Risk Factor For Adverse Prognosis Research Articles

CD3, CD8, IFN-γ, tumor and stroma inflammatory cells as prognostic indicators for surgically resected SCLC: evidences from a 10-year retrospective study and immunohistochemical analysis

Current clinical guidelines limit surgical intervention to patients with cT1-2N0M0 small cell lung cancer (SCLC). Our objective was to reassess the role of surgery in SCLC management, and explore novel prognostic indicators for surgically resected SCLC. We reviewed all patients diagnosed with SCLC from January 2011 to April 2021 in our institution. Survival analysis was conducted using the Kaplan–Meier method, and independent prognostic factors were assessed through the Cox proportional hazard model. In addition, immunohistochemistry (IHC) staining was performed to evaluate the predictive value of selected indicators in the prognosis of surgically resected SCLC patients. In the study, 177 SCLC patients undergoing surgical resection were ultimately included. Both univariate and multivariate Cox analysis revealed that incomplete postoperative adjuvant therapy emerged as an independent risk factor for adverse prognosis (p < 0.001, HR 2.96). Survival analysis revealed significantly superior survival among pN0-1 patients compared to pN2 patients (p < 0.0001). No significant difference in postoperative survival was observed between pN1 and pN0 patients (p = 0.062). Patients with postoperative stable disease (SD) exhibited lower levels of tumor inflammatory cells (TIC) (p = 0.0047) and IFN-γ expression in both area and intensity (p < 0.0001 and 0.0091, respectively) compared to those with postoperative progressive disease (PD). Conversely, patients with postoperative SD showed elevated levels of stromal inflammatory cells (SIC) (p = 0.0453) and increased counts of CD3+ and CD8+ cells (p = 0.0262 and 0.0330, respectively). Survival analysis indicated that high levels of SIC, along with low levels of IFN-γ+ cell area within tumor tissue, may correlate positively with improved prognosis in surgically resected SCLC (p = 0.017 and 0.012, respectively). In conclusion, the present study revealed that the patients with pT1-2N1M0 staging were a potential subgroup of SCLC patients who may benefit from surgery. Complete postoperative adjuvant therapy remains an independent factor promoting a better prognosis for SCLC patients undergoing surgical resection. Moreover, CD3, CD8, IFN-γ, TIC, and SIC may serve as potential indicators for predicting the prognosis of surgically resected SCLC.

Treatment Pattern and Survival of Human Immunodeficiency Virus Infection-Related Lymphoma in China 2008-2021

Background Over the past few decades, little has been known about HIV-related lymphoma, and there has been a lack of treatment. However, with the development of cART therapy in the 1990s, the survival of HIV-related lymphoma patients has been significantly improved, but there is still a lack of large-scale data reports on HIV-related lymphoma patients in China.Therefore, we performed a multi-center study to analyze the clinical characteristics and outcomes of HIV-related lymphoma patients in China. Methods We retrospectively analyzed the data of 443 patients with human immunodeficiency virus infection-related lymphoma from eleven large academic centers in China from 2008 to 2021. Results In the entire cohort, the median age was 47 years (range, 18-90) at lymphoma diagnosis, and 364 patients were male (82.2%).More than half of the patients came from public health treatment centers. The most common type of pathology was DLBCL (61.6%)and BL (10.6%). Most patients had elevated lactate dehydrogenase (56.2%), bulky tumor(30.7%), B symptoms(39.3%), extranodal involvement(52.8%), and advanced Ann Arbor stage (60.3%) at diagnosis. High international prognostic index (IPI) score (3-5) at diagnosis was found in 58.7% of patients. The number of patients with CD4 cell count below 200/μl was 244, accounting for 55.1% of the total. The percentage of patients who gave up chemotherapy was as high as 15.6%. The median follow-up of our cohort was 10.1 (0.1-160) months. The overall 1-year OS rates 70.2%. Cox univariate analysis showed that education level(HR=0.682, 95%CI 0.468-0.994; p=0.046),B symptoms(HR=0.730, 95%CI 0.562-0.948; p=0.018),PLR(ratio of the number of platelets to the number of lymphocytes)(HR=1.000, 95%CI 1.000-1.001; p=0.044),elevated LDH(HR=0.607, 95%CI 0.463-0.769; p=0.000),extranodal involvement(HR=1.498, 95%CI 1.141-1.968; p=0.004) were independent risk factor for adverse prognosis based on overall survival (OS).The overall 1-year PFS rates was 67.4%.Cox univariate analysis showed that age≥60(HR=1.819, 95%CI 1.197-2.763; p=0.005),anemia(Hb&amp;lt;120g/L)(HR=1.564, 95%CI 1.099-2.226; p=0.013),LDH(HR=3.646, 95%CI 2.115-6.286; p=0.000),CNS involvement(HR=2.209, 95%CI 1.384-3.524; p=0.001) were independent risk factor for adverse prognosis based on progression-free survival(PFS). Conclusion This is the largest retrospective study of HIV-associated lymphoma in China to date. Our results show that the proportion of men with HIV infection is much higher than that of women, which is positively correlated with the proportion of HIV infection. Patients with HIV-associated lymphoma have more risk factors at first diagnosis, including late stage, high risk layer, elevated LDH, extranodal involvement, and low CD4 cell count.

Exosomal circ-0020887 and circ-0009590 as novel biomarkers for the diagnosis and prediction of short-term adverse cardiovascular outcomes in STEMI patients.

This study attempted to identify exosomal circular RNAs (circRNAs) as diagnostic and prognostic biomarkers for patients with ST-segment elevation myocardial infarction (STEMI). The differentially expressed exosomal circRNAs (DEECs) were screened from microarray dataset (GSE160717 and GSE197137) and RNA-Seq dataset (GSE208194), and the expression levels of DEECs in patients with STEMI were validated using reverse transcription and quantitative real-time PCR. The diagnostic value of DEECs was assessed using receiver operating characteristic curves. The major adverse cardiovascular event (MACE)-free 1-year survival rate was evaluated using the Kaplan-Meier method, and the factors affecting prognosis were determined using Cox regression model analysis. Results showed that four DEECs were screened including exo-circ-0001490, exo-circ-0020887, exo-circ-0009590, and exo-circ-0055440, and only upregulated exo-circ-0020887 and exo-circ-0009590 expression was validated in patients with STEMI. The exo-circ-0020887 and exo-circ-0009590 expression was positively correlated with hs-CRP, LDL-C, cTnI, and CK-MB. The exo-circ-0020887 and exo-circ-0009590 showed good diagnostic efficacy to distinguish STEMI patients from healthy controls (area under the curves: 0.85 and 0.80). STEMI patients with high levels of exo-circ-0020887 and exo-circ-0009590 had lower MACE-free 1-year survival rate, and exo-circ-0020887 and exo-circ-0009590 expression was independent risk factors for adverse prognosis. In summary, upregulation of plasma exo-circ-0020887 and exo-circ-0009590 might act as potential biomarkers for the diagnosis and prediction of short-term adverse cardiovascular outcomes in patients with STEMI.

Pan-Cancer Profiling and Digital Pathology Analysis Reveal Negative Prognostic Biomarker ZPR1 Associated with Immune Infiltration and Treatment Response in Hepatocellular Carcinoma.

ZPR1 is a zinc finger-containing protein that plays a crucial role in neurodegenerative diseases, lipid metabolism disorders, and non-alcoholic fatty liver disease. However, the expression pattern, prognostic value, and treatment response of ZPR1 in pan-cancer and hepatocellular carcinoma (HCC) remain unclear. Pan-cancer expression profiles and relevant clinical data were acquired from UCSC Xena platform. Pan-cancer expression, epigenetic profile, and clinical correlation analysis for ZPR1 were performed. We next explored the prognostic significance and potential biological functions of ZPR1 in HCC. Furthermore, the relationship between ZPR1 and immune infiltration and treatment response was investigated. Finally, quantitative immunohistochemistry (IHC) analysis was applied to assess the correlation of ZPR1 expression and immune microenvironment in HCC tissues using Qupath software. ZPR1 was differentially expressed in most tumor types and significantly up-regulated in HCC. ZPR1 showed hypo-methylated status in most tumors. Pan-cancer correlation analysis indicated that ZPR1 was closely associated with clinicopathological factors and TMB, MSI, and stemness index in HCC. High ZPR1 expression could be an independent risk factor for adverse prognosis in HCC. ZPR1 correlated with immune cell infiltration and therapeutic response. Finally, IHC results suggested that ZPR1 correlated with CD4, CD56, CD68, and PD-L1 expression and is a promising pathological diagnostic marker in HCC. Immune infiltrate-associated ZPR1 could be considered a novel negative prognostic biomarker for therapeutic response in HCC.

Overview of Long-Term Outcome in Adults with Systemic Right Ventricle and Transposition of the Great Arteries: A Review.

The population of patients with a systemic right ventricle (sRV) in biventricular circulation includes those who have undergone an atrial switch operation for destro-transposition of the great arteries (d-TGA) and those with congenitally corrected transposition of the great arteries (ccTGA). Despite the life expectancy of these patients is significantly increased, the long-term prognosis remains suboptimal due to late complications such as heart failure, arrhythmias, and premature death. These patients, therefore, need a close follow-up to early identify predictive factors of adverse outcomes and to implement all preventive therapeutic strategies. This review analyzes the late complications of adult patients with an sRV and TGA and clarifies which are risk factors for adverse prognosis and which are the therapeutic strategies that improve the long-term outcomes. For prognostic purposes, it is necessary to monitor sRV size and function, the tricuspid valve regurgitation, the functional class, the occurrence of syncope, the QRS duration, N-terminal pro B-type natriuretic peptide levels, and the development of arrhythmias. Furthermore, pregnancy should be discouraged in women with risk factors. Tricuspid valve replacement/repair, biventricular pacing, and implantable cardioverter defibrillator are the most important therapeutic strategies that have been shown, when used correctly, to improve long-term outcomes.

Characteristics of Wellens' Syndrome in the Current PCI Era: A Single-Center Retrospective Study.

The goal of this retrospective study was to reveal the prevalence, angiographic characteristics, clinical presentation, and long-term outcomes of non-ST-segment elevation myocardial infarction (NSTEMI) patients with Wellens' syndrome. Procedural results for percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) have improved in recent years. However, there is still a paucity of available clinical trial data for Wellens' syndrome even though it is a well-known high-risk ACS. Among a total of 3528 patients with ACS who underwent angioplasty from 2017 to 2019 at the Cardiovascular Center of Beijing Friendship Hospital, 476 NSTEMI patients with culprit left anterior descending (LAD) vessels were enrolled in this study. According to electrocardiographic criteria of Wellens' syndrome, the patients were divided into a Wellens group (n = 138) and a non-Wellens group (n = 338). The primary endpoint was cardiac death; the secondary endpoints were main adverse cardiovascular and cerebrovascular events (MACCEs), a composite of all-cause death, cardiac death, heart failure, target lesion revascularization, recurrent myocardial infarction, and stroke. All of the medical and follow-up data were obtained from our institutional database. The incidence of Wellens' syndrome in all ACS patients was 5.7% (200 of 3528). Among the 200 patients with Wellens' syndrome, 138 had NSTEMI, for a proportion of 69%. There was a significant decrease in the percentage of preexisting coronary heart disease (CHD), prior myocardial infarction, and previous PCI (P < 0.05) in the Wellens group compared with the non-Wellens group. On coronary angiography, single-vessel lesions were more common in the Wellens group (11.6% vs. 5.3%, P=0.016), and almost all (97.1%) of these patients received drug-eluting stents. Notably, the Wellens group had a higher proportion of early PCI than the non-Wellens group (71% vs. 61.2%, P=0.044). At 24 months, there was no statistically significant difference in cardiac death (P=0.111) between the two groups, but the MACCEs were comparable (Wellens: 5.1% vs. non-Wellens: 13.3%, P=0.009). Age ≥65 years was the largest independent risk factor for adverse prognosis. With early recognition and aggressive intervention, Wellens' syndrome is no longer a risk factor for adverse prognosis in patients with NSTEMI in the current PCI era.

Circulating Inflammatory Cytokine Associated with Poor Prognosis in Moyamoya Disease: A Prospective Cohort Study.

Inflammation is a key factor in the development of moyamoya disease. However, the cytokine distribution in moyamoya disease and its impact on prognosis remain unclear. A total of 204 patients with moyamoya disease were enrolled in this study. The peripheral blood was analyzed for baseline data and cytokines, which included IL-6, IL-1β, IL-2R, IL-8, and TNF-α. Patients with the RNF213 mutation and those without the mutation were compared in terms of their differences in cytokines. A mRS score ≥2 was defined as a poor prognosis, and a mRS score <2 was described as a good prognosis, and differences in cytokines were compared between the two groups. Regression analysis was performed to identify markers affecting prognosis. TNF-α and IL-6 levels were higher in the group without the RNF213 mutation compared to the mutation group. Multivariate stepwise regression analysis indicated that the G3 subgroup of IL-6 and the G4 subgroup of TNF-α were the independent risk factors for adverse prognosis in adults with moyamoya disease (OR 3.678, 95% CI [1.491, 9.074], p = 0.005; OR 2.996, 95% CI [1.180, 7.610], p = 0.021). IL-6 and TNF-α were associated with poor prognosis in adult patients with moyamoya disease.

COVID-19 Preventive Behaviors and Related Beliefs Among Diabetics: The Use of Protection Motivation Theory

Background: Recent data from coronavirus disease 2019 (COVID-19) confirm that diabetes, along with advanced age, is an important risk factor for adverse prognosis. Therefore, the present study aimed to determine the status of COVID-19 prevention behaviors and related beliefs among diabetic patients in Hamadan province using protection motivation theory (PMT). Methods: This cross-sectional descriptive study was conducted from April to September 2020. The research population included all diabetics, of whom 355 patients, who referred to an adult endocrinologist in Hamadan, were selected using the convenience sampling method. The data collection tool was a researcher-made questionnaire with demographic variables and PMT constructs. Data were analyzed by SPSS 22 using descriptive statistics, correlation, and logistic regression. Results: According to the result, the PMT construct explained 15% of the variance in the frequency of the intention to perform preventive behaviors. Perceived sensitivity (β=-0.128), perceived response efficiency (β=0.140), and perceived response cost (β=0.386) were the best significant predictors of behavior (P&lt;0.05). There was a significant relationship between gender (P&lt;0.001), marital status (P&lt;0.001), and level of education (P=0.040) in observing preventive behaviors. Conclusion: It is necessary to enhance the levels of awareness and self-efficacy of diabetic patients to reduce fear in this at-risk group. Further, it is appropriate to use PMT to promote preventive behaviors.

Clinical characteristics and outcomes of newly diagnosed patients with HIV-associated aggressive B-cell NHL in China.

Little is known about the incidence, clinical characteristics and prognostic factors in HIV associated lymphoma as these are less common than HIV‐negative lymphoma in China. Currently, there are no standard guidelines for treatment of these patients. Therefore, we performed a study to analyse the clinical characteristics and outcomes of newly diagnosed HIV‐associated aggressive B‐cell non‐Hodgkin's lymphoma (NHL) patients in Chongqing University Cancer Hospital (CUCH). Totally 86 newly diagnosed HIV‐associated aggressive B‐cell NHL patients in CUCH, southwest China, from July 2008 to August 2021, were analysed. In the entire cohort, median age was 48 years (range, 23–87 years), and more patients were male (87.2%). Most patients had elevated lactate dehydrogenase (LDH) (82.6%), advanced ann arbor stage (80.2%) and high IPI score (IPI score, 3–5) (62.7%) at diagnosis. Median CD4+ T‐cell count at diagnosis was 191/μl (range, 4–1022), 84 patients (97.7%) were on combination antiretroviral therapy (cART) at lymphoma diagnosis. In DLBCL patients, cox multivariate analysis showed that age ≥ 60 (HR = 2.251, 95%CI 1.122–4.516; p = 0.012), elevated LDH (HR = 4.452, 95%CI 1.027–19.297; p = 0.041) and received less than two cycles of chemotherapy (HR = 0.629, 95%CI 0.589–1.071; p = 0.012) were independent risk factors for adverse prognosis based on PFS. Age ≥ 60 (HR = 3.162, 95%CI 1.500–6.665; p = 0.002) and received less than two cycles of chemotherapy (HR = 0.524, 95%CI 0.347–0.791; p = 0.002) were also independent risk factor for adverse prognosis based on OS. In BL patients, cox multivariate analysis showed that elevated LDH and received less than two cycles of chemotherapy were independent risk factors for adverse prognosis. In the DLBCL group, median PFS times in the received rituximab and no received rituximab groups were not reached and 12 months, respectively (p = 0.006). Median OS times were not reached and 36 months, respectively (p = 0.021). In the BL group, median PFS times in the received rituximab and no received rituximab groups were not reached and 4.8 months, respectively (p = 0.046). Median OS times were not reached and 10.1 months, respectively (p = 0.035). Overall, these data indicated that standardized anti‐lymphoma therapy and rituximab administration were significantly associated with improved outcomes in patients with HIV‐associated DLBCL and BL.

A nomogram based on systemic inflammation markers can predict adverse outcomes in patients with heart failure

To construct a nomogram based on systemic inflammation markers for assessing the risk of adverse outcomes in patients with heart failure (HF). We retrospectively collected the clinical data from 430 patients with HF hospitalized in our hospital from June, 2017 to June, 2019.The patients were randomized into derivation group (n=286) and validation group (n=144) at a 7:3 ratio using R software.The risk factors for adverse prognosis of HF were screened using COX regression analysis to establish the nomogram.The predictive accuracy of the nomogram was assessed using calibration curves.Decision curve analysis (DCA) and Kaplan-Meier curves were used to evaluate the clinical utility of the nomogram. The results of COX multivariate regression analysis showed that age (P=0.030), body mass index (BMI, P=0.002), New York Heart Association classification (NYHA, P < 0.001), hypertension (P=0.004), lymphocyte count (P < 0.001), platelet-to-lymphocyte ratio (PLR, P=0.007), neutrophil-to-lymphocyte ratio (NLR, P < 0.001) and system inflammation response index (SIRI, P < 0.001) were prognostic factors for HF patients.The nomogram was constructed using these prognostic factors.The C-indexes of the derivation and validation cohorts were 0.719(95%CI: 0.680-0.758) and 0.732(95%CI: 0.693-0.771), respectively.The calibration curves showed a good concordance of the nomogram for predicting adverse outcomes in patients with HF. The nomogram constructed based on the systemic inflammation markers and the conventional risk factors can predict adverse outcomes (mortality and readmission) in patients with HF.

The different predictive effects of the intensity and proportion of CD20 expression on the prognosis of B-lineage acute lymphocyte leukemia.

The prognostic effects of the CD20 positivity have been studied extensively in B‐lineage acute lymphocyte leukemia (B‐ALL) patients, but the results remain controversial. The aim of this study is to investigate the different predictive effects of the intensity and proportion of CD20 expression on the prognosis for B‐ALL patients by retrospective analysis. The mean fluorescence intensity (MFI) and percentage of CD20 on B‐ALL cells from 206 patients with B‐ALL were dynamically measured by flow cytometry, and their optimal cut‐off values were determined using the receiver operating characteristic curve. Changes in MFI and percentage of CD20 at various time points and their relationship with prognosis were analyzed. We found that a low baseline CD20 MFI or high CD20 proportion was significantly associated with shorter 5‐year overall survival and progression‐free survival, and the combination of these two factors could more accurately predict worse survival for B‐ALL patients. Furthermore, low CD20 MFI or a high CD20 proportion had different predictive effects for ALL patients with different clinical characteristics and could serve as an independent risk factor for adverse prognosis. There were significant decreases in both the intensity and proportion of CD20 after recurrence in the absence of rituximab treatment, particularly with CD20 intensity. Notably, the decrease of CD20 intensity after recurrence indicated a more shortened survival time. Finally, we conclude that a low intensity or high proportion of CD20 expression may be used as an indicator for inferior prognosis for B‐ALL patients. CD20 intensity is more likely to be a more universal biomarker for worse prognosis.

Clinical characteristics and prognostic features of 63 HIV-associated diffuse large B-cell lymphoma: a single-center real-world study in China

目的探讨HIV相关弥漫大B细胞淋巴瘤（DLBCL）患者的临床特征及预后。方法回顾性分析2008年7月至2021年8月重庆大学附属肿瘤医院确诊的63例HIV相关DLBCL患者的临床资料。生存分析采用Kaplan-Meier方法，组间生存的比较采用Log-rank检验，多因素分析采用Cox回归模型。结果63例患者中，男57例（90.5％），中位年龄49（23～87）岁。主要病理类型为生发中心来源（GCB），为47例（74.6％）。29例（46.0％）患者合并淋巴结外病变，17例（27.0％）患者合并大包块（最大直径≥7.5 cm），20例（31.7％）患者伴随B症状。CD4+淋巴细胞中位数为203（4～1022）×106/L，49％（25/51）的患者CD4+细胞数<200×106/L，51％（26/51）的患者CD4+细胞数≥200×106/L。43.1％（25/58）的患者IPI评分0～2分，56.9％（33/58）的患者IPI评分 3～5分。78％（46/59）的患者Ann Arbor分期Ⅲ/Ⅳ期。16例（25.4％）患者未接受化疗，14例（22.2％）患者接受小于4个周期的化疗，33例（52.4％）患者接受4个周期及以上的化疗。在接受化疗的患者中，61.7％（29/47）的患者采用R-CHOP样方案，38.3％（18/47）的患者采用CHOP样方案。总体患者的1、2、3和5年总生存（OS）率分别为65.0％、53.8％、47.1％和43.5％。单因素分析显示年龄≥60岁（P＝0.012）、美国东部肿瘤协作组体能状况（ECOG-PS）评分2～4分（P＝0.043）、IPI评分3～5分（P＝0.001）、β2-微球蛋白升高（P＝0.007）和全身化疗周期数<4（P<0.001）为影响患者OS的不良预后因素。Cox多因素分析显示年龄≥60岁（HR＝2.272，95％CI 1.110～4.651，P＝0.025）、IPI评分3～5分（HR＝3.562，95％CI 1.794～7.074，P<0.001），ECOG-PS评分2～4分（HR＝2.675，95％CI 1.162～6.153，P＝0.021）和化疗周期数<4（HR＝0.290，95％CI 0.176～0.479，P<0.001）为影响OS的预后危险因素。结论HIV相关DLBCL是最常见的HIV相关肿瘤，男性多见，1年内病死率高，化疗联合抗逆转录病毒治疗可显著改善患者预后。

LncRNA FGD5-AS1 and miR-130a Can Be Used for Prognosis Analysis of Patients with Chronic Periodontitis.

Background lncRNA and microRNA affect the occurrence and development of many diseases, so they are expected to become diagnostic or predictive indicators. But the relationship between lncRNA FGD5-AS1 and miR-130a and the prognosis of chronic periodontitis is still unclear. The purpose of this study is to explore the prognostic value of the two in chronic periodontitis. Objective This study set out to investigate the prognostic value of lncRNA FGD5-AS1 and miR-130a in chronic periodontitis. Methods Eighty-seven patients with chronic periodontitis who visited our hospital from March 2016 to August 2017 were collected as an observation group (OG), and 72 subjects with periodontal health who underwent physical examination at the same time were collected as a control group (CG). The FGD5-AS1 and miR-130a expression levels of subjects in the two groups were compared, and prognosis of 87 patients who were reviewed one year later was counted. The expression levels of patients with different prognoses were compared when they were admitted to our hospital. We drew the ROC curve and explored the prognostic value of FGD5-AS1 and miR-130a. The risk factors for adverse prognosis were analyzed through logistic regression. Results FGD5-AS1 was lowly expressed in patients, while miR-130a was highly expressed. FGD5-AS1 and miR-130a had certain diagnostic and predictive value in chronic periodontitis and patient prognosis. The higher the periodontal pocket, the higher the attachment loss. Lower FGD5-AS1 and higher miR-130a levels were independent prognostic risk factors. Conclusion lncRNA FGD5-AS1 is lowly expressed in patients with chronic periodontitis, while miR-130a is highly expressed. Both of them have certain diagnostic and prognostic value in chronic periodontitis and may be potential diagnostic and prognostic indicators.

Early symptomatic benefit indicates long-term prognosis after transcatheter mitral valve edge-to-edge repair in functional and degenerative etiology

BackgroundMitral regurgitation (MR) is common in patients with heart failure and constitutes an independent risk factor for adverse prognosis besides NYHA-class. The predictive value of dyspnea reduction after transcatheter mitral valve repair (TMVr) on outcome has not been investigated up to now. Methods and resultsWe enrolled 627 consecutive patients (47.0% female, 57.4% functional MR; median follow-up 486 days[IQR 157/961]; survival status available in 96.8%; symptoms assessed in n = 556 at baseline / n = 406 at 1 month) treated with isolated percutaneous mitral valve edge-to-edge repair in our center from 06/2010–03/2018 (exclusion of combined forms of TMVr) in a monocentric retrospective analysis. Survival was 97.6% at discharge, 73.9% after 1, 54.5% after 3, 37.6% after 5 and 21.7% after 7-years. Before TMVr, NYHA-classes III/IV were found in 89.0%. Of these, 74.7% reported symptomatic relief (reduction in NYHA-class) one month after procedure (NYHA class recorded in 406 patients at 30 days). NYHA-classes III/IV were documented in 37.2% (p < 0.001) at 30 days and in 36.6% (p < 0.001) at 1 year without significant changes between the follow-ups. Dyspnea reduction was accompanied by significantly improved long-term survival (1 year, 89.1 vs 71.2%, p = 0.001, 2 years: 75.5 vs 58.7%, p = 0.039) and was identified as an independent predictor for lower mortality (1-year HR for increased mortality by missing symptomatic improvement 2.94 [95%CI 1.53–5.65], p = 0.001; long-term HR 1.95 [95%CI 1.29–2.94], p = 0.001) independently in both etiologies of MR. ConclusionTMVr by edge-to-edge therapy enables early and sustainable symptomatic improvement in nearly 75% of the symptomatic patients. The simple assessment of postinterventional changes in NYHA-class might serve as an independent predictor for mid- and long-term prognosis in both FMR and DMR.

IgA vasculitis with nephritis in children.

Immunoglobulin A vasculitis (IgAV), formerly known as Henoch-Schönlein purpura (HSP), is the most common form of systemic vasculitis in children. Although the first case of IgAV was described more than 200 years ago, its etiology still remains unclear. Nephrological symptoms are observed in 30-50% of children during the course of the disease, and in up to 91% of cases within 6 weeks of the onset of the first symptoms. Whereas other organ manifestations of IgAV are mostly benign and self-limiting, nephritis may lead to chronic kidney disease (CKD) and end-stage renal disease (ESRD). Appropriate treatment commenced early enough can stop the disease progression. However, even in severe cases there are no evidence-based guidelines, which makes the therapeutic decisions more difficult. In this article, which is the most up-to-date overview regarding IgAV, we discuss the disease's pathogenesis, the clinical forms of renal involvement in the course of the disease, the risk factors for adverse prognosis and treatment options in accordance with current recommendations.

The prognostic value of postoperative blood glucose in non-diabetic patients with rheumatic heart disease

BackgroundBlood glucose (BG) is a risk factor of adverse prognosis in non-diabetic patients in several conditions. However, a limited number of studies were performed to explore the relationship between postoperative BG and adverse outcomes in non-diabetic patients with rheumatic heart disease (RHD).MethodsWe identified 1395 non-diabetic patients who diagnosed with having RHD, and underwent at least one valve replacement and preoperative coronary angiography. BG was measured at admission to the intensive care unit (ICU) after surgery. The association of postoperative BG level with in-hospital and one-year mortality was accordingly analyzed.ResultsIncluded patients were stratified into four groups according to postoperative BG level’s (mmol/L) quartiles: Q1 (< 9.3 mmol/L, n = 348), Q2 (9.3–10.9 mmol/L, n = 354), Q3 (10.9–13.2 mmol/L, n = 341), and Q4 (≥ 13.2 mmol/L, n = 352). The in-hospital death (1.1% vs. 2.3% vs. 1.8% vs. 8.2%, P < 0.001) and MACEs (2.0% vs. 3.1% vs. 2.6% vs. 9.7%, P < 0.001) were significantly higher in the upper quartiles. Postoperative BG > 13.0 mmol/L was the best threshold for predicting in-hospital death (area under the curve (AUC) = 0.707, 95% confidence interval (CI): 0.634–0.780, P < 0.001). Multivariate logistic regression analysis indicated that postoperative BG > 13.0 mmol/L was an independent predictor of in-hospital mortality (adjusted odds ratio (OR) = 3.418, 95% CI: 1.713–6.821, P < 0.001). In addition, Kaplan–Meier curve analysis showed that the risk of one-year death was increased for a postoperative BG > 13.2 (log-rank = 32.762, P < 0.001).ConclusionPostoperative BG, as a routine test, could be served as a risk measure for non-diabetic patients with RHD.

Effect of serum tumor necrosis factor receptor-6 level on prognosis of AECOPD patients with respiratory failure

Objective To study the expression of serum tumor necrosis factor receptor-6 (TR6) [decoy receptor 3 (DcR3)] in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with respiratory failure, and to analyze its influence on prognosis. Methods 134 patients with AECOPD admitted to our hospital from March 2015 to March 2017 were selected as the study subjects. According to whether or not respiratory failure occurred, they were divided into respiratory failure group (65 cases) and non-respiratory failure group (69 cases). Another 60 healthy volunteers who underwent physical examination in our hospital during the same period were selected as the control group. Serum albumin (ALB), C-reactive protein (CRP), first-second forced breathing volume (FEV1%), first-second forced breathing volume (FEV1/FVC), arterial partial oxygen pressure (PaO2) and arterial partial carbon dioxide pressure (PaCO2) were collected. Enzyme-linked immunosorbent assay (ELISA) was used to detect serum levels of interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-α) and DcR3. Results The levels of ALB, FEV1, FEV1/FVC and PaO2 in respiratory failure group were significantly lower than those in non-respiratory failure group and control group (P<0.05), and those in non-respiratory failure group were significantly lower than those in control group (P<0.05); the levels of CRP, PaCO2, IL-8, TNF-α and DcR3 in respiratory failure group were significantly higher than those in non-respiratory failure group and control group (P<0.05). The survival rate of high DcR3 level group was significantly lower than that of low DcR3 level group (P<0.05). High levels of TNF-α and DcR3 were independent risk factors for adverse prognosis of AECOPD patients with respiratory failure (P<0.05). Conclusions The high expression of DcR3 in serum of AECOPD patients with respiratory failure is an independent risk factor for adverse prognosis. Key words: Tumor necrosis factor decoy receptors; Pulmonary disease, chronic obstructive; Respiratory insufficiency

DJ-1 is a useful biomarker for invasive extrahepatic cholangiocarcinoma

We have previously reported that DJ-1 protein is up-regulated in cholangiocarcinoma compared with non-neoplastic epithelium of the bile duct in a study using liquid-chromatography mass spectrometry-based proteomics. The aim of this study was to clarify whether DJ-1 expression offers a biomarker for patients with invasive extrahepatic cholangiocarcinoma (EHCC) who undergo surgical resection with curative intent. Positive immunohistochemical (IHC) staining of DJ-1 was significantly more frequent in the cytoplasm of 96 invasive EHCCs (n = 28, 29.2%) than in that of 66 non-neoplastic epithelial lesions adjacent to invasive EHCC (n = 7, 10.6%; P = .006). No significant difference in clinicopathological features was evident between invasive EHCC patients with negative (n = 68) and positive (n = 28) IHC staining. However, negative IHC staining for DJ-1 in cytoplasm was selected as an independent risk factor for adverse prognosis on multivariate analysis (P = .004, hazard ratio 2.13, 95% confidence interval 1.28-3.57). Serum levels of DJ-1 in 16 invasive EHCC patients with metastasis were compared with 12 invasive EHCC patients without metastasis. Serum levels of DJ-1 tended to be higher in 16 patients with metastasis (median, 40.9 ng/ml) than in 12 patients without (27.6 ng/ml, P = .137). In addition, patients with high serum levels (≥ 40 ng/ml) of DJ-1 tended to have metastasis more frequently than those without (P = .054, Fisher's exact test). We concluded that IHC staining pattern and serum level of DJ-1 in patients with invasive EHCC might be predictive of prognosis and metastasis, respectively.

Clinical characteristics of childhood purulent meningitis and its risk factors for adverse prognosis

Objective To investigate the clinical characteristics of childhood purulent meningitis (PM) and the risk factors for its adverse outcome. Methods One hundred and nine children with PM were retrospective analyzed, who were admitted to pediatric department in Xijing Hospital of the Fourth Military Medical University from Ja-nuary 2008 to July 2016.They were divided into 5 age groups, the clinical features were compared among the different age groups.According to Glasgow prognostic score, all cases were then divided into 2 groups, the favorable outcome group and the adverse outcome group.All factors including normal information, disease history, clinical manifestations and laboratory examinations were compared between 2 groups. Results There were 72.5% (79/109 cases) of the patients younger than 3 years old.PM was prone to spring and winter, and most children with PM had preceding infection.The major clinical manifestations of PM were fever, convulsions and intracranial hypertension.The clinical manifestations of PM were different in different age groups, and convulsions were more commonly seen in less than 3 years old children, while headache, vomiting and meningeal stimulation had higher proportion in more than 3 years old children.The single factor analysis showed that there were repeated convulsions after admission (≥3 times), the cerebrospinal fluid (CSF) glucose(≤1.5 mmol/L), CSF protein(≥1 g/L), CSF/blood glucose ratio and complications were significantly different between 2 groups(all P 500×106 /L, blood and CSF cultivate positive rate, co-infection, brain CT/MRI abnormality, electroencephalogram abnormality, treatment and duration of seizure more than 5 minutes were not significantly different(all P>0.05). Multivariate analysis showed that there were repeated convulsions after admission (≥3 times) (OR=27.84, P=0.048), CSF protein(≥1 g/L)(OR=28.44, P=0.027)and low CSF/blood glucose ratio (OR=22.15, P=0.041)were independent risk factors for poor prognosis of PM. Conclusion PM happens mostly in infantile period, with different clinical manifestations at different ages.The independent risk factors for poor prognosis were repeated convulsions after admission (≥3 times), CSF protein(≥1 g/L)and low CSF/ blood glucose ratio.It indicates that if the high risk factors could be identified early, and then intervened immediately and followed up timely, it will be beneficial to improve the long-term prognosis. Key words: Purulent meningitis; Clinical feature; Adverse outcome; Risk factor

Mineral and Bone Disorder and Its Association with Cardiovascular Parameters in Chinese Patients with Chronic Kidney Disease.

Background:Mineral and bone disorder (MBD), especially hyperphosphatemia, is an independently risk factor for adverse prognosis in patients with chronic kidney disease (CKD). However, CKD-MBD among Chinese population was poorly studied. This study aimed to investigate the status of MBD and its association with cardiovascular parameters in Chinese patients with predialysis CKD.Methods:Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE) is a prospective multicenter cohort study involving predialysis CKD patients in China. Markers of MBD, including serum phosphorus, calcium, and intact parathyroid hormone, were measured in baseline samples at the patients’ entry. The association between serum phosphorus and abdominal aortic calcification (AAC), left ventricular hypertrophy (LVH) were examined by logistic regression models.Results:Altogether 3194 predialysis patients with mean estimated glomerular filtration of 51.8 ± 33.1 ml·min−1.1.73 m−2 were included. The proportion of patients with hyperphosphatemia were 2.6%, 2.9%, 6.8%, and 27.1% in CKD Stages 3a, 3b, 4, and 5, respectively. Moreover, 71.6% of the patients with hyperphosphatemia did not receive any phosphate-binder (PB). Lateral abdominal X-rays were obtained in 2280 patients, 9.8% of the patients were diagnosed as having AAC. Altogether 2219 patients had data of echocardiography, and 13.2% of them were diagnosed with LVH. Multivariate logistic regression analysis showed that serum phosphorus was independently associated with the presence of AAC and LVH.Conclusions:In Chinese patients with CKD, the percentage of hyperphosphatemia is comparable to that of other countries while the usage of PBs is suboptimal. The prevalence of vascular calcification in Chinese patients is relatively lower compared with the Caucasian population.