female , Humans , Male , Hematopoietic Stem Cell Transplantation , Myelodysplastic Syndromes/therapy , Prognosis , Retrospective Studies , Treatment OutcomeABSTRACT
OBJECTIVE@#To analyze the clinical characteristics and risk factors of invasive fungal infection (IFI) occurenced in patients with acute leukemia (AL) during treatment in tropical regions.@*METHODS@#The clinical data of 68 AL patients admitted to the Hainan Hospital of PLA General Hospital from April 2012 to April 2019 was retrospectively analyzed. Logistic regression analysis was used to analyze the factors affecting the occurrence of IFI in AL patients.@*RESULTS@#Among the 68 patients, 44 were acute myeloid leukemia, 24 were acute lymphoblastic leukemia, 39 were male, 29 were female and the median age was 41(13-75) years old. The 68 patients received 242 times of chemotherapy or hematopoietic stem cell transplantation(HSCT), including 73 times of initial chemotherapy or inducting chemotherapy after recurrence, 14 times of HSCT, 155 times of consolidating chemotherapy. Patients received 152 times of anti-fungal prophylaxis, including 77 times of primary anti-fungal prophylaxis and 75 times of secondary anti-fungal prophylaxis. Finally, the incidence of IFI was 31 times, including 24 times of probable diagnosis, 7 times of proven diagnosis, and the total incidence of IFI was 12.8%(31/242), the incidence of IFI in inducting chemotherapy was 24.66%(18/73), the incidence of IFI in HSCT patients was 28.57% (4/14), the incidence of IFI in consolidating chemotherapy was 5.80% (9/155). Multivariate analysis showed that inducting chemotherapy or HSCT, the time of agranulocytosis ≥7 days, risk stratification of high risk were the independent risk factors for IFI in AL patients during treatment in tropical regions.@*CONCLUSION@#The incidence of IFI in patients with AL in the tropics regions is significantly higher than that in other regions at homeland and abroad. Anti-fungal prophylaxis should be given to the patients with AL who have the high risk factors of inducting chemotherapy or HSCT, time of agranulocytosis ≥7 days and risk stratification of high risk.