SAPS III is superior to SOFA for predicting 28-day mortality in sepsis patients based on Sepsis 3.0 criteria.

INTRODUCTION: The discrimination and calibration accuracy of prediction models tends to become poor over time. The performance of predictive models should be reevaluated periodically. The aim of this study was to reassess the discrimination of the six commonly used models for predicting 28-day mortality in patients with sepsis based on the Sepsis 3.0 criteria. METHODS: Patient data were extracted from the fourth edition of the Medical Information Mart for Critical Care (MIMIC IV) database. The systemic inflammatory response syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), Oxford Acute Severity of Illness Score (OASIS), Logistic Organ Dysfunction System (LODS), and Simplified Acute Physiology Score II (SAPS II) and III (SAPS III) scores were calculated and collected. The area under the receiver operating characteristic curve (AUROC) was used to compare the discrimination abilities of the models using non-parametric Wilcoxon statistics. The Delong method was used to perform pairwise comparisons of the AUROCs of the models. Multiple subgroup analyses for age, body mass index, and sex were performed with regard to the 28-day mortality prediction of the models. RESULTS: A total of 12 691 patients were included. The mean age of the patients was 65.97 ± 15.77 years; 7673 patients (60.50%) were male. The mean SIRS, SOFA, OASIS, SAPS II, LODS, and SAPS III scores were higher in the non-survivor group than in the survivor group. The discrimination for 28-day mortality with the SAPS III (AUROC 0.812, 95% confidence interval (CI) 0.802-0.822) and LODS (AUROC 0.804, 95% CI 0.743-0.765) models was superior to that of the SIRS (AUROC 0.575, 95% CI 0.562-0.589), SOFA (AUROC 0.612, 95% CI 0.598-0.626), OASIS (AUROC 0.753, 95% CI 0.742-0.764), and SAPS II (AUROC 0.754, 95% CI 0.743-0.765) models. The Youden index of the SAPS III model was 0.484, which was the highest among the models. Subgroup analyses showed similar results to the overall results. CONCLUSIONS: The discrimination for 28-day mortality with the SAPS III and LODS models was superior to that of the SIRS, SOFA, OASIS, and SAPS II models. The SAPS III model showed the best discrimination capacity for 28-day mortality compared with the other models.

Distal Bone Metastasis From Primary Rectal Cancer: A Case Report.

Distal bone metastases from rectal cancer are uncommon. Our case report is from a patient with rectal carcinoma who presented with symptomatic middle finger metastases, and we describe the clinical characteristics of this presentation and the treatment provided. Metastases in bone tissues are a sign of a grave prognostic outcome due to the association of this with advanced terminal disease. Palliative treatment for symptom relief is the only option in this situation.

No association of single nucleotide polymorphisms involved in GHRL and GHSR with cancer risk: a meta-analysis.

BACKGROUND: Ghrelin was associated with several of cancers. The conflict results of SNPs with GHRL and GHSR gene were demonstrated in different studies. Thus, this meta-analysis is to evaluate the associations. METHODS: Systematic literature search was done on PubMed database up to October 2013. We used odds ratios (ORs) with 95% confidence intervals (CIs) to assess the strength of the association by a fixed-effect model and a random-effect model. RESULTS: A total of 7 studies, which included 3 studies for breast cancer, 2 for colorectal cancer, 1 for hepatocellular carcinoma, 1 for esophageal cancer and 1 for Non-Hodgkin lymphoma. When analyzed all the GHRL SNPs with all kinds of cancers, there was significantly difference with cancer patients compared with controls (Recessive model: OR 0.938, 95% CI 0.890-0.989, p=0.017), while no significant difference was existed in the additive model (OR 0.9903, 95% CI 0.957-1.024, p=0.558) and dominant model (OR 1.014, 95% CI 0.970-1.061, p=0.536). When analyzed all the GHSR SNPs with all kinds of cancers, no significant difference was observed. CONCLUSION: Our results suggest that the SNP with GHRL and GHSR might be weaker association with cancer risk, especially with breast cancer risk.

Low protein diet inhibits uric acid synthesis and attenuates renal damage in streptozotocin-induced diabetic rats.

AIM: Several studies indicated that hyperuricemia may link to the worsening of diabetic nephropathy (DN). Meanwhile, low protein diet (LPD) retards exacerbation of renal damage in chronic kidney disease. We then assessed whether LPD influences uric acid metabolism and benefits the progression of DN in streptozotocin- (STZ-) induced diabetic rats. METHODS: STZ-induced and control rats were both fed with LPD (5%) and normal protein diet (18%), respectively, for 12 weeks. Vital signs, blood and urinary samples for UA metabolism were taken and analyzed every 3 weeks. Kidneys were removed at the end of the experiment. RESULTS: Diabetic rats developed into constantly high levels of serum UA (SUA), creatinine (SCr) and 24 h amounts of urinary albumin excretion (UAE), creatinine (UCr), urea nitrogen (UUN), and uric acid (UUA). LPD significantly decreased SUA, UAE, and blood glucose, yet left SCr, UCr, and UUN unchanged. A stepwise regression showed that high UUA is an independent risk factor for DN. LPD remarkably ameliorated degrees of enlarged glomeruli, proliferated mesangial cells, and hyaline-degenerated tubular epithelial cells in diabetic rats. Expression of TNF-α in tubulointerstitium significantly decreased in LPD-fed diabetic rats. CONCLUSION: LPD inhibits endogenous uric acid synthesis and might accordingly attenuate renal damage in STZ-induced diabetic rats.

Tumor-stroma ratio is an independent predictor for survival in esophageal squamous cell carcinoma.

OBJECTIVE: Tumor-stroma ratio (TSR) has been identified as a new and practicable prognostic histological characteristic of solid tumors. The aim of this study was to evaluate the prognostic value of TSR in resected esophageal squamous cell carcinoma (ESCC). METHODS: A total of 95 patients who underwent esophagectomy for ESCC were included in this study. TSR was assessed visually on the hematoxylin-eosin-stained tissue sections of surgical specimens by two independent observers. Patients with more than 50% intratumor stroma were quantified as the stroma-rich group and those with less than 50% as the stroma-poor group. RESULTS: No significant differences were observed in patient, tumor, and treatment characteristics between the stroma-rich and stroma-poor groups. The 3-year overall survival and disease-free survival rates were 64% and 57%, respectively, in the stroma-poor group, and 23% and 23%, respectively, in the stroma-rich group. Both 3-year overall and disease-free survival rates in the stroma-poor group were significantly better than those in the stroma-rich group (p < 0.01). In a multivariate analysis, TSR was identified as a highly significant prognostic factor for 3-year overall survival (hazard ratio 3.450; p = 0.001) and 3-year disease-free survival (hazard ratio 2.995; p = 0.001), independent of pTNM stage and radicality of the primary tumor. CONCLUSION: Stroma-rich tumors were associated with poor prognosis and an increased risk of relapse, which may serve as a new prognostic histological characteristic in ESCC. TSR is simple and quick to determine, is reproducible, and could be easily incorporated in routine histological evaluation.