Development of a novel predictive model for interstitial lung disease in ANCA-associated vasculitis prognostications within the Chinese population

Antineutrophil cytoplasmic antibody vasculitis-associated interstitial lung disease (AAV-ILD) is a potentially life-threatening disease. However, very little research has been done on the condition's mortality risk. Hence, our objective is to find out the factors influencing the prognosis of AAV-ILD and employ these findings to create a nomogram model. Patients with AAV-ILD who received treatment at the First Affiliated Hospital of Zhengzhou University during the period from March 1, 2011, to April 1, 2022 were selected for this research. The development of nomogram entailed a synergistic integration of univariate, Lasso, and multivariate Cox regression analyses. Internal validation ensued through bootstrap techniques involving 1000 re-sampling iterations. Discrimination and calibration were assessed utilizing Harrell's C-index, receiver operating characteristic (ROC) curve, and calibration curve. Model performance was evaluated through integrated discrimination improvement (IDI), net reclassification improvement (NRI), and likelihood ratio test. The net benefit of the model was evaluated using decision curve analysis (DCA). A cohort comprising 192 patients was enrolled for analysis. Throughout observation period, 32.29% of the population died. Key factors such as cardiac involvement, albumin, smoking history, and age displayed substantial prognostic relevance in AAV-ILD. These factors were incorporated to craft a predictive nomogram. Impressively, the model exhibited robust performance, boasting a Harrell's C index of 0.826 and an AUC of 0.940 (95% CI 0.904-0.976). The calibration curves depicted a high degree of harmony between predicted outcomes and actual observations. Significantly enhancing discriminative ability compared to the ILD-GAP model, the nomogram was validated through the IDI, NRI, and likelihood ratio test. DCA underscored the superior predictive value of the predictive model over the ILD-GAP model. The internal validation further affirmed this efficacy, with a mean Harrell's C-index of 0.815 for the predictive model. The nomogram model can be employed to predict the prognosis of patients with AAV-ILD. Moreover, the model performance is satisfactory. In the future, external datasets could be utilized for external validation.

The Clinical Value of Metagenomic Next-Generation Sequencing in Pneumocystis jirovecii Pneumonia

Background

The incidence of Pneumocystis jirovecii pneumonia (PJP) is increasing.

Methods

108 patients were analysed retrospectively at the Wuhan Union Hospital. The patients were classified into the PJP group or the P. jirovecii colonisation (PJC) group based on clinical diagnosis. Clinical data included demographics, laboratory examinations, treatment, and outcomes.

Results

A notable difference in the fungal load was seen between two groups, with median reads of 3215.79 vs. 5.61 in two groups, respectively (P<0.001). The optimal threshold value for discriminating P. jirovecii infection between colonisation for mNGS was six, and serum (1,3)-β-D-glucan (BDG) was 47.6 pg/mL. Besides, the positive detection rate of mNGS for co-pathogens in PJP patients was significantly higher than that of culture (88.16% vs. 22.37%, P<0.0001). Epstein-Barr virus and cytomegalovirus were the most common pathogens of co-infection in PJP patients. The antibiotic therapy in PJP patients was adjusted according to the mNGS results, of which seventeen (22.37%) were downgraded, 38 (50.0%) patients were upgraded, and 21 (27.63%) were unchanged. And almost all patients showed significant improvement in C-reactive protein.

Conclusion

mNGS is a promising and valuable technique with good performance for differentiating P. jirovecii infection and colonisation, the detection of pathogens, and antibiotic treatment.

Clinical Implementation of Dual-Energy CT Technical for Hepatobiliary Imaging

Dual-energy computed tomography (DECT) applies two energy spectra distributions to collect raw data based on traditional CT imaging. The application of hepatobiliary imaging, has the advantages of optimizing the scanning scheme, improving the imaging quality, highlighting the disease characterization, and increasing the detection rate of lesions. In order to summarize the clinical application value of DECT in hepatobiliary diseases, we searched the technical principles of DECT and its existing studies, case reports, and clinical guidelines in hepatobiliary imaging from 2010 to 2023 (especially in the past 5 years) through PubMed and CNKI, focusing on the clinical application of DECT in hepatobiliary diseases, including liver tumors, diffuse liver lesions, and biliary system lesions. The first part of this article briefly describes the basic concept and technical advantages of DECT. The following will be reviewed:the detection of lesions, diagnosis and differential diagnosis of lesions, hepatic steatosis, quantitative analysis of liver iron, and analyze the advantages and disadvantages of DECT in hepatobiliary imaging. Finally, the contents of this paper are summarized and the development prospect of DECT in hepatobiliary imaging is prospected.

Expression and clinical value of NLRP1 and NLRC4 inflammasomes in prostate cancer

The present study explored the clinical value of the protein expression levels of nucleotide binding oligomerization-like receptor family pyrin domain containing 1 (NLRP1) and nucleotide-binding oligomerization domain leucine-rich repeat and caspase recruitment domain-containing 4 (NLRC4) inflammasomes in the diagnosis and treatment of prostate cancer. A total of 54 patients with prostatic hyperplasia and 58 patients with prostate cancer were recruited at The First People's Hospital of Pinghu between January and May 2022. Immunohistochemical staining was used to determine the protein expression levels of the NLRP1 and NLRC4 inflammasomes in addition to the proinflammatory cytokines IL-18 and IL-1β in the two groups of patients. The protein expression levels of NLRP1 and NLRC4 inflammasome were significantly increased in patients with prostate cancer compared with patients with prostate hyperplasia. The differences in expression of NLRP1 and NLRC4 inflammatory vesicles in prostate cancer of different stages were also compared based on data from The Cancer Genome Atlas. The protein expression level of NLRP1 demonstrated a significant positive correlation with IL-1β and IL-18 expression, and the protein expression level of the NLRC4 inflammasome was significantly positively correlated with IL-18 expression. The protein expression levels of both NLRP1 and NLRC4 demonstrated a significant positive correlation with the Gleason score of prostate cancer. The expression of NLRP1 in tumor (T)3/T4 was significantly higher compared with T1 and expression of the NLRC4 inflammasome in T2 and T3/T4 was significantly higher compared with T1. Expression of the NLRP1 and NLRC4 inflammasomes was significantly higher in patients with prostate cancer, compared with patients with prostatic hyperplasia. Therefore, expression of NLRP1 and NLRC4 may promote tumorigenesis by promoting the maturation and release of proinflammatory cytokines IL-1β and IL-18. Expression of the NLRP1 and NLRC4 inflammasomes demonstrated a significant positive correlation with the risk of prostate cancer. Expression of the NLRP1 and NLRC4 inflammasomes in middle- and advanced-stage tumors was higher compared with early-stage tumors. These results suggested that inflammasome expression may serve a significant role in the progression of tumors and could provide a fixed value for the risk assessment and prognosis prediction of prostate cancer.

Identification and verification of novel immune-related ferroptosis signature with excellent prognostic predictive and clinical guidance value in hepatocellular carcinoma

Background: Immunity and ferroptosis often play a synergistic role in the progression and treatment of hepatocellular carcinoma (HCC). However, few studies have focused on identifying immune-related ferroptosis gene biomarkers. Methods: We performed weighted gene co-expression network analysis (WGCNA) and random forest to identify prognostic differentially expressed immune-related genes (PR-DE-IRGs) highly related to HCC and characteristic prognostic differentially expressed ferroptosis-related genes (PR-DE-FRGs) respectively to run co-expression analysis for prognostic differentially expressed immune-related ferroptosis characteristic genes (PR-DE-IRFeCGs). Lasso regression finally identified 3 PR-DE-IRFeCGs for us to construct a prognostic predictive model. Differential expression and prognostic analysis based on shared data from multiple sources and experimental means were performed to further verify the 3 modeled genes' biological value in HCC. We ran various performance testing methods to test the model's performance and compare it with other similar signatures. Finally, we integrated composite factors to construct a comprehensive quantitative nomogram for accurate prognostic prediction and evaluated its performance. Results: 17 PR-DE-IRFeCGs were identified based on co-expression analysis between the screened 17 PR-DE-FRGs and 34 PR-DE-IRGs. Multi-source sequencing data, QRT-PCR, immunohistochemical staining and testing methods fully confirmed the upregulation and significant prognostic influence of the three PR-DE-IRFeCGs in HCC. The model performed well in the performance tests of multiple methods based on the 5 cohorts. Furthermore, our model outperformed other related models in various performance tests. The immunotherapy and chemotherapy guiding value of our signature and the comprehensive nomogram's excellent performance have also stood the test. Conclusion: We identified a novel PR-DE-IRFeCGs signature with excellent prognostic prediction and clinical guidance value in HCC.

Evaluation of the ESMO-Magnitude of Clinical Benefit Scale version 1.1 (ESMO-MCBS v1.1) for adjuvant radiotherapy in breast cancer

BACKGROUND

The European Society of Medical Oncology (ESMO) has suggested using the ESMO-Magnitude of Clinical Benefit Scale (MCBS) to grade the magnitude of clinical benefit of cancer therapies. This approach has not been applied to radiation therapy (RT) yet. We applied the ESMO-MCBS to experiences describing the use of RT to assess (1) the 'scoreability' of the data, (2) evaluate the reasonableness of the grades for clinical benefit and (3) identify potential shortcomings in the current version of the ESMO-MCBS in its applicability to RT.

MATERIALS AND METHODS

We applied the ESMO-MCBS v1.1 to a selection of studies in radiotherapy that had been identified as references in the development of American Society for Radiation Oncology (ASTRO) evidence-based guidelines on whole breast radiation. Of the 112 cited references, we identified a subset of 16 studies that are amenable to grading using the ESMO-MCBS.

RESULTS

Of the 16 studies reviewed, 3/16 were scoreable with the ESMO tool. Six of 16 studies could not be scored because of shortcomings in the ESMO-MCBS v1.1: (1) in 'non-inferiority studies', there is no credit for improved patient convenience, reduced patient burden or improved cosmesis; (2) in 'superiority studies' evaluating local control as a primary endpoint, there is no credit for the clinical benefit such as reduced need for further interventions. In 7/16 studies, methodological deficiencies in the conduct and reporting were identified.

CONCLUSIONS

This study represents a first step in determining the utility of the ESMO-MCBS in the evaluation of clinical benefit in radiotherapy. Important shortcomings were identified that would need to be addressed in developing a version of the ESMO-MCBS that can be robustly applied to radiotherapy treatments. Optimization of the ESMO-MCBS instrument will proceed to enable assessment of value in radiotherapy.

Clinical value of fecal calprotectin for evaluating disease activity in patients with Crohn's disease

Objective: To explore the clinical value of fecal calprotectin (FC) for evaluating disease activity in patients with Crohn's disease (CD) and its relationship with disease location. Methods: Patients with CD were enrolled retrospectively, and clinical data, including FC levels, were collected. Clinical activity was assessed using the Crohn's disease activity index (CDAI). Endoscopic activity was assessed using a simple endoscopic score for Crohn's disease (SES-CD). The partial SES-CD (pSES-CD) was scored for the size of ulcers in each segment as defined by the SES-CD and was calculated as the sum of segmental ulcer scores. Results: This study included 273 CD patients. The FC level was significantly positively correlated with the CDAI and SES-CD, with correlation coefficients of 0.666 and 0.674, respectively. The median FC levels in patients with clinical remission and mildly active and moderately-severely active disease were 41.01, 164.20, and 444.45 μg/g. These values were 26.94, 66.77, and 327.22 μg/g during endoscopic remission and mildly and moderately-severely active stages, respectively. Compared with c-reactive protein (CRP), the erythrocyte sedimentation rate (ESR), and other biomarker parameters, FC was better at predicting disease activity for CD patients. For an FC <74.52 μg/g, the area under the curve (AUC) for predicting clinical remission was 0.86, with a sensitivity of 89.47% and a specificity of 71.70%. Moreover, endoscopic remission was predicted with a sensitivity of 68.02% and a specificity of 85.53%. The AUC was 0.83, and the cutoff value was 80.84 μg/g. In patients with ileal and (ileo) colonic CD, FC was significantly correlated with the CDAI, SES-CD, and pSES-CD. The correlation coefficients were 0.711 (CDAI), 0.473 (SES-CD), and 0.369 (pSES-CD) in patients with ileal CD and 0.687, 0.745, and 0.714 in patients with (ileo) colonic CD, respectively. For patients in remission, those in the active stage, and those with large or very large ulcers, differences in FC levels were not significant between patients with ileal and (ileo) colonic CD. Conclusion: FC is a reliable predictor of disease activity in patients with CD, including those with ileal CD. FC is thus recommended for the routine follow-up of patients with CD.

Perspectives of international multi-center clinical trials on traditional Chinese herbal medicine

With the introduction of various subjects, such as clinical epidemiology and evidence-based medicine, the qualities and levels of Traditional Chinese Herbal Medicine (TCHM) in China improved substantially, and the processes of internationalization of Traditional Chinese Medicine (TCM) are further accelerated. Since, a variety of drug products in China have been approved for marketing in other countries, and approximately 10 products have submitted the IND application to FDA of United States, of which various Chinese herbal preparations such as compound Danshen dripping pills, Xingling granules, and HMPL-004 have been approved to be investigated in phase III clinical trials. In general, multi-center studies of TCHM are increasing with years, but most of the studies are performed in some certain country, and the actual international multi-center clinical trials are very rare. Number of SCI literatures on multi-center clinical trials of TCHM that published in the recent decade also showed increasing tendency with years, despite the evident reduction in the past 2 years due to the influence of COVID-19 pandemic. Of the multi-center clinical trials of TCHM that performed by mainland China and other oversees regions, except for Taiwan, China, nearly 70% were focused on classic Chinese medicinal formulae and Chinese patent medicine, while the other 30% were on dietary supplements and plant extracts. Facing the future, the "human experience" has attracted close attentions from researchers throughout the world. Effectively utilizing the historic "human experience" is an important method to vitalize potential of original scientific and technological resources of TCHM. Performing multi-center clinical trials with high qualities is still an essential method for TCHM in accessing the mainstream medicine market. In addition, it is also required to further improve the evaluation techniques and methods that not only meet the international standards but also meet the characteristics of TCHM. Furthermore, we should also focus on the TCHM specific clinical values and scientific reports.

Expression of lncRNA DLX6-AS1 in patients with hepatic carcinoma and its prognostic value

Hepatic carcinoma (HCC) is one of the most common malignant tumors worldwide, and the prognosis of HCC patients is often poor. Long-chain non-coding RNA (lncRNA) distal-less homeobox 6 antisense 1 (DLX6-AS1) has been shown to be involved in the pathogenesis of various cancers. This study aims to investigate the expression of DLX6-AS1 in HCC patients and its prognostic value. The serum DLX6-AS1 was quantified using a reverse transcription-polymerase chain reaction (RT-PCR) assay in both HCC patients and healthy individuals, and the correlation of DLX6-AS1 with clinicopathological features of HCC patients, as well as the diagnostic and prognostic value of DLX6-AS1 for HCC patients, were analyzed. The results showed that the expression of serum DLX6-AS1 in HCC patients was significantly higher than that of healthy individuals (P < 0.05), and DLX6-AS1 was related to tumor differentiation, pathological staging, and lymph node metastasis (all P < 0.05). Patients with high DLX6-AS1 expression showed significantly higher mortality than those with low DLX6-AS1 expression, and the DLX6-AS1 expression in dead patients was significantly higher than that in living patients. Furthermore, the AUC of DLX6-AS1 for poor prognosis of HCC patients was larger than 0.8. The univariate analysis revealed that the poor prognosis of HCC patients was related to pathological staging, lymph node metastasis, differentiation, and DLX6-AS1 expression (all P < 0.05), and the Cox multivariate analysis revealed that pathological staging, lymph node metastasis, differentiation, and DLX6-AS1 expression were independent risk factors for poor prognosis of HCC patients (all P < 0.05). These findings suggest that DLX6-AS1 may be a promising target for diagnosis, treatment, and prognosis prediction of HCC patients.

tRNA derived fragments:A novel player in gene regulation and applications in cancer

The heterogeneous species of tRNA-derived fragments (tRFs) with specific biological functions was recently identified. Distinct roles of tRFs in tumor development and viral infection, mediated through transcriptional and post-transcriptional regulation, has been demonstrated. In this review, we briefly summarize the current literatures on the classification of tRFs and the effects of tRNA modification on tRF biogenesis. Moreover, we highlight the tRF repertoire of biological roles such as gene silencing, and regulation of translation, cell apoptosis, and epigenetics. We also summarize the biological roles of various tRFs in cancer development and viral infection, their potential value as diagnostic and prognostic biomarkers for different types of cancers, and their potential use in cancer therapy.

Research Progress of BAP1 in Structure, Function, and Cancer

Cancer is an important chronic non-communicable disease that endangers human health and has become the main cause of death of residents around the world in the 21st century. At present, most of the mature treatment methods stay at the level of cell and tissue, which is difficult to fundamentally solve the problem of cancer. Therefore, explaining the pathogenesis of cancer at the molecular level becomes the answer to the key problem of cancer regulation. BRCA-associated protein 1 (brca1- associated protein 1) is a kind of ubiquitination enzyme encoded by the BAP1 gene and composed of 729 amino acids. As a carcinogenic protein, BAP1 can affect the cancer cell cycle and proliferation capacity, mutation, and deletion. For example, depending on catalytic activity, it participates in the regulation of intracellular function through transcription, epigenetic, and DNA damage repair. This article mainly reviews the basic structure and function of BAP1 in cells, its role in cancer development, and cancer-related mutants.

Clinical value of the platelet and inflammatory factor activation in vascular endothelial injury in essential hypertension

OBJECTIVE

To investigate the clinical value of platelet and inflammatory factor activation in vascular endothelial injury in hypertension.

METHODS

A total of 120 hypertension patients diagnosed in our hospital from December 2019 to June 2021 were enrolled as study objects (Hypertension group); besides, another cohort of 60 healthy people undergoing physical examination at the same period were recruited as the controls (Control group). Next, the baseline clinical characteristics of subjects in the two groups were recorded and compared. Specifically, a hematology analyzer was adopt for detecting the mean platelet volume (MPV), platelet distribution width (PDW) and platelet hematocrit (PCT); ELISA for the level of IL-6, IL-8 and TNF-α; PHILIPS EPIQ 7 C (a device assessing endothelial vasodilator function in a non-invasive fashion) for reactive hyperemia index (RHI); univariate and multivariate regression analysis for risk factors triggering endothelial dysfunction; and Spearman correlation analysis for the correlation of platelet activation indicators and inflammatory factor level with vascular endothelial function.

RESULTS

Compared with the Control group, the patients in the Hypertension group exhibited higher levels of MPV, PDW, PCT, inflammatory factors (IL-6, IL-8 and TNF-α) and lower RHI. Moreover, Spearman correlation analysis showed a significant negative correlation of MPV, PDW, PCT, IL-6, IL-8 and TNF-α level with RHI level. In addition, univariate and multivariate regression analysis presented that MPV, PCT, IL-8 and TNF-α were risk factors for vascular endothelial dysfunction.

CONCLUSION

The activation of platelet and inflammatory factor is closely related to vascular endothelial function injury in patients with hypertension. To be specifically, platelet and inflammatory factor activation can effectively reflect the vascular endothelial function injury in patients with hypertension and has high clinical value.

Study of peripheral blood inflammatory factor levels and their clinical value in patients with lupus nephritis

OBJECTIVE

To explore the effect of traditional Chinese and western medicine on the levels of inflammatory cytokines in the peripheral blood of patients with lupus nephritis (LN).

METHODS

A total of 80 patients with LN admitted to the hospital from August 2016 to August 2017 were retrospectively analyzed. They were equally separated into an experimental group and a control group by the different types of medications. The control group was treated with western medicine, and the experimental group was treated with the combination of traditional Chinese and western medicines. The therapeutic effects were compared.

RESULTS

The levels of IL-6, IL-18 and TNF-α in the experimental group after treatment were (5.47±1.66) pg/ml, (31.66±3.87) pg/ml, and (9.28±3.06) pg/ml, respectively, which were significantly lower than (13.71±3.86) pg/ml, (68.47±4.26) pg/ml, and (22.17±6.54) pg/ml before treatment. The difference was statistically significant (t1 = 12.403, t2 = 40.450, t3 = 11.291, all P<0.001). In the control group after treatment, the levels of IL-6, IL-18 and TNF-α were (12.68±1.32) pg/ml, (68.22±3.42) pg/ml, and (19.78±5.57) pg/ml, respectively. The difference in control and experimental groups was statistically significant (t1 = 21.501, t2 = 44.771, t3 = 10.449, P<0.001). The total effective rate was 95.00% (38/40) in the experimental group and 80.00% (32/40) in control group, (X² = 4.114, P<0.001). There SLEDAI scores of the experimental group were much lower than control after 8 and 12 weeks of treatment (t1 = 8.186, t2 = 20.776, P<0.001). Moreover, the liver and kidney Yin deficiency symptoms in both groups were significantly improved after treatment (P<0.01).

CONCLUSION

The combined treatment of traditional Chinese and western medicine can successfully prevent the secretion of serum IL-6, IL-18 and TNF-α, control the development of disease, boost the therapeutic outcome, and alleviate the immune injury of the body.

Advantages of contrast-enhanced CT combined with DCE-MRI in identifying malignant parotid tumor

OBJECTIVE

To study the value of single and combined application of contrast-enhanced computerized tomography (CT) and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in diagnosing parotid tumors.

METHODS

In this retrospective study, 82 patients with parotid gland mass who received contrast-enhanced CT and DCE-MRI detection in The First People's Hospital of Huzhou from March 2018 to March 2022 were selected as study subjects. The nature of the parotid tumor was pathologically examined following the surgery. According to the pathological diagnosis results, these patients were divided into a benign group (n=59) and a malignant group (n=23). All patients underwent contrast-enhanced CT and DCE-MRI examinations. The diagnostic accuracy rates of contrast-enhanced CT, DCE-MRI and the joint application were compared. The CT or MRI images of benign and malignant parotid tumors were compared. The correlation of parotid cancer with the imaging features was analyzed. Diagnostic efficiency of contrast-enhanced CT, DCE-MRI and joint application for parotid cancer was assessed by receiver operating characteristic curve.

RESULTS

In terms of diagnostic accuracy, there was a significant difference between contrast-enhanced CT combined with DCE-MRI and contrast-enhanced CT alone (95.12% vs. 81.71%, P<0.001), and between the joint application and DCE-MRI alone (95.12% vs. 86.58%, P=0.004). Results of contrast-enhanced CT revealed statistical differences in tumor boundary, tumor size, calcification and cystic degeneration between benign and malignant tumors (P<0.05), but no obvious difference in lymph node enlargement between the two groups. MRI results showed that there were differences in the DCE-MRI time-signal intensity curve and ADC value between benign and malignant tumors (P<0.05). Correlation analysis results showed that the malignant tumor was negatively correlated with tumor boundary, calcification, cystic degeneration and ADC values, and it was positively correlated with DCE-MRI time-signal intensity curve and tumor size (P<0.05). Analysis of diagnostic efficacy showed that contrast-enhanced CT combined with DCE-MRI were significantly better than contrast-enhanced CT alone in terms of sensitivity and specificity (P<0.05). Moreover, the sensitivity of the joint application was also higher than that of MRI alone, while no obvious difference was found for specificity between joint application and MRI alone. The areas under the curve of contrast-enhanced CT combined with DCE-MRI in diagnosing malignant parotid tumor was remarkably greater than that of CT or MRI alone (P<0.05).

CONCLUSION

Contrast-enhanced CT combined with DCE-MRI can significantly improve the diagnostic accuracy, sensitivity and specificity for malignant parotid tumor, and the joint application was able to point out the direction of targeted surgical treatment plans.

Changes in lung cancer-related serum tumor markers in patients with chronic kidney disease and determination of upper reference limit

Aims

To investigate the changes in lung cancer-related serum tumor markers in patients with chronic kidney disease (CKD) and determine the upper reference limit for patients with different stages.

Methods

Included inpatients diagnosed with CKD who did not receive dialysis temporarily in our hospital from March to September 2020. Changes in serum CA125, HE4, CYFRA21-1, SCCA, NSE and ProGRP in CKD patients were analyzed. The non-parametric method was used to estimate the upper reference limit of the above indicators in patients with CKD stages 2-5.

Results

The serum levels of HE4, CYFRA21-1, SCCA, and ProGRP in the CKD group were significantly higher than those in the healthy control group; CA125 and NSE levels were not statistically different. The false positives of SCC, CYFRA21-1, ProGRP, and HE4 increased significantly with the CKD stage. Still, NSE and CA125 did not show a significant increasing trend. Both HE4 and ProGRP have independent upper reference limits from CKD2 to CKD5 stage, namely 220.8 pmol/l and 101.4 pg/ml in the CKD2 stage, 496.7 pmol/l and 168.63 pg/ml in CKD3 stage, 4592.4 pmol/l and 272.8 pmol/l for CKD4 stage, CKD5 stage was 4778.2 pmol/l and 491.6 pmol/l.

Conclusion

This study preliminarily determined the upper reference limits of Lung cancer-related tumor markers in patients with different CKD stages and provided laboratory support for the rational use and interpretation of Lung cancer-related tumor markers in special populations.

The potential therapeutic value and application prospect of engineered exosomes in human diseases

Exosomes are tiny vesicles produced by a wide range of cells that contain complex RNA and protein. In the diagnosis, treatment, and prevention of illness, they offer great potential. In vitro engineering technique modifies exosomes to produce designed exosomes that include nucleic acids, proteins, and medicines, and are targeted to particular tissues or cells. Their applications range from tumor imaging and gene therapy to vaccine production and regenerative medicine to targeted medication delivery. Many disciplines have promising futures for using this technology. In this review, we'll look at the potential therapeutic usefulness and use of engineered exosomes in a variety of human illnesses with various systemic manifestations.

Guidance Value of Procalcitonin Detection in Selecting Switching Points for Sequential Therapy in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease Complicated by Respiratory Failure

Objective

To analyse the guiding value of procalcitonin (PCT) for the selection of ventilation switching points in sequential mechanical ventilation for patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and respiratory failure, and to provide a reference for the optimisation of mechanical ventilation for patients with COPD and respiratory failure.

Methods

The study included 160 patients with an acute exacerbation of COPD complicated by respiratory failure who received sequential mechanical ventilation treatment. They were divided into two groups of 80 participants. The critical point of the pulmonary infection observation window (PIC) was used as the switching point for sequential mechanical ventilation treatment in the control group, and PCT clinical node was used as the switching point for sequential mechanical ventilation treatment in the observation group. The invasive ventilation time, non-invasive mechanical ventilation time, total mechanical ventilation time, intensive care unit (ICU) treatment time, complication rate and prognosis were compared for the two groups.

Results

(1) There was no significant difference in the respiratory rate, heart rate, arterial systolic pressure, arterial oxygen partial pressure, arterial carbon dioxide partial pressure or pH value between the two groups after 1 day of treatment, and (2) invasive mechanical ventilation time, non-invasive mechanical ventilation time, total mechanical ventilation time, ICU treatment time and the incidence of complications were significantly different in the two groups (P = 0.0001).

Conclusion

Detecting PCT can guide the selection of ventilation switching points in sequential mechanical ventilation therapy for patients with COPD with respiratory failure in the acute exacerbation stage, effectively reduce the misevaluation of PIC switching points so that patients can obtain stable criteria for judgement and effectively improve the efficiency and safety of mechanical ventilation treatment for patients in the acute exacerbation stage.

The Clinical Value of Methicillin-Resistant Staphylococcus aureus Nasal Screening in the Management of Diabetic Foot Infections

Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) remains an important risk factor for diabetic foot infections (DFIs). We explored herein the clinical value of MRSA-nasal screening in the management of DFIs. In this retrospective case-control study, patients admitted with a DFI between 1/1/2014-6/30/2020 were studied and divided into cases (positive MRSA-nasal screening) and controls (negative MRSA-nasal). We included 171 patients (22 cases and 149 controls). MRSA nasal screening had a negative predictive value (NPV) of 86%. Compared to controls, cases were treated with intravenous vancomycin for a longer duration: (median [IQR], 5[3,11] vs 2[2,6]) days, P = .037). In multivariate analysis, a negative MRSA nasal screening was associated with a 74% decreased risk of AKI (OR = 0.26, 95% CI = 0.07-0.89). MRSA nasal screening in patients admitted with DFI has a high NPV. Obtained early, it can shorten the duration of intravenous vancomycin, consequently preventing AKI.

Research advances of N6-methyladenosine in diagnosis and therapy of pancreatic cancer

BACKGROUND

N6-methyladenosine (m6A) is the addition of a methyl group on the N6 position of adenosine and is the most prevalent and abundant epigenetic modification in eukaryote mRNA. m6A marks are added to mRNA by the m6A methyltransferase complex ("writers"), removed by m6A demethylases ("erasers"), and recognized by m6A-binding proteins ("readers"). Recent evidence has shown that the m6A modification plays a crucial role in the pathogenic mechanism and malignant progression of pancreatic cancer, with roles in cell survival, proliferation, migration, invasion, tumor metastasis, and drug resistance.

METHODS

Literature was searched in Pubmed and Web of Science for the following keywords: "N6-methyladenosine", "pancreatic cancer", "epigenetic modification", "immunotherapy".

RESULTS

Among classical m6A regulators, while METTL3, METTL14, WTAP, FTO, YTHDF2, IGF2BP1-3, hnRNPC, and NKAP are upregulated in pancreatic cancer, METTL16 and ALKBH5 are downregulated in pancreatic cancer. m6A modification has been investigated in pancreatic cancer therapy.

CONCLUSION

Dysregulated m6A and its related factors in pancreatic cancer cells and patients indicate their potential values as novel biomarkers in pancreatic cancer diagnosis and targeted therapy.

Metagenomic next-generation sequencing for accurate diagnosis and management of lower respiratory tract infections

OBJECTIVES

This study aimed to evaluate the clinical value of metagenomic next-generation sequencing (mNGS) in patients with suspected lower respiratory tract infections (LRTIs).

METHODS

This retrospective study reviewed patients with suspected LRTIs in Wuhan Union Hospital. Data including demographic, laboratory, and radiological profiles; treatment; and outcomes were recorded and analyzed.

RESULTS

mNGS identified pathogenic microbes in 100/140 (71.4%) patients, although 135 (96.4%) had received empiric antibiotic treatment before the mNGS tests. Single bacterial infection (35/100, 35%) was the most common type of infection in patients with positive mNGS results, followed by single fungal infection (14/100, 14%), bacterial-viral co-infection (14/100, 14%), single viral infection (12/100, 12%), bacterial-fungal co-infection (9/100, 9%), fungal-viral co-infection (9/100, 9%), and bacterial-fungal-viral co-infection (7/100, 7%). Moreover, compared with culture test, mNGS showed higher sensitivity (63/85, 74.1% vs. 22/85, 25.9% P=0.001) and lower processing time (24 h vs 48 h). Antibiotic treatment was adjusted or confirmed based on the mNGS results in 123 (87.9%) patients, including 5 (3.6%), 33 (23.6%) and 85 (60.7%) patients in whom treatment was downgraded, upgraded and unchanged, respectively, and almost all patients, regardless of escalation, de-escalation, or no change in treatment, showed significant improvement in clinical symptoms and inflammatory indicators. Additionally, 17 (12.1%) patients were referred to Wuhan Pulmonary Hospital for further treatment because of confirmed or suspected tuberculosis.

CONCLUSIONS

mNGS could be a promising technique for microbiological diagnosis and antibiotic management, potentially improving outcomes of patients.

CRNDE: A valuable long noncoding RNA for diagnosis and therapy of solid and hematological malignancies

Colorectal neoplasia differentially expressed (CRNDE) is an oncogenic long noncoding RNA (lncRNA). Increased CRNDE expression was initially discovered in colorectal cancer and then in a variety of solid tumors and hematological malignancies. CRNDE participates in multiple biological processes, such as cell proliferation, differentiation, migration, and apoptosis. CRNDE has been shown to modulate target gene expression through multiple mechanisms, including transcriptional regulation, post-transcriptional regulation, and competition for microRNA (miRNA) binding. In this review, we summarize the evidence that supports CRNDE in the diagnosis and prognosis predicting of cancers. The functional roles and molecular mechanisms of CRNDE are further described for major types of solid tumors and hematological malignancies. The therapeutic potential of CRNDE as a target for research and development is also discussed.

Potential of the miR-200 Family as a Target for Developing Anti-Cancer Therapeutics

MicroRNAs (miRNAs) are small non-coding RNAs (18–24 nucleotides) that play significant roles in cell proliferation, development, invasion, cancer development, cancer progression, and anti-cancer drug resistance. miRNAs target multiple genes and play diverse roles. miRNAs can bind to the 3′UTR of target genes and inhibit translation or promote the degradation of target genes. miR-200 family miRNAs mostly act as tumor suppressors and are commonly decreased in cancer. The miR-200 family has been reported as a valuable diagnostic and prognostic marker. This review discusses the clinical value of the miR-200 family, focusing on the role of the miR-200 family in the development of cancer and anti-cancer drug resistance. This review also provides an overview of the factors that regulate the expression of the miR-200 family, targets of miR-200 family miRNAs, and the mechanism of anti-cancer drug resistance regulated by the miR-200 family.

Percutaneous Radiofrequency Ablation Is an Effective Method for Local Control of Liver Metastases From Lung Cancer

Objective

To investigate the clinical value of percutaneous radiofrequency ablation (RFA) for liver metastasis from lung cancer (LCLM).

Materials and Methods

We retrospectively enrolled 58 patients who underwent RFA for LCLM between January 2014 and December 2019. Primary lung cancer histology included 38 adenocarcinomas, 15 squamous carcinomas, and 5 small cell carcinomas. For 83 metastatic lesions (mean tumor diameter 3.3 ± 1.1 cm, range 0.9-5.0 cm), 65 RFA sessions were performed. Before RFA, 17 and 41 patients presented no and stable extrahepatic metastasis, respectively, whereas 18 and 40 patients had synchronous and metachronous liver metastasis, respectively. Survival was analyzed using the Kaplan-Meier method. Cox proportional hazards model was used for multivariable analysis.

Results

The technical success rate was 96.3% (80/83 lesions). Local tumor progression was observed in 8 (9.8%, 8/82) lesions of 57 (14.0%, 8/57) patients at 4-12 months after RFA. New liver metastases occurred in 27 (46.6%) patients. The overall survival (OS) rates at 1, 2, 3, and 5 years after RFA were 55.2%, 26.0%, 22.0%, and 14.4%, respectively. The median OS after RFA and after liver metastasis were 14.0 ± 1.6 and 20.0 ± 1.5 months, respectively. Based on the univariable analysis, tumor size (p=0.017), histological type (p=0.015), and timing of liver metastasis (p=0.046) were related to OS. In further multivariable analyses, squamous carcinoma (hazard ratio= 2.269, 95% confidence interval: 1.186-4.339, p=0.013) was an independent unfavorable prognostic factor for OS. Based on the univariable analysis, histological type (p=0.010) was identified as parameters significantly related to local tumor progression (LTP)-free survival. Further multivariable analyses revealed that squamous carcinoma (hazard ratio=2.394, 95% confidence interval: 1.260-4.550, p=0.008) was an independent unfavorable prognostic factor for LTP-free survival.

Conclusion

RFA is a safe therapeutic option for LCLM with acceptable local tumor control, especially in patients with a tumor size ≤3 cm, adenocarcinoma/small cell carcinoma, and metachronous liver metastases.

Clinical Significance of miR-21-5p in Predicting Occurrence and Progression of Uremic Vascular Calcification in Patients with End-Stage Renal Disease

PURPOSE

Vascular calcification (VC) is a common complication of end-stage renal disease (ESRD). This study aimed to examine changes in the expression of miR-21-5p in ESRD patients with VC and to explore its clinical value in predicting the occurrence and progression of uremic VC.

MATERIALS AND METHODS

120 ESRD patients were divided into patients without VC group (n=38) and patients with VC group (n=82). All patients were followed up for 2 years to evaluate VC progression. qRT-PCR was used to detect serum miR-21-5p levels. Receiver operating characteristic curves were constructed to assess diagnostic value. Kaplan-Meier and log-rank methods were utilized to calculate associations between VC progression and risk factors.

RESULTS

Serum miR-21-5p levels were significantly higher in ESRD patients with VC than in those without VC and increased progressively with increasing disease severity. Serum miR-21-5p levels were able to distinguish patients with VC from those without VC, with an area under the curve value of 0.883, a sensitivity of 81.7%, and a specificity of 84.2%. After 2 years of follow-up, miR-21-5p expression had increased in patients with worse VC severity, compared with those with stable VC severity. Patients with high miR-21-5p levels were more likely to develop more severe VC, indicating an association between miR-21-5p and VC progression (log-rank p=0.002). Multivariable Cox regression analysis suggested that serum miR-21-5p is an independent predictive factor of VC progression in ESRD patients (hazard ratio=2.064, 95% confidence interval=1.225-3.478, p=0.006).

CONCLUSION

miR-21-5p is overexpressed in the serum of ESRD patients with VC. Our results suggest that overexpression of miR-21-5p is closely associated with VC progression.

Therapeutic Mesenchymal Stem/Stromal Cells: Value, Challenges and Optimization

Cellular therapy aims to replace damaged resident cells by restoring cellular and molecular environments suitable for tissue repair and regeneration. Among several candidates, mesenchymal stem/stromal cells (MSCs) represent a critical component of stromal niches known to be involved in tissue homeostasis. In vitro, MSCs appear as fibroblast-like plastic adherent cells regardless of the tissue source. The therapeutic value of MSCs is being explored in several conditions, including immunological, inflammatory and degenerative diseases, as well as cancer. An improved understanding of their origin and function would facilitate their clinical use. The stemness of MSCs is still debated and requires further study. Several terms have been used to designate MSCs, although consensual nomenclature has yet to be determined. The presence of distinct markers may facilitate the identification and isolation of specific subpopulations of MSCs. Regarding their therapeutic properties, the mechanisms underlying their immune and trophic effects imply the secretion of various mediators rather than direct cellular contact. These mediators can be packaged in extracellular vesicles, thus paving the way to exploit therapeutic cell-free products derived from MSCs. Of importance, the function of MSCs and their secretome are significantly sensitive to their environment. Several features, such as culture conditions, delivery method, therapeutic dose and the immunobiology of MSCs, may influence their clinical outcomes. In this review, we will summarize recent findings related to MSC properties. We will also discuss the main preclinical and clinical challenges that may influence the therapeutic value of MSCs and discuss some optimization strategies.

Clinical Value of COVID-19 Chest Radiography and High-Resolution CT Examination

BACKGROUND

Novel coronavirus disease 2019 (COVID-19) pneumonia remains a matter of concern. Chest CT findings of COVID-19 pneumonia have been reported widely, while there is relatively rare research on chest X-ray (CXR).

OBJECTIVE

The study was aimed to compare the CXR and chest CT findings of patients with confirmed COVID-19 infection and to explore their respective clinical values.

METHODS

28 inpatients with COVID-19 pneumonia who underwent both CXR and CT were included. The pulmonary manifestations of the lesions were recorded. Ground-glass opacity (GGO), consolidation, and fibrosis were quantified in CXR and chest CT separately. Consistency was analyzed using Fleiss' kappa and intraclass correlation coefficient. The stages of the disease in CXR and chest CT were evaluated.

RESULTS

Approximately 67.9% (19/28) of subjects had abnormal findings on CXR. The common manifestations in CXR were ground-glass opacities (GGO) (100%, 19/19) and consolidation (68.4%, 13/19). 92.9% (26/28) of patients had abnormal manifestations on CT. The common manifestations in CT were GGO (88.5%, 23/26), consolidation (69.2%, 18/26), reticular opacity (69.2%, 18/26) and nodule (46.2%, 12/26). Among the abnormalities between CXR and CT, only consolidation was consistent (κ=0.510). GGO (ICC=0.501) and consolidation (ICC=0.431) scores were consistent in CXR and chest CT. The results of staging were the same in 14 cases, most of them were in stage I and stage II. While in other cases with inconsistent results, CT was more advanced in the disease stage than CXR, mainly stage III and stage IV.

CONCLUSION

CXR is helpful to observe the change of the pulmonary lesions in patients with confirmed COVID-19 pneumonia. CT can be used for early diagnosis and staging of lesions.

Exploring the Value of Radiomics Features Based on B-Mode and Contrast-Enhanced Ultrasound in Discriminating the Nature of Thyroid Nodules

Background

With the improvement of ultrasound imaging resolution and the application of various new technologies, the detection rate of thyroid nodules has increased greatly in recent years. However, there are still challenges in accurately diagnosing the nature of thyroid nodules. This study aimed to evaluate the clinical application value of the radiomics features extracted from B-mode ultrasound (B-US) images combined with contrast-enhanced ultrasound (CEUS) images in the differentiation of benign and malignant thyroid nodules by comparing the diagnostic performance of four logistic models.

Methods

We retrospectively collected and ultimately included B-US images and CEUS images of 123 nodules from 123 patients, and then extracted the corresponding radiomics features from these images respectively. Meanwhile, a senior radiologist combined the thyroid imaging reporting and data system (TI-RADS) and the enhancement pattern of the ultrasonography to make a graded diagnosis of the malignancy of these nodules. Next, based on these radiomics features and grades, logistic regression was used to help build the models (B-US radiomics model, CEUS radiomics model, B-US+CEUS radiomics model, and TI-RADS+CEUS model). Finally, the study assessed the diagnostic performance of these radiomics features with a comparison of the area under the curve (AUC) of the receiver operating characteristic curve of four logistic models for predicting the benignity or malignancy of thyroid nodules.

Results

The AUC in the differential diagnosis of the nature of thyroid nodules was 0.791 for the B-US radiomics model, 0.766 for the CEUS radiomics model, 0.861 for the B-US+CEUS radiomics model, and 0.785 for the TI-RADS+CEUS model. Compared to the TI-RADS+CEUS model, there was no statistical significance observed in AUC between the B-US radiomics model, CEUS radiomics model, B-US+CEUS radiomics model, and TI-RADS+CEUS model (P>0.05). However, a significant difference was observed between the single B-US radiomics model or CEUS radiomics model and B-US+CEUS radiomics model (P<0.05).

Conclusion

In our study, the B-US radiomics model, CEUS radiomics model, and B-US+CEUS radiomics model demonstrated similar performance with the TI-RADS+CEUS model of senior radiologists in diagnosing the benignity or malignancy of thyroid nodules, while the B-US+CEUS radiomics model showed better diagnostic performance than single B-US radiomics model or CEUS radiomics model. It was proved that B-US radiomics features and CEUS radiomics features are of high clinical value as the combination of the two had better diagnostic performance.

Clinical Value of Pepsinogen in the Screening, Prevention, and Diagnosis of Gastric Cancer

OBJECTIVES

To compare the levels of serum pepsinogen (PG) in patients with gastric cancer (GC), patients with atrophic gastritis (AG), and healthy donors. Also, we explored the clinical value of PG detection for the diagnosis and treatment of GC.

METHODS

The PG level in peripheral blood from patients and heathy donors was determined using an Abbott automatic chemiluminescence instrument. The study included 117 patients with GC confirmed by gastroscopy and histopathology, of whom 13 patients had cancer at stage I, 47 at stage II, 41 at stage III, and 16 at stage IV. The AG group included 122 patients, and the control group had 120 healthy donors. The relationship between serum PG levels and the occurrence and development of GC, as well as the evaluation of the clinical value of diagnostic tests based on serum PG detection, were investigated by receiver operating characteristic (ROC) curve analyses.

RESULTS

Pepsinogen I (PGI) levels gradually decreased from the control group, the AG group, and the GC group. PGI exhibited high diagnostic value for GC (area under the curve [AUC], 0.834; cutoff, 51.2 ng/mL, sensitivity, 81.7%; specificity, 68.4%), PGII (AUC, 0.587; cutoff value, 13.05 ng/mL; sensitivity, 65.8%; specificity, 53.8%), and PGR (AUC, 0.752; cutoff, 5.65; sensitivity, 54.2%; specificity, 87.2%). The occurrence of GC was negatively correlated with serum levels of PGI (B = -0.054; OR = 0.947; 95% confidence interval [CI], 0.925-0.970; P <.001) and PGR (B = -0.420; OR = 0.657; 95% CI, 0.499-0.864; P = .003).

CONCLUSIONS

The combined detection of PGI, PGII, and PGR has important clinical value for the screening, prevention, and diagnosis of GC and could allow for earlier detection, diagnosis, and treatment of GC.

[Research and development strategies of new Chinese medicines based on new regulations]

In recent years, only a small number of new Chinese medicines have been approved for marketing, which has embodied the bottleneck in the development of the Chinese medicine industry. To tackle this problem, the National Medical Products Administration has issued a series of regulations and technical requirements. In the context of new regulations, this study deeply explored the research and development strategies of new Chinese medicines under the guidance of the new classification of drug registration, and discussed the key technical issues in the research and development.

Clinical Value of Fecal Calprotectin in Predicting Mucosal Healing in Patients With Ulcerative Colitis

Aim: This study aimed to evaluate the clinical significance of fecal calprotectin (FC) in assessment of ulcerative colitis (UC) patients' endoscopic patterns and clinical manifestation.

Methods: A total of 143 UC patients who received colonoscopy and 108 controls were included. After providing stool samples, patients underwent total colonoscopy. FC was measured by an enzyme-linked immunosorbent assay (ELISA). Clinical activity was based on the Mayo score. Endoscopic findings was scored by the Ulcerative Colitis Endoscopic Index of Severity (UCEIS). Correlation analysis and receiver-operator characteristic (ROC) analysis were carried out to determine the significance of measurements.

Results: The median (interquartile range, IQR) of FC levels was 211 (43–990) μg/g in UC and 87.5 (40.50~181) μg/g in the control group. Fecal calprotectin correlated significantly with both Mayo and UCEIS scores (Spearman's r 0.670 and 0.592, P < 0.01). With a cut-off value of 164 μg/g for fecal calprotectin concentration, the area under the curve (AUC) in receiver operator characteristic analysis was 0.830, sensitivity was 85.42%, specificity was 73.68%, positive predictive value (PPV) was 62.12%, and negative predictive value (NPV) was 9.10% in predicting clinical active disease. Similarly, the power of FC to predict mucosal healing (MH) was modest. With a cut-off value of 154.5 μg/g, the AUC was 0.839, sensitivity was 72.34%, and specificity was 85.71%.

Conclusion: For evaluating the disease activity of UC, FC is a clinically relevant biomarker for both clinically active disease and MH in patients with UC. But the cut-off value still needs large and multicenter studies for confirmation.

The clinical effects of high-quality nursing interventions after a diagnosis of upper gastrointestinal bulging lesions with mEUS

PURPOSE

To study and analyze the clinical effectiveness of miniprobe endoscopic ultrasonography (mEUS) in upper gastrointestinal eminence lesions caused by tumors.

METHODS

We recruited 210 patients admitted to our hospital from March 2018 to June 2020 as the study cohort, all of whom were diagnosed with upper gastrointestinal eminence lesions caused by tumors using routine endoscopies. To further clarify the type of disease, mEUS was used in all the patients along with high-quality nursing interventions. The results and the patients' anxiety and depression levels before and after the examinations were analyzed.

RESULTS

After their admission, the patients' SAS and SDS scores were high. Their scores decreased significantly after the nursing (P < 0.05). There were 75 patients with esophageal disease diagnosed among the 223 patients with upper gastrointestinal eminence lesions, accounting for 33.63% of the total. 114 patients with gastric disease were found, accounting for 51.12%; and there were 5 cases of cardia disease, accounting for 2.24% of the total. Another 29 cases of duodenal disease were detected, accounting for 13%. According to the determinations of the pathological types, the main disease types were stromal tumors and leiomyomas, with 79 cases (35.43%) and 53 cases (23.77%). The mEUS examinations in the 210 patients detected a total of 223 eminence lesions. In total, the 213 lesions were consistent with the pathological examinations, and the total diagnosis coincidence rate was 95.52% (213/223).

CONCLUSION

mEUS examinations combined with nursing care applied to tumor-induced upper gastrointestinal swelling lesions can eliminate patient tension and anxiety and other unhealthy emotions and can improve patient compliance with the examinations. mEUS examinations can show the hierarchical structure of the upper gastrointestinal wall and accurately locate any upper gastrointestinal swelling lesions, effectively clarify the nature of the disease, and have a guiding significance for the differential diagnosis and treatment of the disease.

Myocardial Postsystolic Shortening and Early Systolic Lengthening: Current Status and Future Directions

The concept of paradoxical myocardial deformation, commonly referred to as postsystolic shortening and early systolic lengthening, was originally described in the 1970s when assessed by invasive cardiac methods, such as ventriculograms, in patients with ischemia and animal experimental models. Today, novel tissue-based imaging technology has revealed that these phenomena occur far more frequently than first described. This article defines these deformational patterns, summarizes current knowledge about their existence and highlights the clinical potential associated with their understanding.

The expression and clinical value of ubiquitin carboxyl-terminal hydrolase L1 in the blood of neonates with hypoxic ischemic encephalopathy

BACKGROUND

Neonatal hypoxic ischemic encephalopathy (HIE) can result in mental retardation due to the associated brain damage. Early identification of brain injury is vital for the prevention and treatment of brain damage in neonates. This study investigated the expression levels of serum ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) in neonates with HIE and its correlation with brain damage.

METHODS

From January 2019 to December 2020, 56 cases of neonatal patients with HIE were selected as the observation group, and 60 cases of healthy newborns delivered in our hospital during the same period were selected as the control group. Blood samples were obtained from neonates and the serum expression of UCH-L1 was detected by enzyme-linked immunosorbent assays (ELISAs). The relationship between UCH-L1 and neonatal prognosis and clinical features was analyzed.

RESULTS

Compared with the healthy control group, the serum levels of UCH-L1 in the observation group was significantly higher (2.28±1.21 vs. 0.81±0.39 ng/mL, P=0.000). Furthermore, at 6 hours after birth, the serum levels of UCH-L1 were significantly higher in neonates with moderate to severe HIE compared to patients with mild HIE (2.92±0.80 and 1.76±0.72 ng/mL, respectively, P=0.000). Pearson correlation analysis showed that the expression levels of UCH-L1 were negatively correlated with the development quotient (DQ), intelligence index (MI), and the Neonatal Behavioral Neurological Assessment (NBNA) score of HIE newborns (P<0.05).

CONCLUSIONS

The level of UCH-L1 protein expression is elevated in the serum of newborns with HIE, and this may have a certain clinical value in predicting the intelligence of children.

Expression of miR-155 and miR-146a in the saliva of patients with periodontitis and its clinical value

OBJECTIVE

To explore the significance of microRNA-155 (miR-155) and microRNA-46a (miR-46a) in the diagnosis of periodontitis (PD).

METHODS

A total of 41 patients with PD admitted to our hospital between September 2017 and August 2019 were enrolled into an observation group (obs group), and 35 healthy individuals during the same period were enrolled into a control group (con group). A qRT-PCR assay was carried out to quantify miR-155 and miR-146a expression, and the relationship between the expression of miR-155 and miR-146a and severity and clinical indicators of PD was analyzed.

RESULTS

The obs group showed significantly higher expression of saliva miR-155 and miR-146a than the con group (P<0.05), and the expression of them was positively correlated with the severity of their PD. It was also positively correlated with gingival index (GI), attachment loss (AL), plaque index (PLI), probing depth (PD), and bleeding on probing (BOP) of them. Additionally, according to the receiver operating characteristic (ROC) curves, the area under the curve (AUC), specificity, and sensitivity of miR-155 in diagnosing PD were 0.887, 78%, and 97.14%, respectively, and those of miR-146a in diagnosing PD were 0.745, 58.54%, and 88.57%, respectively.

CONCLUSION

MiR-155 and miR-146a were both highly expressed in the saliva of patients with PD, and the expression of them was positively correlated with the severity and clinical indexes of PD, so miR-155 and miR-146a might be involved in the development and progression of PD.

Clinical value analysis of IgM and IgG antibodies detected by nucleic acid in patients with COVID-19

OBJECTIVE

We aimed to analyze the clinical diagnostic value of nucleic acid detection and specific IgM and IgG antibodies in COVID-19 patients. According to the patients' test outcomes of nucleic acid and specific IgM and IgG antibodies, the patients were grouped.

METHODS

Medical records of 788 COVID-19 patients were collected for retrospective analysis, including demographic data, clinical characteristics, CT outcome and laboratory indicators. According to the patients' nucleic acid detection and the results of specific IgM and IgG antibodies, the patients were grouped, and the clinical application value of COVID-19 nucleic acid detection and specific IgM and IgG antibodies was analyzed.

RESULTS

The main clinical manifestations of COVID-19 patients included in this study were fever (431 cases, 54.7%), cough (404 cases, 51.3%), and fatigue (232 cases, 29.4%), and the main comorbidities were hypertension (201 Cases, 25.4%), diabetes (86 cases, 10.9%), coronary heart disease (39 cases, 4.9%), etc. CT abnormalities mainly manifested as ground glass shadows (731 cases, 92.8%), mesh nodules shadows (413 cases, 52.4%), pulmonary fibrosis (118 cases, 15.0%), etc. The majority of patients were positive for IgM and IgG antibodies. There were 50 patients in the qPCR+IgM-IgG- group (only nucleic acid test result was positive), of which 6 patients (12%) were mild in symptoms, and 39 patients (78%) had mild CT findings. There were 321 patients in the qPCR+IgM+IgG+ group (nucleic acid and specific IgM and IgG antibody test results were positive), of which 49 patients (15.5%) were severe or critically ill, and 78 patients (24.8%) had severe CT findings. There were 291 patients in the qPCR-IgM+IgG+ group (specific IgM and IgG antibody test results were positive), of which 22 (7.5%) were severe or critically ill, and 94 (32.3%) patients had severe CT findings. The sensitivity of antibody detection for COVID-19 was higher than that of qPCR (84.9%, 86.4% vs. 53.9%, P<0.001). There were significant differences between IgM+ patients and IgM- patients in terms of age distribution, gender, sore throat, clinical classification, and CT findings (P<0.05).

CONCLUSION

IgM antibody has a high clinical detection rate, which effectively avoids the missed detection of qPCR and increases the detection rate of COVID-19 patients. There are more severe and critically ill patients with IgM tested positive, which finding has certain guiding significance for clinical diagnosis and treatment.

Detection and Clinical Value of Circulating Tumor Cells as an Assisted Prognostic Marker in Colorectal Cancer Patients

BACKGROUND

Circulating tumor cells (CTCs) are cells that have been shed into the vasculature from a primary tumor and circulate in the bloodstream. It has been suggested that detecting CTCs could help the clinician to detect early metastasis or recurrence more effectively. This trial sets out to assess the detection and clinical value of CTCs as an assisted prognostic marker in patients with colon cancer and rectal cancer.

METHODS

A prospective cohort of patients with colorectal cancer (CRC) was enrolled from July 2015 to February 2018 in Shanghai Minimally Invasive Surgery Center, Shanghai, China. In this study, 149 patients with CRC were enrolled and underwent surgical treatment. There were 79 cases of colon cancer and 70 cases of rectal cancer, including 93 males and 56 females. To investigate the correlativity and clinical value of CTCs, the patients were statistically analyzed in different subgroups: colon cancer group vs rectal cancer group, and left hemicolon cancer group vs right hemicolon cancer group.

RESULTS

The results of analysis comparing CTC counts and clinical pathological features in colon and rectal cancer indicated that with increased tumor stage, the number of CTCs also increased, with significant statistical differences. CTC counts in patients with colon and rectal cancer showed positive correlations with TNM staging (P=0.001, 0.013, respectively), T staging (P=0.021, 0.001), N staging (P=0.014, 0.035) and M staging (P=0.018, 0.203). Detection of serum biomarkers in CTC-positive and CTC-negative groups indicated a significantly increasing expression in the CTC-positive group. To confirm the correlations between CTCs and histoembryological differences, analysis was conducted with the patients in two subgroups: left hemicolon cancer group and right hemicolon cancer group. The results showed that the positive rate of CTCs increased in both groups with the increase in tumor stage. The survival analysis indicated that there was a steep gradient in survival in the follow-up period, particularly in the CTC-positive group (P=0.000). Risk assessment curves showed that the change escalated more rapidly in the CTC-positive group. Furthermore, with the increase in T stage, changes in the survival curve and risk curve escalated more rapidly in the CTC-positive group.

CONCLUSION

It was confirmed that in the left hemicolon cancer group, a much higher coincidence rate could be found on CTC-positive rate and clinicopathological features, than in the right hemicolon cancer group. The sensitivity of CTCs may be related to the histoembryological location of the tumor, lymphatic metastasis and the depth of infiltration. Monitoring CTCs may have value in evaluating clinical staging and estimating clinical prognosis.

The clinical value of prenatal assessment of cervical length and placental thickness in pregnant women with placenta previa

OBJECTIVE

This study was designed to investigate the clinical value of prenatal assessment of cervical length (CL) and placental thickness (PT) in pregnancy outcome and prognosis of pregnant women with placenta previa.

METHODS

Eighty pregnant women with placenta previa treated in our hospital were enrolled for prenatal assessment of CL and PT, and were grouped as CL ≤ 30 mm (n=32) and CL > 30 mm (n=48) groups and PT ≥ 10 mm (n=34) and PT < 10 mm (n=46) groups, respectively. The pregnancy and perinatal outcomes were compared in different groups. ROC curve of CL and PT on preterm delivery was drawn, and the diagnostic value of CL and PT in diagnosing preterm delivery was calculated.

RESULTS

The pregnancy and perinatal outcomes of CL ≤ 30 mm group were significantly inferior to those of CL > 30 mm group (P < 0.05). The pregnancy and perinatal outcomes of PT ≥ 10 mm group were also significantly inferior to those of PT < 10 mm group (P < 0.05). PT and CL had good predictive values for preterm delivery (P < 0.05), with high diagnostic sensitivity, specificity and accuracy.

CONCLUSION

Prenatal assessment of CL and PT has practical clinical significance for pregnant women with placenta previa, which helps in assessing pregnancy and perinatal outcomes and is worthy of clinical application.

[Thoughts on post-marketing evaluation of classical Chinese patent medicines based on clinical value]

Classical Chinese patent medicines(CPMs) are a kind of modern preparation developed from the experience of compatibility and application about ancient prescriptions. Its rich history of human use and reliable clinical efficacy imply the unique theoretical essence and precious value of traditional Chinese medicine(TCM). With the development of evidence-based medicine and the improvement of medical policy, it is particularly urgent to evaluate the clinical values of post-marketing classical CPMs. In this paper, some problems on the clinical value evaluation of CPMs would be described, and it is considered that the simplified evaluation procedures can lead to the lack of evidence for evaluating clinical value of CPMs, causing the difficulty in evaluating the quality of CPM, lack of R&amp;D motivation of enterprises, low content of science and technology, and poor international development. Based on this background, it points out that the clinical value evaluation is the core of the post-marketing evaluation of the classical CPMs, and the eva-luation should be based on the direction of literature research and the latest practice. We should adhere to the research mode of combination disease with syndrome, and select the appropriate type of trials, with clinical efficacy, health economic benefits and safety eva-luation as the main content of the studies, in order to refine the indications and standardize the clinical positioning. Clinical value eva-luation is the basis and main content of post-marketing comprehensive researches on classic and famous CPMs to clarify their clinical value, obtain the conditions for continued marketingand standardize their clinical application, so as to optimize the evidence and quality service of classic and famous CPMs and inherit the core value concept of Chinese medicine.

Clinical Value of Complex Echocardiographic Left Ventricular Hypertrophy Classification Based on Concentricity, Mass, and Volume Quantification

Echocardiography is the most validated, non-invasive and used approach to assess left ventricular hypertrophy (LVH). Alternative methods, specifically magnetic resonance imaging, provide high cost and practical challenges in large scale clinical application. To include a wide range of physiological and pathological conditions, LVH should be considered in conjunction with the LV remodeling assessment. The universally known 2-group classification of LVH only considers the estimation of LV mass and relative wall thickness (RWT) to be classifying variables. However, knowledge of the 2-group patterns provides particularly limited incremental prognostic information beyond LVH. Conversely, LV enlargement conveys independent prognostic utility beyond LV mass for incident heart failure. Therefore, a 4-group LVH subdivision based on LV mass, LV volume, and RWT has been recently suggested. This novel LVH classification is characterized by distinct differences in cardiac function, allowing clinicians to distinguish between different LV hemodynamic stress adaptations in various cardiovascular diseases. The new 4-group LVH classification has the advantage of optimizing the LVH diagnostic approach and the potential to improve the identification of maladaptive responses that warrant targeted therapy. In this review, we summarize the current knowledge on clinical value of this refinement of the LVH classification, emphasizing the role of echocardiography in applying contemporary proposed indexation methods and partition values.

The clinical application value of miR-1269 as an unfavorable prognostic indicator of lung cancer

BACKGROUND

Thanks to microRNAs (miR), a myriad of outstanding achievements have been made in multiple fields in recent years. miR-1269, a newly discovered miR, presents high expression profiles in lung cancer (LC), but its clinical implications in LC have not been clarified yet.

METHODS

The miR-1269 expressions in the peripheral blood of LC patients, benign pulmonary disease (BPD) patients, and healthy controls were measured using qRT-PCR. Receiver operating characteristic (ROC) curves were employed for the identification of the diagnostic value of miR-1269 in LC, as were Kaplan-Meier (K-M) analyses and a Cox regression model to determine miR-1269's prognostic value in LC.

RESULTS

qRT-PCR revealed higher miR-1269 expressions in the LC patients than in the BPD patients and the controls (P < 0.001). The LC patients with high miR-1269 expressions had advanced tumor stages (III-IV) and an increased probability of lymph node metastasis (LNM) (P < 0.01). Also, evidently elevated miR-1269 levels were observed in the peripheral blood of patients with the advanced tumor stages (III-IV) and LNM. Via ROC curves, we found that miR-1269 is of high clinical significance in the diagnosis of LC and advanced tumor stages. Our K-M survival analysis revealed a lowered 5-year survival rate in patients with high miR-1269 expressions, and our Cox regression analysis found that miR-1269 is an independent prognostic factor for LC.

CONCLUSIONS

miR-1269, with high expression profiles in LC, indicates unfavorable patient prognoses, so it may be a viable diagnostic and prognostic indicator of LC.

Changes of serum IL-6, IL-10 and TNF-α levels in patients with systemic lupus erythematosus and their clinical value

The levels of serum IL-6, IL-10, and TNF-α in patients with systemic lupus erythematosus (SLE) and their value in clinical practice were studied. A total of 68 patients with active SLE treated in our hospital between March 2015 and January 2018 were enrolled into the active SLE group, and they were divided into three groups according to the mild, moderate, and heavy active periods, and also divided into two groups according to the positive and negative anti dsDNA. A total of 60 healthy individuals in the same period were included in the control group (con group). The levels of serum IL-6, IL-10, and TNF-α in all participants were detected via an enzyme-linked immunosorbent assay (ELISA), and the correlation of these values with SLE activity was analyzed. The independent prognostic factors were analyzed through multivariate logistic regression. It was found that the levels of serum IL-6, IL-10, and TNF-α in the SLE groups were all higher than those in the control group; the levels of the inflammatory markers in the severe active SLE group were higher than those in the mild and moderate active SLE groups, and the levels in the moderate active SLE group were higher than those in the mild active SLE group. Additionally, the anti dsDNA positive group showed much higher levels of these than the anti dsDNA negative group. Pearson correlation analysis revealed a positive correlation between anti dsDNA antibody and IL-6, IL-10, and TNF-α levels. The multivariate logistic regression results, the mean course of disease and IL-10 were independent prognostic factors of SLE. The abnormal secretion of peripheral blood cytokines in SLE patients can affect the prognosis of the disease. Monitoring serum cytokines is helpful to understand the activity and prognosis of patients with lupus and guide clinical treatment.

The clinical value of comprehensive nursing intervention in preventing ventilator-associated pneumonia

OBJECTIVE

The aim of the present study was to evaluate the clinical value of comprehensive nursing intervention in preventing ventilator-associated pneumonia (VAP).

METHODS

Eligible 116 patients who received mechanical ventilation in our hospital from June 2018 to December 2019 were equally randomized into a control group and an observation group. The observation group adopted comprehensive nursing while conventional nursing was adopted in the control group accordingly. The mechanical ventilation time, hospitalization time, VAP incidence, psychological status, quality of life and nursing satisfaction were compared.

RESULTS

The mechanical ventilation and hospitalization time in the observation group was shorter compared to that in the control group (P < 0.05). For the VAP incidence, the observation group exhibited a significantly lower level than the control group (3.44% vs 13.79%) (P < 0.05). SAS and SDS scores before intervention were not different between the groups (P > 0.05); after intervention, the scores in both groups decreased, and the scores of the former group were significantly lower than those of the latter group (P < 0.05). The quality of life scores before intervention did not show any significant difference (P > 0.05); after intervention, a significant increase of quality of life in the observation group was observed compared to the control group (P < 0.05). The nursing satisfaction rate in the observation group was found to be higher when compared with that in the control group (94.87% vs 81.03%, P < 0.05). After intervention, the oxygenation index, the ratio of alveolar arterial oxygen partial pressure difference to arterial oxygen partial pressure (P(A-a)DO₂/PaO₂), and oxygen partial pressure in both groups of patients were improved compared with those before intervention. After intervention, a significant increase in the oxygen partial pressure and oxygenation index was identified in the observation group compared with the control group, while the P(A-a)DO₂/PaO₂ was found to be in a lower level (P < 0.05).

CONCLUSION

Comprehensive nursing intervention can shorten the mechanical ventilation and hospitalization time, prevent the occurrence of VAP, ease the negative emotions of patients, and improve their quality of life as well as nursing satisfaction.

The clinical value of color Doppler ultrasonography in measuring the hemodynamics of liver cirrhosis patients' portal and splenic veins

OBJECTIVE

To investigate the clinical value of color Doppler ultrasonography (CDUS) in measuring the hemodynamics of liver cirrhosis (LC) patients' portal and splenic veins.

METHODS

The clinical data of 81 LC patients admitted to our hospital were collected retrospectively and classified into Group A, and the clinical data from 51 healthy volunteers were classified into Group B. All the patients were examined with CDUS, and the ultrasonography images were analyzed. The hemodynamic indices of the portal and splenic veins were compared, and the differences in the hemodynamic indices of the LC patients with varying degrees of esophageal varices and hepatic injuries were analyzed.

RESULTS

Group A exhibited higher Q_pv, D_pv, Q_sv, and D_sv and lower V_pv and V_sv than Group B (P < 0.05). The Q_pv and D_pv of the patients with Grade B LC were higher than they were in the patients with Grade A LC and lower than they were in the patients with Grade C LC (P < 0.05). The V_pv of the patients with Grade B LC was higher than it was in the patients with Grade C LC and lower than it was in the patients with Grade A LC (P < 0.05). The Q_sv and D_sv of the patients with Grade B LC were higher than they were in the patients with Grade A LC and lower than they were in the patients with Grade C LC (P < 0.05). The V_sv of the patients with Grade B LC was higher than it was in the patients with Grade C LC and lower than it was in the patients with Grade A LC (P < 0.05). The patients with mild, moderate, and severe esophageal varices showed lower V_pv and V_sv and higher Q_pv, D_pv, Q_sv, and D_sv than the patients without esophageal varices (P < 0.05).

CONCLUSION

CDUS has certain clinical values in measuring the hemodynamics of LC patients' portal and splenic veins and can be used to predict the degrees of hepatic injuries and esophageal varices.

Biological roles and potential clinical values of circular RNAs in gastrointestinal malignancies

Circular RNAs (circRNAs), a class of endogenous RNA molecules, are produced by alternative splicing of precursor RNA and are covalently linked at the 5' and 3' ends. Recent studies have revealed that dysregulated circRNAs are closely related to the occurrence and progression of gastrointestinal malignancies. Accumulating evidence indicates that circRNAs, including circPVT1, circLARP4, circ-SFMBT2, cir-ITCH, circRNA_100782, circ_100395, circ-DONSON, hsa_circ_0001368, circNRIP1, circFAT1(e2), circCCDC66, circSMARCA5, circ-ZNF652, and circ_0030235 play important roles in the proliferation, differentiation, invasion, and metastasis of cancer cells through a variety of mechanisms, such as acting as microRNA sponges, interacting with RNA-binding proteins, regulating gene transcription and alternative splicing, and being translated into proteins. With the characteristics of high abundance, high stability, extensive functions, and certain tissue-, time- and disease-specific expressions, circRNAs are expected to provide novel perspectives for the diagnoses and treatments of gastrointestinal malignancies.

Plausibility and redundancy analysis to select FDG-PET textural features in non-small cell lung cancer

Background

Radiomics refers to the extraction of a large number of image biomarker describing the tumor phenotype displayed in a medical image. Extracted from positron emission tomography (PET) images, radiomics showed diagnostic and prognostic value for several cancer types. However, a large number of radiomic features are nonreproducible or highly correlated with conventional PET metrics. Moreover, radiomic features used in the clinic should yield relevant information about tumor texture. In this study, we propose a framework to identify technical and clinical meaningful features and exemplify our results using a PET non‐small cell lung cancer (NSCLC) dataset.

Materials and methods

The proposed selection procedure consists of several steps. A priori, we only include features that were found to be reproducible in a multicenter setting. Next, we apply a voxel randomization step to identify features that reflect actual textural information, that is, that yield in 90% of the patient scans a value significantly different from random texture. Finally, the remaining features were correlated with standard PET metrics to further remove redundancy with common PET metrics. The selection procedure was performed for different volume ranges, that is, excluding lesions with smaller volumes in order to assess the effect of tumor size on the results. To exemplify our procedure, the selected features were used to predict 1‐yr survival in a dataset of 150 NSCLC patients. A predictive model was built using volume as predictive factor for smaller, and one of the selected features as predictive factor for bigger lesions. The prediction accuracy of the both models were compared with the prediction accuracy of volume.

Results

The number of selected features depended on the lesion size included in the analysis. When including the whole dataset, from 19 features reflecting actual texture only two were found to be not strongly correlated with conventional PET metrics. When excluding lesions smaller than 11.49 and 33.10 mL (25 and 50 percentile of the dataset), four out of 27 features and 13 out of 29 features remained after eliminating features highly correlated with standard PET metrics. When excluding lesions smaller than 103.9 mL (75 percentile), 33 out of 53 features remained. For larger lesions, some of these features outperformed volume in terms of classification accuracy (increase of 4–10%). The combination of using volume as predictor for smaller and one of the selected features for larger lesions also improved the accuracy when compared with volume only (increase from 72% to 76%).

Conclusion

When performing radiomic analysis for smaller lesions, it should be first carefully investigated if a textural feature reflects actual heterogeneity information. Next, verification of the absence of correlation with all conventional PET metrics is essential in order to assess the additional value of radiomic features. Radiomic analysis with lesions larger than 11.4 mL might give additional information to conventional metrics while at the same time reflecting actual tumor texture. Using a combination of volume and one of the selected features for prediction yields promise to increase accuracy and reliability of a radiomic model.

Circular RNA in osteoarthritis: an updated insight into the pathophysiology and therapeutics

Osteoarthritis (OA) is a common joint disease that mainly results in chronic pain, stiffness and dysfunction in elderly individuals. The molecular mechanisms in the pathogenesis of OA are still unclear, and available treatments are unable to slowdown the development of OA or reverse the tissue damage. Circular RNAs (circRNAs), a novel type of non-coding RNA, are ubiquitous, stable, evolutionally conserved, tissue-specific and functional. An increasing number of studies have revealed that many circRNAs are differentially expressed in OA-affected joint tissues and engage in the pathogenesis of OA by functioning as miRNA sponges. In this review, we briefly introduce the biogenesis, characteristics and functions of circRNAs, and shed light on the important role of circRNAs in the occurrence and progression of OA and their potential diagnostic and therapeutic value in this disease based on the research over the last five years.

Clinical value and potential mechanisms of LINC00221 in hepatocellular carcinoma based on integrated analysis

Aims:This study aimed to unveil the functional roles of LINC00221 in hepatocellular carcinoma (HCC). Materials and methods:A discovery cohort and a validation cohort were respectively used to identify and verify the clinical value of LINC00221 in HCC. Bioinformatics analysis was performed to explore its potential mechanisms. Results:LINC00221 was upregulated in HCC tissues and serum samples. Survival analysis and receiver operating characteristic curve further revealed its prognostic and diagnostic roles. Exploration of the mechanism showed that LINC00221 might exert a pro-cancer role via the lncRNA-miRNA-mRNA network.Conclusions: Our study reveals that upregulated LINC00221 can serve as a potential diagnostic and prognostic biomarker and provides novel clues as to the role of LINC00221 in HCC.

Specific nature of medicines and value of medicines

Medicines are not ordinary consumer or industrial goods but goods of a specific nature. The article provides an overview of the fundamental characteristics that distinguish medicines from common consumer goods. Another essential attribute of the term medicine is its values (clinical, economic, human), which form a crucial concept of the medicine category.

[Clinical value of individualized pharmaceutical services for patients receiving vancomycin for severe infections: a retrospective case-control study based on real-world data]

OBJECTIVE

To assess the clinical value of individualized pharmaceutical services for patients receiving vancomycin for severe infections and establish clinical monitoring procedures during vancomycin treatment.

METHODS

Data were collected from patients with severe infections who received vancomycin treatment with individualized pharmacy services (test group, 144 cases) or without such services (control group, 884 cases) between January, 2017 and December, 2018. Using propensity score matching, the patients in the two groups with comparable baseline data were selected for inclusion in the study (62 in each group), and the efficacy, safety and economic indicators were compared between the two groups.

RESULTS

The curative effects of the treatment did not differ significantly between the two groups, with the overall response rates of 95.16% in the test group and 91.94% in the control group (P > 0.05). The percentage of neutrophils before vancomycin treatment and calcitonin level after the treatment differed significantly between the two groups (P < 0.05). No significant difference was found in the incidence of adverse events associated with the treatment between the test and control groups (8.06% vs 9.68%, P > 0.05); a significant difference in creatinine level was noted between the two groups after vancomycin treatment (P < 0.05). The number of days of medication, the cost of vancomycin and its proportion in the total expenses differed significantly between the two groups (P < 0.05). Cost-effectiveness analysis showed a better cost-effectiveness in the test group than in the control group (50052.78 vs 57601.23). The intensity of vancomycin use was also lower in the test group than in the control group (0.11 vs 0.36).

CONCLUSIONS

The participation of clinical pharmacists during the treatment can improve the clinical benefits of vancomycin in patients with severe infections.

Prognostic significance of tumor-associated macrophages in patients with nasopharyngeal carcinoma: A meta-analysis

BACKGROUND

To explore the prognostic value of diverse subsets of tumor-associated macrophages (TAMs) in prognosis in patients with nasopharyngeal carcinoma (NPC) using meta-analysis.

METHODS

Relevant studies were searched in the database of PubMed, Web of Science, Embase, Cochrane Library, Scopus, China National Knowledge Infrastructure (CNKI), and Wanfang till November 2019. The relationship between TAMs and survival outcomes was estimated by pooling hazard ratios (HRs) and 95% confidence intervals (CIs); and the correlation of TAMs and clinicopathological factors was evaluated by using odds ratios (ORs) and 95%CIs.

RESULTS

Six studies with 1549 patients were included in this meta-analysis. The high expression of CD68+ TAMs was associated with favorable disease-free survival (DFS) (HR = 0.66, 95%CI = 0.50-0.88, P = .005), whereas the density of M2-like TAMs (CD163+, CD68+CCL18+, and CD206+) was correlated to poor overall survival (OS) (HR = 1.77, 95%CI = 1.22-2.56, P = .003) and DFS (HR = 1.96, 95%CI = 1.00-3.85, P = .050) in patients with NPC.

CONCLUSIONS

CD68+ TAM density is associated with superior DFS, while CD163+ M2-like TAMs predicted poor prognosis in patients with NPC.