Accumulative Survival Rate Research Articles

Early and minimal changes in serum creatinine can predict prognosis in elderly patients receiving invasive mechanical ventilation: A retrospective observational study

BackgroundEmerging evidence suggests that minimal acute kidney injury (stage 1 AKI) is associated with increased hospital mortality rates. However, for those who do not meet the AKI diagnostic criteria, whether a small increase in serum creatinine (SCr) levels is associated with an increased mortality rate in elderly patients is not known. Therefore, we aimed to investigate small elevations in SCr of <26.5 µmol/L within 48 h after invasive mechanical ventilation (MV) on the short-term mortality of critically ill patients in the geriatric population. MethodsWe conducted a retrospective, observational, multicenter cohort study enrolling consecutive elderly patients (≥75 years) who received invasive MV from January 2008 to December 2020. Recursive partitioning was used to calculate the ratio of SCr rise from baseline within 48 h after MV and divided into six groups, (1) <10%, (2) 10%–<20%, (3) 20%–<30%, (4) 30%–<40%, (5) 40%–<50%, and (6) ≥50%, where the reference interval was defined as the ratio <10% based on an analysis, which confirmed that the lowest mortality risk was found in this range. Clinical data and laboratory data were noted. Their general conditions and clinical characteristics were compared between the six groups. Prognostic survival factors were identified using Cox regression analysis. Kaplan–Meier survival analysis was employed for the accumulative survival rate. ResultsA total of 1292 patients (1171 men) with a median age of 89 (interquartile range: 85–92) with MV were suitable for further analysis. In all, 376 patients had any stage of early AKI, and 916 patients had no AKI. Among 916 non-AKI patients, 349 patients were in the ratio <10%, 291 in the 10%–<20% group, 169 in the 20%–<30% group, 68 in the 30%–<40% group, 25 in the 40%–<50% group, and 14 in the ≥50% group. The 28-day mortality rates in the six groups from the lowest (<10%) to the highest (≥50%) were 8.0%, 16.8%, 28.4%, 54.4%, 80.0%, and 85.7%, respectively. In the multivariable-adjusted analysis, patients with a ratio of 10%–<20% (hazard ratio [HR]=2.244; 95% confidence interval [CI]: 1.410 to 3.572; P=0.001), 20%–<30% (HR=3.822; 95% CI: 2.433 to 6.194; P <0.001), 30%–<40% (HR=10.472; 95% CI: 6.379 to 17.190; P <0.001), 40%–<50% (HR=13.887; 95% CI: 7.624 to 25.292; P <0.001), and ≥50% (HR=13.618; 95% CI: 6.832 to 27.144; P <0.001) had relatively higher 28-day mortality rates. The 90-day mortality rates in the six strata were 30.1%, 35.1%, 45.0%, 60.3%, 80.0%, and 85.7%, respectively. Significant interactions were also observed between the ratio and 90-day mortality: patients with a ratio of 10%–<20% (HR=1.322; 95% CI: 1.006 to 1.738; P=0.045), 20%–<30% (HR=1.823; 95% CI: 1.356 to 2.452; P <0.001), 30%–<40% (HR=3.751; 95% CI: 2.601 to 5.410; P <0.001), 40%–<50% (HR=5.735; 95% CI: 3.447 to 9.541; P <0.001), and ≥50% (HR=6.305; 95% CI: 3.430 to 11.588; P <0.001) had relatively higher 90-day mortality rates. ConclusionsOur study suggests that a ≥ 10% SCr rise from baseline within 48 h after MV was independently associated with short-term all-cause mortality in mechanically ventilated elderly patients.

A Retrospective Clinical Evaluation Of Narrow Diameter Implant Supported Dental Prosthesis: Early Results

Background: Narrow-diameter implants are planned for specific clinical conditions as locator implants between adjacent teeth with a narrow bone width or with only a narrow area in between. They are especially advantageous when restoring narrow teeth like lateral maxillary and mandibular incisors and first premolars.&#x0D; Methods: In the period between 2018 and 2019, 21 patients were rehabilitated with implant treatment. A total of 32 implants were placed (The Straumann® Bone Level Tapered Implants, ∅ 2.9 mm). The survival rates of the implants were analyzed and prosthetic complications were evaluated.&#x0D; Results: The accumulative 36-month survival rate of the implants was 96.9%. Prosthetic complications were mainly limited to loosening occlusal screws. No implant abutment fractures, screw fractures, or porcelain chipping were observed.&#x0D; Conclusion: The results show that narrow implants provide satisfactory treatment outcomes. Narrow implants can be preferred in cases, where the dental operation area is not wide enough.&#x0D; Keywords: Narrow Diameter Implants, Fixed Dental Prosthesis, Survival Rate.

A Comparative Study on the Difference in Temperature and Salinity Tolerance of Crassostrea nippona and C. gigas Spat

Although Crassostrea nippona and C. gigas are occasionally found to be sympatric, little is known about the differences in tolerance against environmental stresses between species, which may potentially result in severe economic losses due to the neglect of species-specific biological characteristics in farming practices. Therefore, two independent and consecutive experiments were performed to evaluate the differences in temperature and salinity tolerance between C. nippona and C. gigas spat and determine the optimal environmental conditions for the aquaculture of C. nippona spat. The experimental results of dynamic treatment showed that the accumulative survival rate (ASR) of C. nippona spat was generally lower than that of C. gigas throughout temperature changes and salinity decreases, while the ASR of C. nippona spat was superior to that of C. gigas with increasing salinity. In addition, the daily growth rate (DGR) of both species was significantly inhibited at 18 °C and peaked at 25 °C with increasing temperature (p &lt; 0.05) at each experimental salinity. At 32 °C, the survival rate (SR) of C. nippona spat was significantly lower than that of C. gigas on day 10 at all salinities tested (p &lt; 0.05), whereas the difference in the SR between species at 35 psu gradually disappeared with prolonged stress time. The data indicated that C. gigas spat was suitable for rearing at temperatures of 25 and 32 °C at all salinity levels, except the combination of 32 °C and 35 psu. By contrast, combinations of 25 °C and salinities of 21–35 psu were considered as the optimal environmental conditions for the long-term culture of C. nippona spat. These present findings contribute to a better understanding of the tolerance of C. nippona spat to environmental stresses and suggest that particular attention should be paid to the inferior adaptability of C. nippona when farming in locations outside their natural habitats.

Surgical resection of chemotherapy-insensitive pulmonary metastases in children with hepatoblastoma in China: A single-center experience.

The objective of this study is to investigate the operation timing, methods, and outcome of pulmonary metastases of hepatoblastoma (HB) in children. The clinical and follow-up data of 53 children with pulmonary metastases of HB that were admitted to our hospital from January 2012 to December 2018 were retrospectively analyzed. The pediatric patients, 36 male and 17 female, aged 13-124 months with the median age of 41 months, and all underwent routine thoracotomy. In the 53 cases, 77 lung metastatic tumors were resected. Further, 37 patients received only one operation, 10 received two operations, 4 received 3 operations, and 2 received 4 operations. Based on Kaplan-Meier analysis, the accumulative overall survival (OS) rates at 1, 3, and 5 years were 86.8%, 69.0%, and 57.0%, respectively (median OS time: 60 months; 95% CI: 50.675-69.709 months), and accumulative EFS (vent-free survival) rates at 1, 3, and 5 years were 86.8%, 67.0%, and 55.4%, respectively (median EFS time: 59 months; 95% CI: 49.519-68.578 months). According to univariate analysis, OS was significantly altered for patients with no more than 5 nodules (p = 0.023), lung metastases without extrapulmonary metastases (p = 0.000), and laterality (p = 0.029). Gender and age (less than three years) were not significantly related to survival. According to univariate analysis, lung metastases with extrapulmonary metastases could be considered as individual factor contributing to poorer prognosis. In this pediatric group, patients with residual nodules after chemotherapy of HB could benefit from surgical treatment, but the appropriate surgical indication of metastasectomy needs to be further investigated.

Mid- and long-term outcomes and prognostic factors of drug-coated balloon angioplasty for treatment of femoropopliteal long lesions

Objective: To examine the effective and safe outcomes of drug-coated balloon (DCB) angioplasty for the treatment of femoropopliteal long lesions in mid-term and long-term follow-up. Methods: The clinical data of 114 patients with symptomatic (Rutherford 2 to 6) femoropopliteal long lesions who underwent angioplasty with DCB between June 2016 and May 2021 at Department of Vascular Surgery,Beijing Tsinghua Changgung Hospital were retrospectively analyzed. A total of 75 males and 39 females were enrolled, aged (71.9±8.4)years (range: 49 to 89 years). Among 138 lesions in 114 patients, there were 111 de nove lesions (80.4%, 111/138). Total occlusions were recanalized in 116 limbs (84.1%, 116/138). The lesion length was (280.9±78.7)mm (range: 150 to 520 mm). DCB angioplasty combined with debulking devices was used in 59 lesions (42.8%, 59/138).The bail-out stent implantation was performed in 27 limbs (19.6%, 27/138). The Kaplan-Meier method was used to evaluate cumulative primary patency rate, freedom from the clinically driven target lesion revascularization (CD-TLR) rate and accumulate survival rate. Univariate and multivariate analyses with Cox proportional hazards models were performed to determine the significant prognostic factors for primary patency. Results: DCB angioplasty was completed in 114 patients. The technical success rate was 98.2%(112/114). The mean follow-up time was 18 months (range: 3 to 54 months).The results showed that primary patency rates at 12, 24 and 36 months postoperatively were 87.5%, 75.2% and 55.1%, respectively. Freedom from CD-TLR rate at 12, 24 and 36 months postoperatively were 92.4%, 81.8% and 68.7%, respectively. Accumulate survival rate at 12, 24 and 36 months postoperatively were 96.2%, 94.0% and 80.2%. Multivariate Cox's regression analyses showed that chronic limb-threatening ischemia(CLTI) (HR=2.629, 95%CI:1.519 to 4.547, P<0.01) and hyperlipidemia (HR=2.228, 95%CI: 1.004 to 4.948, P=0.026) were independent prognosis factors for primary patency in DCB treatment of femoropopliteal long lesions. Conclusions: DCB provided favorable outcomes for the treatment of femoropopliteal long lesions. CLTI and hyperlipidemia are independent prognosis factors for restenosis after DCB angioplasty.

Effects of salinity and temperature on growth and survival of diploid and tetraploid larvae of the Pacific oyster, Crassostrea gigas

Tetraploid of Crassostrea gigas was first reported in the 1990s, but its biological characteristics are seldomly known. To understand the adaptation of tetraploid larvae to salinity and temperature, the effects of salinity treatments (10, 15, 20, 25 and 30 psu) and temperature treatments (18, 23 and 28 °C) on the growth and survival of tetraploid and diploid larvae were comparatively studied. In salinity treatments, the accumulative survival rate (ASR) and relative growth rate (RGR) of tetraploid larvae were generally lower than that of diploid larvae (P < 0.05). The maximum ASR and RGR of tetraploid larvae occurred at 30 psu, with the values of 41.09% and 152.91%, respectively. At day 16, the maximum difference in ASR between diploid and tetraploid larvae was 36.41% at 20 psu, and the maximum difference in RGR of diploid and tetraploid larvae was 62.36% at 10 psu. The ASR and RGR of tetraploid larvae were lower than that of diploid larvae under temperature treatments (P < 0.05). The maximum ASR and RGR of tetraploid larvae occurred at 28 °C, with the values of 19.67% and 235.40%, respectively. The ASR of both diploid and tetraploid larvae decreased sharply in the first four days. The RGR of larvae at 18 °C was much lower than that at 23 °C and 28 °C (P < 0.05). Hence, a salinity range of 25–30 psu and a temperature range of 23–28 °C are suitable culture conditions for tetraploid larvae. These results indicate that the natural environment conditions can meet the temperature and salinity requirements for the survival and growth of tetraploid larvae. However, tetraploid larvae are less adaptable to temperature and salinity than diploid larvae. The environmental adaptability of tetraploid needs further improvement.

Identification of antigenic domains and peptides from VP15 of white spot syndrome virus and their antiviral effects in Marsupenaeus japonicus

White spot syndrome virus (WSSV) is one of the most devastating pathogens in penaeid shrimp and can cause massive damage in shrimp aquaculture industries. Previously, the WSSV structural protein VP15 was identified as an antigenic reagent against WSSV infections. In this study, we truncated this protein into VP15(1–25), VP15(26–57), VP15(58–80), and VP15(1–25,58–80). The purified proteins from the E. coli expression system were assayed as potential protective agents in Kuruma shrimp (Marsupenaeus japonicus) using the prime-and-boost strategy. Among the four truncated constructs, VP15(26–57) provided a significant improvement in the shrimp survival rate after 20 days of viral infection. Subsequently, four peptides (KR11, SR11, SK10, and KK13) from VP15(26–57) were synthesized and applied in an in vivo assay. Our results showed that SR11 could significantly enhance the shrimp survival rate, as determined from the accumulated survival rate. Moreover, a multiligand binding protein with a role in the host immune response and a possible VP15-binding partner, MjgC1qR, from the host M. japonicus were employed to test its binding with the VP15 protein. GST pull-down assays revealed that MjgC1qR binds with VP15, VP15(26–57), and SR11. Taken together, we conclude that SR11 is a determinant antigenic peptide of VP15 conferring antiviral activity against WSSV.

Predictive value of lactate concentration combined with lactate clearance rate in the prognosis of neonatal septic shock

Objective: To investigate the predictive value of lactate concentration within 1 h after admission combined with lactate clearance rate (LC) at 6 h after fluid resuscitation in prognosis of neonatal septic shock. Methods: In this retrospective study, 58 newborns with septic shock admitted to the Neonatal Intensive Care Unit of Xi'an Children's Hospital,Xi'an Jiao Tong University from June 2016 to March 2020 were enrolled. According to the mortality within 60 days after admission,which was also set as the end point, the patients were divided into death group and survival group. The general demographic data and clinical variables including blood cell counts, procalcitonin, C-reactive protein, D-dimer, serum creatinine, and lactate concentration within 1 h after admission (Lac1) and at 6 h after fluid resuscitation (Lac2) were collected. The differences in the clinical variables between the survival and death group were compared by independent sample t test or Rank-Sum test, and the risk factors of poor prognosis were analyzed by binary Logistic regression. The predictive values of these risk factors were tested by receiver operating characteristic (ROC) curve. Furthermore, the cut-off of the risk factors were used to analyze the accumulative survival rate by Kaplan-Meier curve. Results: A total of 58 neonates were enrolled, among whom 24 survived and 34 died within 60 days after admission. The rate of premature rupture of membranes in the death group was higher than that in the survival group (41% (14/34) vs.13%(3/24), P=0.021). There were also significant differences in infection site, pathogenic characteristics, total fluid volume of resuscitation, vasoactive drug index, rate and complications of mechanical ventilation between the two groups (all P<0.05). The levels of Lac1, Lac2, procalcitonin, D-dimer and serum creatinine in the death group were higher than those in the survival group ((12±6) vs. (7±4) mmol/L, (14±6) vs. (4±2) mmol/L, (59±23) vs.(24±14) ng/L, (24±11) vs.(11±6) mg/L, (167±31) vs.(92±23) μmol/L, t=3.549, 3.112, 3.859, 4.499, 3.288, all P<0.05). While the blood pressure and LC at 6 h after fluid resuscitation were lower than those in the survival group ((41±12) vs. (52±5) mmHg (1 mmHg=0.133 kPa), t =4.230;-16 (-40, 20) % vs. 40 (18, 70) %, Z= 3.558, all P<0.05). Binary Logistic regression analysis showed that LC was negatively associated with the risk of death in neonates with septic shock (odds ratio (OR) and 95% confidence interval (CI): 0.679 (0.662-0.999), P<0.05), while Lac1 was the risk factor and positively associated with the risk of death (OR and 95% CI: 1.203 (0.965-1.500), P<0.05). Furthermore, the predictive values of LC, Lac1 and the combination of these two variables in the prognosis of neonatal septic shock were analyzed by ROC curve analysis, and the area under the curve (AUC) were 0.699, 0.875, 0.965, respectively, with the sensitivity of 83.32%, 89.65% and 94.31%, and the specificity of 72.52%, 77.18% and 88.76%, respectively. According to the cut-off value of Lac1, the newborns with Lac1>4 mmol/L had significantly lower accumulative survival rate than those with Lac1≤4 mmol/L by Kaplan-Meier analysis (21% (8/38) vs. 80% (16/20), χ²=54.520, P<0.05). According to the cut-off value of LC, the newborns with LC ≤ 10% had significantly lower accumulative survival rate than those with LC>10% by Kaplan-Meier analysis (19% (6/32) vs. 69% (18/26), χ²=14.140, P<0.05). Conclusion: The combination of lactate concentration and lactate clearance rate have an optimal predictive value in the prognosis of neonatal septic shock.

Comparison of Peripheral Nerve Block and Spinal Anesthesia in Terms of Postoperative Mortality and Walking Ability in Elderly Hip Fracture Patients - A Retrospective, Propensity-Score Matched Study.

PurposeTo compare the effects of peripheral nerve block (PNB) and spinal anesthesia (SA) on one-year mortality and walking ability of elderly hip fracture patients after hip arthroplasty.MethodsPatients ≥65 years who underwent unilateral hip arthroplasty due to femoral neck fracture, using either PNB or SA from 2014 to 2019, were included. Demographic data, comorbidities, and results of preoperative screening were retrospectively collected. Propensity score matching (PSM) was performed in a ratio of 1:1 for PNB and SA groups. The primary outcomes were 30-day, 90-day, and one-year mortality. Secondary outcomes included walking ability in the first postoperative year, major complications, length of stay, and the cost of hospitalization. Survival analysis was performed using Kaplan–Meier method.ResultsThree hundred and sixteen patients were included, of whom 200 received SA and 116 received PNB. Eighty-nine patients in each group were matched after PSM. Patients in the PNB group showed significantly lower risks of death in 30 days (2.2% vs 10.1%, P=0.029) and 90 days (3.4% vs 12.4%, P=0.026) after hip arthroplasty, when compared to the SA group. There was no significant difference in one-year mortality, walking ability, major complications, and length of stay. Higher hospitalization cost was found in the PNB group (53,828.21 CNY vs 59,278.83 CNY, P=0.024). One-year accumulated survival rate was higher in the PNB group without reaching a significant level.ConclusionPNB was related to lower 30- and 90-day mortality but higher hospitalization cost in elderly hip fracture patients after hip arthroplasty. However, the anesthesia types were not associated with one-year mortality, one-year walking ability, major complications, and length of stay.

Long-term outcomes of pregnant women with pulmonary hypertension diagnosed by echocardiography: a retrospective cohort study in a single center from China.

Recent studies suggest that pregnancy may not be absolutely contraindicated in women with moderate pulmonary hypertension. We aimed to evaluate the long-term outcomes of pregnant women with pulmonary hypertension diagnosed by echocardiography in our clinical department. Pregnant women with pulmonary hypertension, diagnosed by a pulmonary systolic arterial pressure > 30 mmHg via echocardiography, who were admitted in our department for termination of pregnancy or delivery between 2004 and 2016 were included in this retrospective cohort study. Demographic characteristics, clinical histories, perinatal outcomes, and follow-up outcomes after discharge were reported. The primary outcome was survival of the pregnant women after discharge. A total of 88 pregnant women with pulmonary hypertension were included in this cohort study. The women were categorized into severe and moderate pulmonary hypertension groups according to their pulmonary systolic arterial pressure at admission. Women with severe pulmonary hypertension were significantly more likely to have deteriorated cardiac function and higher incidence of neonatal complications during the perinatal periods (p < 0.05). During a median follow-up of 26 months, the mortality rate was significantly higher in women with severe pulmonary hypertension (p < 0.05). However, the accumulated survival rate was >90% for women with moderate pulmonary hypertension within the follow-up period. Multivariate Cox regression analyses showed that poor cardiac function before pregnancy, irregular antenatal care, and hyperuricemia were independent mortality risk factors for women with pulmonary hypertension after discharge. In conclusion, the long-term survival of pregnant women with moderate pulmonary hypertension diagnosed by echocardiography was considered acceptable in this cohort. Our findings suggest that pregnancy might not be absolutely contraindicated in women with moderate pulmonary hypertension.

Elevated plasma phenylalanine predicts mortality in critical patients with heart failure.

AimsPrevious studies found a relationship between elevated phenylalanine levels and poor cardiovascular outcomes. Potential strategies are available to manipulate phenylalanine metabolism. This study investigated whether increased phenylalanine predicted mortality in critical patients with either acute heart failure (HF) or acute on chronic HF, and its correlation with inflammation and immune cytokines.Methods and resultsThis study recruited 152 subjects, including 115 patients with HF admitted for critical conditions and 37 normal controls. We measured left ventricular ejection fraction (LVEF), plasma concentrations of phenylalanine, C‐reactive protein, albumin, pre‐albumin, transferrin, and pro‐inflammatory and immune cytokines. Acute Physiology and Chronic Health Evaluation (APACHE II), Sequential Organ Failure Assessment (SOFA), and maximal vasoactive–inotropic scores (VISmax) were calculated. Patients were followed up until death or a maximum of 1 year. The primary endpoint was all‐cause death. Of the 115 patients, 37 (32.2%) were admitted owing to acute HF, and 78 (67.8%) were admitted owing to acute on chronic HF; 64 (55.7%) had ST elevation/non‐ST elevation myocardial infarction. An LVEF measured during the hospitalization of <40%, 40–50%, and ≥50% was noted in 51 (44.3%), 15 (13.1%), and 49 (42.6%) patients, respectively. During 1 year follow‐up, 51 (44.3%) patients died. Death was associated with higher APACHE II, SOFA, and VISmax scores; higher levels of C‐reactive protein and phenylalanine; higher incidence of atrial fibrillation and use of inotropic agents; lower cholesterol, albumin, pre‐albumin, and transferrin levels; and significant changes in pro‐inflammatory and immune cytokines. Phenylalanine levels demonstrated an area under the receiver operating characteristic curve of 0.80 for mortality, with an optimal cut‐off value set at 112 μM. Phenylalanine ≥ 112 μM was associated with a higher mortality rate than was phenylalanine < 112 μM (80.5% vs. 24.3%, P < 0.001) [hazard ratio = 5.07 (2.83–9.05), P < 0.001]. The Kaplan–Meier curves revealed that phenylalanine ≥ 112 μM was associated with a lower accumulative survival rate (log rank = 36.9, P < 0.001). Higher phenylalanine levels were correlated with higher APACHE II and SOFA scores, higher C‐reactive protein levels and incidence of using inotropic agents, and changes in cytokines suggestive of immunosuppression, but lower levels of pre‐albumin and transferrin. Further multivariable analysis showed that phenylalanine ≥ 112 μM predicted death over 1 year independently of age, APACHE II and SOFA scores, atrial fibrillation, C‐reactive protein, cholesterol, pre‐albumin, transferrin, and interleukin‐8 and interleukin‐10.ConclusionsElevated phenylalanine levels predicted mortality in critical patients, phenotypically predominantly presenting with HF, independently of traditional prognostic factors and cytokines associated with inflammation and immunity.

MRNA and protein of p33ING1 in normal and cancer tissues.

BackgroundInhibitor growth protein 1 (ING1) is a tumor suppressor, and its down-regulation is involved in the progression and aggressive phenotypes of human malignancies through its interactions with the H3K4me3 and p53.MethodsWe collected datasets to analyze the relationship between ING1b mRNA expression and accumulative survival rate, and carried out immunohistochemistry analyses to determine the expression profiles of the p33ING1 protein on the mouse, normal human, and human cancer tissue microarrays.ResultsCompared with normal tissues, the ING1b mRNA was highly expressed in various types of cancer tissues, including, colorectal, lung, and breast cancers, and was positively correlated with the overall survival rate of gastric cancer patients. In mouse tissues, the subcellular location of p33ING1 was frequently nuclear; however, it was occasionally cytoplasmic or nucleocytoplasmic. There was a positive detection in the neuron body, a part of glial cells, the glandular epithelium of the stomach, intestines, breast, hepatocytes, heart, skeletal muscle cells, the bronchial and alveolar epithelium, and nephric tubules. In human tissues, the p33ING1 protein, apart from its cytoplasmic distribution, was distributed in the nuclei of the tongue, esophagus, stomach, intestine, lung, trachea, skin, appendix, cervix, endometrium, ovary, and breast. p33ING1 immunoreactivity was strongly detected in the stomach, trachea, skin, cervix, and breast, while it was weak in the other tissues. The positive rate of p33ING1 was 41.0% in the tested cancer entities (489/1,194). In general, p33ING1 expression was restricted to only the cytoplasm for all cancers, whereas it was found in the nucleus of renal clear cells, ovarian and colorectal cancers. Among them, p33ING1 was expressed in more than half of squamous cell carcinomas derived from the esophagus and cervix, while it was rarely expressed in hepatocellular (21.0%) and renal clear cell carcinoma (19.4%).ConclusionsThe findings suggest that p33ING1 might be participated in the repair and regeneration of organs or tissues the repair and regeneration of organs or tissue, and the carcinogenesis of the highly proliferative epithelium.

Prognostic and Clinical Value of CD44 and CD133 in Esophageal Cancer: A Systematic Review and Meta-analysis.

Despite the importance of CD44 and CD133 in various cancers, the clinicopathological and prognostic values of these biomarkers in esophageal cancer remain debated. Hence, in this study, we did a meta-analysis to explore the correlation between overexpression of these markers and some clinicopathological features and their influence on the survival of esophageal cancer patients. A search in PubMed and Web of Science (among all articles published up to January 16, 2018) was done using the following keywords: esophageal cancer, CD44, CD133, prominin-1, AC133. Suitable studies, that were selected based on the criteria listed in the Materials and Methods section, were chosen and hazard ratios with 95% confidence intervals were estimated if available. Heterogeneity and sensitivity were also analyzed. Furthermore, publication bias was assessed using funnel plots, Egger, and Begg tests. The study included 1346 patients from 13 related studies. The median rates of marker expressions by immunohistochemistry were 35.7% (30%-76.6%) from 9 studies for CD44 and 31.9% (21%-44.2%) from 5 studies for CD133. The accumulative 5-year overall survival rates of CD44-positive and CD133-positive were 1.59% (1.22-2.06) and 1.27% (0.93-1.73), respectively. Meta-analysis showed that CD44 expression had a significant correlation with 5-year overall survival. CD44 overexpression showed a correlation with some clinicopathological features such as lymph node metastasis, vascular invasion, and recurrence of the disease, while it was not the case for coexpression of CD44 and CD133. In conclusion, CD44 overexpression was associated with a 5-year overall survival rate and thus this biomarker can be a suitable prognostic tool in esophageal cancer.

How can the shade intolerant Korean pine survive under dense deciduous canopy?

The regeneration of Korean pine (Pinus koraiensis Sieb. et Zucc) is a core issue for restoration from secondary to primary forests. There is a lack of Korean pine regeneration in primary forests, compared to an abundance of regeneration in secondary forests. However, the mechanisms behind this mysterious phenomenon have not been studied. This study investigated seasonal understory light availability in addition to carbon (C) gain of understory Korean pine, nonstructural carbohydrate (NSC) storage of Korean pine in secondary forests, and the growth and survival of seedlings under manipulated light regimes. Understory light intensities in early spring and late autumn in secondary forests were significantly higher than in primary forests. The C gain of understory Korean pine occurred mostly in early spring and late autumn, whereas it was negative in the growing season (summer). Total NSC concentrations of Korean pine saplings increased between growing seasons, and decreased during the growing season. In particular, the NSC was dominated by a progressive increase in starch in early spring and by a peak in soluble sugar in late autumn. In this study, the biomass, NSC concentration and pool sizes, as well as survival rates, were positively correlated with light availability, revealing that the species is shade intolerant. The accumulated survival rate, examined in the autumn, was less correlated with biomass, but positively correlated with the carbohydrate storage in autumn. High light availability and positive C gain in early spring and late autumn are key factors affecting the growth and survival of understory seedlings. These two periods in secondary forests are crucial for the survival of seedlings by ensuring sufficient energy to live through the long-lasting dark summer. In primary forests, however, light availability was relatively stable across all seasons, especially in the leafless period, and insufficient through-canopy radiation, along with dense lateral closure, caused seedlings mortality.

Survival analysis on Former Plasma Donors living with HIV/AIDS after initiation of antiretroviral therapy in Henan province, 2002-2017

Objective: To explore the survival status and influencing factors on former plasma donors (FPD) living with HIV/AIDS after initiation of antiretroviral therapy (ART) during 2002-2017 in Henan province. Methods: A retrospective study was conducted, using data from the ART database of national comprehensive HIV/AIDS information system. The inclusion criteria on patients would include HIV/AIDS cases with current residence in Henan province, route of infection being blood-borne (plasma collection), initiation of ART between 2002 and 2017, and 15 year-olds or above. According to the time of initation on antiviral treatment, observation was carried on between January 1, 2002 and December 31, 2017. Outcome of observation was defined as death caused by AIDS or related diseases. Life Table was used to estimate the survival rate and Kaplan-Meier method was used to draw the survival curve. Log-rank test was used to compare the univariate intergroup survival rates while Cox proportional hazards regression model was used to analyze the influencing factors on survival status among deaths due to AIDS or related diseases. Excel 2010 software and SPSS 23.0 software was used for data cleaning and statistical analysis. Results: A total of 25 825 HIV/AIDS patients were enrolled in this study. During the follow-up period, the overall mortality was 3.9/100 person year (8 354/214 796.3), among all the patients. The accumulate survival rates of 1 year, 4 years, 8 years, 12 years and 16 years after the initiation of ART were 91.2%, 80.1%, 71.2%, 65.7% and 61.5%, respectively. The results from the multivariate Cox proportional hazards regression model analysis showed that male vs. female (aHR=1.46, 95%CI: 1.39-1.53); aged 45-49 years group and aged 60 and older years group of initiating ART vs. aged 15-44 years group of initiating ART respectively (aHR=1.47, 95%CI: 1.40-1.54; aHR=2.50, 95%CI: 2.22-2.81); other marital status vs. being married or under cohabitation (aHR=1.29, 95%CI: 1.21-1.36); baseline CD(4)(+)T cells counts (CD(4))<50, 50-199 and 200-349 cells/μl respectively vs. baseline CD(4)≥350 cells/μl (aHR=4.50, 95%CI: 4.14- 4.89; aHR=2.49, 95%CI: 2.31-2.69; aHR=1.44, 95%CI: 1.33-1.56); number of opportunistic infections at baseline were one case, 2-3 cases and 4-5 cases respectively vs. non opportunistic infections cases at baseline (aHR=1.17, 95%CI: 1.06-1.29; aHR=1.47, 95%CI: 1.35-1.59; aHR=1.74, 95%CI: 1.60-1.89); taking TMP-SMZ vs. not taking TMP-SMZ (aHR=0.69, 95%CI: 0.65- 0.73). Conclusions: The 16-year accumulate survival rate was 61.5% among FPD living with HIV/AIDS after initiation of ART, during 2002 to 2017 in Henan province. The risk factors for FPD death case would include: being males, aged 45 and older years at the initiation of ART, baseline CD(4)<350 cells/μl and the number of baseline opportunistic infections cases ≥1. The protective factors on FPD death appeared as: being married or cohabited as wel as on TMP-SMZ.

Clinical efficacy of Da Vinci robot-assisted radical gastrectomy for gastric cancer

Objective To explore the clinical efficacy of Da Vinci robot-assisted radical gastrectomy for gastric cancer. Methods The retrospective cohort study was conducted. The clinicopathological data of 472 patients who underwent radical gastrectomy for gastric cancer in the 940 Hospital of the People′s Liberation Joint Service from June 2016 to June 2018 were collected. There were 372 males and 100 females, aged (57±11)years, with a range from 17 to 85 years. Patients underwent gastrointestinal angiography, magnetic resonance imaging, computed tomography or gastrointestinal endoscopy before surgery, and were diagnosed with gastric cancer by biopsy. Of the 472 patients, 241 underwent Da Vinci robot-assisted radical gastrectomy for gastric cancer were allocated into robotic group and 231 underwent laparoscopy-assisted radical gastrectomy were allocated into laparoscopic group. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up and survival. Follow-up using outpatient examination and telephone interview was performed to detect the tumor recurrence and metastasis and survival of patients up to January 30, 2019. Measurement data with normal distribution were expressed as Mean±SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were described as M (range). Count data were described as absolute number or percentage, and the chi-square test was used for comparison between groups. Comparison of ordinal data was done using the rank-sum test. The accumulative survival rate, tumor-bearing survival rate and mortality of tumor recurrence were calculated by the Kaplan-Meier method, and Log-rank test was used for survival analysis. Results (1) Surgical situations: 472 patients underwent successful operation, with R0 margin. Cases with total gastrectomy + D2 lymph node dissection + Roux-en-Y anastomosis, cases with distal subtotal gastrectomy + D2 lymph node dissection + Billroth Ⅱ anastomosis, operation time, upper margin distance, lower margin distance, tumor diameter, cases with shallow muscular invasion, deep muscular invasion, subserosal invasion and serosal invasion (depth of tumor invasion)were 107, 134, (234±44)minutes, (4±3)cm, (6±4)cm, (5 ±3)cm, 8, 17, 32, 184 in the robotic group, and 94, 137, (239±46)minutes, (4±3)cm, (6±4) cm, (5±3)cm, 7, 19, 30, 175 in the laparoscopic group, respectively; there was no significant difference in above indicators between the two groups (χ2=0.200, 2.459, t=-1.212, -1.074, -0.420, -1.236, Z=0.171, P>0.05). The volume of intraoperative blood loss, number of lymph nodes dissected in total gastrectomy, number of lymph nodes dissected in distal subtotal gastrectomy were (126±113)mL, 45±14, and 36±18 in the robotic group, and (149±132) mL, 39±14, 30±16 in the laparoscopic group, showing statistically significant differences between the two groups (t=-2.093, 3.275, 2.195, P 0.05). Eighteen out of 472 patients had complications. There were 3 cases of anastomotic leakage in the robotic group, 2 cases of gastroplegia, 1 case of duodenal stump, and 1 case of pulmonary infection, with a incidence of postoperative complication as 2.90%(7/241). There were 4 cases of anastomotic leakage in the laparoscopic group, 1 case of gastroplegia, 1 case of duodenal stump, and 3 cases of pulmonary infection, with a incidence of postoperative complication as 3.90%(9/231). There was no statistically significant difference in the incidence of postoperative complication between the two groups (χ2=1.503, P>0.05). Patients with digestive tract fistula were re-explored and performed continuous flushing-negative pressure aspiration and nutritional support treatment, and then discharged after improvement. Patients with gastroplegia and lung infection were discharged after corresponding conservative treatment. (3) Follow-up and survival: 404 out of 472 patients were followed up for 7-31 months, with a median follow-up time of 19 months, including 212 in the robotic group and 192 in the laparoscopic group. The 3-year survival rates were 96.70% and 91.67% in the robotic group and laparoscopic group, with no statistically significant difference between the two groups (χ2=1.037, P>0.05). During the follow-up, the tumor-bearing survival rate and mortality of tumor recurrence of the robotic group were 0.47% and 2.36%, respectively, versus 1.04% and 6.77% of the laparoscopic group, with statistically significant differences between the two groups (χ2=3.198, 4.208, P<0.05). Conclusion The Da Vinci robot-assisted radical gastrectomy for gastric cancer is safe and effective, which can reduce volume of intraoperative blood loss, shorten the postoperative recovery time, increase the number of lymph node dissection, however, it will increase the treatment expense. Key words: Gastric neoplasms; Gastric cancer; Radical gastrectomy; Efficacy; Economy; Da Vinci robotic surgical system; Laparoscopy

Effect of preoperative splenectomy on the prognosis after liver transplantation

Objective To investigate the influence of preoperative splenectomy on the prognosis after liver transplantation. Methods The retrospective cohort study was conducted. The clinical data of 95 patients who underwent liver transplantation in the Third Affiliated Hospital of Sun Yat-sen University between January 2004 and January 2014 were collected. Thirty-five patients undergoing preoperative splenectomy and pericardial devascularization and 60 undergoing spleen-preserving liver transplantation were allocated into the study group and control group, respectively. All patients received modified piggyback liver transplantation by the same team. Observation indicators: (1) intra- and post-operative situations; (2) follow-up and survival. The follow-up using telephone interview and outpatient examination was performed once every a week within 3 months postoperatively, once every one month within 6 months postoperatively and once every 3 months after 1 year postoperatively up to January 2016, including routine blood test, plasma-drug concentration of immunosuppressive agent and function of liver and kidney. Ultrasound and abdominal CT were used to monitor the long-term complication and survival. The measurement data with normal distribution were represented as ±s, and comparison between groups was done by the t test. Comparison of count data was done by the chi-square test. Results (1) Intra- and post-operative situations: all patients underwent successful liver transplantation. The operation time, volumes of intraoperative blood loss and blood transfusion were (483 ± 136) minutes, (5 683±2 950)mL, (4 887±3 682)mL in the study group and (392±103)minutes, (3 522±1 885)mL, (3 455±2 630)mL in the control group, respectively, with statistically significant differences between groups (t=3.683, 4.358, 2.202, P 0.05). The cases with postoperative infection, acute rejection, new-onset PVT in level 1-2 and 3-4 and PV stenosis were respectively 23, 0, 2, 0, 2 in the study group and 35, 1, 2, 0, 1 in the control group, with no statistically significant difference between groups (χ2=1.171, 0.590, 0.547, 1.184, P>0.05). Patients with postoperative infection and acute rejection were improved by symptomatic treatment. Two patients in the study group with PVT underwent anticoagulant and thrombolytic therapy, including 1 receiving interventional thrombectomy therapy. Two patients in the control group with new-onset PVT were cured by anticoagulant and thrombolytic therapy. Three patients with PV stenosis underwent percutaneous transhepatic portography (PTA) for balloon dilation, including 1 in the study group with good improvement after stent implantation. (2) Follow-up and survival: 95 patients were followed up for 3-24 months, with an average time of 18 months. During the follow-up, the rate of chronic rejection in study and control groups was 5.7%(2/35) and 5.0%(3/60), showing no statistically significant difference between groups (χ2=0.023, P>0.05). The 1- and 2-year accumulative survival rates were respectively 91.4%(32/35), 82.9%(29/35) in the study group and 93.3%(56/60), 76.7%(46/60) in the control group, with no statistically significant difference between groups (χ2=0.780, P>0.05). Conclusion The splenectomy before liver transplantation is easy to form PVT, increase time and difficulty of transplantation surgery, however, it doesn′t increase complication risk after transplantation and affect postoperative survival. Key words: Liver diseases; Liver transplantation; Splenectomy; Portal vein; Complications

Clinical significance of chromodomain helicase/ATPase DNA binding protein 1-like and human mutL homolog 1 gene expression in cholangiocarcinoma.

Cholangiocarcinoma is a highly malignant form of gastrointestinal cancer with an unfavorable prognosis. The novel oncogene chromodomain helicase/ATPase DNA binding protein 1-like (CHD1L) has been confirmed to serve a vital role in numerous types of cancer, including liver cancer. Mismatch repair (MMR) is a common DNA repair process that contributes to the preservation of the integrity and stability of genetic substances. Human mutL homolog 1 gene (hMLH1) is an important MMR protein family member. The present study aimed to evaluate the pathological and clinical features of cholangiocarcinoma, and to investigate the clinical significance of CHD1L and hMLH1 expression in cholangiocarcinoma. A total of 108 samples from cholangiocarcinoma tumor tissues and 60 samples from normal bile duct tissue were obtained from patients admitted to The Second Affiliated Hospital of Nanchang University between May 2005 and May 2014. All cholangiocarcinoma cases were pathologically confirmed. The expression of CHD1L and hMLH1 was examined by immunohistochemistry analysis. The expression of CHD1L in cholangiocarcinoma (94.44%) was significantly higher than in normal bile duct tissues (40.00%). CHD1L expression was associated with gallstone history, serum carbohydrate antigen 19-9 (CA19-9) level and Tumor-Node-Metastasis (TNM) stage (P<0.05). hMLH1 expression in cholangiocarcinoma (77.78%) was significantly lower than in normal bile duct tissues (96.67%), and was associated with gender, age, serum CA19-9 level, the presence of hepatitis B virus surface antigen, TNM stage and tumor diameter (P<0.05). Kaplan-Meier survival curve analysis indicated that the 3-year accumulative survival rates for CHD1L-positive and -negative patients differed significantly (P<0.05; 17.90 and 83.33%, respectively). There was no statistically significant difference (P>0.05) between the 3-year accumulate survival rates for hMLH1-positive and -negative patients (38.90 and 33.30%, respectively). High CHD1L expression and low hMLH1 expression levels were observed in patients with cholangiocarcinoma, and their abnormal expression patterns were associated with the progression of malignancy and an unfavorable disease prognosis. Therefore, CHD1L and hMLH1 may be potential prognostic biomarkers for cholangiocarcinoma.

Effect of postoperative systemic antipsychotic therapy on psychiatric recurrence in patients with meningiomas

A number of patients with meningiomas and psychiatric disorders will suffer psychiatric symptom recurrence following tumorectomies. The present study reported a retrospective analysis regarding 42 cases of patients with meningiomas using complete clinical follow-up data from June 2005 to June 2013. The patients were divided into the systemic antipsychotic (SP) group (n=20) following 6months of postoperative SP therapy and the none-SP (NSP) group (n=22), who did not receive postoperative antipsychotic treatment. Patients were assessed using the Positive and Negative Syndrome Scale (PANSS) and Brief Psychiatric Rating Scale (BPRS) at the time points of prior to surgery, immediately following surgery, and 6 months, 12 months and 3 years following surgery. The effective rate, recurrence rate, rehospitalization rate and survival analysis were calculated. The BPRS score and PANSS scores (including PANSS positive, PANSS negative, PANSS general psychopathology and PANSS overall) in the SP group at 6 months, 12 months and 3 years following surgery were significantly decreased compared with the NSP group (P<0.05). The effective rate was 95, 90 and 90% at 6 months, 12 months and 3 years, respectively, in the SP group, whilst it was 68.2, 63.6 and 59%, respectively, in the NSP group, which was statistically significant (χ2=4.89, χ2=4.01 and χ2=5.12; P<0.05). The recurrence rate of the SP group was 0, 5 and 10% at 6 months, 12 months and 3 years, respectively, whilst in the NSP group it was 22.7, 31.8 and 54.5%, respectively, which was statistically significant (χ2=5.16, χ2=4.89 and χ2=9.34; P<0.05). The rehospitalization rate of the SP group was 0, 0 and 5% at 6 months, 12 months and 3 years, respectively, whilst in the NSP group it was 13.6, 22.7 and 36.4%, respectively, and the data at 12 months and 3 years was statistically significant (χ2=5.16 and χ2=6.12; P<0.05). Kaplan-Meier survival analysis indicated that the accumulative survival rates of recurrence and rehospitalization in the SP group were improved compared with the NSP group. The log-rank of recurrence was χ2=9.369 (P=0.002) and the log-rank of rehospitalization was χ2=6.330 (P=0.012). In conclusion, postoperative SP therapy is of great importance to the consolidation of mental symptoms in patients with meningiomas and psychiatric symptoms, and it may significantly reduce the recurrence and rehospitalization rates.

Developmental responses of Cryptolaemus montrouzieri to heavy metals transferred across multi-trophic food chain

The current studies were carried out to observe the variations in development, biology and life table parameters of ladybird beetle, Cryptolaemus montrouzieri, feeding on pink hibiscus mealybug (Dysmicoccus neobrevipes) contaminated with heavy metals (cadmium, lead, and nickel) bio-transferred across a multi-trophic chain. The developmental time required for immature life stages (1st, 2nd, 3rd, 4th instar nymphs, pupae) and total developmental period (egg-adult) differed significantly among different heavy metal treatments and control. The accumulated survival rate of C. montrouzieri immature life stages also differed significantly among different heavy metal treatments and control. Different parameters of adult female biology (Pre-oviposition period, fecundity, female longevity) were adversely affected by different heavy metals. Life table analysis revealed that all the heavy metals caused significant reduction in net reproduction rate (R0) and intrinsic rate of increase (r) while the mean generation time (T) and doubling time (Dt) were significantly higher than control. The results obtained provide possible insight into the implications of heavy metals on the population dynamics of insect predator (C. montrouzieri) in a multi-trophic food chain. However, further research is required on genetic as well as physiological processes involved in the regulation of growth and development of C. montrouzieri.