Comparison of clinical characteristics in patients with coronavirus disease and influenza A in Guangzhou, China

BACKGROUND: This study aims to compare the epidemiological, clinical and laboratory characteristics between patients with coronavirus disease(COVID-19) and influenza A(H1N1), and to develop a differentiating model and a simple scoring system.METHODS: We retrospectively analyzed the data from patients with COVID-19 and H1N1. The logistic regression model based on clinical and laboratory characteristics was constructed to distinguish COVID-19 from H1N1. Scores were assigned to each of independent discrimination factors based on their odds ratios. The performance of the prediction model and scoring system was assessed. RESULTS: A total of 236 patients were recruited, including 20 COVID-19 patients and 216 H1N1 patients. Logistic regression revealed that age >34 years, temperature ≤37.5℃, no sputum or myalgia, lymphocyte ratio ≥20% and creatine kinase-myocardial band isoenzyme(CK-MB) >9.7 U/L were independent differentiating factors for COVID-19. The area under curves(AUCs) of the prediction model and scoring system in differentiating COVID-19 from H1N1 were 0.988 and 0.962, respectively. CONCLUSIONS: There are certain differences in clinical and laboratory features between patients with COVID-19 and H1N1. The simple scoring system may be a useful tool for the early identification of COVID-19 patients from H1N1 patients.

Association of HBV DNA replication.with antiviral treatment outcomes in the patients with early-stage HBV-related hepatocellular carcinoma undergoing curative resection

Background:It remains unclear what the antiviral therapy affects disease-free survival(DFS) and overall survival(OS)of patients with hepatitis B virus(HBV)-related hepatocellular carcinoma(HCC) at different tumor stages and baseline HBV DNA levels.In this study,we analyzed the association of antiviral treatment with DFS and OS based on the stratification of baseline HBV DNA load in early-stage(stages Ⅰ and Ⅱ) HCC patients.Methods:We included 445 patients with early-stage HBV-related HCC who underwent curative resection,and then classified them into four subgroups based on baseline HBV DNA load and antiviral therapy stratification.The KaplanMeier and Cox regression analyses were performed to determine the association of clinical characteristics with survival.Results:The median follow-up period was 74 months.For all patients,cumulative OS rates in the antiviral group were significantly higher than those in the non-antiviral group(log-rank test,P = 0.023),whereas no significant differences in DFS rates were observed.High baseline HBV DNA level was a risk factor associated with short DFS and OS in all patients.In patients with baseline HBV DNA levels ≥2000 lU/mL,antiviral treatment was significantly associated with prolonged DFS and OS(log-rank test,P = 0.041 and 0.001,respectively).In patients with HBV DNA levels <2000 lU/mL or undetectable,antiviral treatment did not show a significant benefit in prolonging DFS and OS.Conclusions:High baseline HBV DNA levels are associated with poor prognosis in the patients with early-stage HCC,and the antiviral treatment could generate survival benefits for the patients.Therefore,antiviral treatment should be given for these patients.However,the effect of antiviral treatment on the patients with low viral load remains unclear,and further investigation is warranted.

Effect of Cesarean Section on the Severity of Postpartum Hemorrhage in Chinese Women： The Shanxi Study

Postpartum hemorrhage （PPH） is one of the most adverse obstetric outcomes. Our aim is to detect the risks of multilevel PPH in different cesarean section （CS） groups [including nulliparous CS with indications, nulliparous CS without indications, repeat cesarean （RC）, vaginal birth after cesarean （VBAC）, cesarean after vaginal birth （CAVB）]. We conducted a retrospective cohort study, and the data on 127 145 women collected from January 2014 to May 2016 and from 35 tertiary hospitals in Shanxi province, China, were reviewed. Based on the measuring results of PPH, an ordered logistic regression model was used to analyze the adjusted PPH risks for each of the CS groups, and comparisons were drawn between them. Finally, a total of 99 066 nulliparous （77.92%） and 28 079 multiparous （22.08%） women were observed. The number of CS cases was 61 117, and the rate for CS was 48.07%. A total of 10 029 women did not show indications for CS and accounted for 16.41% of the CS parturient, whereas 9103 women underwent a repeated cesarean, with a CS frequency of 14.89%. The number of VBAC cases was 989, whose rate was 9.88% in prior CS women. The number （proportions） of PPH was 3658 （2.88%） in L1 （PPH volume： ≥900 and 〈1500 mL）, 520 （0.41%） in L2 （PPH volume： ≥1500 and〈2100 mL）, and 201 （0.16%） in L3 （PPH volume： ≥2100 mL）. The Ln （n= 1, 2, 3, etc.） represented the increasing order of PPH severity. In the adjusted results, compared with spontaneous vaginal delivery （SVD） as the reference group, in the adjusted result for nulliparous, there was a decreased PPH risk in CS with indications （OR： 2.32; CI： 2.04-2.62）, which was lower than that of CS without indications （OR： 2.50; CI： 2.01-2.96）. The highest PPH risk in all subgroups （i.e. nulliparous and multiparous groups） was observed in the RC （OR： 3.61; CI： 3.16-4.17）, which was nearly twice higher than that of the VBAC （OR： 1.82; CI： 1.33-2.52）. CAVB （OR： 1.03; CI： 0.65-1.62） showed no significant difference with the reference group. Thus, we deemed that CS should be avoided in nulliparous pregnancies unless indicated, to prevent or reduce the rates for the use of RC or VBAC which are high risks of severe PPH to the parturient women.

Impact of oral anti-hepatitis B therapy on the survival of patients with hepatocellular carcinoma initially treated with chemoembolization

Introduction:Most hepatocellular carcinomas(HCC) develop in a background of underlying liver disease including chronic hepatitis B.However,the effect of antiviral therapy on the long-term outcome of patients with hepatitis B virus(HBV)-related HCC treated with chemoembolization is unclear.This study aimed to evaluate the survival benefits of anti-HBV therapy after chemoembolization for patients with HBV-related HCC.Methods:A total of 224 HCC patients who successfully underwent chemoembolization were identified,and their survival and other relevant clinical data were reviewed.Kaplan-Meier and Cox regression analyses were performed to validate possible effects of antiviral treatment on overall survival(OS).Results:The median survival time(MST) was 15.9(95%confidence interval[CI],9.5-27.7) months in the antiviral group and 9.6(95%CI,7.8-13.7) months in the non-antiviral group(log-rank test,P = 0.044).Cox multivariate analysis revealed that antiviral treatment was a prognostic factor for OS(P = 0.008).Additionally,a further analysis was based on the stratification of the TNM tumor stages.In the subgroup of early stages,MST was significantly longer in the antiviral-treatment group than in the non-antiviral group(61.8 months[95%CI,34.8 months to beyond the follow-up period]versus 26.2[95%CI,14.5-37.7]months,P= 0.012).Multivariate analysis identified antiviral treatment as a prognostic factor for OS in the early-stage subgroup(P = 0.006).However,in the subgroup of advanced stages,MST of the antiviral-treated group was comparable to that of the non-antiviral group(8.4[95%CI,5.2-13.5]months versus 7.4[95%CI,5.9-9.3]months,P = 0.219).Multivariate analysis did not indicate that antiviral treatment was a significant prognostic factor in this subgroup.Conclusion:Antiviral treatment is associated with prolonged OS time after chemoembolization for HCC,especially in patients with early-stage tumors.

Transarterial chemoembolization combined with recombinant human adenovirus type 5 H101 prolongs overall survival of patients with intermediate to advanced hepatocellular carcinoma: a prognostic nomogram study

Background: Patients with intermediate to advanced hepatocellular carcinoma(HCC) are most commonly treated with transarterial chemoembolization(TACE). Previous studies showed that TACE combined with recombinant human adenovirus type 5(H101) may provide a clinical survival benefit. In the present study, we aimed to determine the survival benefit of TACE with or without H101 for patients with intermediate to advanced HCC and to develop an e ective nomogram for predicting individual survival outcomes of these patients.Methods: We retrospectively collected data from 590 patients with intermediate to advanced HCC who were treated at Sun Yat?sen University Cancer Center between January 2007 and July 2015. After propensity score matching, 238 patients who received TACE with H101(TACE with H101 group) and 238 patients who received TACE without H101(TACE group) were analyzed. Overall survival(OS) was evaluated using the Kaplan–Meier method; the nomogram was developed based on Cox regression analysis. Discrimination and calibration were measured using the concordance index(c?index) and calibration plots.Results: Clinical and radiologic features were similar between the two groups. OS rates were significantly lower in the TACE group than in the TACE with H101 group(1?year OS rate, 53.8% vs. 61.3%; 2?year OS rate, 33.4% vs. 44.2%; 3?year OS rate, 22.4% vs. 40.5%; all P < 0.05). Multivariate Cox regression analysis for the entire cohort showed that alpha?fetoprotein level, alkaline phosphatase level, tumor size, metastasis, vascular invasion, and TACE with or without H101 were independent factors for OS, all of which were included in the nomogram. Calibration curves showed good agreement between nomogram?predicted survival and observed survival. The c?index of the nomogram for predict?ing OS was 0.716(95% confidence interval 0.686–0.746).Conclusions: TACE plus H101 extends the survival of patients with intermediate to advanced HCC. Our proposed nomogram provides individual survival prediction and stratification for patients with intermediate to advanced HCC who receive TACE with or without H101.

经动脉化疗栓塞术和重组人5型腺病毒H101联合治疗延长中晚期肝细胞癌患者总生存期:预后列线图研究

背景与目的经动脉化疗栓塞术(transarterial chemoembolization,TACE)是对中晚期肝细胞癌(hepatocellular carcinoma,HCC)患者最常见的治疗方法。有研究表明,TACE联合重组人5型腺病毒即H101可提供临床生存获益。本研究旨在明确在TACE是否联合H101治疗的情况下对中晚期HCC患者的生存获益的影响,并建立一个有效的列线图来预测这些患者的个体生存情况。方法回顾分析2007年1月至2015年7月在中山大学肿瘤防治中心接受治疗的590例中晚期HCC患者的资料。倾向评分匹配后,对238例接受TACE联合H101(TACE联合H101组)治疗的患者和238例单独接受TACE(TACE组)治疗的患者进行分析。采用Kaplan-Meier法评估总生存期(overall survival,OS);基于Cox回归分析建立列线图。并使用一致性指数(concordance Index,c-index)和校准曲线来评价模型的区分度和校准度。结果两组的临床和放射学特征相似。然而TACE组的OS率显著低于TACE联合H101组(1年OS率,53.8%vs. 61.3%;2年OS率,33.4%vs. 44.2%;3年OS率,22.4%vs. 40.5%;均P <0.05)。将列线图中所有相关因素进行Cox多因素回归分析,结果表明,甲胎蛋白水平、碱性磷酸酶水平、肿瘤大小、转移、血管浸润及TACE联合H101或单独治疗均为OS的独立预后因素。校准曲线表明列线图预测的生存期与实际观察的生存期有较好的一致性。列线图预测OS的c-index为0.716(95%置信区间:0.686–0.746)。结论 TACE联合H101治疗可延长中晚期肝细胞癌患者的生存期。我们提出的列线图为接受TACE联合H101或TACE单独治疗的中晚期肝细胞癌患者提供了个体化生存预测和分层。

单发肝细胞癌合并微血管侵犯患者根治性切除术后辅助经导管动脉化疗栓塞治疗的疗效和安全性:一项随机临床试验

背景与目的单发肝细胞癌(hepatocellular carcinoma,HCC)合并微血管侵犯(microvascular invasion,MVI)患者根治性切除术后的最佳辅助治疗方案一直存有争议。本试验旨在评估肝切除术后辅助经导管动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)与单纯肝切除术对直径≥5 cm单发HCC合并MVI患者的疗效和安全性。方法在本随机、开放性、III期试验中,将直径≥5 cm单发HCC合并MVI患者随机分为2组(1∶1):在肝切除术后接受1–2个周期的辅助TACE治疗(肝切除–TACE组)或单纯接受肝切除(单纯肝切除组)。主要终点是无病生存期(disease-free survival,DFS),次要终点包括总生存期(overall survival,OS)和不良事件。结果在2009年6月1日至2012年12月31日期间,共纳入250例患者,随机分为肝切除–TACE组(n=125)或单纯肝切除组(n=125)。两组患者的临床病理特征相似。从随机开始的中位随访时间为37.5个月(四分位距为18.3–48.2个月)。肝切除–TACE组的中位DFS显著长于单纯肝切除组[17.45个月(95%置信区间,confidence interval,CI:11.99–29.14)vs. 9.27个月(95%CI:6.05–13.70),风险比(hazard ratio,HR)=0.70(95%CI:0.52–0.95),P=0.020]。肝切除–TACE组中位OS也显著长于单纯肝切除组[44.29个月(95%CI:25.99–62.58)vs. 22.37个月(95%CI:10.84–33.91),HR=0.68(95%CI:0.48–0.97),P=0.029]。治疗相关不良事件在肝切除–TACE组中更为多见,虽然这些不良事件一般都是轻度和可控的。两组中最常见的3级或4级不良事件为中性粒细胞减少和肝功能异常。结论对于直径≥5 cm单发HCC合并MVI患者,根治术后进行辅助TACE治疗是一种合适的选择,且毒性是可接受的。

Adjuvant transcatheter arterial chemoembolization after curative resection for hepatocellular carcinoma patients with solitary tumor and microvascular invasion: a randomized clinical trial of efficacy and safety

Background:The optimal strategy for adjuvant therapy after curative resection for hepatocellular carcinoma(HCC)patients with solitary tumor and microvascular invasion(MVI)is controversial.This trial evaluated the efficacy and safety of adjuvant transcatheter arterial chemoembolization(TACE)after hepatectomy versus hepatectomy alone in HCC patients with a solitary tumor≥5 cm and MVI.Methods:In this randomized,open-labeled,phase III trial,HCC patients with a solitary tumor≥5 cm and MVI were randomly assigned(1:1)to receive either 1-2 cycles of adjuvant TACE after hepatectomy(Hepatectomy-TACE)or hepatectomy alone(Hepatectomy Alone).The primary endpoint was disease-free survival(DFS);the secondary end-points included overall survival(OS)and adverse events.Results:Between June 1,2009,and December 31,2012,250 patients were enrolled and randomly assigned to the Hepatectomy-TACE group(n=125)or the Hepatectomy Alone group(n=125).Clinicopathological characteristics were balanced between the two groups.The median follow-up time from randomization was 37.5 months[interquartile range 18.3-48.2 months].The median DFS was significantly longer in the Hepatectomy-TACE group than in the Hepatectomy Alone group[17.45 months(95%confidence interval[CI]11.99-29.14)vs.9.27 months(95%CI 6.05-13.70),hazard ratio[HR]=0.70(95%CI 0.52-0.95),P=0.020],respectively.The median OS was also significantly longer in the Hepatectomy-TACE group than in the Hepatectomy Alone group[44.29 months(95%CI 25.99-62.58)vs.22.37 months(95%CI 10.84-33.91),HR=0.68(95%CI 0.48-0.97),P=0.029].Treatment-related adverse events were more frequently observed in the Hepatectomy-TACE group,although these were generally mild and manageable.The most common grade 3 or 4 adverse events in both groups were neutropenia and liver dysfunction.Conclusion:Hepatectomy followed by adjuvant TACE is an appropriate option after radical resection in HCC patients with solitary tumor≥5 cm and MVI,with acceptable toxicity.