Association between delta anion gap and hospital mortality for patients in cardiothoracic surgery recovery unit: a retrospective cohort study.

BACKGROUNDS: High level of anion gap (AG) was associated with organic acidosis. This study aimed to explore the relationship between delta AG (ΔAG = AGmax - AGmin) during first 3 days after intensive care unit (ICU) admission and hospital mortality for patients admitted in the cardiothoracic surgery recovery unit (CSRU). METHODS: In this retrospective cohort study, we identified patients from the open access database called Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC III). A logistic regression model was established to predict hospital mortality by adjusting confounding factors using a stepwise backward elimination method. We conducted receiver operating characteristic (ROC) curves to compare the diagnostic performance of acid-base variables. Cox regression model and Kaplan Meier curve were applied to predict patients' 90-day overall survival (OS). RESULTS: A total of 2,860 patients were identified. ΔAG was an independent predictive factor of hospital mortality (OR = 1.24 per 1 mEq/L increase, 95% CI: 1.11-1.39, p < 0.001). The area under curve (AUC) values of ΔAG suggested a good diagnostic accuracy (AUC = 0.769). We established the following formula to estimate patients' hospital mortality: Logit(P) = - 15.69 + 0.21ΔAG + 0.13age-0.21BE + 2.69AKF. After calculating Youden index, patients with ΔAG ≥ 7 was considered at high risk (OR = 4.23, 95% CI: 1.22-14.63, p = 0.023). Kaplan Meier curve demonstrated that patients with ΔAG ≥ 7 had a poorer 90-day OS (Adjusted HR = 3.20, 95% CI: 1.81-5.65, p < 0.001). CONCLUSION: ΔAG is a prognostic factor of hospital mortality and 90-day OS. More prospective studies are needed to verify and update our findings.

MUC1 overexpression predicts worse survival in patients with non-small cell lung cancer: evidence from an updated meta-analysis.

BACKGROUND: Previous studies on the prognostic role of MUC1 expression in non-small cell lung cancer (NSCLC) remain controversial. We conducted a meta-analysis to appraise the clinicopathological and prognostic effect of MUC1 in NSCLC patients. MATERIALS AND METHODS: Searches of PubMed, EMBASE and CNKI (Chinese National Knowledge Infrastructure) were conducted and relevant studies were extracted. The pooled hazard ratio (HR) or odds ratio (OR) with 95% confidence intervals (CIs) were used to estimate effects. Heterogeneity among studies and publication bias were also evaluated. RESULTS: A total of 15 studies with 1,682 patients were included in this meta-analysis. The pooled HRs indicated that elevated MUC1 expression was associated with poorer overall survival (HR = 2.12, 95% CI: 1.47-3.05; P < 0.001) and progression-free survival (HR = 2.00, 95% CI: 1.53-2.62; P < 0.001) in patients with NSCLC. Significant associations were also found in patients treated with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) (HR = 3.16, 95% CI: 2.21-4.52, P < 0.001) and with a platinum-based regimen (HR = 4.35, 95% CI: 2.45-7.72, P < 0.001). Additionally, MUC1 overexpression was significantly associated with performance status (OR = 2.32, 95% CI: 1.13-4.73, P = 0.021). CONCLUSIONS: MUC1 could be a valuable biomarker of the prognoses of NSCLC patients.

Prognostic value of endocan expression in cancers: evidence from meta-analysis.

Endocan is a 50 kDa dermatan sulfate proteoglycan. Numerous previous studies have indicated that endocan might be an attractive prognostic tumor biomarker. However, the results of different studies are inconsistent. We conducted a meta-analysis to explore the association between endocan expression and cancer prognosis. A systematic, comprehensive search of the PubMed, Embase, and China National Knowledge Infrastructure databases was performed. Expression of endocan and its association with overall survival were evaluated by pooled hazard ratios (HRs) and their 95% confidence intervals (CIs). In total, 15 eligible studies of 1,464 patients were finally included in this meta-analysis. A significant association was found between elevated endocan expression and poorer overall survival (pooled HR: 2.48, 95% CI: 2.12-2.90, P<0.001). In the cancer-type subgroup, significant associations were detected for gastrointestinal (HR: 2.27, 95% CI: 1.77-2.91, P<0.001) and hepatocellular (HR: 2.61, 95% CI: 1.96-3.48, P<0.001) carcinoma. Our results demonstrate that endocan could be useful to exploit as a novel prognostic biomarker for patients with cancer.

Clinicopathological and prognostic significance of MUC4 expression in cancers: evidence from meta-analysis.

Mucin4 (MUC4) is a secreted glycoprotein. Numerous studies had indicated that MUC4 was an attractive prognostic tumor biomarker. However, the results of different studies have been inconsistent. So we conducted this meta-analysis to explore the association between MUC4 expression and cancer prognosis. A systematically comprehensive search was performed through PubMed, EMBASE and CNKI (Chinese National Knowledge Infrastructure). Prognostic value of MUC4 expression in malignancy patients was evaluated by pooled hazard ratios (HRs) and their 95% confidence intervals (CIs). Meanwhile, pooled odds ratio (OR) with 95% CI was appropriate for the association between MUC4 expression and clinicopathological parameters. Eighteen studies including 1,933 patients were enrolled in this meta-analysis. Significant association was found between elevated MUC4 expression and poorer overall survival (OS) with pooled hazard ratio (HR) of 1.87 [95% confidence interval (CI): 1.58-2.23, P<0.001]. Significant associations were also detected in biliary tract carcinoma (HR: 2.41, 95% CI: 1.69-3.42, P<0.001), pancreatic cancer (HR: 2.01, 95% CI: 1.42-2.86, P<0.001) and colorectal cancer (HR: 1.73, 95% CI: 1.17-2.54, P=0.006). Moreover, combined odds ratio (OR) of MUC4 indicated that MUC4 overexpression was associated with tumor stage, tumor invasion and lymph node metastasis. Our results demonstrated that MUC4 may be exploited as a novel prognostic biomarker for cancer patients.

Nasogastric placement of sump tube through the leak for the treatment of esophagogastric anastomotic leak after esophagectomy for esophageal carcinoma.

OBJECTIVE: We seek to retrospectively analyze the nasogastric placement of sump tube through the leak for the treatment of intra-thoracic esophagastric anastomotic leak after esophagectomy for esophageal carcinoma. MATERIALS AND METHODS: Esophagectomy with intrathoracic esophagogastric anastomotic procedures were performed in 2954 patients who suffered from esophageal carcinoma in our hospital between May 2004 and July 2008. Anastomotic leak had developed in 38 patients, of whom four patients were treated by reoperations. Stent insertion, the traditional "three-tube method" and the nasogastric placement of sump tube through the leak were applied in two, seven, and 25 patients, respectively. RESULTS: The presence of anastomotic leak was proven by radiographic contrast examinations in 38 patients (1.3%). Among them, four received reoperations and recovered. Two patients were treated with the placement of self-expanding metallic coated stents and both died 10 and 13 d after placement due to uncontrollable hematemesis. Seven and 25 patients were managed by the traditional "three-tube method" and the nasogastric placement of sump tube through the leak, respectively. The mean time interval of the leak treatment was 42 d in the traditional "three-tube method" group and 31.2 d in the nasogastric placement of sump tube through the leak group, and the relatively average hospital mortality rates were 14.3% and 12%, respectively. CONCLUSION: The nasogastric placement of sump tube through the leak appears to be an effective, technically feasible, and minimally invasive option for the treatment of intrathoracic esophagogastric anastomotic leak.

A Swine model for long-term evaluation of prosthetic heart valves.

BACKGROUND: The objective of this study was to develop a porcine model of mitral valve replacement (MVR) for long-term evaluation of prosthetic heart valves. METHODS: Sixteen 25-kg male Bama miniature pigs underwent MVR using St Jude Medical valve (21 mm). Each animal was allocated to an anticoagulation protocol after surgery (group I, s.c. heparin injection and warfarin (n = 8); group II, s.c. low-molecular-weight heparin and warfarin (n = 8)) and was followed for up to 20 weeks. Terminal studies were carried out on all animals having survived for more than 140 days or died. RESULTS: Fourteen animals survived for more than 1 month without signs of heart failure. One of group I animals died from haemorrhagic (haemopericardium) complications on the 9th postoperative day, and another animal of group I died on the 18th postoperative day because of valve thrombosis. CONCLUSIONS: Compared with other species, humans and pigs show remarkable anatomical and physiological similarities. This model is promising for long-term preclinical evaluation of prosthetic heart valves and evaluation of postoperative anticoagulant agents.