Application of autologous bone marrow mononuclear cells in six patients with advanced chronic critical limb ischemia as a result of diabetes: our experience

Background aimsPrevious clinical studies have reported that the injection of bone marrow (BM)-derived mononuclear cells (MNC) results in improvement in symptoms and healing of ulcers in patients with critical limb ischemia (CLI) up to stage IV of Fontaine's classification. However, most patients with Fontaine stage IV CLI limbs had to undergo amputation even after stem cell therapy. We report on six patients, who had poorly controlled diabetes with extensive ulceration and gangrene of limbs because of Fontaine stage IV CLI and had been advised amputation elsewhere, who underwent injection of autologous BM MNC.MethodsIn all six patients, BM was aspirated and the isolated MNC from the BM were injected intralesionally at various sites of the ulcer and its surroundings after necessary debridement. The patients were followed up at regular intervals for at least 6 months.ResultsAt the end of the 6-month follow-up, the lower limb pain and ulcers had improved significantly in all patients. The mean toe–brachial index had increased from 0.26 to 0.36. One patient died a month after therapy because of causes unrelated to the procedure. Limb salvage was possible in the remaining five patients and they had a pain-free walking distance of 100 m within 6 months.ConclusionsLimb salvage was possible in all six diabetic patients with Fontaine stage IV CLI following autologous BM MNC injection. The procedure was safe without any adverse outcomes.     

Geriatric Nutritional Risk Index (GNRI) Independently Predicts Amputation Inchronic Criticallimb Ischemia (CLI)

Objective

General malnutrition usually occurs in critical limb ischemia (CLI) patients because of shortness of appetite and sleeplessness leaded by chronic pain. And amputation frequently is end-point of CLI patients. So the aim of this study was to assess the predictive ability of Geriatric nutritional risk index (GNRI) for predicting amputation in patients with CLI.

Methods

A retrospective study was designed. Demographics, history, comorbidity, and risk factors for peripheral vascular disease of admitted patients, and laboratory study were documented. Patients’ height, weight and BMI were recorded. Amputation was identified as end-point during follow-up. Patients’ amputation-free survival (AFS) was recorded.

Result

172 patients were identified, with mean age 71.98±3.12. Geriatric nutritional risk index (GNRI) = 90 was taken as cutoff value of high risk of amputation for CLI patients via using receiver operating characteristic (ROC) curve. Span of follow-up was 12–48 months. During follow-up, 60 patients (36.04%) received amputation surgery. And analyzed by Cox proportional hazards model, it is found that GNRI was the independent predictive factor for amputation in long term.

Conclusion

This study revealed that GNRI was a reliable and effective predictive marker for AFS. GNRI could identify patients with high risk for amputation in early time.     

Marrow changes and reduced proliferative capacity of mesenchymal stromal cells from patients with “no-option” critical limb ischemia; observations on feasibility of the autologous approach from a clinical trial

Background aimsApproximately 1 in 3 patients with critical limb ischemia (CLI) are not suitable for surgical or endovascular revascularization. Those “no-option” patients are at high risk of amputation and death. Autologous bone marrow mesenchymal stromal cells (MSCs) may provide a limb salvage option. In this study, bone marrow characteristics and expansion potentials of CLI-derived MSCs produced during a phase 1b clinical trial were compared with young healthy donor MSCs to determine the feasibility of an autologous approach. Cells were produced under Good Manufacturing Practice conditions and underwent appropriate release testing.MethodsFive bone marrow aspirates derived from patients with CLI were compared with six young healthy donor marrows in terms of number of colony-forming units–fibroblast (CFUF) and mononuclear cells. The mean population doubling times and final cell yields were used to evaluate expansion potential. The effect of increasing the volume of marrow on the CFUF count and final cell yield was evaluated by comparing 5 CLI-derived MSCs batches produced from a targeted 30 mL of marrow aspirate to five batches produced from a targeted 100 mL of marrow.ResultsCLI-derived marrow aspirate showed significantly lower numbers of mononuclear cells with no difference in the number of CFUFs when compared with healthy donors’ marrow aspirate. CLI-derived MSCs showed a significantly longer population doubling time and reduced final cell yield compared with young healthy donors' MSCs. The poor growth kinetics of CLI MSCs were not mitigated by increasing the bone marrow aspirate from 30 to 100 mL.ConclusionsIn addition to the previously reported karyotype abnormalities in MSCs isolated from patients with CLI, but not in cells from healthy donors, the feasibility of autologous transplantation of bone marrow MSCs for patients with no-option CLI is further limited by the increased expansion time and the reduced cell yield.     

Comparison of the effect of stem cell therapy and percutaneous transluminal angioplasty on diabetic foot disease in patients with critical limb ischemia

Background aimsThe aim of our study was to compare the effect of autologous stem cell therapy (SCT) and percutaneous transluminal angioplasty (PTA) on diabetic foot disease (DFD) in patients with critical limb ischemia (CLI).MethodsThirty-one patients with DFD and CLI treated by autologous stem cells and 30 patients treated by PTA were included in the study; 23 patients with the same inclusion criteria who could not undergo PTA or SCT formed the control group. Amputation-free survival, transcutaneous oxygen pressure (TcPO₂) and wound healing were assessed over 12 months.ResultsAmputation-free survival after 6 and 12 months was significantly greater in the SCT and PTA groups compared with controls (P = 0.001 and P = 0.0029, respectively) without significant differences between the active treatment groups. Increase in TcPO₂ did not differ between SCT and PTA groups until 12 months (both Ps < 0.05 compared with baseline), whereas TcPO₂ in the control group did not change over the follow-up period. More healed ulcers were observed up to 12 months in the SCT group compared with the PTA and control groups (84 versus 57.7 versus 44.4 %; P = 0.042).ConclusionsOur study showed comparable effects of SCT and PTA on CLI, a major amputation rate that was superior to conservative therapy in patients with diabetic foot and an observable effect of SCT on wound healing. Our results support SCT as a potential promising treatment in patients with CLI and diabetic foot.     

Prognostic factors for post-recurrence survival among patients with locally advanced cervical cancer who underwent definitive concurrent chemoradiation

BackgroundThe prognostic factors affecting post-recurrence survival (PRS) in patients with locally advanced cervical cancer (LACC) who receive concurrent chemoradiation (CCRT) are not well established. This study aimed to assess the prognostic factors for PRS in patients with recurrent LACC who underwent CCRT as the primary treatment.Materials and methodsWe retrospectively reviewed the medical records of patients with a first recurrence of cervical cancer (stage IB2–IVA), who were initially treated with CCRT and completed the planned radiotherapy from 2002 to 2018. Multivariate analysis of independent factors for PRS was performed with the Cox proportional-hazards model.ResultsOf 1,658 patients with LACC primarily treated with CCRT, 424 (25.6%) had recurrence, with 142, 125, and 157 patients having locoregional, distant, and combined recurrence, respectively. Approximately 75% of recurrence cases were detected within 2 years after completed treatment, and 81.8% of cases demonstrated symptoms at recurrence diagnosis. The median PRS was 8.4 months, and the 1- and 5-year PRS rates were 36.0% and 5.3%, respectively. Multivariate analysis found that the recurrence-free interval (RFI) (p < 0.001), recurrence pattern (p < 0.001), white blood cell count (p < 0.001), and treatment at recurrence (p < 0.001) were independent prognostic factors for PRS.ConclusionThe prognosis of recurrent LACC initially treated with CCRT was notably poor. RFI, recurrence pattern, white blood cell count, and treatment at recurrence were independent prognostic factors for PRS.     

Autologous bone marrow mesenchymal stromal cell therapy for “no-option” critical limb ischemia is limited by karyotype abnormalities

BackgroundCritical limb ischemia (CLI) is the most severe manifestation of peripheral vascular disease. Revascularization is the preferred therapy, but it is not achievable in 25%–40% of patients due to diffuse anatomic distribution of the disease or medical comorbidities. No-option CLI represents an unmet medical need. Mesenchymal stromal cells (MSCs) may provide salvage therapy through their angiogenic and tissue-trophic properties. This article reports a phase 1b clinical study examining the safety and feasibility of intramuscular transplantation of autologous bone-marrow MSCs for patients with no-option CLI.MethodsTwelve patients were enrolled in the clinical trial, and nine proceeded to bone marrow aspiration and culture expansion of MSCs.ResultsA high rate of karyotype abnormality (>30%) was detected in the produced cell batches, resulting in failure of release for clinical administration. Four patients were treated with the investigational medicinal product (IMP), three with a low dose of 20 × 10⁶ MSCs and one with a mid-dose of 40 × 10⁶ MSCs. There were no serious adverse events related to trial interventions, including bone marrow aspiration, IMP injection or therapy.ConclusionsThe results of this trial conclude that an autologous cell therapy approach with MSCs for critical limb ischemia is limited by the high rate of karyotype abnormalities.     

Long-Term Prognostic Analysis after Endoscopic Endonasal Surgery for Olfactory Neuroblastoma: A Retrospective Study of 13 Cases

ObjectivesTo summarize the characteristics and long–term outcomes of olfactory neuroblastoma through the analysis of 13 cases in single institution, with the assessment of treatment modality, prognostic factors.MethodA retrospective study of thirteen cases diagnosed as olfactory neuroblastoma and underwent combined treatments during the period 2000–2010. Statistical analysis was performed to search for prognostic factors and compared different treatment modalities.Results13 patients were enrolled in this study, including 8 male and 5 female, ranging from 15 to 69 (median 43) years old. One patient at stage A was only treated with endoscopic endonasal surgery (EES). Seven patients were treated with preoperative radiotherapy and EES, two with EES and postoperative radiotherapy, and the other three with combined radiotherapy and chemotherapy. The range of follow-up time varied from 23 to 116 months (median 65 months). The 5-year overall survival rate was 46.2% (6/13). To date, these thirteen patients have not suffered local recurrences while two patients had lymph node recurrences and one had distant metastasis in the bone marrow. In 13 patients, 61.5% were diagnosed as late T stage (T3/4), 69.2% late Kadish stage (C/D) and 53.8% were high Hyams grade (I/ II), which indicated poor prognosis. Related prognostic factors were the TNM stage (T stage P = 0.028, N stage P = 0.000, M stage P = 0.007), Kadish stage (P = 0.025) and treatment modality (P = 0.015).ConclusionLate stage of TNM and Kadish staging system indicated a poor prognosis. Combined treatment modality, including endoscopic endonasal surgery, achieved a better outcome than non-surgical approach.     

TACE联合抗病毒治疗HBV相关性肝癌的预后观察及相关因素分析

摘要 目的：分析影响肝动脉化疗栓塞（TACE）联合抗病毒治疗乙型肝炎病毒（HBV）相关性肝癌预后的相关因素。方法：纳入的130例HBV相关性肝癌选自于本院2018年2月至2020年3月期间所收治，所有患者均行TACE联合抗病毒治疗，记录其生存情况，并对影响患者预后的相关因素进行分析与探讨。结果：130例患者随访截止时，死亡58例，存活72例，中位生存期为24个月，1年生存率为82.31%，2年生存率为55.38%；单因素及多因素Cox回归分析结果显示，肿瘤最大直径、血清AFP、Child-Pugh分级、腹腔转移、门静脉癌栓是患者预后不良的的危险因素。结论：肿瘤最大直径、血清AFP、Child-Pugh分级、腹腔转移、门静脉癌栓是影响TACE联合抗病毒治疗HBV相关性肝癌病患预后的影响因素。     

玻璃体切割术治疗复杂眼外伤的疗效及预后影响因素分析

目的:探讨玻璃体切割术治疗复杂眼外伤的临床疗效、安全性及其预后影响因素。方法:选取我院收治的80例眼外伤患者,均行玻璃体切割术治疗,观察并记录患者的术前、术后6个月的最佳矫正视力(BCVA),术前、术后3个月、6个月的汉密尔顿焦虑量表(HAMA)评分,分析影响患者预后的危险因素及随访6个月期间并发症的发生情况。结果:患者术后BCVA比例较术前显著提高,差异具有统计学意义(P0.05)。术前视力、眼内异物、受伤类型、手术时机均是影响患者预后的危险因素。患者术后3个月、6个月的HAMA评分明显低于术前(P0.05)。随访6个月期间,共有71例患者眼内炎症反应,17例术后继发青光眼,6例角膜水肿。结论:玻璃体切割术治疗复杂眼外伤能明显改善患者视力,缓解患者焦虑情绪,患者术前视力情况及手术时机的选择是患者预后重要的影响因素。     

不同病因肝硬化患者临床特征及其预后影响因素分析

摘要 目的：探讨不同病因肝硬化患者临床特征及其预后影响因素。方法：回顾性选择2017年1月至2020年12月来我院诊治的具有完整资料，同时明确诊断为肝硬化，病因为乙肝后肝硬化（78例）、酒精性肝硬化（42例）。分析两组患者的一般资料、并发症发生情况、合并疾病情况，分析乙肝后肝硬化、酒精性肝硬化患者的预后影响因素。结果：两组患者在性别、职业、临床表现（黄疸、黑便、呕血、蜘蛛痣、脾脏增大）、肝脏体积缩小、并发症（上消化道出血、肝性脑病）、合并疾病（脂肪肝、糖尿病、胰腺炎、胆结石）方面有统计学意义（P<0.05）。乙肝后肝硬化组的疾病进展发生率明显较酒精性肝硬化组高（P<0.05）。单因素分析结果表明，临床表现（乏力、食欲减退、皮肤瘙痒、腹痛、腹胀、呕血、黑便、腹水）、Child-Pugh分级、并发症（上消化道出血、肝性脑病）是影响乙肝后肝硬化患者预后的因素（P<0.05）；Logistic回归分析结果表明，Child-Pugh分级在B、C级、存在上消化道出血与肝性脑病是影响乙肝后肝硬化患者预后的危险因素（P<0.05）。单因素分析结果表明，临床表现（黄疸）、Child-Pugh分级、并发症（上消化道出血、肝性脑病、感染）是影响酒精性肝硬化患者预后的因素（P<0.05）；Logistic回归分析结果表明，Child-Pugh分级为C级、存在上消化道出血肝性脑病、感染是影响酒精性肝硬化患者预后的危险因素（P<0.05）。结论：乙肝后肝硬化与酒精性肝硬化的差异主要体现在性别、职业、临床表现、并发症与合并疾病中，影响乙肝后肝硬化预后的危险因素为Child-Pugh分级在B、C级、存在上消化道出血与肝性脑病，影响酒精性肝硬化预后的危险因素为Child-Pugh分级为C级、存在上消化道出血、肝性脑病、感染，需防治并发症，以改善患者预后。     

淋巴细胞/单核细胞比值对急性脑梗死患者预后的预测价值研究

目的:探讨淋巴细胞/单核细胞比值(LMR)对急性脑梗死预后的预测价值。方法:回顾性分析急性脑梗死患者242例的临床资料,根据发病90天改良m RS评分分为预后良好组(163例,m RS 0-2分)和预后不良组(79例,m RS 3-6分),比较其入院时一般人口学资料、美国国立卫生研究院卒中量表评分(NIHSS评分)、血常规、血生化、C反应蛋白(CRP)等资料,根据入院时淋巴细胞与单核细胞计数计算出LMR值,采用logistics回归分析评估LMR与急性脑梗死预后的关系。采用受试者工作特征(ROC)曲线评价入院时LMR水平对急性脑梗预后的预测价值。结果:与预后良好组相比,预后不良组年龄、入院时NIHSS评分、伴随房颤、尿素氮、白细胞、CRP较高,而LMR水平较低,组间差异具有统计学意义(P0.05)。预后不良组LMR水平较预后良好组明显降低(3.48±2.23 vs. 4.39±1.84,P0.05),入院时NIHSS评分增高与低水平LMR是预后不良的独立危险因素(OR值分别为2.066、0.835,95%可信区间为1.668-2.559、0.759-0.946,P0.05)。入院时LMR水平ROC曲线下面积为0.762(95%CI 0.692-0.832),Youden法计算出LMR低于2.633(最佳临界值)预示预后不良,敏感性为86.9%,特异性为47%。结论:入院时LMR水平与急性脑梗死预后不良负相关,低水平LMR对预测急性脑梗死患者预后不良具有一定的参考价值。     

The Largest Known Survival Analysis of Patients with Brain Metastasis from Thyroid Cancer Based on Prognostic Groups

PurposeTo analyze the clinical features and prognostic factors associated with the survival of patients with a very rare occurrence of brain metastasis (BM) from differentiated thyroid cancer (DTC).ResultsThe median age at BM was 63 years, and the median time from initial thyroid cancer diagnosis to BM was 3.8 years. The median survival and the 1-year actuarial survival rate after BM were 8.8 months and 47%, respectively. According to univariate and multivariate analyses, four good prognostic factors (GPFs) were identified including age ≤ 60 years, PS ≤ ECOG 2, ≤ 3 BM sites, and without extracranial metastasis prior to BM. Three prognostic groups were designed based on age and number of remaining GPFs: patients ≤ 60 years of age with at least 2 GPFs (Group A) had the most favorable prognosis with a median survival of 32.8 months; patients ≤ 60 years of age with fewer than 2 GPFs and those > 60 years of age with at least 2 GPFs (Group B) had an intermediate prognosis with a median survival of 9.4 months; and patients > 60 years of age with fewer than 2 GPFs (Group C) had the least favorable prognosis with a median survival of 1.5 months.ConclusionsThe survival of patients with BM form DTC differed among the prognostic groups based on the total number of good prognostic factors.     

85例多系统萎缩患者预后影响因素的分析

目的:探讨多系统萎缩(multiple system atrophy,MSA)患者预后的影响因素。方法:连续收集2016年1月到2019年1月空军军医大学第一附属医院神经内科住院及门诊收治的85名临床确诊MSA患者的临床资料,每隔6月对患者进行随访记录,直至需辅助行走时间,研究时限3.5年,筛选10个可能影响MSA独立行走的危险因素,应用Cox比例风险回归模型进行单因素及多因素回归分析。结果:85例MSA患者中,很可能MSA38例(44.7%),可能MSA47例(55.3%),以帕金森表现(MSA-P)43例(50.6%),以小脑性共济失调表现(MSA-C)42例(49.4%),男性46例(54.1%),女性39例(45.9%),起病年龄54.7±8.8岁,首发运动症状30例(35.3%),首发非运动症状55例(64.7%)。起病至非运动症状合并运动症状中位时程27.9(11.5, 40.5)月。截至本研究终止,28例(32.9%)患者独立行走,57例(67.1%)患者不能独立行走,起病至辅助行走中位时程36.0(22.5, 54.0)月。Cox比例风险回归模型显示起病年龄大(HR=1.041, 95%CI 1.000-1.083, P=0.049)、HY高分期(HR=2.015,95%CI 1.031-3.938,P=0.040)、起病至非运动症状合并运动症状短时程(HR=0.980,95%CI 0.967-0.993, P=0.003)是MSA患者发展至辅助行走状态的危险因素。结论:起病年龄大、HY高分期、起病至非运动症状合并运动症状短时程是MSA患者辅助行走的不良预后因素。     

快速序贯器官衰竭评分联合血清同型半胱氨酸、三酰甘油对急性胰腺炎短期预后的预测价值研究

摘要 目的：探讨快速序贯器官衰竭评分（qSOFA）联合血清同型半胱氨酸（Hcy）、三酰甘油（TG）对急性胰腺炎（AP）短期预后的预测价值。方法：选取2019年9月至2021年9月苏州大学附属第一医院消化科收治的210例AP患者为研究对象,根据亚特兰大AP分类指南分为轻症AP（MAP组）125例,中重症AP（MSAP组）45例和重症AP（SAP组）40例。对比三组的qSOFA评分和Hcy、TG水平。根据入院后28d预后结局,将所有患者分为存活组192例、死亡组18例。单因素及多因素Logistic回归分析AP患者预后的影响因素。采用受试者工作特征（ROC）曲线分析qSOFA评分、Hcy和TG对AP患者短期预后的预测价值。结果：SAP组和MSAP组患者的qSOFA评分、Hcy、TG水平均高于MAP组患者,且SAP组高于MSAP组（P＜0.05）;单因素、多因素Logistic回归最终分析结果显示,qSOFA评分较高、TG、Hcy水平升高是AP患者死亡的危险因素（P＜0.05）;qSOFA评分联合Hcy、TG预测AP患者短期预后的曲线下面积（AUC）为0.982,明显高于三指标单独检测的0.715、0.780、0.782。结论：qSOFA评分、TG、Hcy水平均是AP患者短期预后的影响因素,并且联合检测qSOFA评分和Hcy、TG水平对AP患者的短期预后具有较高的预测价值。     

血浆纤维蛋白原和D-二聚体在老年NSCLC患者预后中的意义

目的:探讨老年非小细胞肺癌(non-small cell lung cancer,NSCLC)患者抗癌治疗前血浆纤维蛋白原(fibrinogen,FIB)和D-二聚体(D-dimer)的预后意义。方法:测定97例肺癌患者(肺癌组)及36例健康体检者(对照组)血浆D-dimer、FIB水平并进行比较,并分析其与NSCLC临床病理因素之间关系及预后价值。结果:肺癌组血浆FIB、D-dimer水平高于健康对照组(P0.05)。肺癌组FIB与TNM分期有关,D-dimer与淋巴结转移和TNM分期有关。单因素分析提示FIB、D-dimer、肿瘤大小、淋巴结转移、TNM分期与总体生存时间(overall survival,OS)和无进展生存时间(progression free survival,PFS)相关,而多因素分析仅提示D-dimer、FIB是老年NSCLC患者的独立危险预后因素。结论:检测老年NSCLC患者抗癌治疗前纤维蛋白原和D-二聚体可以指导预后,为肺癌个体化治疗提供一定的参考价值。     

MHR、sCD14-ST、ApoM与糖尿病足溃疡预后的关系及对预后的预测价值

摘要 目的：探讨单核细胞数/高密度脂蛋白胆固醇比值（MHR）、可溶性白细胞分化抗原14亚型（sCD14-ST）、载脂蛋白M（ApoM）与糖尿病足溃疡（DFU）患者预后的关系及对预后的预测价值。方法：选取2018年1月-2020年12月本院收治的100例DFU患者资料进行回顾性分析,记录其性别、年龄、病程、体重指数（BMI）等一般临床资料以及空腹血糖、MHR、sCD14-ST、ApoM等实验室指标,并对纳入的100例患者进行6个月的随访,获得患者DFU愈合、截肢及死亡例数。采用单因素分析以及二元Logistics回归分析MHR、sCD14-ST、ApoM与DFU患者预后的关系,并采用ROC曲线检测MHR、sCD14-ST、ApoM水平及三项指标联合检测对不良预后的预测价值。结果：预后不良患者DFU病程、Wagner分级、MHR、sCD14-ST、ApoM水平均与预后良好患者有统计学差异（P＜0.05）。随着MHR、sCD14-ST水平的升高,不良结局发生率呈上升趋势（P＜0.05）;随着ApoM水平升高,不良结局发生率呈下降趋势（P＜0.05）。二元Logistic回归分析结果显示,DFU病程、MHR、sCD14-ST为DFU患者不良结局发生的独立危险因素（P＜0.05）,而ApoM为保护因素（P＜0.05）。ROC曲线分析显示,MHR、sCD14-ST、ApoM以及三项指标联合检测对DFU患者不良结局发生的预测线下面积（AUC）分别为0.731、0.729、0.763和0.864,其中联合检测的预测效能最高,其预测敏感度为68.57%、特异度为89.23%。结论：MHR、sCD14-ST、ApoM均与DFU患者的预后存在相关性,三项指标联合检测具有一定的预后预测价值。     

脓毒症患者血清炎症因子与SOFA评分的关系研究

目的:探究脓毒症患者血清炎症因子与序贯器官衰竭评估(SOFA)评分的关系,从而有助于评价患者病情严重程度,科学判断预后效果。方法:选择2014年1月至2015年12月期间在本院内接受治疗的脓毒血症患者142例作为研究对象。入院后24 h内患者进行血清炎症因子IL-6、PCT、CRP水平测定,同时进行SOFA评分。按照患者在入院治疗28天内生存结局状况进行分组,分别为死亡组(87例)和存活组(55例),另按照患者合并多器官功能障碍综合症(MODS)与否,分为MODS组(76例)和非MODS组(66例),对比不同组别间IL-6、PCT、CRP及SOFA评分差别;对比不同SOFA评分患者血清IL-6、PCT、CRP水平差异,分析其相关性。结果:IL-6、PCT以及SOFA评分比较,死亡组高于存活组,MODS组高于非MODS组,差异有统计学意义(P0.05);SOFA评分越高,血清IL-6、PCT水平越高,差异有统计学意义(P0.05);SOFA评分升高,患者病死率显著增加,SOFA10分,病死率为78.3%,差异有统计学意义(P0.05);Spearman相关分析结果显示,SOFA评分与血清IL-6水平呈显著正相关关系(r=0.261,P=0.012),与血清PCT水平呈正相关关系(r=0.453,P=0.000),SOFA与CRP水平无相关性(r=0.112,P=0.323)。结论:血清IL-6、PCT水平与SOFA评分具有相关性,可以在脓毒症患者病情严重程度及预后状况判断中作为生物学指标进行常规监测。     

心脏彩超检查联合血清BNP、ALB、CysC在慢性心力衰竭患者预后评估中的临床价值分析

摘要 目的：分析心脏彩超检查联合血清B型钠尿肽（BNP）、白蛋白（ALB）、胱抑素C（CysC）在慢性心力衰竭（CHF）患者预后评估中的临床价值。方法：选取2017年6月-2018年5月我院收治的123例CHF患者,心脏彩超检查左心室射血分数（LVEF）、左心房内径（LAD）和左心室内径（LVD）,实验室检测血清BNP、ALB、CysC水平。按照3年随访后患者是否死亡分为死亡组35例和存活组88例,收集临床资料,采用多因素Logistic回归分析CHF患者预后的影响因素。采用受试者工作特征（ROC）曲线分析心脏彩超检查联合血清BNP、ALB、CysC对CHF患者预后的评估价值。结果：死亡组患者的LAD、LVD及血清BNP、CysC水平高于存活组患者,而LVEF及血清ALB水平低于存活组患者（P＜0.05）。心脏彩超指标LVEF、LAD、LVD及血清BNP、ALB、CysC是CHF患者预后的影响因素（P＜0.05）。心脏彩超指标LVEF、LAD、LVD联合血清BNP、ALB、CysC检测对CHF患者预后评估的ROC曲线下面积（AUC）（0.95CI）为0.857（0.771～0.938）,灵敏度及特异度分别为0.914（32/35）、0.795（70/88）,均明显高于上述各指标单独检测。结论：心脏彩超指标LVEF、LAD、LVD和血清BNP、ALB、CysC均为CHF患者预后的影响因素,且联合检测对患者预后的评估价值较高,具有一定的临床应用价值。     

CD40 expression on human lung cancer correlates with metastatic spread

 Purpose: The poor prognosis associated with lung cancer is related to the high incidence of regional and distant metastasis. There is a crucial need to identify parameters that can predict a tendancy to metastatic spread to allow better prognostic evaluation and therapeutic approach. Methods: Using flow cytometry we evaluated 18 human lung cancer cell lines for the expression of different surface markers on lung cancers suggested to be possible prognostic parameters, including epidermal growth factor receptor (EGFR), intercellular adhesion molecule 1 (ICAM-1), Fas and CD40. Results: No correlation was found between tumor prognosis and EGFR, ICAM-1 or Fas. However, a statistically significant correlation was found between the surface expression of CD40 and the metastatic spread of the tumor. In this study, 14 of 18 lung cancer cell lines (78%) expressed CD40 on their surface. All of the 4 tumors that were CD40-negative, were stage I tumors, without any evidence of regional or distant metastasis. Of the 14 tumors that expressed CD40, all but 1 (93%) had either nodal or systemic metastasis at the time of diagnosis. Patients whose tumors were CD40-negative showed a significantly better N stage, overall stage at presentation and survival than those patients with CD40-positive patients. No significant differences between the two groups were observed in tumor size, gender, age, histology, differentiation or preoperative therapy. Conclusions: These results suggest that CD40 expression on lung cancer may play a role in metastatic spread, and also may serve as a prognostic marker and an indicator of advanced disease. Received: 30 August 1999 / Accepted: 22 December 1999     

多模态MRI、CT多期增强扫描联合D-二聚体对重症急性胰腺炎的预后评价作用分析

摘要 目的：分析多模态MRI、CT增强扫描联合D-二聚体对重症急性胰腺炎（SAP）的预后评价作用。方法：收集2018年7月至2021年12月于我院诊治的85例SAP患者的影像学及临床资料。所有患者入院48小时内均接受多模态MRI及CT多期增强扫描检查,入院24小时内完善D-二聚体测定,分析多模态MRI、CT多期增强扫描、D-二聚体单独及联合应用对SAP患者预后的评价效能。结果：（1）经MRSI评分,低分组52例,高分组33例,低分组住院天数、病死率低于高分组（P<0.05）;（2）经MCTSI评分,低分组42例,高分组43例,低分组住院天数、病死率低于高分组（P<0.05）;（3）以2 mg/L为界,D-二聚体低水平组39例,高水平组46例,低水平组住院天数、病死率低于高水平组（P<0.05）;（4）MRSI评分、MCTSI评分、D-二聚体水平预测SAP预后的ROC曲线下面积（AUC）分别为：0.804、0.738、0.810,三种方式均能有效预测SAP的死亡,且D-二聚体水平> MRSI评分>MCTSI评分;（5）多模态MRI、CT多期增强扫描联合D-二聚体诊断SAP的灵敏度为94.77%,特异度为92.58%,均高于多模态MRI、CT多期增强扫描、D-二聚体三种方法单独诊断以及两两结合诊断（P<0.05）。结论：多模态MRI、CT多期增强扫描联合D-二聚体共同检查可提高SAP诊断的灵敏度及特异度,有助于提高对患者预后评估的准确率。