Development and Validation of 18F-FDG PET/CT-Based Multivariable Clinical Prediction Models for the Identification of Malignancy-Associated Hemophagocytic Lymphohistiocytosis

Objective@#18F-fluorodeoxyglucose (FDG) PET/CT is often used for detecting malignancy in patients with newly diagnosed hemophagocytic lymphohistiocytosis (HLH), with acceptable sensitivity but relatively low specificity. The aim of this study was to improve the diagnostic ability of 18F-FDG PET/CT in identifying malignancy in patients with HLH by combining 18F-FDG PET/CT and clinical parameters. @*Materials and Methods@#Ninety-seven patients (age ≥ 14 years) with secondary HLH were retrospectively reviewed and divided into the derivation (n = 71) and validation (n = 26) cohorts according to admission time. In the derivation cohort, 22 patients had malignancy-associated HLH (M-HLH) and 49 patients had non-malignancy-associated HLH (NM-HLH). Data on pretreatment 18F-FDG PET/CT and laboratory results were collected. The variables were analyzed using the Mann-Whitney U test or Pearson’s chi-square test, and a nomogram for predicting M-HLH was constructed using multivariable binary logistic regression. The predictors were also ranked using decision-tree analysis. The nomogram and decision tree were validated in the validation cohort (10 patients with M-HLH and 16 patients with NM-HLH). @*Results@#The ratio of the maximal standardized uptake value (SUVmax) of the lymph nodes to that of the mediastinum, the ratio of the SUVmax of bone lesions or bone marrow to that of the mediastinum, and age were selected for constructing the model. The nomogram showed good performance in predicting M-HLH in the validation cohort, with an area under the receiver operating characteristic curve of 0.875 (95% confidence interval, 0.686–0.971). At an appropriate cutoff value, the sensitivity and specificity for identifying M-HLH were 90% (9/10) and 68.8% (11/16), respectively. The decision tree integrating the same variables showed 70% (7/10) sensitivity and 93.8% (15/16) specificity for identifying M-HLH. In comparison, visual analysis of 18F-FDG PET/CT images demonstrated 100% (10/10) sensitivity and 12.5% (2/16) specificity. @*Conclusion@#18F-FDG PET/CT may be a practical technique for identifying M-HLH. The model constructed using 18F-FDG PET/CT features and age was able to detect malignancy with better accuracy than visual analysis of 18F-FDG PET/CT images.

Analysis of the Correlation between the Use Density of Antibiotic and Antifungal Drugs and the Positive Rate of Aspergillus / 医药导报

Objective To investigate the correlation between the use density of antibiotic and antifungal drugs and the positive rate of aspergillus in our hospital from 2009 to 2013,in order to provide a scientific basis for rational use of antibiotic and antifungal drugs. Methods The use density of carbapenems,two third-generation cephalosporins,and antifungal drugs,and the positive rate of aspergillus in our hospital from 2009 to 2013 were studied retrospectively. Their correlation was analyzed using SPSS software. Results There was significantly positive correlation between the use density of imipenem and that of fluconazole (r=0.913,P<0.05).The use density of biapenem was positively correlated with that of voriconazole (r=0.915,P<0.05).The use density of biapenem and that of voriconazole was positively correlated with positive rate of aspergillus,respectively ( r=0.918,r=0.955,both P<0.05).The other antibiotic and antifungal drugs were not significantly correlated to the positive rate of aspergillus.

Dynamic measurement of CRP, IL-6 and Fib levels of unstable angina and its clinical significance / 中国基层医药

Objective To study the clinical significance of dynamic determination of serum CRP,IL-6 and fibrinogen(Fib) levels in unstable angina pectoris (UAP) patients.Methods 162 UAP patients were selected as UAP group(including 52 cases of low risk group,53 cases in medium risk group and 57 cases in high risk group),58 healthy people were selected as control group.The CRP,IL-6 and Fib contents were observed in UAP patients after cardiac events.Results At discharge,CRP,IL-6,Fib in UAP low risk group were (3.47 ±0.55)mg/L,(10.38 ± 1.57) ng/L,(1.64 ± 0.65) g/L,which were significantly lower than the admission contents [(6.50 ±0.87) mg/L,(14.35 ± 1.22) ng/L,(3.01 ± 0.28) g/L] (t =2.761,2.945,2.118,P =0.028,0.003,0.031).CRP,IL-6,Fib levels in the medium risk group were (6.87±0.75) mg/L,(14.35 ± 1.02) ng/L,(2.26 ± 0.33) g/L,which were significantly lower than the admission contents [(9.21±1.03) mg/L,(19.24±1.58) ng/L,(4.15 ±0.47) g/L] (t =2.985,3.157,3.548,P =0.003,0.001,0.000).CRP,IL-6,Fib levels in the high risk group were (8.71 ±0.84) mg/L,(17.37 ± 1.26) ng/L,(4.67 ±0.85) g/L,which were significantly lower than the admission contents [(12.48 ± 1.24) mg/L,(25.13 ± 1.84) ng/L,(7.28 ± 0.64) g/L] (t =3.472,4.018,5.097,P =0.000,0.000,0.000).Six months after hospital discharge,in CRP,IL-6,Fib elevated groups,the incidence rates of cardiac event were 40.20％,40.35％ and 47.50％,which were significantly higher than those in normal group (5.0％,4.17％,14.29％,x2 =23.655,2.211,14.442,P=0.000,0.000,0.000).Conclusion CRP,IL-6 and Fib levels in UAP patients were significantly higher than those in healthy people,and with remission,contents would be lower,which was the index to reflect the severity of UAP,but its specificity is bad,need to use caution.

The ability to identify the yeast-like fungi by YST identification cards and pyrosequencing analysis / 中华检验医学杂志

Objective To evaluate the ability of Vitek 2 Compact YST identification cards and pyrosequencing analysis for identifying the clinical isolates of yeast-like fungi.Methods Vitek 2 Compact YST identification cams and ITS1 region pyrosequencing analysis were used to identify the clinical isolates of yeast-like fungi at Jinan Military General Hospital in 2011.The strains which could not be identified to species by pyrosequencing analysis were identified again by the method of ITS1 region Sanger sequencing.The strains with inconsistent identified results by YST and pyrosequencing were identified again using API 20C.Results A total of 282 srtains were isolated from various clinical specimens for culturing in 2011.In addition to the three which could only be identified to similar species,other strains could be clearly identified to species by the method of ITS1 reverse pyrosequencing.Three strains which failed identified to species by pyrosequencing couldn't be distinguished fully by the method of Sanger sequencing.There were 7 strains unidentified,14 strains low discrimination(％ id ＜ 80％),and 6 strains misidentification using YST cams.The identification coincidence rate was 90.4％.The identification coincidence rates were various in different species of yeast-like fungi using YST cards.Conclusions The vast majority of clinical isolates of yeast-like fungi could be identified by ITS1 reverse pyrosequencing analysis.Vitek 2 Compact YST caRD basically meets the needs.But attention should be paid to the standard operating and regular internal quality control.For some rare species it is also needed to combine the source of specimen,colonies and characteristics to determine the identification results for the rare stains.

The evidence-based evaluation of the safety of contrast media in patients with diabetes mellitus / 介入放射学杂志

Contrast-induced nephropathy (CIN) has now been the third most common cause of acquired renal failure. Diabetes mellitus (DM), the type of contrast agent used and the intra-arterial route of administration are three important risk factors inducing CIN. The incidence rate of CIN is very high in patients with DM or renal insufficiency after iodinated contrast was administered. Unfortunately, it has not yet attracted physicians’and radiologists’sufficient attention. This paper aims to make an evidence-based evaluation of the safety and rephrotoxicity of various contrast agents when they are used in patients with DM. Usually, intravenous administration of contrast media will not cause permanent damage to the kidney in highrisk patients. Low-osmolarity contrast media is relatively safe for patients with DM only, while it takes much risk of CIN when low-osmolarity contrast media is used in patients with diabetic nephropathy or in patients of DM accompanied with renal insufficiency, for such patients, the iso-osmolarity contrast media, iodixanol, can be used.