Risk Factor For Worse Prognosis Research Articles

Risk factors and outcomes of COVID-19 in New York City; a retrospective cohort study.

Coronavirus disease 2019 (COVID‐19) is a global pandemic and information on risk factors for worse prognosis is needed to accurately identify patients at risk and potentially provide insight into therapeutic options. In this retrospective cohort study, including 3703 patients with laboratory confirmed COVID‐19, we identified risk factors associated with all‐cause mortality, need for hospitalization and mechanical ventilation. Male gender was independently associated with increased risk of hospitalization (adjusted odds ratio [ORadj]: 1.62; 95% confidence interval [95% CI]: 1.38‐1.91)), mechanical ventilation (ORadj: 1.35; 95% CI: 1.08‐1.69) and death (ORadj: 1.46; 95% CI: 1.17‐1.82). Patients > 60 years had higher risk of hospitalization (ORadj: 5.47; 95% CI: 4.29‐6.96), mechanical ventilation (ORadj: 3.26; 95% CI: 2.08‐5.11) and death (ORadj: 13.04; 95% CI: 6.25‐27.24). Congestive heart failure (ORadj: 1.47; 95% CI: 1.06‐2.02) and dementia (ORadj: 2.03; 95% CI: 1.46‐2.83) were associated with increased odds of death, as well as the presence of more than two comorbidities (ORadj: 1.90; 95% CI: 1.35‐2.68). Patients with COVID‐19 of older age, male gender, or having more than two comorbidities are at higher risk of hospitalization, mechanical ventilation and death, and should therefore be closely monitored.

Virtual powers of observation: A telemedicine approach for the suspected COVID-19 patient.

Prior to COVID-19, telemedicine and its applications to the emergency department (ED) had made significant inroads toward remote evaluation and care. During the local peak of the COVID-19 pandemic in New York City (NYC), there was a dramatic increase in telemedicine based patient encounters for suspected COVID-19 symptoms. In response, pathways were developed to promote a standardized telemedicine approach to remote evaluation and assessment of suspected COVID-19 patients. A pathway was developed and implemented at two academic EDs in NYC, which collectively had approximately 8,300 telemedicine visits for suspected COVID-19 from March 2020 to June 2020. A protocol was developed by an expert consensus panel of four board-certified emergency physicians and two pediatric emergency physicians, all with telemedicine training/administrative roles. The pathway was initiated for any telehealth patient with suspected COVID-19 symptoms (cough, fever, shortness of breath, and bodyaches). A standardized history solicited known or suspected risk factors for worse prognosis, including age > 50, cardiovascular or lung disease, obesity, immunosuppression, and living alone, as well as a focused assessment of symptom severity and exercise tolerance. An exam at rest included visual counting of breaths along with instruction on palpation of radial pulse. Saturation was included if pulse oximetry was available. If exam at rest was reassuring, providers were instructed to repeat the respiratory assessment on exertion by having the patient walk in place briskly for 1 minute. Patients with severe illness defined by resting or exertional respiratory rate greater than 30 and/or oxygen saturation less than 90 percent were instructed to go to the ED. Patients with moderate illness defined by exertional metrics of respiratory rate less than 22, oxygen saturation greater than 94 percent, and heart rate less than 125 were discharged from the virtual urgent care visit with a repeat telehealth follow-up call at either 12 or 24 hours depending on the number of risk factors. Patients without risk factors and with reassuring respiratory assessment were discharged from the telemedicine encounter with reassurance and standard discharge precautions for escalation of care. Designing and disseminating a standardized pathway helped to provide a framework to approach patients suspected of COVID-19 over telemedicine. Future work focusing on patient outcome data will help guide and refine any standardized telehealth approach to the COVID-19-suspected patient.

Decreased PTGDS Expression Predicting Poor Survival of Endometrial Cancer by Integrating Weighted Gene Co-Expression Network Analysis and Immunohistochemical Validation.

PurposeTo identify key pathogenic genes and reveal the potential molecular mechanisms of endometrial cancer (EC) using bioinformatics analysis and immunohistochemistry validation.Materials and MethodsThrough weighted gene co-expression network analysis (WGCNA), a co-expression network was constructed based on the top 25% variant genes in the GSE50830 dataset downloaded from gene expression omnibus (GEO). GO and KEGG pathway enrichment analyses were performed using the DAVID online tool. Candidate genes were selected using the cytoHubba plug-in of Cytoscape, mRNA expression levels and prognostic values in EC were analyzed by Oncomine, GEPIA, and Kaplan–Meier Plotter database to determine hub genes. One hub gene was validated by immunohistochemical (IHC) staining of 116 paraffin-embedded endometrial tissues and TCGA-UCEC cohort. Genes co-expressed with this hub gene were identified by LinkedOmics. Finally, its correlation with immune infiltration was evaluated by TIMER.ResultsThree co-expression modules and five candidate genes in each module were obtained by WGCNA; four hub genes were identified (LGR5, SST, ZNF558, and PTGDS). The mRNA levels of LGR5 and SST were significantly upregulated in EC, whereas those of ZNF558 and PTGDS were significantly downregulated; the expression of all four genes was associated with EC prognosis. Further validation demonstrated that PTGDS was significantly downregulated in the EC group compared with the atypical hyperplasia and normal endometrial groups, and its low expression was an independent risk factor for worse prognosis of EC. Biological function analysis indicated that PTGDS might be involved in the adaptive immune response, leukocyte migration, as well as in the regulation of cell adhesion molecules and chemokine signaling. Additionally, PTGDS expression was positively correlated with immune infiltration status of B cells, CD4+ T cells and macrophages.ConclusionLGR5, SST, ZNF558, and PTGDS may participate in the development, progression, and prognosis of EC, in which PTGDS may be a novel biomarker and therapeutic target for EC.

Identification of glutathione S-transferase π 1 as a prognostic proteomic biomarker for multiple myeloma using proteomic profiling.

Multiple myeloma (MM) is a B-cell hematological malignancy with monoclonal plasma cell proliferation in the bone marrow. Early diagnosis of MM remains difficult due to the lack of specific symptoms and biomarkers. In the present study, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and the ClinProt system was used to detect potential biomarkers for MM from the bone marrow samples of 30 patients and 30 healthy controls. A total of 10 of the most significantly differentiated peaks between the patients and controls were identified. When patients with MM were compared with controls, 6 peaks with m/z values of 1,779.24, 1,866.32, 2,022.36, 2,878.9, 4,417.76 and 7,155.38 were upregulated, and 4 peaks with m/z values of 1,466.54, 1,520.02, 1,546.53 and 2,991.05 were downregulated. Of these 10 peaks, 4 peaks (pk 8, 1,866.32 Da; pk 15, 2,878.90 Da; pk 17, 2,991.05 Da; and pk 3, 1,520.02 Da) were further sequenced and identified using liquid chromatography/electrospray ionization-tandem mass spectrometry (LC-ESI-MS/MS). Furthermore, the expression of fibronectin 1 and glutathione S-transferase π 1 (GSTP1) were validated in patients with MM via ELISAs. Clinical data and statistical analysis indicated that GSTP1 expression was closely associated with the clinical stage of patients with MM. High GSTP1 levels were an independent risk factor for worse prognosis in patients with MM. These results demonstrate that GSTP1 may be a novel biomarker for early diagnosis, prognosis and monitoring of minimal residual disease in MM.

Fibroscan and low-density lipoprotein as determinants of severe liver fibrosis in diabetic patients with nonalcoholic fatty liver disease.

Fibroscan is an effective and noninvasive tool to quantify fibrosis and steatosis in liver diseases including nonalcoholic fatty liver disease (NAFLD). Type-2-diabetes is a known risk factor for worse prognosis in NAFLD. In this study, we compare liver status in NAFDL diabetic and nondiabetic patients, identify potential risk factors, and determine the usefulness of Fibroscan in this population. The charts of all patients with NAFLD who underwent Fibroscan at our institution were reviewed. Fibroscan results, demographics, and clinical data were collected and analyzed using SPSS software. Of the 248 NAFLD patients, 73 (29.4%) were diabetic and 175 (70.6%) were nondiabetic. As detected by the NAFLD' liver stiffness measure, 35 (47.94%) diabetic patients had severe liver fibrosis (F4) in contrast to only 46 (26.3%) nondiabetics. Diabetic patients also presented more with hypertension, dyslipidemia, coronary artery disease, and chronic kidney disease. Liver steatosis, liver function tests, and noninvasive scores did not vary significantly between the two groups, except for γ-glutamyltransferase, prothrombin time-international normalized ratio, and BMI-alanine aminotransferase ratio-diabetes score. Diabetic patients had significantly lower high-density lipoproteins and low-density lipoproteins. Fibroscan results and low-density lipoprotein are potential diagnostic factors of liver fibrosis in diabetic patients with NAFLD. Further studies are necessary to verify liver fibrosis diagnostic tools and prognostic and genetic markers in diabetic patients.

Progress and prospects of biomarkers for liver injury in critically ill patients

Liver injury is an independent risk factor for worse prognosis of patients with critically ill.The criteria for diagnosis of liver injury are based on the levels of alanine aminotransferase(ALT ≥ 2 fold the upper limit of normality)or total bilirubin(TBIL≥ 68 μmol/L). All these classic indicators have limitation to early identify liver injury.Recently, accumulated evidences indicated that novel potential biomarkers for predicting liver injury are worth more attention due to quick response to liver injury up to 0.5-2 h. Here, we summarized these potential biomarkers including serum total bile acids, bile acids profiling, regulator of iron metabolism(transferrtin, ferritin and hepcidin), enzymes involved in mitochondria function(GLDH and MDH), key proteins for ornithine circulation pathway(Arg Ⅰ, OCT and ASS), hepatocytes-derived cytokines(CK18, HMGB1 and miR122)and immunologic regulator(MIF). Key words: Liver injury; Biomarker; Critically ill

Multi-institutional analysis of outcomes in patients with dedifferentiated chondrosarcoma (DDCS).

11028 Background: DDCS is a rare bone tumor with a poor prognosis. While no standard therapy exists, NCCN guidelines recommend osteosarcoma regimens (ORs). Methods: We performed a retrospective review (January 1, 2007-June 1, 2018) at three sarcoma centers and identified 46 patients (pts) with DDCS to evaluate treatments and outcomes. Results: Median age was 62.5 years (23-83); 61% were male. Median tumor size was 10.5cm (2-34). Most pts had localized disease at diagnosis (dx) (80%), extremity primary (76%), and did not receive neo/adjuvant chemotherapy (70%) or radiotherapy (69%). Local and distant recurrences were frequent (35% and 57%, respectively) and rapid (6.6 months (m) and 5.4 m, respectively). Twenty-eight pts received chemotherapy, 9 neo/adjuvant and 19 for metastasis (met) (Table). Response rate to first line ORs was poor (53% progressed). Notably, 11% had a partial response (D/I). Tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) led to stable disease. Median overall survival was 22.8 m and 7.2 m; 5-year survival rates were 30% and 0% in localized and metastatic disease, respectively. Median follow-up was 12.5 m (1.4-120). A multivariate cox proportional hazards model (age, sex, location, met at dx) identified met at dx as the only risk factor for worse prognosis (HR 2.8, p=0.026). Conclusions: DDCS is an aggressive malignancy with a poor prognosis. Despite guidelines to treat with ORs, the benefit is unclear, illustrating the need for randomized trials comparing standard regimens to novel agents. [Table: see text]

Higher Ki67 Index, Nodal Involvement, and Invasive Growth Were High Risk Factors for Worse Prognosis in Conventional Mammary Analogue Secretory Carcinoma

The prognostic factors of salivary (mammary analogue) secretory carcinoma (SC) are unclear because of the rarity of the tumor. This report presents the largest case series to investigate the prognosis-related clinicopathologic factors in conventional SC. This study was based on a retrospective cohort study from 1993 to 2015 of patients whose sections were reviewed and who were newly diagnosed as having SC by the detection of ETV6 rearrangement. Clinicopathologic features, including age, gender, involvement site, tumor category, node category, histopathologic subtype, cellular atypia, tumor necrosis, growth pattern (noninvasive vs invasive), perineural invasion, margin, hyalinized fibrous septa, Ki67 expression, and postoperative treatment, were analyzed as primary predictors. Patients' final outcomes-including no evidence of disease, recurrence, metastasis, and death-were collected during follow-up. Survival analysis was performed only for conventional SC using the Kaplan-Meier method and the Cox proportional hazards regression model. Sixty-two cases of SC were retrospectively confirmed. Fifty-nine cases were identified as conventional SC, whereas 3 cases were identified as high-grade SC. In conventional SC, univariate analyses showed that nodal metastasis, invasive growth, and a Ki67 index of at least 10% were related to decreased recurrence-free survival (RFS), distant disease-free survival (DDFS), and disease-free survival (DFS). Age older than 44years, T3 and T4 stages, and markedly hyalinized fibrous septa were associated with decreased DDFS. T3 and T4 stages, positive margins, and tumor necrosis were associated with decreased overall survival. By multivariate analysis, the Ki67 index was found to be an independent prognostic factor for RFS (P=.008) and DFS (P=.003). Although most patients with conventional SC had a favorable clinical prognosis, patients with nodal involvement, invasive growth, and a Ki67 index higher than 10% showed a poor clinical outcome by exhibiting local recurrence or distal metastasis. Patients with a higher Ki67 index especially need close observation for local recurrence.

Association between the concurrence of pre-existing chronic liver disease and worse prognosis in patients with an herb- Polygonum multiflorum thunb. induced liver injury: a case-control study from a specialised liver disease center in China

ObjectivesThe present study aimed to evaluate the association between the concurrence of pre-existing chronic liver diseases (CLD) and worse prognosis in patients with HILI.DesignA case–control study.SettingTertiary hospital specialising in liver...

Non-Typhi, non-Paratyphi Salmonella-related hospitalisations in Spain: trends, clinical aspects, risk factors for worse prognosis and hospital costs.

This study reviews non-typhoid Salmonella (NTS)-related hospitalisations at National level in Spain between 2010 and 2015. NTS hospitalisations were obtained from the National Registry of Hospitalisations. A descriptive analysis of the hospitalisations was performed, including hospitalisation rates (HR) and case-fatality rates (CFR%) calculation. For those with NTS as Main Diagnosis logistic regression were used to estimate the relationship between the different factors and death outcome. 21,660 registered NTS-related hospitalisations were described (88.8% with Salmonella coded as Main Diagnosis). Average HR2010-2015 was 7.7 (range, 7.3 to 8.1) hospitalisations/100,000 population. Those with NTS infections as Secondary Diagnosis were on average (p < 0.001) older (47.9 vs. 36.5years), presented worse Charlson Comorbidity Index (2.1 vs. 1.2), higher CFR% (4.8% vs. 0.7%), spent more days hospitalised (15.1 vs. 5.8days), and generated more costs (6173 vs. 4272 euros/per hospitalisation) than those with NTS as Main Diagnosis. For those with NTS as Main Diagnosis increased risk of death was related to being > 64years old (OR= 20.99; p < 0.001); presenting septicaemia (OR= 15.82; p < 0.001) or localised infections (OR= 3.98; p = 0.061); Charlson Comorbidity Index > 3 (OR= 4.57; p < 0.001); a non-HIV co-infection (OR= 1.80; p = 0.013); other risk factors (OR= 5.70; p < 0.001); bowel perforation (OR= 70.30; p < 0.001); or acute renal failure (OR= 1.95; p = 0.001). In those with Salmonella as Main Diagnosis, among all complications, bowel perforation presented the strongest association with death outcome. Clinical practice guidelines can help to identify patients at risk of bowel perforation to reduce the fatality of the disease.

PREDICTORS OF MORTALITY IN EARLY- VERSUS LATE-ONSET ALZHEIMER’S DISEASE: AN 18-YEAR FOLLOW-UP

Background: Few studies have focused on predictors of survival in patients with early-onset Alzheimer’s disease (EOAD) compared with late-onset Alzheimer’s disease (LOAD). We aimed to investigate the effect of genetic, sociodemographic, and clinical factors on mortality in the two groups.Methods: The Swedish Alzheimer Treatment Study (SATS) is a prospective, observational, multicenter study for longitudinal assessment of cholinesterase inhibitor (ChEI) therapy in clinical practice that includes 1,021 participants diagnosed with mild-to-moderate Alzheimer’s disease (AD) (Mini-Mental State Examination score, 10–26) at the start of ChEI treatment. Of these, 143 were defined as having EOAD (onset =65 years), and four missing age-at-onset; thus, 1,017 patients were included. Cox proportional hazards regression was used to determine characteristics that affected life expectancy: sex, apolipoprotein E genotype, solitary-living, duration of AD, age at baseline, years of education, specific concomitant medications, cognition (Alzheimer’s Disease Assessment Scale–cognitive subscale [ADAS-cog]) and activities of daily living (ADL) (Instrumental Activities of Daily Living scale [IADL] and Physical Self-Maintenance Scale [PSMS]) at baseline, and their rates of decline.Results: After 18 years of follow-up, 115 (80%) of the EOAD and 797 (91%) of the LOAD patients had died (p<0.001). In EOAD, males living alone, hazard ratio (95% confidence interval), 2.71 (1.18–6.22), p=0.019, lower IADL capacity at baseline, 1.07 (1.02–1.11), p=0.002, and faster rate of basic ADL deterioration/year 0.87 (0.77–0.98), p=0.026 independently predicted shorter survival. In LOAD, males of any living status 1.64 (1.41–1.92), p<0.001, older age at baseline, 1.04 (1.03–1.06), p<0.001, use of antihypertensive/cardiac therapy, 1.26 (1.09–1.47), p=0.002, use of antidiabetics, 1.51 (1.06–2.14), p=0.021, lower cognitive ability 1.02 (1.01–1.03), p<0.001 and worse basic ADL at baseline 1.05 (1.02–1.09), p=0.004, and faster rates of progression/year (ADAS-cog, 0.99 (0.98–0.99), p=0.004, PSMS, 0.92 (0.89–0.95), p<0.001) independently predicted shorter survival.Conclusions: Predictors of mortality differed between age groups. More impaired IADL, but not cognitive performance, was a risk factor for worse prognosis in EOAD. Solitary-living younger males exhibited nearly a threefold risk of death compared with corresponding males living with a family. In LOAD, demographic factors, cardiovascular comorbidities, and cognitive status had a significant impact on survival. (Less)

Glomerular crescents are associated with worse graft outcome in allograft IgA nephropathy.

The prognosis of patients with allograft IgA nephropathy (IgAN) requires further investigation. We performed a bicenter retrospective cohort study on kidney transplant recipients diagnosed with IgAN in allograft biopsy. Recipients without allograft IgAN but with known IgAN before transplantation were included as the control group. We investigated the associations between clinicopathological characteristics, including allograft crescents, and the risk of death-censored graft failure. In total, 1256 IgAN patients in both pre- and posttransplant stages were included. Among them, 559 were diagnosed with allograft IgAN, which was a time-dependent risk factor for worse prognosis (adjusted hazard ratio =5.009 [3.610-6.951]; P<.001) during a median of 8.1years of follow-up. Of the patients with allograft IgAN, 88 (15.9%) had glomerular crescents, including 40 patients (7.2%) with >10% crescent formation in the total biopsied glomeruli. The presence of glomerular crescents in IgAN was associated with a worse graft prognosis, and the association was still valid with the C scores of the current Oxford classification. In conclusion, allograft IgAN is a time-dependent event and is associated with worse graft outcomes. The pathological characteristics of allograft, particularly the degree of glomerular crescent formation, may represent important risk factors for a poor prognosis.

Clinical and Imaging Characteristics of Cerebral Infarction in Patients with Nonvalvular Atrial Fibrillation Combined with Cerebral Artery Stenosis.

Aims: Nonvalvular atrial fibrillation often occurs in combination with carotid atherosclerosis, but less is known about it in combination with cerebral artery stenosis. This study investigated the characteristics of cerebral infarction in patients with nonvalvular atrial fibrillation with or without cerebral artery stenosis.Methods: A retrospective analysis was conducted on 172 cerebral infarction patients with nonvalvular atrial fibrillation hospitalized at the Affiliated Ganzhou Hospital of Nanchang University between December 2011 and January 2016. The patients were divided into two groups (stenosis and non-stenosis groups) based on whether the cerebral infarction was combined with cerebral artery stenosis or not. Clinical characteristics, related supplementary examination, and the imaging characteristics of cerebral infarction lesions were compared between the groups.Results: Mean age [(75.73 ± 8.46) years vs. (63.44 ± 9.95) years], National Institute of Health stroke scale (NIHSS) score [(8.66 ± 6.73) vs. (4.59 ± 3.51)], CHA2DS2-VASc score [(2.93 ± 1.40) vs. (0.96 ± 0.98)], history of hypertension (74.4% vs. 30.0%), and history of stroke/ transient ischemic attack (TIA) (55.8% vs. 13.3%) were higher in the stenosis group (n = 107) than in the non-stenosis group (n = 65) (P < 0.01). In the stenosis group, there were different types of cerebral infarction lesions, including multiple infarction (multifocal type), massive infarction, watershed infarction, and lacunar infarction; in the non-stenosis group, the 60.0% lesions were multiple infarction (multifocal type), a significantly higher proportion than the stenosis group (26.2%, P < 0.05). NIHSS score was an independent risk factor for worse prognosis at follow-up (OR (95%CI) 1.251–1.674, P < 0.001).Conclusions: Advanced age, hypertension, and stroke/TIA were increased in patients with cerebral infarction with nonvalvular atrial fibrillation combined with cerebral artery stenosis.

Dermatofibrosarcoma protuberans: A retrospective study of clinicopathologic features and related Akt/mTOR, STAT3, ERK, cyclin D1, and PD-L1 expression

Little is known regarding oncoproteins other than platelet-derived growth factor subunit B in dermatofibrosarcoma protuberans (DFSP). Moreover, the risk factors for worse prognosis are controversial. We sought to determine the clinicopathologic features and key factors for adverse outcome in DFSP, including the implication of expression of protein kinase B (Akt)/mammalian target of rapamycin (mTOR), signal transducer and activator of transcription 3 (STAT3), extracellular signal regulated kinase (ERK), cyclin D1, and programmed death ligand 1 (PD-L1). Clinicopathologic and immunohistochemical analyses were performed for 44 DFSPs having wide local excision and 92 dermatofibromas as controls. Compared with the 35 nonrecurrent DFSPs, the 9 recurrent DFSPs exhibited larger tumor size, deeper invasion beyond the subcutis, and more diverse histologic subtype. The fibrosarcomatous subtype revealed frequent mitotic figures and a high cyclin D1-positive index. The 2 metastatic DFSPs (1 each of the fibrosarcomatous and myxoid subtypes) demonstrated 4 and 11 instances of local recurrence, respectively, as well as larger tumor size, deeper invasion beyond the subcutis, and high expression of cyclin D1. Expression of Akt/mTOR, STAT3, ERK, and PD-L1 ranged from none or low in the primary skin lesions to high in the corresponding metastatic sites. Akt/mTOR and ERK were expressed more frequently in DFSP than in dermatofibroma. Lack of information on patients before hospital evaluation. Complex factors beyond fibrosarcomatous subtype may portend local recurrence or metastasis. Akt/mTOR, STAT3, ERK, and PD-L1 may be associated with development and/or progression of DFSP.

Kawasaki e fatores de risco para pior prognóstico

A Residência Pediátrica (RP) é uma revista eletrônica trimestral, em publicação contínua, da Sociedade Brasileira de Pediatria (SBP), disponível em português e inglês, destinada aos médicos residentes de nossa especialidade, áreas afins e aos pediatras. O conteúdo da revista pode ser acessado livremente. A missão da RP é contribuir para a formação acadêmica dos residentes e incentivá-los a uma participação ativa na produção científica sobre temas pediátricos e relacionados à adolescência.

Worse Prognosis in Papillary, Compared to Tubular, Early Gastric Carcinoma.

Purpose: Papillary early gastric carcinoma (EGC) is uncommon but shows worse prognosis in our most recent study in a Chinese population with unknown reasons. The aim of the present study was to further investigate risk factors for worse prognosis in patients with papillary adenocarcinoma, compared to those with tubular adenocarcinoma.Methods: We searched the electronic pathology databank for radical gastrectomy cases over an 8-year period at a single medical center in Nanjing, China, and identified consecutive 240 EGC cases that were classified as either papillary (n=59) or tubular (n=181) EGC tumors in accordance with the World Health Organization (WHO) gastric cancer diagnosis criteria. We investigated and compared clinicopathologic risk factors for prognosis between papillary and tubular EGC groups. All patients were followed up and their 5-year survival rate was compared statistically with the Kaplan-Meier method with a log rank test.Results: Compared to tubular EGCs, papillary EGCs were significantly more common in elderly patients, more frequently occurred in the proximal stomach with protruding/elevated growth patterns, submucosal invasion, and a micropapillary component. Although lymphovascular invasion (16.9%), nodal (13.6%) and distant (11.8%) metastases in papillary EGCs were more frequent than those (8.3%, 7.2%, and 3.7%, respectively) in tubular EGCs, the differences approached but did not reach statistically significant levels. Significant risk factors for nodal metastasis included lymphovascular invasion in both EGC groups, but the ulcerative pattern and submucosal invasion only in tubular EGCs. The 5-year survival rate was significantly worse in papillary (80.5%) than in tubular (96.8%) EGCs.Conclusions: Compared to tubular EGCs, papillary EGCs diagnosed with the WHO criteria in Chinese patients were more frequent in elderly patients, proximal stomach and showed the significantly worse 5-year survival rate with more protruding/elevated growth patterns and the micropapillary component. Further studies in larger samples are urgently needed to validate these findings for precision individualized EGC patient management.

Vomiting and Hyponatremia Are Risk Factors for Worse Clinical Outcomes Among Patients Hospitalized Due to Nonsurgical Abdominal Pain: A Retrospective Cohort Study.

After initial evaluation in the Emergency Department (ED), many patients complaining of abdominal pain are classified as suffering from nonsurgical abdominal pain (NSAP). Clinical characteristics and risk factors for worse prognosis were not published elsewhere.Characterizing the clinical profile of patients hospitalized due to NSAP and identifying predictor variables for worse clinical outcomes.We made a retrospective cohort analysis of patients hospitalized due to NSAP compared to matched control patients (for age, gender, and Charlson comorbidity index) hospitalized due to other, nonsurgical reasons in a ratio of 1 to 10. We further performed in-group analysis of patients admitted due to NSAP in order to appreciate variables (clinical and laboratory parameters) potentially associated with worse clinical outcomes.Overall 23,584 patients were included, of which 2144 were admitted due to NSAP and 21,440 were matched controls. Patients admitted due to NSAP had overall better clinical outcomes: they had lower rates of in-hospital and 30-days mortality (2.8% vs 5.5% and 7.9% vs 10.4% respectively, P < 0.001 for both comparisons). They also had a significantly shorter length of hospital stay (3.9 vs 6.2 days, P < 0.001). Rates of re-hospitalization within 30-days were not significantly different between study groups. Among patients hospitalized due to NSAP, we found that vomiting or hyponatremia at presentation or during hospital stay were associated with worse clinical outcomes.Compared to patients hospitalized due to other, nonsurgical reasons, the overall prognosis of patients admitted due to NSAP is favorable. The combination of NSAP with vomiting and hyponatremia is associated with worse clinical outcomes.

Motor neurone disease in Lancashire and South Cumbria in North West England and an 8 year experience with enteral nutrition

Motor neurone disease (MND) is a fatal neurodegenerative disease of unknown aetiology. Malnutrition is a common occurrence and an independent risk factor for worse prognosis. However, it remains unclear whether provision of enteral nutrition (EN) through a gastrostomy tube offers any survival advantage. Our aim was to describe the demographic and clinical characteristics of MND in Lancashire and South Cumbria in North West England and the impact of EN on survival in the 8year period of 2005–2012. Four hundred and seven patients with MND were identified through the Preston MND care and research centre registry giving a crude incidence rate of 3.15/100,000. Three hundred and forty patients with adequate information were included in the final analysis of whom 53.2% were male. The presentation was limb/spinal in 62.1% and bulbar in 37.9% of patients, bulbar onset being more common in elderly females. Mean age of onset was 67.28years (standard deviation 11.06; range 22.78–93.06). Median survival was 1.98years (range 1.18–3.05). Ninety-one patients received EN of whom 67% had bulbar onset disease. EN was not associated with a statistically significant survival advantage except for the subgroup who received EN more than 500days after symptom onset. In conclusion, the early requirement for EN may indicate a prognostically less favourable subgroup.

Retinoic acid receptor alpha: One of plasma biomarkers associated with exacerbation of chronic obstructive pulmonary disease

Background: Exacerbation of COPD is a major risk factor for bad prognosis of COPD. A few plasma proteins have been discovered to associate with hospital admission due to exacerbation up to date. We tried to find new plasma biomarkers to predict the exacerbation of COPD. Methods: We examined the plasma of normal control (n = 8) and COPD stable (n = 8) and exacerbation (n = 8) using 2-Dimentional Electrophoresis. The differentially expressed protein spots were identified by MALDI-TOF. ELISA were performed for quantitative measurement of RARα in plasma from normal control (n = 37) and COPD (n = 35). Results: 17 proteins were differentially expressed in plasma between stable and exacerbation state in the subjects with COPD. Identification using MALDI-TOF showed that retinoic acid receptor alpha, ninein, isoform CRA_a, alpha-1 antitrypsin, fibrinogen gamma, tyrosyl-DNA phosphodiesterase 2, and T cell receptor delta chain were increased in exacerbation of COPD, while fibrin beta, Crystal Structure Of An Autoimmune Complex Between A Human Igm RF* And Igg1 Fc, transferrin, serpin peptidase inhibitor member 6, complement factor B preproprotein, Chain B, Crig Bound To C3c, and WD repeat-containing protein 1 isoform 1 were decreased. Quantitative measurement showed that RARα plasma levels significantly increased in exacerbation state compared to stable state of COPD (n = 14). In the plasma of stable state, the COPD subjects (n = 14) having more than 0.4 time/yr of admission had very high levels of RAR alpha protein and those (n = 11) having less than 0.4 times/yr of admission had the intermediate levels compared to those having no exacerbation (n = 10). ROC analysis of RAR alpha levels to frequency of admission showed an area under the curve of 0.844. A cut-off of 0.154 ng/ml of RAR alpha predicted hospital admission with a sensitivity of 71.4% and a specificity of 92.8%. Conclusion: The proteomic analysis of plasma indicates that alteration of several proteins may be associated with admission of COPD. Among them, plasma RAR alpha level may predict hospital admission with a sensitivity of 71.4% and a specificity of 92.8%.

Colorectal liver metastases: Hepatic pedicle clamping during hepatectomy reduces the incidence of tumor recurrence in selected patients. Case-matched analysis

Hepatic pedicle clamping (HPC) during Liver Resection (LR) is a vascular procedure designed to prevent bleeding from the liver during hepatectomy. Outgrowth of pre-existing colorectal micrometastases may occur 5-6 times faster in occluded liver lobes than in non-occluded lobes. We conducted a case-matched analysis at our Institution to assess the effects of HPC on overall and recurrence-free survival in highly selected patients, who underwent LR due to Colorectal liver metastases (CLM). From January 2002 to December 2010, 120 patients operated for CLM were included into this case-matched study. Patients were allocated to two groups: Group-A patients who underwent HPC during LR; Group-B patients who underwent LR without HPC. HPC during liver resection was associated with better overall patient 5-year survival (47.2% in Group-A and 32.1% in Group-B) (P-value = 0.06), and significantly better 5-year recurrence-free survival (49.9% in Group-A vs 18.3% in Group-B) (P-value = 0.010) The Cox regression model identified the following risk factors for worse prognosis in terms of shorter recurrence-free survival and higher incidence of tumor recurrence: no HPC (Group-B) (P-value = 0.032) and positive lymph nodes at the time of LR (P-value = 0.018). Lack of HPC in selected patients who underwent LR for CLM results to be a strong independent risk factor for higher patient exposure to tumor recurrence. We suggest that hepatic hilum clamping should be seriously taken into consideration in this patient setting. A case-matched study was performed in 120 patients undergoing liver resection due to colorectal liver metastases, comparing patients who received intermittent hepatic pedicle clamping (HPC) with those who did not. The 5-year overall survival rate was similar, but the 5-year recurrence-free rate was significantly higher with no HPC (p = 0.012).