Prognostic value of left ventricular ejection fraction on admission in patients with septic cardiomyopathy / 中华危重病急救医学

Objective:To investigate the prognostic value of cardiac ultrasound left ventricular ejection fraction (LVEF) on admission in patients with septic cardiomyopathy.Methods:A retrospective cohort study was conducted. The patients with septic cardiomyopathy hospitalized in the intensive care unit of Zhoupu Hospital Affiliated to Shanghai Health College from January 2019 to March 2023 were enrolled. The general information including gender and age, LVEF on admission, severity of illness scores within 24 hours after admission [acute physiology and chronic health evaluationⅡ (APACHEⅡ) score and sequential organ failure assessment (SOFA) score], procalcitonin (PCT), cardiac biomarkers [N-terminal pro-brain natriuretic peptide (NT-proBNP), cardiac troponin T (cTnT), and MB isoenzyme of creatine kinase (CK-MB)], mitochondria related indicators [aspartate aminotransferase (AST), AST/alanine aminotransferase (ALT) ratio], blood lactate (Lac), the usage of vasoactive drugs and mechanical ventilation, and the prognosis during hospitalization were collected. The differences in above clinical data between the two groups were compared. The variables with statistically significant differences in univariate analysis were incorporated into multivariate Logistic regression analysis to analyze the independent risk factors for death during hospitalization in patients with septic cardiomyopathy. Receiver operator characteristic curve (ROC curve) was drawn to evaluate the prognostic value of LVEF by echocardiography on admission in patients with septic cardiomyopathy during hospitalization.Results:A total of 62 patients were enrolled, including 36 males and 26 females. Thirty-nine cases died and 23 cases survived during hospitalization, and the mortality was 62.90%. Compared with the survival group, the LVEF of patients on admission was lower in the death group [0.51 (0.40, 0.57) vs. 0.56 (0.51, 0.63), P < 0.01], APACHEⅡ score, SOFA score, Lac, NT-proBNP, CK-MB within 24 hours after admission were higher [APACHEⅡ score: 22.18±8.38 vs. 17.39±8.22, SOFA score: 9.90±3.87 vs. 7.09±3.27, Lac (mmol/L): 5.10 (2.63, 11.50) vs. 2.00 (1.40, 5.00), NT-proBNP (μg/L): 5.24 (2.84, 11.29) vs. 2.53 (0.35, 6.63), CK-MB (U/L): 1.88 (0.21, 5.33) vs. 0.17 (0.02, 1.62), all P < 0.05], and the proportion of vasoactive drug application was higher (82.05% vs. 47.83%, P < 0.01). Multivariate Logistic regression analysis showed that LVEF on admission was an independent risk factor for predicting the prognosis of patients with septic cardiomyopathy during hospitalization [odds ratio ( OR) = 0.920, 95% confidence interval (95% CI) was 0.855-0.990, P = 0.025]. ROC curve analysis showed that the area under the ROC curve (AUC) of LVEF on admission for predicting the death of patients with septic cardiomyopathy was 0.715 (95% CI was 0.585-0.845, P = 0.005). When LVEF ≤ 0.52, the sensitivity was 73.9%, and the specificity was 61.5%. Conclusions:The lower cardiac ultrasound LVEF on admission, the worse the prognosis of patients with septic cardiomyopathy. The cardiac ultrasound LVEF on admission can be used as a clinical index to evaluate the severity of the condition and predict the prognosis of patients with septic cardiomyopathy.

Prognostic Value of Pre-treatment Albumin/Fibrinogen Ratio in Patients with Diffuse Large B-cell Lymphoma / 中国实验血液学杂志

OBJECTIVE@#To investigate the value of pre-treatment albumin/fibrinogen ratio (AFR) on the prognosis of patients with diffuse large B-cell lymphoma (DLBCL).@*METHODS@#The data of DLBCL patients in the Affiliated Hospital of North Sichuan Medical College from April 2014 to March 2021 were retrieved, and 111 newly diagnosed patients who completed at least 4 cycles of R-CHOP or R-CHOP-like chemotherapy with complete data were included in the study. The clinical, laboratory examination and follow-up data of the patients were collected, and the receiver operating characteristic curve (ROC) was drawn according to patients' AFR before treatment and the survival status at the end of the follow-up, which could be used to preliminarily evaluate the predictive value of AFR for disease progression and patients' survival outcome. Furthermore, the correlation of AFR with the clinical and laboratory characteristics, progression-free survival (PFS) and overall survival (OS) was analyzed, and finally, univariate and multivariate Cox proportional hazard regression models were used to analyze factors affecting PFS and OS of DLBCL patients.@*RESULTS@#The ROC curve indicated that AFR level had a moderate predictive value for PFS and OS in DLBCL patients, with the area under the curve (AUC) of 0.616 (P =0.039) and 0.666 (P =0.004), respectively, and the optimal cut-off values were both 9.06 for PFS and OS. Compared with high-AFR (≥9.06) group, the low-AFR (<9.06) group had a higher proportion of patients with Lugano III-IV stage ( P <0.001), elevated lactate dehydrogenase (P =0.007) and B symptoms (P =0.038). The interim analysis of response showed that the overall response rate (ORR) in the high-AFR group was 89.7%, which was significantly higher than 62.8% in the low-AFR group (P =0.001). With a median follow-up of 18.5 (3-77) months, the median PFS of the high-AFR group was not reached, which was significantly superior to 17 months of the low-AFR group (P =0.009). Similarly, the median OS of high-AFR group was not reached, either, which was significantly superior to 48 months of the low-AFR group (P < 0.001). In multivariate Cox regression analysis, AFR <9.06 was an independent risk factor both for PFS and OS (HR PFS=2.047, P =0.039; HR OS=4.854, P =0.001).@*CONCLUSION@#Pre-treatment AFR has a significant value for the prognosis evaluation in newly diagnosed DLBCL patients.

Correlation between 25-hydroxyvitamin D and nephroblastoma in children and its value in assessing disease prognosis / 中国当代儿科杂志

OBJECTIVES@#To study the correlation between 25-hydroxyvitamin D [25-(OH)D] and nephroblastoma in children and its value in assessing the prognosis of the disease.@*METHODS@#A total of 50 children with nephroblastoma who were admitted from January 2018 to December 2022 were included as the nephroblastoma group, and according to the postoperative pathological type, they were divided into a good prognosis group with 38 children and a poor prognosis group with 12 children. A total of 50 healthy children who underwent physical examination during the same period of time served as the healthy control group. The above groups were compared in terms of serum creatinine and 25-(OH)D level. A Spearman correlation analysis was used to investigate the correlation between serum 25-(OH)D level and therapeutic effect reaction. A multivariate logistic regression analysis was used to identify the risk factors affecting the prognosis of nephroblastoma in children.@*RESULTS@#The nephroblastoma group had significantly lower levels of serum creatinine and 25-(OH)D than the healthy control group (P<0.05). Compared with the good prognosis group, the poor prognosis group had a significantly larger tumor diameter, a significantly higher proportion of children with stage III-IV tumors, a significantly higher rate of tumor metastasis, and significantly lower serum levels of creatinine and 25-(OH)D (P<0.05). The Spearman correlation analysis showed that serum 25-(OH)D level was negatively correlated with therapeutic effect reaction (rs=-0.685, P<0.001). The multivariate logistic regression analysis showed that tumor diameter ≥10 cm, stage III-IV tumors, presence of tumor metastasis, and 25-(OH)D <19 ng/mL were closely associated with the poor prognosis of nephroblastoma in children (P<0.05). Serum 25-(OH)D level had an area under the curve of 0.805 (95%CI: 0.706-0.903, P<0.001) in evaluating the prognosis of nephroblastoma in children, with a Youden index of 0.512, a sensitivity of 0.938, and a specificity of 0.575 at the optimal cut-off value of 1.764 ng/mL.@*CONCLUSIONS@#There is a significant correlation between 25-(OH)D level and the prognosis of nephroblastoma in children, and 25-(OH)D can be used for prognosis prediction.

Changes in retinal nerve fiber layer and macular retinal thickness and predictive value of outcome in children with abnormal refractive amblyopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the changes in retinal nerve fiber layer(RNFL)and macular retinal thickness(MRT)in children with refractive abnormalities and amblyopia, and their predictive value of outcome.METHODS: A total of 168 children with myopic refractive abnormalities and monocular amblyopia admitted to our hospital from January 2020 to October 2022 were selected as the observation group, with 118 cases of mild to moderate amblyopia and 50 cases of severe amblyopia, and 168 children with normal vision were included as the control group in a 1:1 ratio during the same period. The changes of RNFL and MRT in two groups of children were statistically counted, and the correlation between the severity of refractive abnormalities and RNFL and MRT in children with amblyopia was analyzed. Additionally, the observation group was divided into effective subgroup and ineffective subgroup based on the therapeutic effect. The general information, as well as RNFL and MRT of the effective subgroup and the ineffective subgroups before and after treatment were compared. Logistic was used to analyze the factors influencing efficacy, and ROC curves was plotted to analyze the predictive value of RNFL and MRT alone or in combination for efficacy.RESULTS: RNFL and MRT of cases of severe amblyopia were higher than those of the mild to moderate amblyopia and the control groups(all P&#x0026;#x003C;0.05); the severity of amblyopia in children with refractive abnormalities is positively correlated with RNFL and MRT(rs=0.745 and0.724, both P&#x0026;#x003C;0.001); among patients of mild to moderate and severe, there were statistically significant differences between the effective and ineffective subgroups in terms of initial treatment age, fixation form, treatment compliance, as well as RNFL, MRT, and their differences before and 1mo postoperatively(all P&#x0026;#x003C;0.05). Logistic analysis showed that initial treatment age, fixation nature, treatment compliance, RNFL and MRT before and 1mo postoperatively were all factors influencing the therapeutic effect of amblyopia with refractive abnormalities in children(all P&#x0026;#x003C;0.05); after 1mo of treatment, the combined prediction of RNFL and MRT was significantly better than that of single prediction in children with mild to severe amblyopia.CONCLUSION:There are differences in RNFL and MRT in children with abnormal refractive amblyopia, and they are closely related to the different degrees and curative effects of children. The combination of RNFL and MRT after 1mo of treatment has certain value in predicting children with different degrees of abnormal refractive amblyopia.

The Prognostic Value of Prognostic Nutritional Index in Patients with Lymphoma--Review / 中国实验血液学杂志

The morbidity and mortality of hematological tumors have shown a rising tendency in recent years and become one of the major diseases which affect public health. The nutritional and inflammation status of the body has been proved to play an important role in the occurrence, development and prognosis of the blood system disease. The prognostic nutritional index (PNI) is an important index to reflect the nutritional and inflammation status of the body, and it can be calculated by serum albumin level and peripheral blood lymphocyte count. A large number of studies have reported that PNI can effectively predict the prognosis of several hematological tumors, including lymphoma. In this review, the prognostic value of PNI in patients with lymphoma was summarized briefly.

Prognostic value of coagulation function combined with acute physiology and chronic health evaluationⅡ and sequential organ failure assessment scores for patients with bloodstream infection / 中华危重病急救医学

Objective:To evaluate the prognostic value of platelet count (PLT), coagulation indexes, acute physiology and chronic health evaluationⅡ(APACHEⅡ), and sequential organ failure assessment (SOFA) in patients with bloodstream infection.Methods:A retrospective single center cohort study was conducted, patients with at least one positive blood culture bloodstream infection hospitalized in the intensive care unit (ICU) of Ningxia Medical University General Hospital from January 2016 to October 2020 were selected as the research objects, basic data and pathogen distribution, coagulation function, and prognosis at 28 days were collected, the APACHEⅡscore, SOFA score based on the results of laboratory examination within 24 hours of blood culture were calculated. Patients were divided into the survival group and the death group according to the 28-day prognosis, and the differences of the above indicators were compared. Multivariate Logistic regression analysis was used to screen out the risk factors for 28-day death of patients with bloodstream infection. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive efficacy of various risk factors for 28-day prognosis of patients with bloodstream infection.Results:A total of 215 patients with bloodstream infection were enrolled, of which 117 survived and 98 died within 28 days. The 256 strains of pathogenic bacteria were detected, including 161 (62.89%) Gram-negative bacteria (G -), 76 (29.69%) Gram-positive bacteria (G +), 17 fungi (6.64%), and 2 other strains (0.78%). The main pathogenic bacteria were Escherichia coli (53 strains, 20.70%), Enterococcus (37 strains, 14.45%), and Klebsiella pneumoniae (34 strains, 13.28%). Compared with the survival group, patients in the death group were older (years old: 60.98±16.08 vs. 55.64±16.35), had higher levels of body temperature, SOFA score, APACHEⅡ score, proportion of malignant tumor and pulmonary infection, blood lactic acid (Lac), and creatinine [Cr; body temperature (℃): 39.12±1.10 vs. 38.67±1.09, SOFA score: 13.05±4.40 vs. 7.85±3.74, APACHEⅡscore: 24.01±8.18 vs. 15.38±6.59, proportion of malignant tumor: 15.31% (15/98) vs. 12.82% (15/117), proportion of patients with pulmonary infection: 84.69% (83/98) vs. 72.65% (85/117), Lac (mmol/L): 7.13±6.04 vs. 4.31±2.98, Cr (μmol/L): 189.73±141.81 vs. 124.55±106.17, all P < 0.05]. The prothrombin time (PT), activated partial thrombin time (APTT), and thrombin time (TT) were significantly longer [PT (s): 19.51±15.16 vs. 14.94±2.86, APTT (s): 52.74±26.82 vs. 40.77±15.30, TT (s) : 21.59±18.46 vs. 17.38±2.59, all P < 0.05], PLT was significantly decreased [×10 9/L: 43.50 (18.75, 92.75) vs. 86.00 (36.00, 154.50), P < 0.05]. Logistic regression analysis showed that body temperature, age, SOFA score and APACHEⅡ score were independent risk factors [odds ratio ( OR) were 1.388, 1.023, 0.817 and 0.916, respectively, 95% confidence intervals (95% CI) were 1.001-1.926, 1.001-1.046, 0.730-0.913, 0.867-0.968, with respective P values of 0.046, 0.043, 0.000, 0.002]. ROC curve analysis showed that SOFA score, APACHEⅡ score, temperature, age had certain predictive values for the prognosis of patients with bloodstream infection, and area under ROC curve (AUC) was 0.815, 0.795, 0.625 and 0.594, respectively (all P < 0.05). The AUC predicted by the combination of the 4 variables was as high as 0.851, the specificity was 79.3%, and the sensitivity was 74.2%, suggesting that the combination variables could predict the death of patients with bloodstream infection with higher accuracy. Conclusions:PLT and coagulation indexes are helpful to evaluate the prognosis of patients with bloodstream infection in ICU. APACHEⅡscore and SOFA score are directly related to the prognosis of patients with bloodstream infection.

Paranasal Sinus Invasion in Nasopharyngeal Carcinoma after Intensity-Modulated Radiotherapy / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The aim of this study is to evaluate the prognostic significance of paranasal sinus invasion for nasopharyngeal carcinoma (NPC) and its suitable position in the T classification. MATERIALS AND METHODS: The magnetic resonance imaging (MRI) scans of 695 patients with previously untreated, biopsy-proven, non-metastatic NPC that was treated with intensity-modulated radiotherapy (IMRT) were reviewed retrospectively. RESULTS: The incidence of paranasal sinus invasion was 39.4% (274 of 695 patients). Multivariate analysis showed that paranasal sinus invasion was an independent negative prognostic factor for local failure-free survival (LFFS) (p < 0.05). According to the eighth American Joint Committee on Cancer (AJCC) staging system, 275 patients were classified as T3 classification. Of these, 78 patients (28.4%) developed paranasal sinus invasion (T3b) and 197 (71.6%) didn't (T3a). The estimated 5-year LFFS and overall survival (OS) rates for the patients with T3b and T3a classification were 88.6% versus 95.0% (p=0.047), and 84.5% versus 93.3% (p=0.183), respectively. The estimated 5-year LFFS and OS rates for the patientswith T4 classificationwere 89.5% and 83.2%,whichwere similarwith the outcomes of patients with T3b classification. CONCLUSION: MRI-determined paranasal sinus invasion is an independent prognostic factor of NPC treated by IMRT. Paranasal sinus invasion is recommended to classify as T4 classification in the 8th AJCC staging system for NPC.

Relationship of preoperative blood lymphocyte-to-monocyte ratio with the clinicopathological features and prognosis of penile cancer / 医学研究生学报

Objective　This study aimed to investigate the relationship of the preoperative blood lymphocyte-to-monocyte ratio (LMR) with the clinicopathological features and prognosis of penile cancer.　Methods　We collected the clinicopathological data on 44 cases of penile cancer treated by surgery in our hospital between January 2000 and January 2018. Based on the preoperative LMR, we divided the patients into a low-LMR (LMR < 3.4, n=21) and a high-LMR group (LMR ≥ 3.4, n=23), compared the clinicopathological features between the two groups of patients, performed log-rank univariate analysis on the prognostic factors, and investigated the independent risk factors affecting the prognosis using the Kaplan-Meier survival curve and COX regression model. Results Log-rank univariate analysis revealed that the tumor diameter, cell grade and LMR were the risk factors affecting the recurrence-free survival (RFS) (P<0.05) and that postoperative lymph node metastasis, invasion of nerves and LMR were those affecting the overall survival (OS) of the penile cancer patients (P<0.05). The median RFS was significantly longer in the high-LMR than in the low-LMR group (26 vs 7 months, P=0.010), and so was the median OS (73 vs 29 months, P=0.045). COX multivariate survival analysis showed preoperative LMR to be the risk factor affecting RFS and OS of the patients (P < 0.05). The tumor recurrence rate was significantly lower (HR = 0.398, 95% CI: 0.174-0.909) and the OS rate markedly higher (HR = 0.428, 95% CI: 0.185-0.994) in the high-LMR than in the low-LMR group.　Conclusion　Penile cancer patients with a higher LMR have longer RFS and OS and are less susceptible to tumor invasion of the nerves. Preoperative LMR plays a valuable role in predicting the postoperative survival of penile cancer patients.

The prognostic value of 18F-FDG PET/CT in patients with extranodal natural killer/T-cell lymphoma / 中国肿瘤临床

Extranodal natural killer/T-cell lymphoma(ENKTL)is an Epstein-Barr virus-associated aggressive non-Hodgkin's lymphoma (NHL).It is prevalent in Asia and South America with an aggressive clinical course and a dismal prognosis.Currently,the prognostic models that are commonly used for ENKTL include the International Prognostic Index(IPI),Korean Prognostic Index(KPI),Prognostic In-dex of Natural Killer Cell Lymphoma(PINK),and Prognostic Index of Natural Killer Cell Lymphoma with Epstein-Barr virus DNA(PINK-E), all of which have some limitations.Positron emission tomography/computed tomography(PET/CT)is a new imaging technique combin-ing anatomical and functional imaging,with the advantages of high sensitivity and specificity,which is essential for diagnosis,staging, efficacy evaluation,and prognosis prediction of various malignant lymphomas.However,the prognostic value of PET/CT in ENKTL re-mains controversial.Therefore,in this article,we review relevant studies on the prognostic value of pretreatment,interim,and end-of-treatment PET/CT in patients with ENKTL.

Prognostic values of common definition of contrast-induced nephropathy after coronary catheterization in patients with normal serum creatinine / 实用医学杂志

Objective To evaluate the prognostic values of common definition compared to traditional definition of contrast-induced nephropathy (CIN) in patients with normal serum creatinine (SCr). Methods Patients undergoing percutaneous coronary angiology or intervention with normal baseline SCr were enrolled prospectively. Those who were diagnosed as CIN according to common definition were divided into two groups based on the peak increase from baseline in the SCr concentration within 48 ~ 72 hours after the procedure: ≥ 44.2 μmol/L (CIN44.2 group, in common with traditional definition), ≥25% of baseline to < 44.2 μmol/L (CIN25%-44.2 group, interval between the two definitions). Hospital stay and long-term outcomes were compared among CIN44.2, CIN25%-44.2, and non-CIN groups. Results Of all 3,044 patients enrolled, 302 (9.9%) patients developed CIN according to common definition including CIN44.2 occurred in 56 (1.8%) patients and CIN25%-44.2 in 246 (8.1%) patients. Patients in CIN44.2 group indicated significant longer hospital stay and long-term outcomes compared with non-CIN group (P < 0.05). However, patients in CIN25%-44.2 group had similar in-hospital mortality and long-term cumulative risk of major clinical adverse events (MACE) and death with non-CIN group (all, P = 1.00). Multivariate Cox proportional hazard analyses also demonstrated that CIN25%-44.2 did not associate with long-term MACE (HR 1.16, P = 0.645) and death (HR 0.98, P = 0.964) after adjusting for potential confounding factors. Conclusions For patients with normal baseline SCr, common definition based on traditional definition of CIN is unreasonable and overestimates the incidence of CIN, whose extension of traditional denifition proves no significant clinical value.

The evaluation of the prognostic value of the18F-FDG PET/CT standard uptake value in the treatment of pancreatic cancer with tomotherapy / 中国医学装备

Objective:To investigate the prognostic value of18F-FDG PET/CT by calculating maximal standard uptake values(SUVmax) in patients with pancreatic carcinoma of TOMO knife radiotherapy.Methods:Sixty five cases of pancreatic carcinoma who underwent18F-FDG PET/CT scan before TOMO radiotherapy were reviewed retrospectively, the18F-FDG uptake of primary tumors was measured with the SUVmax. SUVmax<3.0 was divided into group A(32 cases), SUVmax≥3.0 was divided into group B(33 cases), the relationship of SUVmax and other clinical factors with the survival of the 65 patients were analyzed.Results:By Log-rank univariate analysis showed that the differences in group A(SUVmax<3.0) and group B(SUVmax≥3.0) in patiengts with middle survival time was statistically significant(15.5:7 months)atP=0.001. TNM stages(x2=6.625,P<0.010), CA19-9(x2=10.298,P<0.001) and GTV dose(x2=8.054, P<0.005) were also statistically different at (P<0.05). Multivariate analysis showed that the SUVmax and preoperative serum CA19-9 level were independent risk factors that prevent the long-term survival of the prognosis of patients in this group.Conclusion: SUVmax has a certain clinical value in predicting the prognosis of patients with pancreatic cancer, and can guide clinical diagnosis and treatment planning, and extend the lifespan of patients with pancreatic carcinoma.

Study of prognostic value of serum and RBC acetyle cholinesterase level in organophosphorus poisoning and its correlation with the outcome

Introduction: Organophosphorus compound (OPC) poisoning has assumed alarming proportions and it is primarily a problem of the developing countries. Serum cholinesterase levels are easier to estimate and usually depressed after OP poisoning. Peradeniya OP poisoning scale has not been studied much in Indian scenario. So, we decided to have first hand information and hence conducted this study. Aim and objectives: To find out severity of patients with OP poisoning by calculating Peradeniya OP Poisoning score, level of plasma and RBC cholinesterase level of patients of OP poisoning on admission before any treatment, and correlate the level with severity and outcome of patients and requirement of ventilator support with OP poisoning. Material and methods: All patients who presented to emergency department with history of poisoning with known compound were taken as study subjects. A detailed history, clinical examination and relevant biochemical investigations were performed. Peradeniya OP poisoning scale Patel P, Patel VP, Patel H, Rathod GB. Study of prognostic value of serum and RBC acetyle cholinesterase level in organophosphorus poisoning and its correlation with the outcome. IAIM, 2016; 3(3): 147-157. Page 148 was applied to all study subjects and the severity of OP poisoning was graded as mild, moderate, severe. In all study subjects, 3 ml of plain blood was collected on admission before administration of atropine and plasma cholinesterase and RBC cholinesterase was estimated. Results: Most of the patients consumed poison with a suicidal intent. Majority had consumed poison orally. Most patients had consumed 50 – 100 ml of poison. Quantity of poison consumed did not correlate with severity of poisoning. In this study, requirement of ventilatory support was seen in 16% of patients. Mortality in our study was 9%. Pseudo cholinesterase levels were significantly depressed in patients who required ventilatory support and correlated with mortality. Miosis, Bradycardia, increased respiratory rate, impaired level of consciousness, all correlated well with need for ventilatory support and increased mortality. Peradeniya OP poisoning score of more than 8 correlated in predicting the need for ventilatory support and mortality. RBC and Plasma cholinesterase levels estimation in conjunction with Peradeniya OP poisoning score is a useful parameter for grading severity of OP poisoning and in predicting the need for ventilatory support and mortality. Conclusion: The POP scale and RBC Che and plasma cholinesterase levels both showed a significant association in predicting the need for ventilatory support and outcome. Lower grade of poisoning had a better outcome whereas higher severity of poisoning had a poorer outcome.

Prognostic factors of protein-losing enteropathy in a Mexican cohort of patients with congenital heart disease, surgically corrected with Fontan procedure / Factores pronósticos de enteropatía perdedora de proteínas en una cohorte mexicana de pacientes con cardiopatía congénita, corregidas quirúrgicamente con cirugía de Fontan

Background: Protein-losing enteropathy (PLE) is a known postoperative complication affecting about 10% of patients surgically managed with Fontan procedure. The mortality rate associated with this complication increases to 50%. Objective: To determine the risk factors associated to the development of PLE in patients surgically managed with Fontan procedure. Methods: This was a case-cohort study, and the universe of the trial comprised all patients treated with univentricular surgery. We included male and female patients with congenital heart disease that conditioned a single ventricle syndrome. Those patients with previous intestinal disease causing protein loss, were excluded, cow's milk protein allergy, intestinal resection (previous or after heart surgery), use of cyclic parenteral nutrition or Fontan's dismantlement. Follow-up began immediately after hospital discharge from Fontan procedure. Outcome variable was the development of PLE; independent variables were some before and after surgery hemodynamic and echocardiographic variables, infections and treatment. Statistical analysis: We used measures of statistical dispersion and central tendency. Risk was calculated for each variable estimating the hazard ratio (HR), adjusted for confounding factors; and Kaplan-Meier estimator was used for survival analysis. Results: Eleven (26%) out from patients 42 developed PLE. The median of time between Fontan procedure and the development of this complication was five years. The prognostic variables were: systolic pressure of pulmonary artery between 12-15 mmHg, > 3 years between Glenn and Fontan procedures, aggravated chronic malnutrition, direct bilirubin values > 1.5 mg/dL, pulmonary resistances (APR) between 3-3.5 Wood units, previous hepatomegaly and pleural effusion > 6 day-period. The probability of dying from PLE was 63% in a 10-year period. Conclusions: The prognostic factors associated with PLE are previous hepatic damage and borderlines values of venous pressure.

Antecedentes: La enteropatía perdedora de proteínas (EPP) es una conocida complicación que afecta alrededor del 10% de los sujetos operados con el procedimiento de Fontan. La mortalidad asociada a esta complicación se eleva al 50%. Objetivo: Determinar los factores de riesgo asociados al desarrollo de EPP en pacientes postoperados de procedimiento de Fontan. Métodos: Este es un estudio de caso-cohorte y el universo comprendió a todos los pacientes corregidos con cirugía univentricular. Se incluyeron pacientes de ambos géneros, con cardiopatías que condicionaran síndrome de ventrículo único. Se excluyeron aquellos con enfermedad previa intestinal causante de pérdida de proteínas, alergia a las proteínas de la leche de vaca, resección intestinal (previa o después de la cirugía cardiaca), aquellos con nutrición parenteral cíclica o desmantelamiento del Fontan. El inicio de seguimiento comenzó inmediatamente después del egreso de la cirugía de Fontan. La variable de desenlace fue el desarrollo de enteropatía perdedora de proteínas. Las variables independientes estudiadas fueron algunas variables hemodinámicas y ecocardiográficas pre- y postquirúrgicas, infecciones y tratamiento. Análisis estadístico: Se usaron medidas de dispersión y tendencia central. Se calculó el riesgo por cada variable, estimando el cociente de riesgo (Hazard Ratio, HR en inglés), ajustándose a variables de confusión. Se utilizó el estimador de Kaplan-Meier para el análisis de supervivencia. Resultados: Once de 42 pacientes (26%) desarrollaron EPP. La mediana de tiempo entre la cirugía de Fontan y el desarrollo de esta complicación fue de cinco años. Las variables pronósticas fueron presión sistólica de la arteria pulmonar entre 12-15 mmHg, el tiempo > 3 años entre las intervenciones de Glenn y Fontan, la desnutrición crónica agudizada, una cifra de bilirrubina directa > 1.5 mg/dL, URP entre 3 y 3.5 Unidades Wood, hepatomegalia previa y derrame > 6 días. La probabilidad de mortalidad al desarrollar EPP a 10 años fue de 63%. Conclusiones: Los factores pronósticos asociados a EPP son el daño hepático previo y las variables limítrofes de presión venosa.

Comparative prognostic value of C-reactive protein & fibrinogen in patients with coronary artery disease.

Background & objectives: The comparative prognostic value of C-reactive protein (CRP) and fibrinogen for cardiovascular events has been inconclusively investigated. this study was carried out to compare the prognostic value of CRP versus fibrinogen in patients with coronary artery disease (CAD). Methods: The study included 13,100 patients with coronary angiography-confirmed CAD. Plasma CRP and fibrinogen levels were measured before angiography in all patients. The levels of CRP>3 mg/l and fibrinogen>350 mg/dl were considered as elevated. The primary outcome was 1-year all-cause mortality. Results: Patients were divided into four groups: patients with CRP≤3 mg/l and fibrinogen ≤350 mg/dl (n=4206); patients with CRP≤3 mg/l and fibrinogen >350 mg/dl (n=3132); patients with CRP>3 mg/l and fibrinogen ≤ 350 mg/dl (n=1273) and CRP >3 mg/l and patients with fibrinogen >350 mg/dl (n=4489). There were 634 deaths: 75 deaths in patients with CRP ≤3 mg/l and fibrinogen ≤350 mg/dl, 91 deaths in patients with CRP ≤3 mg/l and fibrinogen >350 mg/dl, 87 deaths in patients with CRP >3 mg/l and fibrinogen ≤350 mg/dl and 381 deaths in patients with CRP >3 mg/l and fibrinogen >350 mg/dl (Kaplan-Meier estimates of all-cause mortality, 1.8, 3.0, 7.0 and 8.7 %, log-rank test P<0.001). The multivariate analysis showed that CRP [adjusted hazard ratio (HR)=1.31, 95% confidence interval (CI) 1.18-1.45, for each standard deviation increase in the logarithmic scale] but not fibrinogen [adjusted HR=0.99 (0.90-1.09), for each standard deviation increase in the logarithmic scale] was an independent correlate of mortality. Interpretation & conclusions: The findings indicated that in patients with CAD, CRP was a better predictor of mortality than fibrinogen and offered prognostic information beyond that provided by the conventional cardiovascular risk factors.

p16 (INK4a) has clinicopathological and prognostic impact on oropharynx and larynx squamous cell carcinoma

CDKN2A encodes proteins such as p16 (INK4a), which negatively regulate the cell-cycle. Molecular genetic studies have revealed that deletions in CDKN2A occur frequently in cancer. Although p16 (INK4a) may be involved in tumor progression, the clinical impact and prognostic implications in head and neck squamous cell carcinoma (HNSCC) are controversial. The objective of this study was to evaluate the frequency of the immunohistochemical expression of p16 (INK4a) in 40 oropharynx and 35 larynx from HNSCC patients treated in a single institution and followed-up at least for 10 years in order to explore potential associations with clinicopathological outcomes and prognostic implications. Forty cases (53.3%) were positive for p16 (INK4a) and this expression was more intense in non-smoking patients (P = 0.050), whose tumors showed negative vascular embolization (P = 0.018), negative lymphatic permeation (P = 0.002), and clear surgical margins (P = 0.050). Importantly, on the basis of negative p16 (INK4a) expression, it was possible to predict a probability of lower survival (P = 0.055) as well as tumors presenting lymph node metastasis (P = 0.050) and capsular rupture (P = 0.0010). Furthermore, increased risk of recurrence was observed in tumors presenting capsular rupture (P = 0.0083). Taken together, the alteration in p16 (INK4a) appears to be a common event in patients with oropharynx and larynx squamous cell carcinoma and the negative expression of this protein correlated with poor prognosis.

Prognostic value of 18F-fluorodeoxyglucose positron emission tomography, computed tomography and magnetic resonance imaging in oral cavity squamous cell carcinoma with pathologically positive neck lymph node

PURPOSE: To evaluate the prognostic value of preoperative neck lymph node (LN) assessment with 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), computed tomography (CT), and magnetic resonance imaging (MRI) in oral cavity squamous cell carcinoma (OSCC) patients with pathologically positive LN. MATERIALS AND METHODS: In total, 47 OSCC patients with pathologically positive LN were retrospectively reviewed with preoperative 18F-FDG PET and CT/MRI. All patients underwent surgical resection, neck dissection and postoperative adjuvant radiotherapy and/or chemotherapy between March 2002 and October 2010. Histologic correlation was performed for findings of 18F-FDG PET and CT/MRI. RESULTS: Thirty-six (76.6%) of 47 cases were correctly diagnosed with neck LN metastasis by 18F-FDG PET and 32 (68.1%) of 47 cases were correctly diagnosed by CT/MRI. Follow-up ranged from 20 to 114 months (median, 56 months). Clinically negative nodal status evaluated by 18F-FDG PET or CT/MRI revealed a trend toward better clinical outcomes in terms of overall survival, disease-free survival, local recurrence-free survival, regional nodal recurrence-free survival, and distant metastasis-free survival rates even though the trends were not statistically significant. However, there was no impact of neck node standardized uptake value (SUVmax) on clinical outcomes. Notably, SUVmax showed significant correlation with tumor size in LN (p < 0.01, R2 = 0.62). PET and CT/MRI status of LN also had significant correlation with the size of intranodal tumor deposit (p < 0.05, R2 = 0.37 and p < 0.01, R2 = 0.48, respectively). CONCLUSION: 18F-FDG PET and CT/MRI at the neck LNs might improve risk stratification in OSCC patients with pathologically positive neck LN in this study, even without significant prognostic value of SUVmax.

Practical value of MIB-1 index in predicting behavior of astrocytomas.

Background : The MIB-1 labeling index (LI) has proved to be useful in assigning grading and prognosis to astrocytomas. The purpose of our study was to analyze the utility of MIB-1 LI in differentiating astrocytomas of varying grades and the possible relationships of MIB-1 LI with clinical parameters like age and sex. We also wanted to study the prognostic role of MIB-1 index in predicting behavior of astrocytomas. Materials and Methods : Our study included 145 patients with astrocytic tumors of varying grades. Immunolabeling for all patients was done using MIB-1 antibody. Survival data could be obtained for 64 patients. A Mann-Whitney U test was used to test the difference in MIB-1 LI between different histological grades. The univariate analysis was done by the Kaplan-Meier method, and the multivariate analysis for survival was performed using the Cox proportional hazard model. Results : Significant differences were noted in mean MIB-1 LI of high-grade and low-grade diffuse astrocytomas. MIB-1 LI did not vary significantly with age and sex. Univariate analysis showed favorable prognostic factors for low histopathological grade, young patient age and low MIB-1 LI; however, multivariate analysis showed that only histopathological grade had independent prognostic significance. Conclusions : Our study proves that MIB-1 LI is not dependent on factors like age and sex and is solely dependent on histological grade. Though the average level of MIB-1 LI varies considerably in the different grades of astrocytomas, considerable overlap can be observed between them. MIB-1 LI is a very useful adjunct to the histopathological diagnosis and can be of great help in situations where the clinical and radiological findings do not correlate with histological diagnosis.

Evaluation on prognosis of esophageal squamous cell carcinoma patients after three-dimensional conformal radiotherapy with different clinical stage system / 中华放射肿瘤学杂志

Objective To evaluate the prognostic significance of 3 clinical stage system in 3-dimensional conformal radiotherapy (3DCRT) for esophageal squamous cell carcinoma. Methods From January 2004 to August 2007, 179 cases of esophageal squamous cell carcinoma were treated with 3DCRT.Before radiation, each patient was staged with UICC 2003 TNM stage, stage of Chinese esophageal cancer cooperation group (cooperation group' stage), and Zhu's clinical stage respectively. Concordance of each clinical stage and prognosis was analyzed with SPSS 11.5. Results In 179 cases of esophageal cancer,Concordance was better in T stage ( Kappa = 0. 271 ) than in TNM stage ( Kappa = 0. 167 ) between cooperation group' stage and Zhu's stage. Among them, 98 cases was staged with UICC stage, concordance of T stage was better between UICC-T and cooperation group' T stage (Kappa =0. 261 ) than between UICCT and Zhu's T stage (Kappa = 0. 045 ) ;concordance of TNM stage was better between UICC-TNM and Zhu's TNM stage ( Kappa = 0. 597 ) than between UICC-TNM and cooperation group' TNM stage ( Kappa =0. 299 ). With multivariate analysis, T ( χ2 value is 11.58, 26. 00 and 51.05, all P ＜ 0. 01 ), N ( χ2 value is 15.28, 16. 10 and 16. 10,all P＜0. 01), M (χ2 value is 5.59, 27.78 and 27.78,all P＜0. 01), and TNM (χ2 value is 15.77, 34,35 and 51. 10,all P＜0. 01 ) stage in 3 kinds of clinical stage were independent prognostic factors. In UICC stage, T1-T3 was difficult to definite and the prognosis was not significantly different in T1 -T3 stage. Conclusions In this study, 3 kinds of clinical stage could evaluate prognosis of esophageal cancer after radiotherapy;cooperation group' stage and Zhu's stage need further application, with further accuracy needed.

Breast cancer in Brunei Darussalam - Incidence and the role of evaluation of molecular markers

Introduction: Molecular markers determined by immunohistochemistry are routinely used for predicting and prognosticating cancers including breast cancer. Molecular markers for breast cancer such as oestrogen and progesterone receptors, Her2, p53, pS2, Bcl2, EGFR, Ki67, CD34 and Cathepsin D have been used in Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital. This study assessed the ethnic variations in breast cancer incidence as well as the relationships between expression of these markers with tumour stage and grade and patient survival in Brunei Darussalam . Materials and Methods: Records of breast cancer patients between 2001 and 2009 were retrieved and abstracted from the Cancer Registry maintained by the Department of Pathology at the RIPAS Hospital. These were reviewed and analysed using appropriate statistical methods. Results: Overall, the mean age at diagnosis was 49.2 years. The incidence rate of breast cancer among Chinese (56.4 per 100,000 per year) was significantly higher than Malays (27.8) and the other ethnic groups (12.3). The expression of oestrogen and progesterone receptors and pS2 was significantly greater in the more differentiated tumours while that of Ki67 and p53 in tumours and CD34 in blood vessels within the tumour was significantly greater in the less differentiated tumours. Positivity for oestrogen receptor was significantly associated with the absence of metastases in regional lymph nodes. Expression of oestrogen and progesterone receptors in tumour cells was significantly associated with enhanced patient survival, while the detection of CD34 in blood vessels within tumours was associated with poorer survival. Survival trends seen for other markers were not statistically significant. Conclusions: The different incidence of breast cancer among the different ethnic groups merits more detailed investigation of the responsible genetic, social and environmental factors. Oestrogen and progesterone receptors and CD34 are confirmed as useful markers for prognosis among our population with breast cancer. Expression of p53, Ki67 and pS2 may also be useful. These markers will be helpful in determining treatment options and for patient education.

Prognostic value of GCS and NIHSS in patients with acute top of basilar syndrome / 中国神经精神疾病杂志

Objective To assess the effectiveness of initial Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) as predictors for clinical outcomes in patients with top of the basilar syndrome (TOBS).Methods A total of 64 patients with TOBS were selected from Nanjing Stroke Registration Program (NSRP). Initial GCS and NIHSS were retrospectively evaluated by reviewing patients' records for details of clinical presentation and outcomes at 30 days measured by modified Rankin Scale (mRS) score. Patients were categorized as favorable outcome group (mRS 0-3) and unfavorable outcome group (mRS 4-6).Results The mean GCS was lower in the cases with mRS of 4-6 compared with those with mRS of 0-3 (P<0.01) and the mean NIHSS score was higher in favorable outcome group compared with unfavorable outcome group (P=0.011). In multivariate logistic regression analysis, after adjusting for age, gender and treatment approaches, the GCS OR was 0.301(95% CI 0.167～0.542), NIHSS OR was 1.436(95% CI 1.147～1.796), and both of them turned out to be the independent predictors of outcome at 30 days. ROC curve analysis suggested that GCS score of 10 represented a good cut-off point for predicting the outcome with the prognostic sensitivity of 87.9% and specificity of 83.9%. NIHSS score of 14 could also serve as a good cut-off point with the prognostic sensitivity of 63.6% and specificity of 77.4%.Conclusions Conclusions Both GCS and NIHSS can predict outcomes in patients with acute TOBS with GCS score ≤10 and NIHSS score ≥14 as the cutoff points of poor outcome. GCS cutoff point is more strongly predictive of outcome than that of NIHSS.