Higher vocational college students are suffering foreign language anxiety in their English learning. Actually, negative cor-relation exists between foreign language anxiety and PRETCO-B scores. Foreign language anxiet...Higher vocational college students are suffering foreign language anxiety in their English learning. Actually, negative cor-relation exists between foreign language anxiety and PRETCO-B scores. Foreign language anxiety debilitates English learning.It ishoped that the finding will be of value to the English teaching and learning in higher vocational colleges.展开更多
目的基于淀粉样β前体蛋白(amyloid beta precursor protein,APP)家族、淀粉样β前体蛋白结合蛋白A(amyloid beta precursor protein binding family A,APBA)家族和淀粉样β前体蛋白结合蛋白B(amyloid beta precursor protein binding f...目的基于淀粉样β前体蛋白(amyloid beta precursor protein,APP)家族、淀粉样β前体蛋白结合蛋白A(amyloid beta precursor protein binding family A,APBA)家族和淀粉样β前体蛋白结合蛋白B(amyloid beta precursor protein binding family B,APBB)家族构建胃癌预后评估模型。方法从基因表达综合(gene expression omnibus,GEO)数据库下载GSE62254胃癌数据集作为训练集,GSE15459作为验证集。利用Cox回归分析筛选APP家族、APBA家族和APBB家族中胃癌预后的独立危险因素;分别建立基于三家族独立预后因素的风险评分1(risk score 1,RS1)、RS1联合病理学参数的RS2、传统TNM分期的RS3;卡方检验分析RS1与胃癌患者临床病理特征的关系;利用单细胞在线分析网站,分析纳入RS1模型的基因在不同细胞亚群中的表达情况;利用CIBERSORT分析RS1对不同免疫细胞浸润的影响;利用基因集富集分析(gene set enrichment analysis,GSEA)进行通路富集分析。结果APLP2、APBB1、APBB2是胃癌患者预后的独立危险因素(P<0.05),基于三者的风险评分RS1高组患者生存期明显短于RS1低组患者。联合临床病理学参数的Cox回归分析显示,N分期、M分期、Lauren分型和RS1是胃癌患者预后的独立危险因素(P<0.05)。基于此构建的RS2(AUC=0.767)比仅基于T分期、N分期、M分期构建的RS3(AUC=0.719)预测准确率提高了4.8%。RS1和肿瘤T分期呈正相关(P<0.05),RS1高组CD4静息细胞浸润较高,激活细胞浸润较低,M2巨噬细胞浸润较高。GSEA通路分析显示,高RS1组患者富集于MAPK、MTOR和WNT等通路。结论本研究成功构建了基于APP、APBA和APBB家族的胃癌预后评估模型,该模型能够较准确地判断胃癌患者预后。展开更多
目的探讨慢性乙型肝炎肝硬化患者aMAP评分与高危食管静脉曲张(HEV)发生风险之间的关联性。方法选取2017年1月1日至2023年1月1日于安徽医科大学第一附属医院确诊为慢性乙型肝炎肝硬化的患者为研究对象。收集所有研究对象的一般资料,同时...目的探讨慢性乙型肝炎肝硬化患者aMAP评分与高危食管静脉曲张(HEV)发生风险之间的关联性。方法选取2017年1月1日至2023年1月1日于安徽医科大学第一附属医院确诊为慢性乙型肝炎肝硬化的患者为研究对象。收集所有研究对象的一般资料,同时收集入院24小时内的实验室检查指标并计算aMAP评分。所有研究对象均完成胃镜检查以评估食管静脉曲张(EV)程度。采用多元Logistic回归评估aMAP评分与HEV风险之间的相关性,采用趋势性检验(P for trend)评估两者之间的相关性是否存在剂量反应关系,最后采用平滑曲线拟合和阈值效应分析明确两者之间是否存在非线性关系。结果最终共纳入患者207例,其中HEV患者104例。与非HEV患者相比,HEV患者aMAP评分更高(P=0.002)。在多个模型中,aMAP评分与HEV之间存在明显的正向相关关系,全调整模型的结果为(OR=1.16,95%CI∶1.03-1.30)。随着aMAP评分的增加,HEV的发生风险也随之增加,趋势性检验具有显著的统计学差异(P for trend<0.01),平滑曲线拟合分析和阈值效应分析提示两者之间为直线效应关系。受试者工作特征曲线(ROC)下面积(AUC)为0.73(0.64-0.78),aMAP评分对HEV诊断的最佳截断值为63.57。结论在慢性乙型肝炎肝硬化患者中,aMAP评分与HEV发病风险之间存在直线性的正性相关关系,并且随着aMAP评分的升高这种正性相关关系更加明显。aMAP评分对HEV具有较好的诊断价值,最佳截断值为63.57。展开更多
AIM: To establish a clinical scoring model to predict risk of acute-on-chronic liver failure(ACLF) in chronic hepatitis B(CHB) patients.METHODS: This was a retrospective study of 1457 patients hospitalized for CHB bet...AIM: To establish a clinical scoring model to predict risk of acute-on-chronic liver failure(ACLF) in chronic hepatitis B(CHB) patients.METHODS: This was a retrospective study of 1457 patients hospitalized for CHB between October 2008 and October 2013 at the Beijing Ditan Hospital, Capital Medical University, China. The patients were divided into two groups: severe acute exacerbation(SAE) group(n = 382) and non-SAE group(n = 1075). The SAE group was classified as the high-risk group based on the higher incidence of ACLF in this group than in the non-SAE group(13.6% vs 0.4%). Two-thirds of SAE patients were randomly assigned to risk-model derivation and the other one-third to model validation. Univariate risk factors associated with the outcome were entered into a multivariate logistic regression model for screening independent risk factors. Each variable was assigned an integer value based on the regression coefficients, and the final score was the sum of these values in the derivation set. Model discrimination and calibration were assessed using area under the receiver operating characteristic curve and the Hosmer-Lemeshow test. RESULTS: The risk prediction scoring model includedthe following four factors: age ≥ 40 years, total bilirubin ≥ 171 μmol/L, prothrombin activity 40%-60%, and hepatitis B virus DNA > 107 copies/m L. The sum risk score ranged from 0 to 7; 0-3 identified patients with lower risk of ACLF, whereas 4-7 identified patients with higher risk. The Kaplan-Meier analysis showed the cumulative risk for ACLF and ACLF-related death in the two risk groups(0-3 and 4-7 scores) of the primary cohort over 56 d, and log-rank test revealed a significant difference(2.0% vs 33.8% and 0.8% vs 9.4%, respectively; both P < 0.0001). In the derivation and validation data sets, the model had good discrimination(C index = 0.857, 95% confidence interval: 0.800-0.913 and C index = 0.889, 95% confidence interval: 0.820-0.957, respectively) and calibration demonstrated by the Hosmer-Lemeshow test(χ2 = 4.516, P = 0.808 and χ2 = 1.959, P = 0.923, respectively).CONCLUSION: Using the scoring model, clinicians can easily identify patients(total score ≥ 4) at high risk of ACLF and ACLF-related death early during SAE.展开更多
目的筛选乙肝病毒(hepatitis B virus,HBV)DNA阴性的乙肝表面抗原(hepatitis B surface antigen,HBsAg)和乙肝表面抗体(hepatitis B surface antibody,HBsAb)阳性的慢性乙型肝炎(chronic hepatitis B,CHB)患者的血清危险因素,探讨危险...目的筛选乙肝病毒(hepatitis B virus,HBV)DNA阴性的乙肝表面抗原(hepatitis B surface antigen,HBsAg)和乙肝表面抗体(hepatitis B surface antibody,HBsAb)阳性的慢性乙型肝炎(chronic hepatitis B,CHB)患者的血清危险因素,探讨危险因素评分与预后的相关性。方法筛选2020年1月~2022年6月江苏大学附属金坛第一人民医院收治的HBV-DNA阴性的CHB患者193例,其中HBsAg和HBsAb阳性的119例患者作为观察组,HBsAg阳性且HBsAb阴性的74例患者作为对照组。收集所有患者的临床资料并计算外周血炎性指标[嗜中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR),血小板-淋巴细胞比值(platelet-to-lymphoccyte ratio,PLR),全身免疫炎症指数(systemic immune inflammatory index,SII)]和肝纤维化指标[谷氨酰转肽酶-血小板比值(gamma-glutamyl transpeptidase to platelet ratio,GPR),门冬氨酸转移酶纤维化指数(aspartate aminotransferase to platelet ratio index,APRI),肝纤维化4因子指数(fibrosis 4 score,FIB-4)],采用t检验和U检验比较两组间各指标的差异。采用ROC曲线评价差异指标的预测价值,多因素回归分析影响HBsAg和HBsAb阳性模式的危险因素。随访观察组患者二年内HBsAg和HBsAb变化,将20例HBsAg水平明显降低的患者作为预后良好组,24例HBsAg水平没有明显降低甚至HBsAb消失的患者作为预后不良组。结果与对照组相比,观察组的PLT水平[(181.07±63.31)×10^(9)/L vs(158.27±61.55)×10^(9)/L]和TP水平[70.20(65.73,74.90)g/L vs 67.00(64.45,71.25)g/L]明显升高,差异有统计学意义(t=2.459,U=3254.00,均P<0.05);而观察组的HBsAg水平[1.60(0.37,13.15)IU/ml vs 138.78(8.66,161.94)IU/ml]和APRI比值[0.31(0.22,0.47)vs 0.46(0.32,0.71)]明显降低,差异有统计学意义(U=1685.50,2972.00,均P<0.05)。ROC曲线确定PLT,TP,APRI和HBsAg在两组间的差异的截断值分别为157.50×10^(9)/L,69.45 g/L,0.29和22.56 IU/ml。单因素回归分析结果显示,PLT≥157.50×10^(9)/L,TP≥69.45 g/L,APRI≤0.29,HBsAg≤22.56IU/ml与CHB患者的HBsAg和HBsAb阳性模式相关(χ^(2)=8.231~50.862,均P<0.05);多因素回归分析显示,HBsAg≤22.56 IU/ml[OR(95%CI):9.853(4.722~20.560)]和TP≥69.45 g/L[OR(95%CI):2.358(1.132~4.912)]是HBsAg和HBsAb阳性模式的独立危险因素(均P<0.05)。基于上述危险因素建立的评分模型预测HBsAg和HBsAb阳性模式发生的ROC曲线下面积(area under curve,AUC)为0.703,灵敏度和特异度分别为66.7%和73.9%。随访结果显示,预后良好组主要分布在评分模型的高分段(2分),而预后不良组主要分布在评分模型的低分段(0分和1分),差异有统计学意义(χ^(2)=13.838,P=0.001)。结论HBsAg≤22.56 IU/ml和TP≥69.45 g/L是影响HBV-DNA阴性且HBsAg与HBsAb阳性的CHB患者的独立危险因素,据此建立的评分模型对上述患者的预后有一定的预测价值。展开更多
Day 100 prognostic factors post-autologous peripheral blood hematopoietic stem cell transplantation (APBHSCT) to predict clinical outcomes in diffuse large B-cell lymphoma (DLBCL) patients have not been studied. Thus,...Day 100 prognostic factors post-autologous peripheral blood hematopoietic stem cell transplantation (APBHSCT) to predict clinical outcomes in diffuse large B-cell lymphoma (DLBCL) patients have not been studied. Thus, we retrospectively examined if day 100 absolute monocyte/lymphocyte prognostic score (AMLPS-100) affects clinical outcomes by landmark analysis from day 100 post-APBHSCT in DLBCL. Only DLBCL patients in complete remission at day 100 post-APBHSCT were evaluated. From 2000 to 2007, 134 consecutive DLBCL patients are qualified for the study. Patients with a day 100 absolute monocyte count (AMC-100) ≥ 630 cells/μL and day 100 absolute lymphocyte count (ALC-100) ≤ 1000 cells/μL experienced inferior overall survival (OS) and progression free survival (PFS). On multivariate analysis, the AMC-100 and ALC-100 remained independent predictors of OS and PFS. Combining both values into the AMLPS-100, the 5-year OS rates for low, intermediate, and high AMLPS-100 risk groups were 94% (95% CI, 83.0% - 98.1%), 70% (95% CI, 58.6% - 80.1%), and 13% (95% CI, 3.4% - 40.5%), respectively;and the 5-year PFS rates were 87% (95% CI, 74.0% - 94.1%), 68% (95% CI, 56.0% - 77.8%), and 13% (95% CI, 3.4% - 40.5%), respectively. The AMLPS-100 is a simple biomarker score that can stratify clinical outcomes from day 100 post-APBHSCT in DLBCL patients.展开更多
目的:探讨营养状态指标包括控制营养状态(controlling nutritional status,CONUT)评分和预后营养指数(prognostic nutritional index,PNI)在预测弥漫大B细胞淋巴瘤(diffuse large B cell lymphoma,DLBCL)预后中的作用。方法:回顾性收集...目的:探讨营养状态指标包括控制营养状态(controlling nutritional status,CONUT)评分和预后营养指数(prognostic nutritional index,PNI)在预测弥漫大B细胞淋巴瘤(diffuse large B cell lymphoma,DLBCL)预后中的作用。方法:回顾性收集105例在南京医科大学附属淮安第一医院血液科就诊的DLBCL患者的临床资料,计算出每个患者的CONUT评分和PNI,并通过ROC曲线确定截断值。CONUT评分和PNI分别以6.5和47.28作为截断值,将患者根据截断值进行分组。依次进行Kaplan-Meier生存分析、单因素和多因素COX回归分析以及Spearman相关分析。结果:生存曲线显示CONUT评分和PNI对患者的总生存期(overall survival,OS)具有预测作用(P<0.05)。单因素分析显示CONUT评分、PNI、国际预后指数(international prognostic index,IPI)危险度分型、白蛋白、胆固醇均是患者OS的预后因素。多因素分析结果表明CONUT评分对DLBCL患者的OS具有独立预测作用(HR=2.742,95%CI:1.030~7.300,P<0.05),PNI不是患者OS的独立预测因素(HR=0.526,95%CI:0.135~2.047,P=0.35)。相关性分析结果显示两种营养状态指标呈高度负相关(r=-0.79,P<0.01)。结论:CONUT评分是DLBCL患者预后的独立预测因素,患者CONUT评分越高,预后越差。展开更多
Objoctive： There is heterogeneity in the prognosis of gastric cancers staged according to the tumornodes-metastasis （TNM） system. This study evaluated the prognostic potential of an immune score system to supplemen...Objoctive： There is heterogeneity in the prognosis of gastric cancers staged according to the tumornodes-metastasis （TNM） system. This study evaluated the prognostic potential of an immune score system to supplement the TNM staging system. Mothodsg An immunohistochemical analysis was conducted to assess the density of T cells, B cells, and myeloid-derived suppressor cells （MDSCs） in cancer tissues from 100 stage IIIA gastric cancer patients; the expression of the high-mobility group protein B1 （HMGB1） was also evaluated in cancer cells. The relationship between the overall survival （OS）, disease-free survival （DFS）, and immunological parameters was analyzed.Results： An immune score system was compiled based on the prognostic role of the density ofT cells, B cells, MDSCs, and the expression of HMGB1 in cancer tissues. The median 5-year survival of this group of patient was 32%. However, the 5-year survival rates of 80.0%, 51.7%, 0%, 5.8%, and 0% varied among the patients with an immune score of 4 to those with an immune score of 0 based on the immune score system, respectively. Similarly, differences in DFS rates were observed among the immune score subgroups. Concluslons： An immune score system could effectively identify the prognostic heterogeneity within stage IliA gastric cancer patients, implying that this immune score system may potentially supplement the TNM staging system, and help in identifying a more homogeneous group of patients who on the basis of prognosis can undergo adjuvant therapy.展开更多
It is controversial whether universal screening for bacterial vaginosis (BV) should be done in the early stages of pregnancy in order to prevent preterm birth. In particular, whether the intermediate vaginal flora typ...It is controversial whether universal screening for bacterial vaginosis (BV) should be done in the early stages of pregnancy in order to prevent preterm birth. In particular, whether the intermediate vaginal flora type should be included in the group to be treated for BV. This vaginal smear type is a mixture of Lactobacillus and Gardnerella or Bacteroides spp. We examined three vaginal flora types, excluding the mixed-type, with a Nugent Score of 4 and evaluated their significance in achieving term delivery. The subjects were pregnant women who were examined at our Hospital between June 2009 and December 2010. Their vaginal swabs were taken at their first prenatal visit and were studied by Gram staining. The resulting Nugent Score 4 organisms were further classified into the following four types: mixed-type, gram-positive cocci type, Bifidobacterium type, and non-bacterial type. The clinical courses for all the types except “mixed-type” were followed-up. Among the 566 pregnant women, 58 (10.2%) had a Nugent Score of 4. There were 38 cases of mixed-type (65.5%), 3 cases of gram-positive cocci type (5.2%), 10 cases of Bifidobacterium type (17.2%), and 7 cases of non-bacterial type (12.1%). The three women with the gram-positive cocci type attained successful term delivery despite two of them experiencing GBS infection and requiring treatment with penicillin and tocolytics. Among the 10 cases of Bifidobacterium type, 5 cases were term delivery with no therapy, 3 cases were term delivery with metronidazole treatment and 2 cases were preterm birth with maternal complications. Among the 7 cases of non-bacterial type, 6 cases were diagnosed with preterm PROM, and 5 of them resulted in preterm birth despite prophylactic antibiotic therapy. Classification of smears with a Nugent score of 4 into four bacterial morphotypes may be effective, for required treatment may vary depending on the morphotype.展开更多
Patients with acute-on-chronic hepatitis B liver failure（HBV-ACLF） show high morbidity and mortality. Independent prognostic predictors of short-term HBV-ACLF mortality include the Child-Turcotte-Pugh（CTP） score, ...Patients with acute-on-chronic hepatitis B liver failure（HBV-ACLF） show high morbidity and mortality. Independent prognostic predictors of short-term HBV-ACLF mortality include the Child-Turcotte-Pugh（CTP） score, the model for end-stage liver disease（MELD） score, other MELD-based indices and the dynamic changes in these indices. The aims of this study were to evaluate the existing prognostic scores in a large cohort of HBV-ACLF patients and create a new predictive model. We retrospectively reviewed 392 HBV-ACLF patients from December 2008 to November 2011 and evaluated their 3-month survival. The predictive accuracy of CTP, MELD and MELD-based indices and the dynamic changes in the MELD-related scores（Δ scoring systems） upon admission and after two weeks of treatment were compared using the area under the receiver operating characteristic（ROC） curve method. Life-threatening factors and a series of bio-clinical parameters were studied by univariate and multivariate analyses. Among the existing scores, MELD had the best predictive ability. However, our new regression model provided an area under the curve of 0.930±0.0161（95% CI： 0.869 to 0.943）, which was significantly larger than that obtained with the MELD score at admission and after two weeks of treatment as well as with the dynamic changes of the MELD score（0.819, 0.921, and 0.826, respectively）（Z=3.542, P=0.0004）. In a large cohort of patients retrospectively reviewed for this study, our prognostic model was superior to the MELD score and is, therefore, a promising predictor of short-term survival in patients with HBV-ACLF.展开更多
文摘Higher vocational college students are suffering foreign language anxiety in their English learning. Actually, negative cor-relation exists between foreign language anxiety and PRETCO-B scores. Foreign language anxiety debilitates English learning.It ishoped that the finding will be of value to the English teaching and learning in higher vocational colleges.
文摘目的基于淀粉样β前体蛋白(amyloid beta precursor protein,APP)家族、淀粉样β前体蛋白结合蛋白A(amyloid beta precursor protein binding family A,APBA)家族和淀粉样β前体蛋白结合蛋白B(amyloid beta precursor protein binding family B,APBB)家族构建胃癌预后评估模型。方法从基因表达综合(gene expression omnibus,GEO)数据库下载GSE62254胃癌数据集作为训练集,GSE15459作为验证集。利用Cox回归分析筛选APP家族、APBA家族和APBB家族中胃癌预后的独立危险因素;分别建立基于三家族独立预后因素的风险评分1(risk score 1,RS1)、RS1联合病理学参数的RS2、传统TNM分期的RS3;卡方检验分析RS1与胃癌患者临床病理特征的关系;利用单细胞在线分析网站,分析纳入RS1模型的基因在不同细胞亚群中的表达情况;利用CIBERSORT分析RS1对不同免疫细胞浸润的影响;利用基因集富集分析(gene set enrichment analysis,GSEA)进行通路富集分析。结果APLP2、APBB1、APBB2是胃癌患者预后的独立危险因素(P<0.05),基于三者的风险评分RS1高组患者生存期明显短于RS1低组患者。联合临床病理学参数的Cox回归分析显示,N分期、M分期、Lauren分型和RS1是胃癌患者预后的独立危险因素(P<0.05)。基于此构建的RS2(AUC=0.767)比仅基于T分期、N分期、M分期构建的RS3(AUC=0.719)预测准确率提高了4.8%。RS1和肿瘤T分期呈正相关(P<0.05),RS1高组CD4静息细胞浸润较高,激活细胞浸润较低,M2巨噬细胞浸润较高。GSEA通路分析显示,高RS1组患者富集于MAPK、MTOR和WNT等通路。结论本研究成功构建了基于APP、APBA和APBB家族的胃癌预后评估模型,该模型能够较准确地判断胃癌患者预后。
文摘目的探讨慢性乙型肝炎肝硬化患者aMAP评分与高危食管静脉曲张(HEV)发生风险之间的关联性。方法选取2017年1月1日至2023年1月1日于安徽医科大学第一附属医院确诊为慢性乙型肝炎肝硬化的患者为研究对象。收集所有研究对象的一般资料,同时收集入院24小时内的实验室检查指标并计算aMAP评分。所有研究对象均完成胃镜检查以评估食管静脉曲张(EV)程度。采用多元Logistic回归评估aMAP评分与HEV风险之间的相关性,采用趋势性检验(P for trend)评估两者之间的相关性是否存在剂量反应关系,最后采用平滑曲线拟合和阈值效应分析明确两者之间是否存在非线性关系。结果最终共纳入患者207例,其中HEV患者104例。与非HEV患者相比,HEV患者aMAP评分更高(P=0.002)。在多个模型中,aMAP评分与HEV之间存在明显的正向相关关系,全调整模型的结果为(OR=1.16,95%CI∶1.03-1.30)。随着aMAP评分的增加,HEV的发生风险也随之增加,趋势性检验具有显著的统计学差异(P for trend<0.01),平滑曲线拟合分析和阈值效应分析提示两者之间为直线效应关系。受试者工作特征曲线(ROC)下面积(AUC)为0.73(0.64-0.78),aMAP评分对HEV诊断的最佳截断值为63.57。结论在慢性乙型肝炎肝硬化患者中,aMAP评分与HEV发病风险之间存在直线性的正性相关关系,并且随着aMAP评分的升高这种正性相关关系更加明显。aMAP评分对HEV具有较好的诊断价值,最佳截断值为63.57。
基金Supported by Grants from National Natural Science Foundation of China,No.81273743,No.81473641and 215 Program,No.2013-2-11
文摘AIM: To establish a clinical scoring model to predict risk of acute-on-chronic liver failure(ACLF) in chronic hepatitis B(CHB) patients.METHODS: This was a retrospective study of 1457 patients hospitalized for CHB between October 2008 and October 2013 at the Beijing Ditan Hospital, Capital Medical University, China. The patients were divided into two groups: severe acute exacerbation(SAE) group(n = 382) and non-SAE group(n = 1075). The SAE group was classified as the high-risk group based on the higher incidence of ACLF in this group than in the non-SAE group(13.6% vs 0.4%). Two-thirds of SAE patients were randomly assigned to risk-model derivation and the other one-third to model validation. Univariate risk factors associated with the outcome were entered into a multivariate logistic regression model for screening independent risk factors. Each variable was assigned an integer value based on the regression coefficients, and the final score was the sum of these values in the derivation set. Model discrimination and calibration were assessed using area under the receiver operating characteristic curve and the Hosmer-Lemeshow test. RESULTS: The risk prediction scoring model includedthe following four factors: age ≥ 40 years, total bilirubin ≥ 171 μmol/L, prothrombin activity 40%-60%, and hepatitis B virus DNA > 107 copies/m L. The sum risk score ranged from 0 to 7; 0-3 identified patients with lower risk of ACLF, whereas 4-7 identified patients with higher risk. The Kaplan-Meier analysis showed the cumulative risk for ACLF and ACLF-related death in the two risk groups(0-3 and 4-7 scores) of the primary cohort over 56 d, and log-rank test revealed a significant difference(2.0% vs 33.8% and 0.8% vs 9.4%, respectively; both P < 0.0001). In the derivation and validation data sets, the model had good discrimination(C index = 0.857, 95% confidence interval: 0.800-0.913 and C index = 0.889, 95% confidence interval: 0.820-0.957, respectively) and calibration demonstrated by the Hosmer-Lemeshow test(χ2 = 4.516, P = 0.808 and χ2 = 1.959, P = 0.923, respectively).CONCLUSION: Using the scoring model, clinicians can easily identify patients(total score ≥ 4) at high risk of ACLF and ACLF-related death early during SAE.
文摘目的筛选乙肝病毒(hepatitis B virus,HBV)DNA阴性的乙肝表面抗原(hepatitis B surface antigen,HBsAg)和乙肝表面抗体(hepatitis B surface antibody,HBsAb)阳性的慢性乙型肝炎(chronic hepatitis B,CHB)患者的血清危险因素,探讨危险因素评分与预后的相关性。方法筛选2020年1月~2022年6月江苏大学附属金坛第一人民医院收治的HBV-DNA阴性的CHB患者193例,其中HBsAg和HBsAb阳性的119例患者作为观察组,HBsAg阳性且HBsAb阴性的74例患者作为对照组。收集所有患者的临床资料并计算外周血炎性指标[嗜中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR),血小板-淋巴细胞比值(platelet-to-lymphoccyte ratio,PLR),全身免疫炎症指数(systemic immune inflammatory index,SII)]和肝纤维化指标[谷氨酰转肽酶-血小板比值(gamma-glutamyl transpeptidase to platelet ratio,GPR),门冬氨酸转移酶纤维化指数(aspartate aminotransferase to platelet ratio index,APRI),肝纤维化4因子指数(fibrosis 4 score,FIB-4)],采用t检验和U检验比较两组间各指标的差异。采用ROC曲线评价差异指标的预测价值,多因素回归分析影响HBsAg和HBsAb阳性模式的危险因素。随访观察组患者二年内HBsAg和HBsAb变化,将20例HBsAg水平明显降低的患者作为预后良好组,24例HBsAg水平没有明显降低甚至HBsAb消失的患者作为预后不良组。结果与对照组相比,观察组的PLT水平[(181.07±63.31)×10^(9)/L vs(158.27±61.55)×10^(9)/L]和TP水平[70.20(65.73,74.90)g/L vs 67.00(64.45,71.25)g/L]明显升高,差异有统计学意义(t=2.459,U=3254.00,均P<0.05);而观察组的HBsAg水平[1.60(0.37,13.15)IU/ml vs 138.78(8.66,161.94)IU/ml]和APRI比值[0.31(0.22,0.47)vs 0.46(0.32,0.71)]明显降低,差异有统计学意义(U=1685.50,2972.00,均P<0.05)。ROC曲线确定PLT,TP,APRI和HBsAg在两组间的差异的截断值分别为157.50×10^(9)/L,69.45 g/L,0.29和22.56 IU/ml。单因素回归分析结果显示,PLT≥157.50×10^(9)/L,TP≥69.45 g/L,APRI≤0.29,HBsAg≤22.56IU/ml与CHB患者的HBsAg和HBsAb阳性模式相关(χ^(2)=8.231~50.862,均P<0.05);多因素回归分析显示,HBsAg≤22.56 IU/ml[OR(95%CI):9.853(4.722~20.560)]和TP≥69.45 g/L[OR(95%CI):2.358(1.132~4.912)]是HBsAg和HBsAb阳性模式的独立危险因素(均P<0.05)。基于上述危险因素建立的评分模型预测HBsAg和HBsAb阳性模式发生的ROC曲线下面积(area under curve,AUC)为0.703,灵敏度和特异度分别为66.7%和73.9%。随访结果显示,预后良好组主要分布在评分模型的高分段(2分),而预后不良组主要分布在评分模型的低分段(0分和1分),差异有统计学意义(χ^(2)=13.838,P=0.001)。结论HBsAg≤22.56 IU/ml和TP≥69.45 g/L是影响HBV-DNA阴性且HBsAg与HBsAb阳性的CHB患者的独立危险因素,据此建立的评分模型对上述患者的预后有一定的预测价值。
文摘Day 100 prognostic factors post-autologous peripheral blood hematopoietic stem cell transplantation (APBHSCT) to predict clinical outcomes in diffuse large B-cell lymphoma (DLBCL) patients have not been studied. Thus, we retrospectively examined if day 100 absolute monocyte/lymphocyte prognostic score (AMLPS-100) affects clinical outcomes by landmark analysis from day 100 post-APBHSCT in DLBCL. Only DLBCL patients in complete remission at day 100 post-APBHSCT were evaluated. From 2000 to 2007, 134 consecutive DLBCL patients are qualified for the study. Patients with a day 100 absolute monocyte count (AMC-100) ≥ 630 cells/μL and day 100 absolute lymphocyte count (ALC-100) ≤ 1000 cells/μL experienced inferior overall survival (OS) and progression free survival (PFS). On multivariate analysis, the AMC-100 and ALC-100 remained independent predictors of OS and PFS. Combining both values into the AMLPS-100, the 5-year OS rates for low, intermediate, and high AMLPS-100 risk groups were 94% (95% CI, 83.0% - 98.1%), 70% (95% CI, 58.6% - 80.1%), and 13% (95% CI, 3.4% - 40.5%), respectively;and the 5-year PFS rates were 87% (95% CI, 74.0% - 94.1%), 68% (95% CI, 56.0% - 77.8%), and 13% (95% CI, 3.4% - 40.5%), respectively. The AMLPS-100 is a simple biomarker score that can stratify clinical outcomes from day 100 post-APBHSCT in DLBCL patients.
基金support from the National Nature Science Foundation of China ( Grant No.81272341, 81401156)Research Program of Guangzhou Municipal Health Bureau Foundation of China (Grant No.20141A011085, 20141A011088)The PhD Start-up Fund Guangzhou Medical University (Grant No.2013C49)
文摘Objoctive： There is heterogeneity in the prognosis of gastric cancers staged according to the tumornodes-metastasis （TNM） system. This study evaluated the prognostic potential of an immune score system to supplement the TNM staging system. Mothodsg An immunohistochemical analysis was conducted to assess the density of T cells, B cells, and myeloid-derived suppressor cells （MDSCs） in cancer tissues from 100 stage IIIA gastric cancer patients; the expression of the high-mobility group protein B1 （HMGB1） was also evaluated in cancer cells. The relationship between the overall survival （OS）, disease-free survival （DFS）, and immunological parameters was analyzed.Results： An immune score system was compiled based on the prognostic role of the density ofT cells, B cells, MDSCs, and the expression of HMGB1 in cancer tissues. The median 5-year survival of this group of patient was 32%. However, the 5-year survival rates of 80.0%, 51.7%, 0%, 5.8%, and 0% varied among the patients with an immune score of 4 to those with an immune score of 0 based on the immune score system, respectively. Similarly, differences in DFS rates were observed among the immune score subgroups. Concluslons： An immune score system could effectively identify the prognostic heterogeneity within stage IliA gastric cancer patients, implying that this immune score system may potentially supplement the TNM staging system, and help in identifying a more homogeneous group of patients who on the basis of prognosis can undergo adjuvant therapy.
文摘It is controversial whether universal screening for bacterial vaginosis (BV) should be done in the early stages of pregnancy in order to prevent preterm birth. In particular, whether the intermediate vaginal flora type should be included in the group to be treated for BV. This vaginal smear type is a mixture of Lactobacillus and Gardnerella or Bacteroides spp. We examined three vaginal flora types, excluding the mixed-type, with a Nugent Score of 4 and evaluated their significance in achieving term delivery. The subjects were pregnant women who were examined at our Hospital between June 2009 and December 2010. Their vaginal swabs were taken at their first prenatal visit and were studied by Gram staining. The resulting Nugent Score 4 organisms were further classified into the following four types: mixed-type, gram-positive cocci type, Bifidobacterium type, and non-bacterial type. The clinical courses for all the types except “mixed-type” were followed-up. Among the 566 pregnant women, 58 (10.2%) had a Nugent Score of 4. There were 38 cases of mixed-type (65.5%), 3 cases of gram-positive cocci type (5.2%), 10 cases of Bifidobacterium type (17.2%), and 7 cases of non-bacterial type (12.1%). The three women with the gram-positive cocci type attained successful term delivery despite two of them experiencing GBS infection and requiring treatment with penicillin and tocolytics. Among the 10 cases of Bifidobacterium type, 5 cases were term delivery with no therapy, 3 cases were term delivery with metronidazole treatment and 2 cases were preterm birth with maternal complications. Among the 7 cases of non-bacterial type, 6 cases were diagnosed with preterm PROM, and 5 of them resulted in preterm birth despite prophylactic antibiotic therapy. Classification of smears with a Nugent score of 4 into four bacterial morphotypes may be effective, for required treatment may vary depending on the morphotype.
基金supported by grants from National Eleventh Five Major Science and Technology Projects(No.2008ZX10002-007)China’s 12th Five Major Science and Technology Projects(No.2012ZX10002007002009)
文摘Patients with acute-on-chronic hepatitis B liver failure（HBV-ACLF） show high morbidity and mortality. Independent prognostic predictors of short-term HBV-ACLF mortality include the Child-Turcotte-Pugh（CTP） score, the model for end-stage liver disease（MELD） score, other MELD-based indices and the dynamic changes in these indices. The aims of this study were to evaluate the existing prognostic scores in a large cohort of HBV-ACLF patients and create a new predictive model. We retrospectively reviewed 392 HBV-ACLF patients from December 2008 to November 2011 and evaluated their 3-month survival. The predictive accuracy of CTP, MELD and MELD-based indices and the dynamic changes in the MELD-related scores（Δ scoring systems） upon admission and after two weeks of treatment were compared using the area under the receiver operating characteristic（ROC） curve method. Life-threatening factors and a series of bio-clinical parameters were studied by univariate and multivariate analyses. Among the existing scores, MELD had the best predictive ability. However, our new regression model provided an area under the curve of 0.930±0.0161（95% CI： 0.869 to 0.943）, which was significantly larger than that obtained with the MELD score at admission and after two weeks of treatment as well as with the dynamic changes of the MELD score（0.819, 0.921, and 0.826, respectively）（Z=3.542, P=0.0004）. In a large cohort of patients retrospectively reviewed for this study, our prognostic model was superior to the MELD score and is, therefore, a promising predictor of short-term survival in patients with HBV-ACLF.
