Evaluación de índices pronósticos en el trauma abdominal cerrado / Evaluation of Prognostic Indexes in Closed Abdominal Trauma

RESUMEN Introducción: El trauma accidental o intencional es la causa número uno de muerte en personas jóvenes. Objetivo: Evaluar la capacidad pronóstica en la predicción de la muerte de índices pronóstico en pacientes con trauma abdominal cerrado. Métodos: Se desarrolló un estudio observacional y descriptivo con fases analíticas en un universo de 72 pacientes con trauma abdominal cerrado en el Hospital Universitario "Celia Sánchez Manduley", Manzanillo, Granma, entre enero de 2016 a diciembre 2017. Los datos fueron procesados en el sistema Excel, construyéndose la curva de características operativas del receptor para el análisis de la efectividad de los índices pronósticos. Resultados: Predominaron los pacientes masculinos (70,83 por ciento) con una edad media de 43,31 años. El bazo fue el órgano más lesionado (5,56 por ciento) y el shock séptico la principal causa directa de la muerte (4,17 por ciento). El índice de severidad de lesiones, la escala revisada de trauma, la escala CRAMS y la metodología TRISS resultaron en una sensibilidad, de predicción de la muerte, de 91,02 por ciento, 87,5 por ciento, 83,5 por ciento y 95,8 por ciento respectivamente a un punto de corte de 25 puntos, 6 puntos, 7 puntos y hasta 19 por ciento respectivamente. Conclusiones: La metodología TRISS resultó ser el índice pronóstico de mayor sensibilidad y en consecuencia el más recomendado para la práctica clínica habitual(AU)

ABSTRACT Introduction: Accidental or intentional trauma is the leading cause of death among young people. Objective: To evaluate the mortality prediction capacity of prognostic indexes in patients with closed abdominal trauma. Methods: An observational and descriptive study with analytical phases was developed in a population of 72 patients with closed abdominal trauma, at Celia Sánchez Manduley University Hospital in Manzanillo, Granma Province, between January 2016 and December 2017. The data were processed in the Excel system, and the receiver operating characteristics curve was constructed to analyze the effectiveness of the prognostic indexes. Results: There was a predominance of male patients (70.83 percent) with a mean age of 43.31 years old. The spleen was the most injured organ (5.56 percent). The septic shock was the main direct cause of death (4.17 percent). The injury severity index, the revised trauma scale, the CRAMS scale, and the TRISS methodology produced a mortality prediction sensitivity of 91.02 percent, 87.5 percent, 83.5 percent, and 95.8 percent, respectively, at a cut point of 25, 6, and 7 points, and up to 19 percent, respectively. Conclusions: The TRISS methodology turned out to be the prognostic index with the highest sensitivity and, consequently, the most recommended for routine clinical practice(AU)

Clinicopathological characteristics of patients of certain molecular subtypes and elevated postoperative cancer antigen 15.3 levels and its correlation with menopausal status.

Context: It is well established that breast cancer subtypes differ in their outcome and treatment response. Aim: To observe tumor characteristics of different molecular subgroup and patients with postoperative (PO) raised cancer antigen 15.3 (CA 15.3) group and variation of tumor nature between pre‑ and post‑menopausal breast cancer patients. Materials and Methods: Blood samples and tumor blocks were collected from 95 nonmetastatic female breast cancer patients. Immunohistochemical stains for estrogen receptors (ER), progesterone receptor (PR), and HER2/Neu were used to classify molecular subtypes. CA 15.3 level was detected by ELISA. Significance levels were ascertained by Pearson Chi‑square test. Results: Prevalence of luminal A tumor with grade 3 was high. Triple negative and ER positive (ER+) types showed tumors with high grade and high lymph node (LN) metastasis. More nodal involvement was noticed in patients with PO raised CA 15.3. In addition, premenopausal patients with triple‑negative and ER+ subtypes exhibited more aggressive tumors which were characterized by high grade and large numbers of LN metastasis. Conclusion: Clinicopathological characteristics of certain molecular subtypes and influence of menopausal status on it can predict disease recurrence or overall survival of breast cancer patients.

Analysis of prognostic factors and index model in patients with brain metastases after whole-brain radiotherapy / 中国癌症杂志

Background and purpose: Radiation therapy is still the most primary treatment of brain metastases, and prognosis is affected by many factors. The aim of this study was to identify the prognostic factors and to establish a prognostic index model in patients with brain metastases after whole-brain radiotherapy (WBRT). Methods: We reviewed the clinical date of 140 patients with brain metastases radiotherapy in our hospital from Jan. 2008 to Jul. 2011. The signiifcance of prognostic variables in the survival was resulted from both univariate analysis and multivariate analysis. The prognostic index (PI) was established based on Cox regression analysis and subgrouping values. It was assessed whether recursive partitioning analysis classes (RPA), basic score for brain metastases (BS-BM) and the graded prognostic assessment index (GPA) were related to prognosis. Results:The median survival time was 222 days. The univariate analysis showed that the independent prognostic factors were KPS performance status, number of brain metastases, presence of extracranial metastases, primary tumor status, radiation dose, hemoglobin. The multivariate analysis showed that KPS performance status (P=0.002, Wald=9.700), presence of extracranial metastases (P=0.018, Wald=5.604) and primary tumor status (P=0.001, Wald=10.212) were signiifcantly correlated with overall survival. RPA, BS-BM and GPA were closely related to their prognosis by Log-rank test. In predicting 3 months and 6 months of survival for patients, PI was better than other modes. Conclusion:Our data suggest that the 3 indexes RPA,BS-BM and GPA are valid prognostic index models, but PI model is better.

Traumatismos e inmunidad celular según el índice predictivo TRISS / Traumata and cellular immunity according to the TRISS predictive index

Introducción: las lesiones por traumatismos graves constituyen una amenaza constante para el individuo y estas adquieren particular interés, ya que afectan, por lo general, a personas jóvenes y sanas en plena capacidad productiva Objetivo: valorar el comportamiento en el tiempo de los componentes de la inmunidad celular en los pacientes traumatizados en general, en los que sufren complicaciones y en los que fallecen, y su relación con la probabilidad de sobrevida (PS) según el índice predictivo trauma injury severity score (TRISS) Métodos: se realizó un estudio prospectivo en 70 pacientes traumatizados con valores de injury severity score superiores a 8, ingresados en el Hospital Militar Central "Dr. Luis Díaz Soto", en un período de 2 años. Se realizaron estudios inmunitarios durante las primeras 24 h, a los 3 días y a los 7 días. Se aplicaron los métodos estadísticos análisis de componentes principales; clasificación aglomerativa Cluster Analysis, la cual estratificó la muestra según la PS en el grupo PS< 80 por ciento, entre 80 y 95 por ciento y PS> 95 por ciento; prueba de correlación de Pearson; prueba de regresión logística; análisis de tabla de contingencia y discriminación diagnóstica, según los conceptos de sensibilidad, especificidad, prevalencia, y valores predictivos de pruebas positivas y negativas. Resultados: se encontraron complicaciones infecciosas significativamente frecuentes (47,9 por ciento). El estudio cinético de la inmunidad celular, constató disminución a las 72 h de la actividad de los linfocitos T y de la capacidad de fagocitosis de los neutrófilos. Se observó depresión de estos componentes en los pacientes complicados y en los que después fallecieron, más marcada a las 72 h e intensificadas a los 7 días en estos últimos. En la medida en que disminuyó la PS, decrecieron la actividad de los linfocitos T (RA: p= 0,04; RE: p= 0,02) y la capacidad de fagocitosis de los neutrófilos

Introduction: injuries from severe traumata are a constant threat for subject acquiring a particular interest since generally they affect to young and healthy persons in a complete productive ability. Objective: To assess the behavior in time of components of the cellular immunity in trauma patients in general, in those underwent complications and in those deceased, ant its relation to survival probability (SP) according the "trauma injury severity score" (TRISS) predictive index. Methods: a prospective study was conducted in 70 trauma patients with "injury severity score" values higher to 8, admitted in the "Dr. Luis Díaz Soto" Central Military Hospital over two years. Immunity studies were conducted during the first 24 hours, at three days and at 7 days. The statistic methods including main components analysis, agglomerative Cluster Analysis classification, which stratified the sample according to SP in group SP< 80 percent, between 80 and 95 percent and SP> 95 percent; test of Pearson's correlation; logistic regression test, contingence table analysis and diagnostic discrimination, according to the sensitivity, specificity, prevalence concepts and the predictive values of positive and negative tests. Results: There were very frequent infectious complications (47.9 percent). The kinetic study of the cellular immunity confirmed a decrease at 72 hours of activity of phagocytosis of neutrophiles. It was noted a depression of components in complicated patients and in those after died, more marked at 72 hours and intensified at 7 days in this latter. According to SP reduction, also decreased the lymphocyte T activity (RA: p= 0.04; RE: p= 0.02) and the phagocytosis ability of neutrophiles. The deficiency of cellular immune response was accompanied by a great incidence of complicated and deceased patients. Conclusions: traumata are accompanied of cellular immunodepression and this is related to SP according to the TRISS predictive index

Traumatismos e inmunidad humoral según índice predictivo TRISS / Traumata and humoral immunity according to TRISS predictive index

Introducción: el trauma, reconocido como epidemia no resuelta de la sociedad moderna, representa, en Cuba, un verdadero problema de salud. Objetivo: determinar el comportamiento cinético de la inmunidad humoral en los pacientes traumatizados, en general, y en los complicados en particular, precisar el momento de mayor afectación, así como sus relaciones con la probabilidad de sobrevida (PS) según índice predictivo trauma injury severity score (TRISS). Métodos: se realizó un estudio prospectivo en 70 pacientes traumatizados con valores de injury severity score superiores a 8, ingresados en el Hospital Militar Central "Dr. Luis Díaz Soto", en un período de 2 años. Se realizaron estudios inmunitarios durante las primeras 24 h, a los 3 días y a los 7 días. Se aplicaron las pruebas estadísticas necesarias para avalar el estudio. La muestra quedó estratificada en 3 grupos: PS< 80 %, entre 80 y 95 % y PS> 95 %. Resultados: hubo complicaciones infecciosas significativamente frecuentes (47,9 %). El estudio cinético de la inmunidad humoral constató disminución a las 72 h, del factor C-3 del complemento sérico, del complemento hemolítico total CH-50, y de las inmunoglobulinas G y M. Se observó depresión de estos componentes en los pacientes complicados y en los que fallecieron después, más marcada a las 72 h e intensificada a los 7 días en estos últimos. En la medida en que disminuyó la probabilidad de sobrevida, decrecieron los valores del complemento hemolítico total CH-50 (p= 0,009), de las inmunoglobulinas G y M (p= 0,004) y el factor C-3 del complemento sérico. La deficiencia de la respuesta inmunitaria humoral se acompañó de mayor incidencia de complicados y fallecidos. Conclusiones: los traumatismos se acompañan de inmunodepresión humoral y esta se relaciona con la probabilidad de sobrevida según índice predictivo TRISS.

Introduction: the trauma is recognized as a non-solved epidemic of the current society, in Cuba it is a real health problem. Objective: to determine the kinetic behavior of the humoral immunity in trauma patients, in general and in those complicated in particular, and to specify exactly the moment of great affection, as well as its relations to survival probability (SP) according the trauma predictive index "injury severity score" (TRISS). Methods: a prospective study was conducted in 70 trauma patients with values of "injury severity score" higher than 8 admitted in the "Dr. Luis Díaz Soto" Central Military Hospital over two years, as well as immunity studies over the first 24 hours, at 3 days and at 7 days. The needed statistic tests were applied to assess the study. Sample was stratified in three groups: SP< 80 %, between 80 and 95 % and SP>95 %. Results: there were infectious complications significantly frequent (47,9 %). The kinetic study of the humoral immunity confirmed a decrease at 72 hours, of C-3 factor of the serum complement, of the CH-50 total hemolytic complement, and of immunoglobulin G and M. Also, there was decrease of these components in the patients complicated and in those died after, more marked at 72 hours and intensified at 7 days en these latter. Insofar as the survival probability decreased, also decreased the values of the CH-50 total hemolytic complement (p= 0.009), of the immunoglobulin G and M (p= 0.004) and the C-3 factor of serum complement. The deficiency in the humoral response was accompanied of a greater incidence of complicated and deceased patients. Conclusions: the traumata are accompanied of humoral immunodepression and it is related to the survival probability according the predictive index-TRISS.