Short-term Prognosis Of Patients Research Articles

Impact of Low Muscularity and Myosteatosis on Long-term Outcome After Curative Colorectal Cancer Surgery: A Propensity Score-Matched Analysis.

Muscle loss, characterized by reduced muscle mass (myopenia), and infiltration by intermuscular and intramuscular fat (myosteatosis), predicts a poor short-term prognosis in patients with colorectal cancer. However, little is known about the influence of myopenia and myosteatosis on long-term outcomes. The present study aimed to evaluate the prognostic influence of both myopenia and myosteatosis on long-term outcomes after curative colorectal cancer surgery. This is a retrospective analysis using a propensity score-matched analysis to reduce the possibility of selection bias. The study was conducted at a single institution. We performed a retrospective analysis of 211 consecutive patients with stage I to III colorectal cancer who underwent curative surgery between 2010 and 2011. CT scans were analyzed to calculate the lumbar skeletal muscle index and mean muscle attenuation using a SYNAPS VINCENT. The primary outcome measure was cancer-specific survival. Secondary end points included overall survival and disease-free survival. Of 211 patients, a total of 102 and 106 were matched for myopenia and myosteatosis analyses. The median follow-up was 57.6 months. Versus the nonmyopenia group, the myopenia group manifested a significantly shorter cancer-specific survival, overall survival, and disease-free survival. Significantly shorter cancer-specific survival and overall survival times were also identified for the myosteatosis versus the nonmyosteatosis group. Before matching, multivariate analyses identified both myopenia and myosteatosis as independent prognostic factors for cancer-specific survival (p = 0.04 and p < 0.01), overall survival (p = 0.03 and p < 0.01), and disease-free survival (p < 0.01 and p < 0.01). This study is limited by its retrospective, nonrandomized design. Myopenia and myosteatosis adversely affect long-term outcomes after curative colorectal cancer resection. See Video Abstract at http://links.lww.com/DCR/A463.

Effect of high-dose finasteride combined with transurethral plasmakinetic resection of prostate on prostatespecific antigen and inflammatory factors in patients with benign prostatic hyperplasia

Purpose: To ascertain the effect of perioperative application of high-dose of finasteride on prostatespecific antigen (PSA) in serum, tumor necrosis factor α (TNF-α) and interleukin-1β (IL-1β) in prostatic fluid of prostatic hyperplasia (BPH) patients with transurethral plasmakinetic resection of prostate (PKRP). Methods: In total, 141 BPH patients treated with PKRP in Hunan Provincial People’s Hospital, Changsha City, China from January 2015 to January 2017 were randomly divided into three groups of 47 cases each, viz, high-dose (10 mg of finasteride), low-dose (5 mg of finasteride), control (0 mg of finasteride). The levels of PSA in serum, as well as the levels of TNF-α and IL-1β in prostatic fluid were evaluated 7 days before and after surgery. Re-bleeding within 3 months after surgery in the three groups were performed and the patients observed. Results: Intra-operative bleeding volume, bleeding volume per unit resected tissue, and intra-operative volume of rinsing fluid were significantly less in high- and low-dose groups than those in the control group (p &lt; 0.05); furthermore, the operation time was significantly shorter than that for the control group (p &lt; 0.05). Seven days after surgery, international prostate symptom score (IPSS), serum PSA, and TNF-α and IL-1β in prostatic fluid of the high- and low-dose groups were significantly lower than those of the control group (p &lt; 0.05). Also, maximum urine flow rate was significantly higher than that of the control group. Serum PSA, and TNF-α and IL-1β levels in prostatic fluid were significantly lower than those of low-dose group (p &lt; 0.05). Serum PSA as well as TNF-α and IL-1β levels in prostatic fluid were positively correlated with IPSS score (r = 0.817, 0.838, 0.859, p &lt; 0.001). The admission rate due to rebleeding was lowest in the high-dose group, followed by the low-dose group. Conclusion: Finasteride combined with PKRP for BPH acts synergistically to reduce serum PSA levels and local inflammatory reaction. High-dose finasteride/PKRP combination is more efficacious than the low-dose combination, thereby improving short-term prognosis in patients. Keywords: Finasteride, Transurethral plasmakinetic resection, Prostate, Prostate-specific antigen, Inflammatory factors

Clinical Characteristics and Short-term Outcomes of Acute Low Frequency Sensorineural Hearing Loss With Vertigo.

Objectives This study analyzed short-term prognosis in patients with acute low frequency hearing loss (ALHL), and also investigate hearing recovery rates in patients with ALHL accompanied vertigo.Methods Retrospective medical record review of the patients who received treatment for ALHL between June 2005 and June 2015 were analyzed. Of the 84 patients, 53 were without vertigo, and 31 were with vertigo. Of the 31 patients, eight were treated with steroids, seven with diuretics alone, and 16 with both. Clinical and auditory characteristics before and after treatment were compared in these three groups.Results Pure tone audiometry after 8 weeks of treatment showed that patients with vertigo had significantly higher than patients without vertigo (P=0.020). Patients with vertigo who recovered from ALHL had a greater tendency to receive early treatment than patients who did not recover. Patients who received the two steroid therapy groups (steroids alone and steroids plus diuretics) had a higher recovery rate than patients who received diuretics alone (P=0.043 and P=0.037, respectively).Conclusion The prognosis of patients with ALHL is worse in those with vertigo compared to without vertigo. The hearing recovery rate in patients with vertigo tends to be higher in those treated with steroids than with diuretics alone.

Predictive Value of Major Inflammatory Markers in Complete Blood Count for Short-Term Prognosis in Patients with Acute Carbon-monoxide Poisoning

Background: Acute carbon monoxide poisoning (ACOP) has high morbidity and mortality. The best inflammatory markers or indices can be identified by retrospective analysis the associations of inflammatory indices in completed blood count and short-term prognosis in ACOP patients and the indices can be used to guide in clinical diagnosis and treatment. Method: There were 256 ACOP patients who admitted into No. 123 Hospital from Jan 2008 to Dec 2017 were enrolled into this study. According to the health condition of ACOP patients after 2 months, the patients were divided into poor (n=21) and good (n=235) prognosis groups. The inflammatory indices, age, Glasgow coma scale (GCS) and other parameters were compared between the groups. Receiver operating characteristic (ROC) curves were used to evaluate the predictive values of various indicators towards prognosis of patients with ACOP. Results: The count of white blood cells, neutrophil, red blood cell distribution width, age and hypertension morbidity rate were significantly higher in poor prognosis group than that of the good prognosis group while the GCS was significant lower in the poor prognosis group compared to the good prognosis group. Multifactor analysis showed that neutrophil, age and GCS were risk factors for poor prognosis in patients with ACOP. Thus the results of combination of neutrophil count with age and GSC can be best in predicting the prognosis of ACOP. Conclusion: Neutrophil count is the indicator in predicting the short-term prognosis of ACOP and its predictive value can be increased by combining the parameters like age and GCS.

Comparison of the Effects of Ticagrelor and Clopidogrel on Inflammatory Factors, Vascular Endothelium Functions and Short-Term Prognosis in Patients with Acute ST-Segment Elevation Myocardial Infarction Undergoing Emergency Percutaneous Coronary Intervention: a Pilot Study

Background/Aims: Acute ST-segment elevation of myocardial infarction (STEMI) is the most severe type of acute coronary syndrome (ACS). Particular attention has been focused on studying the pathogenesis of STEMI, and how to prevent thrombosis, reduce inflammatory reaction, stabilize plaques and improve vascular endothelial functions to preserve the survived myocardium. This study aimed to compare the anti-inflammatory endothelium-protective effects, clinical prognosis, and relevant bleeding risks of ticagrelor versus clopidogrel in patients with STEMI who underwent urgent percutaneous coronary intervention (PCI) and provide certain experimental evidence and a theoretical basis for the selection of safe and effective drugs and their proper dosage, thereby further guiding clinical medication. Methods: We sequentially enrolled 193 patients (104 males and 89 females) admitted to hospital due to acute STEMI. These patients underwent urgent PCI between December 2013 and May 2015 and met the inclusion criteria. They were assigned (1: 1) into two groups according to different treatments, 97 patients in the ticagrelor group (treatment group), and 96 patients in the clopidogrel group (control group). Levels of hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), and endothelial cell-specific molecule 1 (ESM-1) taken at admission and 24 h, 4 days, and 7 days after administration, as well as the correlation between the levels of IL-6, hs-CRP, and ESM-1, were determined in the two groups. At the same time, the effects of treatment with ticagrelor and clopidogrel on the efficacy endpoint events (ischemic and safety) were explored. Results: No statistically significant difference was found in the levels of hs-CRP, IL-6, or ESM-1 at admission between the two groups (P> 0.05); Their levels were significantly elevated 24 h after administration, with statistical differences between two groups (P< 0.05). Furthermore, a downward trend with statistically significant differences was found on Day 4 and Day 7 (P< 0.05); ESM-1 levels increased along with increases of hs-CRP and IL-6 levels, indicating ESM-1 was positively correlated with hs-CRP (r=0.523, P< 0.001) and IL-6 (r=0.431, P< 0.001); and the occurrence rates of ischemic endpoint events at 30 days were lower in the treatment group than in the control group. The occurrence of safety endpoint events was higher than in the control group; however, no statistically significant difference was found (P> 0.05). Conclusions: Compared with clopidogrel, ticagrelor appears to rapidly reduce the prevalence of inflammatory reactions and stabilize the functions of vascular endothelium to improve the stability of atherosclerotic plaque and decrease the occurrence rate of thrombosis as well as ischemic outcome events without any obvious increase in the risk of bleeding in patients with acute STEMI receiving urgent PCI. This renders it a potential drug for clinical practice. At the same time, measurement of ESM-1, a new biological marker for vascular endothelial function disorder, could possibly become a simple, effective, and practical new method for clinical evaluation of risk stratification of patients with acute STEMI at admission.

终末期肝病模型(MELD)评分联合血清甲胎蛋白和胆碱酯酶对乙型肝炎病毒相关慢加急性肝衰竭患者短期预后的评估价值

终末期肝病模型(MELD)评分联合血清甲胎蛋白和胆碱酯酶对乙型肝炎病毒相关慢加急性肝衰竭患者短期预后的评估价值

Transcatheter aortic valve implantation and surgical aortic valve replacement among hospitalized patients with and without type 2 diabetes mellitus in Spain (2014\u20132015)

BackgroundType 2 diabetes mellitus (T2DM) is strongly related to the in-hospital and short-term prognosis in patients with cardiovascular diseases needing surgical or invasive interventions. How T2DM might influence the treatment of aortic stenosis (AS) has not been completely elucidated for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). The aims of this study were: (1) to describe the use of aortic valve replacement procedures (TAVI and SAVR) among hospitalized patients with and without T2DM; and (2) to identify factors associated with in hospital mortality (IHM) among patients undergoing these procedures.MethodsWe analyzed data from the Spanish National Hospital Discharge Database between January 1, 2014 and December 31, 2015 for patients aged ≥ 40 years. We selected patients whose medical procedures included TAVI (ICD-9-CM codes 35.05, 35.06) and SAVR (ICD-9-CM codes 35.21, 35.22). We stratified each cohort by diabetes status: T2DM (ICD-9-CM codes 250.x0, 250.x2) and no diabetes. We retrieved data about specific comorbidities, risk factors, procedures, and specific in-hospital postoperative complications. Hospital outcome variables included IHM, and length of hospital stay (LOHS).ResultsWe identified a total of 2141 and 16,013 patients who underwent TAVI (n = 715; 33.39% with T2DM) and SAVR (n = 4057; 25.33% with T2DM). In patients who underwent TAVI we found no differences in IHM (3.64% in T2DM vs. 5.12% in non-T2DM, p = 0.603). In the cohort of SAVR, mean LOHS was significantly lower in patients with T2DM than in non-diabetic patients (13.77 vs. 17.27 days). IHM was lower in patients with T2DM (4.36% vs. 6.31%, p < 0.01). After multivariable adjustment for both procedures, patients with T2DM had significantly lower IHM than patients without diabetes (adjusted OR 0.60; IC 95% 0.37–0.99 for TAVI and adjusted OR 0.80; IC 95% 0.66-0-96 for SAVR).ConclusionsT2DM diabetic patients with AS undergoing a valvular replacement procedure through SAVR or TAVI did not have a worse prognosis compared to non-diabetic patients during hospitalization, showing lower IHM after multivariable adjustment. However, given the limitations of administrative data more prospective studies and clinical trials aimed at evaluating the influence of these procedures in diabetic patients with AS are needed.

Changes of serum uric acid in patients with cerebral infarction in different neurological deficits and their relationship with short-term prognosis

Objective To investigate the changes of serum uric acid (SUA)and its relationship with short-term prognosis in patients with cerebral infarction due to different neurological deficits. Methods A retrospective study was performed on 112 cases of patients with cerebral infarction due to different neurological deficits who were admitted from February 2014 to December 2016.According to the National Institutes of Health Stroke Scale (NIHSS), patients were divided into the mild-moderate group (n=51)and the moderate-severe group (n=61). The NIHSS score was statistically analyzed after the 1st and 7th day onset of disease, respectively, the SUA level was determined, and the prognosis of the patients was assessed by the improved RANKIN scale (mRS)at the 1st and 3rd month. Results In the moderate-severe group, level of SUAday7 was significantly lower than that of SUAday1, the difference value of SUA in the moderate-severe group was significantly higher than that in the mild-moderate group, and the difference had statistical significance (P<0.05); the prognosis in the mild-moderate group was good at the 1st and 3rd month after onset, while in the moderate-severe group, 31 patients had poor prognosis at the end of the first month, 20 patients had poor prognosis at the end of the third month.The logistic regression analysis showed that ΔSUA and NIHSSday1 were the risk factors of prognosis at the end of the first posterior cerebral infarction (P<0.05), NIHSSday1 was a risk factor for prognosis at the end of 3rd month after cerebral infarction (P<0.05). Conclusion The NIHSS score is the risk factor of prognosis in the first day of cerebral infarction, while the reduction of SUA is related to the short-term prognosis. Key words: Neurological deficit; Cerebral infarction; Uric acid; Short-term prognosis

Serum potassium level and short-term prognosis in patients with anti-GM1 antibody positive Guillan-Barre syndrome - preliminary study -

Background: Two different patterns of prognosis have been recognized in Guillain-Barré syndrome with IgG anti-GM1 antibody (GM1-GBS), such as poor and good prognosis. However factors related to such differences have not been fully identified.

Effect of regional synergistic treatment system on the treatment time and short-term prognosis of ST-segment elevation myocardial infarction

To explore the effect of regional synergistic treatment system on the treatment time and short-term prognosis of patients with ST-segment elevation myocardial infarction (STEMI). A retrospective analysis of the clinical data of STEMI patients who admitted to emergency center of Suzhou Kowloon Hospital Affiliated to Shanghai Jiaotong University School of Medicine and underwent primary percutaneous coronary intervention (PPCI) from January 2013 to January 2017 were conducted. All patients were divided into two groups, group A was the patients who underwent the PPCI before the establishment of the acute chest pain area co-treatment system (from January 2013 to December 2014), and group B was the patients who received the treatment after the establishment of the area co-treatment system (from January 2015 to January 2017). The length of time from onset of symptoms to the balloon dilatation (S2B), the length of time from the first medical contact to the balloon dilatation (FMC2B), the length of time from entering the gate of hospital to the balloon dilatation (D2B), and the incidence of 90-day end point events (including heart failure, all-cause death, and other related adverse events) were collected. The relations of the establishment of the acute chest pain area co-treatment system and the incidence of 90-day end point events were analyzed by multivariable Logistic regression analysis. Among the 221 enrolled patients with STEMI, 83 patients were in group A and 138 patients were in group B respectively. Compared with group A, S2B time [minutes: 180 (140, 210) vs. 201 (154, 225)], FMC2B time [minutes: 89 (78, 100) vs. 94 (83, 107)] and D2B time [minutes: 66 (62, 70) vs. 85 (72, 99)] were significantly shortened in group B (all P < 0.05), the incidence of 90-day end point events were significantly decreased (heart failure: 20.3% vs. 32.5%, all-cause death: 1.4% vs. 7.2%, other related adverse events: 23.2% vs. 36.1%, all P < 0.05). It was shown by multivariable Logistic regression analysis that the establishment of the acute chest pain area co-treatment system could lower the incidence of 90-day end point events [heart failure: odds ratio (OR) = 1.904, 95% confidence interval (95%CI) = 0.968-1.004, P = 0.048; all-cause death: OR = 11.724, 95%CI = 0.955-1.048, P = 0.013; other related adverse events: OR = 1.925, 95%CI = 1.049-3.530, P = 0.034]. The construction of regional synergistic treatment system can shorten the emergency treatment time of STEMI patients and reduce the incidence of 90-day end point events including heart failure and death.

Comprehensive evaluation of the effectiveness and safety of balloon pulmonary angioplasty for inoperable chronic thrombo-embolic pulmonary hypertension: long-term effects and procedure-related complications

Although balloon pulmonary angioplasty (BPA) improves haemodynamics and short-term prognosis in patients with inoperable chronic thrombo-embolic pulmonary hypertension (CTEPH), the long-term effects of BPA, and procedure-related complications remain to be fully elucidated. From July 2009 to October 2016, we performed a total of 424 BPA sessions in 84 consecutive patients with inoperable CTEPH. We used 3D reconstructed computed tomography to determine target lesions of pulmonary arteries and optical computed tomography to select balloon size, if needed. In 77 patients (92%) who completed the BPA treatment [65 ± 14 (SD) years-old, male/female 14/63], haemodynamics and exercise capacity were examined at 6 months after last BPA and in the chronic phase [>12 months after first BPA, 31 (20, 41) months]. The BPA treatment significantly improved mean pulmonary arterial pressure (38 ± 10 to 25 ± 6 mmHg), pulmonary vascular resistance (7.3 ± 3.2 to 3.8 ± 1.0 Wood units), and 6-minute walk distance (380 ± 138 to 486 ± 112 m) (all P < 0.01), and the improvements persisted throughout the follow-up period (43 ± 27 months) (N = 53). In the 424 sessions, haemoptysis was noted in 60 sessions (14%), and non-invasive positive pressure ventilation (NPPV) was used to treat haemoptysis and/or hypoxemia in 33 sessions (8%). Furthermore, 5-year survival was 98.4% (only one patient died of colon cancer) with no peri-procedural death. These results indicate that BPA improves haemodynamics and exercise capacity in inoperable CTEPH patients with acceptable complication rate and that the beneficial haemodynamic effects of BPA persist for years with resultant good long-term prognosis.

Clinicopathological and long-term prognostic features of membranous nephropathy with crescents: a Japanese single-center experience.

Three recent studies from the United States and China reported the clinicopathological features and short-term prognosis in patients with membranous nephropathy (MN) and crescents in the absence of secondary MN, anti-glomerular basement membrane (GBM) antibodies, and anti-neutrophil cytoplasmic antibodies (ANCA). We compared clinicopathological and prognostic features in 16 MN patients with crescents (crescent group) and 38 MN patients without crescents (control group), in the absence of secondary MN, anti-GBM antibodies, and ANCA. Median follow-up periods in the crescent and control groups were 79 and 50months, respectively. Decreased estimated glomerular filtration rates (<50mL/min/1.73m2), glomerulosclerosis, and moderate-to-severe interstitial fibrosis were more frequently observed in the crescent group than in the control group (P=0.043, P=0.004, and P=0.035, respectively). Positive staining rates for glomerular IgG2 and IgG4 were significantly different between the 2 groups (P=0.032, P=0.006, respectively). Doubling of serum creatinine during follow-up was more frequently observed in the crescent group than in the control group (P=0.002), although approximately two-thirds of patients in the crescent group were treated with immunosuppressive therapy. Crescent formation and interstitial fibrosis were risks for doubling of serum creatinine [hazard ratio (HR)=10.506, P=0.012; HR=1.140, P=0.009, respectively]. This is the first Japanese study demonstrating significant differences in clinicopathological and prognostic features between the 2 groups. Most patients in the crescent group may develop a long-term decline in renal function despite immunosuppressive therapy.

Clinical Characteristics and Prognosis of Pulmonary Embolism Caused by Economy Class Syndrome

ObjectiveClinical presentation and short-term prognosis of patients with travel-associated acute pulmonary embolism (PE) (i.e., economy class syndrome [ECS]) is not well understood. MethodsIn this retrospective cohort study of patients with acute PE identified from a single center registry, we assessed the clinical presentation and the association between ECS and the outcomes of all-cause mortality, PE-related mortality, nonfatal venous thromboembolism and nonfatal major bleeding rates through 30days after initiation of PE treatment. ResultsOf the 2333 patients with acute symptomatic PE, 124 (5.3%; 95% confidence interval, 4.4%–6.3%) had ECS. Patients with ECS were younger and had fewer comorbid diseases (recent bleeding, chronic obstructive pulmonary disease, congestive heart failure), but they presented with more signs of clinical severity (syncope [48% vs 14%; P<.001], tachycardia [37% vs 21%; P<.001], right ventricular dysfunction [31% vs 19%; P<.01] and myocardial injury [57% vs 28%; P<.001]) compared to those without ECS. Regression analyses showed a significantly lower risk of all-cause mortality for patients with ECS compared to patients without ECS (1.6% vs 9.6%; P<.01). We did not detect a difference in PE-related mortality at 30days between those with and those without ECS (0.8% vs 3.1%; P=.18). ConclusionsPE patients with ECS are younger and have fewer comorbid diseases compared to those without ECS. Though they present with more signs of clinical severity, their short-term prognosis is excellent.

Compliance with the enhanced recovery after surgery protocol and prognosis after colorectal cancer surgery: A prospective cohort study.

We explored the effects of different levels of compliance with an enhanced recovery after surgery (ERAS) protocol on the short-term prognosis of patients who underwent colorectal cancer surgery. We conducted a single-center prospective cohort study in which 254 patients who received surgical treatment in a teaching tertiary care hospital were enrolled from March 2016 to November 2016. The patients were divided into four groups (I, II, III, and IV) based on individual compliance rates; the corresponding range of compliance rates was 0-60%, 60-70%, 70-80%, and 80-100%, and the number of patients in each group was 66, 63, 53, and 72, respectively. In the four groups from low to high compliance with ERAS (group I, II, III, and IV), the incidence of surgical site infections was 24.2%, 20.6%, 9.4%, and 6.9% (P < 0.05); the overall incidence of postoperative complications was 41.3%, 33.3%, 26.4%, and 16.7% (P < 0.05); the median length of postoperative hospital stay (in days) was 12.5, 10, 9, 8 (P < 0.05); and the median total hospital cost (Chinese Yuan) was 71,733, 73,632, 65,861, and 63,289 (P < 0.05), respectively. These results suggest that higher compliance with the ERAS protocol was associated with a lower incidence of surgical site infections, lower overall postoperative complication rate, shorter postoperative hospital stays, and lower total hospital costs.

Association of digitalis treatment with outcomes following myocardial infarction in patients with heart failure or evidence of left ventricular dysfunction: an analysis from the High-Risk Myocardial Infarction Database Initiative

Contradictory findings have been reported regarding the safety and efficacy of digitalis in patients recovering from acute myocardial infarction (MI). We studied the association of digitalis use with long-term and short-term prognosis in patients presenting with an acute MI complicated with heart failure (HF), left ventricular dysfunction, or both. Using the High-Risk MI Database Initiative combining data from 4 major clinical trials, totaling 27,673 patients, we investigated the association between digitalis use at baseline (3093 patients with digitalis and 24,580 without) with the rate of all-cause death, sudden cardiac death, cardiovascular death, HF hospitalization and the combination of the latter two, over a mean follow-up time of 2.7years. Patients with and without atrial fibrillation (AF) were studied separately. After a propensity score-based analysis, among patients without AF, those receiving digitalis experienced a higher rate of all-cause [hazard ratio (HR) 1.54, 95% confidence interval (CI) 1.42-1.67] and sudden cardiac death (HR 1.65, 95% CI 1.44-1.89), compared to those not receiving digitalis; similar results were found for the other 3 endpoints (all HR around 1.6). In contrast, in AF patients, digitalis had a milder effect on all outcomes (all HR≤1.12), with significant association only for the composite endpoint (HR 1.10, 95% CI 1.00-1.21, p=0.049); comparable results were obtained at 30days. Finally, the detrimental effect associated with digitalis use appeared to be more pronounced in patients with ejection fraction ≥ 40%. In MI survivors with HF and/or systolic dysfunction, digitalis was associated with a significant increased risk of death in patients without AF with mild to neutral associations for patients with AF. These findings raise concerns regarding the safety of digitalis in MI survivors with HF, especially for those without AF.

Características clínicas y pronóstico de la tromboembolia pulmonar secundaria al síndrome de clase turista

ObjectiveClinical presentation and short-term prognosis of patients with travel-associated acute pulmonary embolism (PE) (i.e., economy class syndrome [ECS]) is not well understood. MethodsIn this retrospective cohort study of patients with acute PE identified from a single center registry, we assessed the clinical presentation and the association between ECS and the outcomes of all-cause mortality, PE-related mortality, nonfatal venous thromboembolism and nonfatal major bleeding rates through 30days after initiation of PE treatment. ResultsOf the 2,333 patients with acute symptomatic PE, 124 (5.3%; 95% confidence interval, 4.4-6.3%) had ECS. Patients with ECS were younger and had fewer comorbid diseases (recent bleeding, chronic obstructive pulmonary disease, congestive heart failure), but they presented with more signs of clinical severity (syncope [48% vs. 14%; P<.001], tachycardia [37% vs. 21%; P<.001], right ventricular dysfunction [31% vs. 19%; P<.01] and myocardial injury [57% vs. 28%; P<.001]) compared to those without ECS. Regression analyses showed a significantly lower risk of all-cause mortality for patients with ECS compared to patients without ECS (1.6% vs. 9.6%; P<.01). We did not detect a difference in PE-related mortality at 30days between those with and those without ECS (0.8% vs. 3.1%; P=.18). ConclusionsPE patients with ECS are younger and have fewer comorbid diseases compared to those without ECS. Though they present with more signs of clinical severity, their short-term prognosis is excellent.

The impact of hyponatremia on short-term prognosis of patients with acute ST-elevation myocardial infarction treated with percutaneous coronary intervention

Objective To investigate the impact of hyponatremia on the short-term prognosis in patients with acute ST-elevation myocardial infarction(STEMI) treated with percutaneous coronary intervention (PCI). Methods The present study included 324 patients with acute STEMI treated with PCI within 12 hours after admission from March 2014 to May 2016. Patients were divided into three groups according to plasma sodium levels (Na+ ) at admission: group A with Na+ <130 mmol/L, group B with Na+ 130-134 mmol/L and group C with Na+ ≥135 mmol/L (normal plasma sodium level). Clinical data and biochemical variables were compared among the three groups. Logistic regression analysis was used to examine the correlation between plasma sodium levels and short-term prognosis. Results There were significant differences in age, fasting glucose, NT-proBNP, LVEF (left ventricular ejection fraction) and hsCRP (high sensitive C-reactive protein) among the three groups(P<0.05). The mortality in group A was obviously higher than that in Group B (20.0% vs. 6.3%, P<0.05) and in group C (20.0% vs. 6.0%, P<0.05). In addition, there were significant differences in rates of cardiogenic shock and acute renal failure among three groups. Logistic regression analysis showed that old age, low LVEF and hyponatremia were independent risk factors for 30-day mortality (P<0.05). Compared with group B, patients in group A had significantly high risks of death (OR=3.058, 95%CI: 1.339-4.358, P=0.003), suggesting that the high risk of 30-day mortality associated with the severity of hyponatremia. Conclusions At admission, the hyponatremia in patients with acute STEMI treated with PCI is an independent risk factor for 30-day mortality, and prognosis worsens with the severity of hyponatremia. Key words: Hyponatremia; Acute ST-elevation myocardial infarction; Percutaneous coronary intervention; Short-term prognostic impact

Correlation Between the Revised Brain Symmetry Index, an EEG Feature Index, and Short-term Prognosis in Acute Ischemic Stroke.

The present study aims to investigate the correlation between EEG features and short-term prognosis in patients who have experienced an acute ischemic stroke. The present study included 29 patients who had experienced an acute ischemic stroke and were treated at the Beijing Dongzhimen Hospital affiliated with Beijing University of Chinese Medicine between January 2010 and January 2012. Patients were evaluated using the revised Brain Symmetry Index (r-BSI), National Institutes of Health Stroke Scale, and Glasgow Coma Scale. Functional outcomes were assessed 21 days after admission using the Barthel Index and modified Rankin Scale. Two groups were created based on the Barthel Index (<60 vs. ≥60) and modified Rankin Scale (<3 vs. ≥3). Significant differences were observed in r-BSI, National Institutes of Health Stroke Scale, and Glasgow Coma Scale scores between the two groups. Poor functional outcomes were associated with higher r-BSI and National Institutes of Health Stroke Scale scores as well as lower Glasgow Coma Scale scores in comparison with those obtained for patients with good prognosis. Logistic regression analysis revealed that r-BSI scores at admission exhibited significant negative correlation with Barthel Index scores (-2.070, P = 0.049) and significant positive correlation with modified Rankin Scale scores (2.256, P = 0.033). The r-BSI may be a valuable prognostic tool in the prediction of short-term outcomes for patients who have experienced acute ischemic stroke. The early prediction of functional outcomes after stroke may enhance clinical management and minimize short-term mortality.

The clinical characteristics and short-term prognosis in elderly patients with Guillain-Barré syndrome.

To investigate the clinical characteristics and short-term prognosis of elderly patients with Guillain–Barré syndrome (GBS).We retrospectively analyzed the clinical data of adult GBS. According to the age, the enrolled subjects were divided into 2 groups, that is, patients ≥60 years (elderly group) and those aged 18 to 59 years (nonelderly group). The clinical characteristics and short-term prognosis of the patients in the 2 groups were compared.In total, 535 patients were enrolled. There were 67 patients fell into the elderly group with a mean age of 69 years old; while 468 patients fell into the nonelderly group with a mean age of 39 years old. We found that the elderly patients had significantly lower incidence of antecedent infections (49.3% vs 66.2%, P < 0.01). The time from onset to admission (5 vs 4 days, P < 0.05) and time from onset to nadir (7 vs 6 days, P < 0.05) were significantly longer in the elderly patients. It was noteworthy that more elderly patients were found with lymphocytopenia (55.4% vs 37.3%, P < 0.01), hyponatremia (25.0% vs 10.2%, P < 0.01), hypoalbuminemia (9.0% vs 2.6%, P < 0.05), and hyperglycemia (34.3% vs 15.2%, P < 0.01). Importantly, the elderly patients had longer duration of hospitalization (17 vs 14 days, P < 0.05), higher incidence of pneumonia (29.9% vs 18.8%, P < 0.05), and poorer short-term prognosis (58.2% vs 42.7%, P < 0.05). In patients with severe GBS, no significant differences were observed in disease severity, treatment modality, incidence of pneumonia, and duration of hospitalization between the 2 groups. However, more patients in the elderly group showed poor short-term prognosis (84.1% vs 63.8%, P < 0.01). Further, old age (≥60 years) (OR = 2.906, 95% CI: 1.174–7.194, P < 0.05) and lower Medical Research Council (MRC) score at nadir (OR = 0.948, 95% CI: 0.927–0.969, P < 0.01) were risk factors for poor short-term prognosis in severe GBS patients.The clinical characteristics and short-term prognosis of elderly patients with GBS are distinct from nonelderly adults. Old age (≥60 years) and lower nadir MRC score serve as predictor for poor short-term prognosis in severe GBS patients.

Circulating miR-29b and miR-424 as Prognostic Markers in Patients with Acute Cerebral Infarction.

Down-regulation of miR-29b and miR-424 have been observed in patients with acute cerebral infarction (ACI); however, the clinical significance of circulating miR-29b and miR-424 as prognostic markers still requires further investigation. A total of 45 patients diagnosed with ACI and 45 healthy volunteers were enrolled in this study, and the clinical information of the patients were collected. The serum samples of the participants were collected and stored at -80°C. The relative expression of miR-29b and miR-424 was determined using RT-qPCR, and the serum levels of IL-6, IL-4, TNF-α, and IFN-γ were measured using an enzyme-linked immunosorbent assay (ELISA) kits. The short-term prognosis of patients was evaluated using the Glasgow Outcome scale (GOS) at day 30. The serum levels of miR-29b and miR-424 were significantly lower in patients with ACI compared with the healthy controls (p < 0.01) and the serum level of IL-6, IL-4, and TNF-α were significantly up-regulated in patients with ACI (p < 0.05); moreover, using the Glasgow Outcome scale (GOS) as a prognostic index, it has been proved that the serum level of both miR-29b and miR-424 were positively associated with the short-term prognosis of the patients; finally, the expression of the circulating miR-29b and miR-424 were negatively correlated with the serum level of IL-6, IL-4, and TNF-α. Lower levels of circulating miR-29b and miR-424 in patients with acute cerebral infarction may predict poor prognosis, and the expression of circulating miR-29b and miR-424 are negatively correlated with the serum level of some pro-inflammatory cytokines, suggesting that circulating miR-29b and miR-424 may have the potential to become prognostic markers and therapeutic targets for the management of acute cerebral infarction.