Clinical manifestations,diagnosis and long-term prognosis of adult autoimmune enteropathy:Experience from Peking Union Medical College Hospital

BACKGROUND Autoimmune enteropathy(AIE)is a rare disease whose diagnosis and long-term prognosis remain challenging,especially for adult AIE patients.AIM To improve overall understanding of this disease’s diagnosis and prognosis.METHODS We retrospectively analyzed the clinical,endoscopic and histopathological characteristics and prognoses of 16 adult AIE patients in our tertiary medical center between 2011 and 2023,whose diagnosis was based on the 2007 diagnostic criteria.RESULTS Diarrhea in AIE patients was characterized by secretory diarrhea.The common endoscopic manifestations were edema,villous blunting and mucosal hyperemia in the duodenum and ileum.Villous blunting(100%),deep crypt lymphocytic infiltration(67%),apoptotic bodies(50%),and mild intraepithelial lymphocytosis(69%)were observed in the duodenal biopsies.Moreover,there were other remarkable abnormalities,including reduced or absent goblet cells(duodenum 94%,ileum 62%),reduced or absent Paneth cells(duodenum 94%,ileum 69%)and neutrophil infiltration(duodenum 100%,ileum 69%).Our patients also fulfilled the 2018 diagnostic criteria but did not match the 2022 diagnostic criteria due to undetectable anti-enterocyte antibodies.All patients received glucocorticoid therapy as the initial medication,of which 14/16 patients achieved a clinical response in 5(IQR:3-20)days.Immunosuppressants were administered to 9 patients with indications of steroid dependence(6/9),steroid refractory status(2/9),or intensified maintenance medication(1/9).During the median of 20.5 months of followup,2 patients died from multiple organ failure,and 1 was diagnosed with non-Hodgkin’s lymphoma.The cumulative relapse-free survival rates were 62.5%,55.6%and 37.0%at 6 months,12 months and 48 months,respectively.CONCLUSION Certain histopathological findings,including a decrease or disappearance of goblet and Paneth cells in intestinal biopsies,might be potential diagnostic criteria for adult AIE.The long-term prognosis is still unsatisfactory despite corticosteroid and immunosuppressant medications,which highlights the need for early diagnosis and novel medications.

Robotic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: Analysis of surgical outcomes and long-term prognosis in a high-volume center

Background: Robotic pancreaticoduodenectomy(RPD) has been reported to be safe and feasible for patients with pancreatic ductal adenocarcinoma(PDAC) of the pancreatic head. This study aimed to analyze the surgical outcomes and risk factors for poor long-term prognosis of these patients. Methods: Data from patients who underwent RPD for PDAC of pancreatic head were retrospectively analyzed. Multivariate Cox regression analysis was used to seek the independent prognostic factors for overall survival(OS), and an online nomogram calculator was developed based on the independent prognostic factors. Results: Of the 273 patients who met the inclusion criteria, the median operative time was 280.0 minutes, the estimated blood loss was 100.0 m L, the median OS was 23.6 months, and the median recurrence-free survival(RFS) was 14.4 months. Multivariate analysis showed that preoperative carbohydrate antigen 19-9(CA19-9) [hazard ratio(HR) = 2.607, 95% confidence interval(CI): 1.560-4.354, P < 0.001], lymph node metastasis(HR = 1.429, 95% CI: 1.005-2.034, P = 0.047), tumor moderately(HR = 3.190, 95% CI: 1.813-5.614, P < 0.001) or poorly differentiated(HR = 5.114, 95% CI: 2.839-9.212, P < 0.001), and Clavien-Dindo grade ≥ Ⅲ(HR = 1.657, 95% CI: 1.079-2.546, P = 0.021) were independent prognostic factors for OS. The concordance index(C-index) of the nomogram constructed based on the above four independent prognostic factors was 0.685(95% CI: 0.640-0.729), which was significantly higher than that of the AJCC staging(8th edition): 0.541(95% CI: 0.493-0.589)( P < 0.001). Conclusions: This large-scale study indicated that RPD was feasible for PDAC of pancreatic head. Preoperative CA19-9, lymph node metastasis, tumor poorly differentiated, and Clavien-Dindo grade ≥ Ⅲ were independent prognostic factors for OS. The online nomogram calculator could predict the OS of these patients in a simple and convenient manner.

Prevalence and long-term prognosis in Takayasu arteritis patients with left ventricular dilatation and a decreased ejection fraction:data from 1,105 Chinese cases

Background Left ventricular dilatation and a decreased ejection fraction is one of the most serious complications in patients with Takayasu arteritis(TA).We aim to describe the prevalence,clinical features,treatment,and long-term prognosis of TA patients with this complication.

Impact of baseline smoking status on long-term prognosis of patients with coronary artery disease underwent percutaneous coronary intervention:a large single-center data

Objective This study analyzed a large single-center sample in China to explain the impact of smoking state at baseline on long-term prognosis of coronary artery disease (CAD) patients who received percutaneous coronary intervention (PCI).

The Evaluation of Tolvaptan Therapy and Long-Term Prognosis in Hepatocellular Carcinoma with Refractory Ascites

We investigated Tolvaptan efficacy and long-term prognosis with focus on nutrition in 20 patients with refractory hepatic ascites in hepatocellular carcinoma (HCC). Bloating improved in 55% of patients, as determined using a Japanese version of the Support Team Assessment Schedule. Nutritional status improved with Tolvaptan treatment, based on the Controlling Nutritional Status score and Onodera’s prognostic nutritional index. Long-term prognosis was better in responders than in non-responders (mean survival time: 308 days vs. 97 days, p = 0.031). Tolvaptan was even effective in many patients with HCC, with additional improvement in long-term prognosis expected with improvement in the nutritional status.

The Effect of Loop Diuretics on Sarcopenia and Long-Term Prognosis in Patients with Refractory Hepatic Ascites Treated with Tolvaptan

We investigated sarcopenia, focusing on the dose of loop diuretics used in 70 patients with refractory hepatic ascites treated with tolvaptan. Bloating improved in 68.5% of patients, as determined using the Japanese version of the Support Team Assessment Schedule. The psoas muscle index (PMI) was used to define sarcopenia. A statistically significant difference was observed in the PMI between patients receiving low-dose (3.6 ± 1.2 cm2/m2) and high-dose furosemide (3.1 ± 1.2 cm2/m2) before tolvaptan treatment (P = 0.048). The PMI increased from 3.2 ± 1.1 cm2/m2 to 3.5 ± 1.3 cm2/m2 (P = 0.002) in responders, but decreased from 3.4 ± 1.2 cm2/m2 to 3.0 ± 1.0 cm2/m2 (P = 0.106) in non-responders before and after tolvaptan treatment, respectively. The long-term prognosis improved in responders compared with non-responders (mean survival time: 646 days vs. 228 days, P < 0.001). Early introduction of tolvaptan treatment is necessary to prevent the progression of sarcopenia.

Prognosis of cancer with branch duct type IPMN of the pancreas

AIM:To examine the coexistence of metachronous and synchronous cancer in branch duct intraductal papillary mucinous neoplasms of the pancreas (IPMN).METHODS: We reviewed the records of 145 patients with branch duct IPMN between January 1991 and April 2008 and assessed the relationship between IPMN and intraor extra-pancreatic carcinoma and the outcome of IPMN.RESULTS: The mean observation period was 55.9 ± 45.3 mo. Among the 145 patients, the frequency of extra-pancreatic cancer was 29.0%. The frequency of gastric cancer, colon cancer, breast cancer, and pan-creatic cancer were 25.5%, 15.7%, 13.7%, and 9.8%, respectively. Twenty (13.8%) of the patients died. The cause of death was extra-pancreatic carcinoma in 40%,pancreatic cancer in 25%, IPMN per se in 20%, and benign disease in 15% of the patients.CONCLUSION: The prognosis for IPMN depends not on the IPMN per se, but on the presence of intraor extra-pancreatic cancer.

The effect of NAFLD (non-alcoholic fatty liver disease) on long-term outcome of chronic hepatitis B in Iranian patients

Background: The influence of Non-Alcoholic Fatty Liver Disease on the outcome of chronic hepatitis B disease, including viral, biochemical and histologic characteristics, in Iranian patients is not yet fully un- derstood. Aim: To evaluate the effect of Non-Alcoholic Fatty Liver Disease (NAFLD) on long-term histology- cal, biochemical and viral outcome of chronic he- pa-tictis B in Iranian patients. Methods: We retro- spec-tively evaluated 94 “e Ag” negative chronic hepatitis B patients (with NAFLD: 44, without NAFLD: 50). Non-Alcoholic Fatty Liver Disease was diagnosed based on liver biopsy according to Kleiner classifica-tion. Liver biopsy was done for all patients. Serologi-cal and biochemical variables were evaluated with repeated measure analysis. Results: Non-Alcoholic Fat- ty Liver Disease (NAFLD) was present in 47% of the patients (44 out of 94 patients). In the NAFLD group, increase in AST, ALT, stage (P = 0.002), grade, and total score of liver biopsy were independently related to non-alcoholic fatty liver disease, while HBV-DNA viral load did not correlate with the presence of a fatty liver. Conclusion: Abnormalities of liver enzymes and liver histopathology are more prevalent in concurrent chronic hepatitis B and Non-Alcoholic Fatty Liver Disease (NAFLD).

The prognosis of biopsy-proven lupus nephritis in Chinese patients: long-term follow-up of 86 cases

Objective To investigate the prognosis of lupus nephritis (LN) and its influencing factors in patients with lupus nephritis in China. Methods A retrospective study was carried out in 86 patients followed up for at least 5 years. Clinical features, serological and immunological tests were investigated. Renal biopsies were performed at the beginning of the study and repeated in some cases during the follow up period. All the 86 patients had serum creatinine (Scr) level less than 132.6 μmol/L at the inital presentation and were divided into three groups according to the level of Scr at the end of the study. Group Ⅰ: the patients with normal renal function (Scr<132.6 μmol/L); Group Ⅱ: the patients with mild～moderate renal insufficiency (132.6 μmol/L≤Scr≤530.4 μmol/L); Group Ⅲ: the patients with end stage real failure (ESRF) (Scr≥ 530.4 μmol/L). Results Forty seven patients reached clinical remission with normal renal function, 11 had with stabilization of renal function although the systemic lupus erythematosis (SLE) acti vity relapsed repeatedly, while 28 subjects developed renal insufficiency after 60～170 (mean 88.12±28.23) months of observation. ESRF rate was 11.6% in this group of patients. Eight patients died (2 died of infections and 6 died of ESRF) during the follow up period. At the beginning of the study the rates of hypertension, persistent anemia and hematuria in Group Ⅲ were 50%, 70% and 70% respectively, being much higher than those in Group I. The calculation of AI and CI in 60 patients revealed that there were 65% of patients with AI ≥7 and 70% of patients with CI≥3 in Groups Ⅱ and Ⅲ, while in Group I there were only 32% of patients with AI≥7 and 19% of patients with CI≥3. Sixteen cases had pathologic class changed in 48 repeated biopsies. Seven cases changed to Class Ⅳ, 5 to Class Ⅱ, 3 to Class Ⅴ from other classes and one to class Ⅲ from Class Ⅱ. Conclusions Factors associated with the development of renal insufficiency in these lupus patients included hypertension, anemia and hematuria. Renal biopsy evaluation offered additional prognostic information and showed that patients with severe active and chronic histologic changes were at risk for developing renal isufficiency. During the clinical course, the renal classification of LN changed in certain patients, thus the histologic classification of renal morphology at initial presentation did not fully predict the outcome.

Effect of Shenmai Injection on Long-Term Prognosis of Patients with Chronic Heart Failure:A Multicenter,Large Sample Capacity,Long-Term Follow-Up Retrospective Cohort Study

Objective:To explore the effect of Shenmai Injection(SMI)on the long-term prognosis of patients with chronic heart failure(CHF).Methods:The Hospital Information System was used to extract data of CHF patients,and the retrospective cohort study was conducted for analysis.In non-exposed group,standardized Western medicine treatment and Chinese patent medicine or decoction were applied without combination of SMI while in the exposed group,SMI were applied for more than 7 days.Evaluation indicators are followed with New York Heart Association functional classification(NYHA classification),left ventricular ejection fraction(LVEF),N-terminal brain natriuretic peptide precursor(NT-ProBNP),cardiogenic death and heart failure(HF)readmission.Statistical analysis includes Kaplan-Meier analysis and Cox regression which are used to explore the relationship between SMI and outcome events.Results:A total of 1,211 eligible CHF patients were involved and finally 1,047 patients were followed up successfully.After treatment,the cases of NYHA classification decline in the exposed and non-exposed groups accounted for 64.30%and 43.45%,respectively;the improvement values of LVEF were 8.89%and 7.91%,respectively;the improvement values of NT-ProBNP were 909 pg/mL and 735 pg/mL,respectively.After exposure on SMI,the rates of cardiogenic death and HF readmission reduced from 15.43%to 10.18%and 38.93%to 32.37%.According to Kaplan-Meier analysis,the log-rank P value of SMI and cardiogenic death was 0.014,while the counterpart of SMI and HF readmission was 0.025.Cox regression analysis indicated that for cardiogenic death,age,cardiomyopathy,diabetes,and NYHA classification were risk factors whileβ-blockers,aldosterone receptor antagonists,Chinese patent medicine/decoction and SMI were protective factors.Likewise,for HF readmission,age,cardiomyopathy,and NYHA classification were risk factors while SMI was a protective factor.Conclusion:Combination with SMI on the standardized Western medicine treatment can effectively reduce cardiogenic mortality and readmission rate in CHF patients,and thereby improve the long-term prognosis.

Long-term prognosis of patency of infarct-related coronary artery after thrombolytic treatment in acute myocardial infarction

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Laparoscopic surgery for rectal cancer:The state of the art

At present time,there is evidence from randomized controlled studies of the success of laparoscopic resection for the treatment of colon cancer with reported smaller incisions,lower morbidity rate and earlier recovery compared to open surgery.Technical limitations and a steep learning curve have limited the wide application of miniinvasive surgery for rectal cancer.The present article discusses the current status of laparoscopic resection for rectal cancer.A review of the more recent retrospective,prospective and randomized controlled trial(RCT) data on laparoscopic resection of rectal cancer including the role of trans-anal endoscopic microsurgery and robotics was performed.A particular emphasis was dedicated to mid and low rectal cancers.Few prospective and RCT trials specif ically addressing laparoscopic rectal cancer resection are currently available in the literature.Improved short-term outcomes in term of lesser intraoperative blood loss,reduced analgesic requirements and a shorter hospital stay have been demonstrated.Concerns have recently been raised in the largest RCT trial of the oncological adequacy of laparoscopy in terms of increased rate of circumferential margin.This data however was not conf irmed by other prospective comparative studies.Moreover,a similar local recurrence rate has been reported in RCT and comparative series.Similar f indings of overall and disease free survival have been reported but the follow-up time period is too short in all these studies and the few RCT trials currently available do not draw any def initive conclusions.On the basis of available data in the literature,the mini-invasive approach to rectal cancer surgery has some short-term advantages and does not seem to confer any disadvantage in term of local recurrence.With respect to longterm survival,a definitive answer cannot be given at present time as the results of RCT trials focused on long-term survival currently ongoing are still to fully clarify this issue.

Stellate ganglion block reduces inflammation and improves neurological function in diabetic rats during ischemic stroke

Diabetes mellitus is an independent risk factor for ischemic stroke.Both diabetes mellitus and stroke are linked to systemic inflammation that aggravates patient outcomes.Stellate ganglion block can effectively regulate the inflammatory response.Therefore,it is hypothesized that stellate ganglion block could be a potential therapy for ischemic stroke in diabetic subjects.In this study,we induced diabetes mellitus in rats by feeding them a high-fat diet for 4 successive weeks.The left middle cerebral artery was occluded to establish models of ischemic stroke in diabetic rats.Subsequently,we performed left stellate ganglion block with 1%lidocaine using the percutaneous posterior approach 15 minutes before reperfusion and again 20 and 44 hours after reperfusion.Our results showed that stellate ganglion block did not decrease the blood glucose level in diabetic rats with diabetes mellitus but did reduce the cerebral infarct volume and the cerebral water content.It also improved the recovery of neurological function,increased 28-day survival rate,inhibited Toll like receptor 4/nuclear factor kappa B signaling pathway and reduced inflammatory response in the plasma of rats.However,injection of Toll like receptor 4 agonist lipopolysaccharide 5 minutes before stellate ganglion block inhibited the effect of stellate ganglion block,whereas injection of Toll like receptor 4 inhibitor TAK242 had no such effect.We also found that stellate ganglion block performed at night had no positive effect on diabetic ischemic stroke.These findings suggest that stellate ganglion block is a potential therapy for diabetic ischemic stroke and that it may be mediated through the Toll like receptor 4/nuclear factor kappa B signaling pathway.We also found that the therapeutic effect of stellate ganglion block is affected by circadian rhythm.

Prognostic factors of survival and a new scoring system for liver resection of colorectal liver metastasis

BACKGROUND Hepatic resection has become the preferred treatment of choice for colorectal liver metastasis(CLM)patients.AIM To identify the prognostic factors and to formulate a new scoring system for management of CLM.METHODS Clinicopathologic and long-term survival data were analyzed to identify the significant predictors of survival by univariate and multivariate analyses with the Cox model.A clinical score was constructed based on the analysis results.RESULTS Three factors of worse overall survival were identified in the multivariate analysis.They were number of liver metastases≥5,size of the largest liver lesion≥4 cm,and the presence of nodal metastasis from the primary tumor.These three factors were chosen as criteria for a clinical risk score for overall survival.The clinical score highly correlated with median overall survival and 5-year survival(P=0.002).CONCLUSION Priority over surgical resection should be given to the lowest score groups,and alternative oncological treatment should be considered in patients with the highest score.

Clinical value of extended lymphadenectomy in radical surgery for pancreatic head carcinoma at different T stages

BACKGROUND As the lymph-node metastasis rate and sites vary among pancreatic head carcinomas(PHCs)of different T stages,selective extended lymphadenectomy(ELD)performance may improve the prognosis of patients with PHC.AIM To investigate the effect of ELD on the long-term prognosis of patients with PHC of different T stages.METHODS We analyzed data from 216 patients with PHC who underwent surgery at our hospital between January 2011 and December 2021.The patients were divided into extended and standard lymphadenectomy(SLD)groups according to extent of lymphadenectomy and into T1,T2,and T3 groups according to the 8 th edition of the American Joint Committee on Cancer’s staging system.Perioperative data and prognoses were compared among groups.Risk factors associated with prognoses were identified through univariate and multivariate analyses.RESULTS The 1-,2-and 3-year overall survival(OS)rates in the extended and SLD groups were 69.0%,39.5%,and 26.8%and 55.1%,32.6%,and 22.1%,respectively(P=0.073).The 1-,2-and 3-year disease-free survival rates in the extended and SLD groups of patients with stage-T3 PHC were 50.3%,25.1%,and 15.1%and 22.1%,1.7%,and 0%,respectively(P=0.025);the corresponding OS rates were 65.3%,38.1%,and 21.8%and 36.1%,7.5%,and 0%,respectively(P=0.073).Multivariate analysis indicated that portal vein invasion and lymphadenectomy extent were risk factors for prognosis in patients with stage-T3 PHC.CONCLUSION ELD may improve the prognosis of patients with stage-T3 PHC and may be of benefit if performed selectively.

Is there utility for fluorine-18-fluorodeoxyglucose positron-emission tomography scan before surgery in breast cancer? A 15-year overall survival analysis

BACKGROUND The prognostic value of preoperative fluorine-18-fluorodeoxyglucose positronemission tomography(18 F-FDG PET)scan for determining overall survival(OS)in breast cancer(BC)patients is controversial.AIM To evaluate the OS predictive value of preoperative PET positivity after 15 years.METHODS We performed a retrospective search of the Universitair Ziekenhuis Brussel patient database for nonmetastatic patients who underwent preoperative PET between 2002-2008.PET positivity was determined by anatomical region of interest(AROI)findings for breast and axillary,sternal,and distant sites.The prognostic role of PET was examined as a qualitative binary factor(positive vs negative status)and as a continuous variable[maximum standard uptake value(SUVmax)]in multivariate survival analyses using Cox proportional hazards models.Among the 104 identified patients who received PET,36 were further analyzed for the SUVmax in the AROI.RESULTS Poor OS within the 15-year study period was predicted by PET-positive status for axillary(P=0.033),sternal(P=0.033),and combined PET-axillary/sternal(P=0.008)nodes.Poor disease-free survival was associated with PET-positive axillary status(P=0.040)and combined axillary/sternal status(P=0.023).Cox models confirmed the long-term prognostic value of combined PETaxillary/sternal status[hazard ratio(HR):3.08,95%confidence interval:1.42-6.69].SUVmax of ipsilateral breast and axilla as continuous covariates were significant predictors of long-term OS with HRs of 1.25(P=0.048)and 1.54(P=0.029),corresponding to relative increase in the risk of death of 25%and 54%per SUVmax unit,respectively.In addition,the ratio of the ipsilateral axillary SUVmax over the contralateral axillary SUVmax was the most significant OS predictor(P=0.027),with 1.94 HR,indicating a two-fold relative increase of mortality risk.CONCLUSION Preoperative PET is valuable for prediction of long-term survival.Ipsilateral axillary SUVmax ratio over the uninvolved side represents a new prognostic finding that warrants further investigation.

Effect of acute kidney injury on short-and long-term mortality of patients with acute myocardial infarction

Objective To evaluate the role of acute kidney injury(AKI)in predicting early(30-day)and late(30-day to5-year)mortality of acute myocardial infarction(AMI)patients during hospitalization.Methods A total of 1371adult patients diagnosed with AMI in the First People’s Hospital of Changzhou from January 2008 to December2012 were analyzed retrospectively while their

Influence of insulin resistance on long-term outcomes in patients with coronary artery disease after sirolimus-eluting stent implantation

Background Insulin resistance（IR）is significantly associated with coronary artery disease and cardiovascular events in patients with or without type 2 diabetes mellitus.This study aimed to evaluate the influence of IR on long-term outcomes of patients undergoing percutaneous coronary intervention（PCI）with sirolimus-eluting stent（SES）implantation.Methods A total of 467 consecutive patients undergoing SES-based PCI were divided into lR group（n=104）and non-IR group（n=363）.The patients were followed up for one year.The rate of major adverse cardiac events（MACEs） including death, non-fatal myocardial infarction and recurrent angina pectoris was compared by the log-rank test,and the independent risk factors were identified by the Cox regression analysis.Results MACEs occurred more frequently,and cumulative survival rate was lower in the IR group than in the non-IR group during the follow-up （all P〈0.05）.IR was an independent risk factor for the occurrence of cardiac death and non-fatal myocardial infarction（OR=2176,95% CI=1.35-5.47,P=0.034）.Old age,diabetes,and multi-vessel disease were determinants for recurrent angina pectoris after PCI（P〈0.05）.Subgroup analysis revealed that IR（OR=3.35,95% CI=1.07-13.59,P=0.013）and multi-vessel disease（OR=2.19,95%CI=1.01-5.14,P=0.044）were independent risk predictors for recurrent angina pectoris in patients with diabetes after PCI.Conclusions IR is associated with reduced MACE-free survival and remains an independent predictor for recurrent angina pectoris after PCI with SES implantation.

Clinical Study on Long-Term Overall Survival of Advanced Non-Small-Cell Lung Cancer Patients Treated with Chinese Medicine and Western Medicine

Objective： To investigate the prognostic influence on long-term overall survival （OS） from treatment with Chinese medicine （CM） and chemotherapy or targeted therapy in advanced non-small-cell lung cancer （NSCLC） patients. Methods： The clinical data of 206 advanced NSCLC patients who were treated with CM and Western medicine in Beijing Cancer Hospital from April 1999 to July 2013 were retrospectively analyzed. Long-term survivors were defined as OS ≥ 3 years after treatment with CM and chemotherapy. Twenty-eight patients had OS ≥ 3 years, 178 had OS 〈 3 years, and all clinical data were statistically analyzed with the Cox model. Variables were gender, age, smoking status, performance status （PS） score, pathological type, clinical stage, first-line chemotherapy, targeted therapy, and use of CM. Univariate survival analysis was performed using the Kaplan-Meier method and log-rank sequential inspection. Multivariate survival analysis was used to analyze the meaningful factors of univariate survival analysis with the Cox model. Results： The survival rate of patients with OS ≥ 3 years was 13.6% （28/206）. Cox multivariate regression analysis showed that PS score, clinical stage, disease control rate to first-line chemotherapy, and use of CM were independent factors of long- term OS （all P〈0.05）. However, gender, age, smoking, and use of epidermal growth factor receptor tyrosine- kinase inhibitor were not significant （P〉0.05）. Conclusion： PS score, clinical stage, disease control rate to first- line chemotherapy, and use of CM are probably independent prognostic factors for long-term OS in patients with advanced NSCLC.

Long-term outcome of acute central nervous system infection in children

Importance:Central nervous system infection is a severe illness in children.Little is known about the long-term outcome in children with central nervous system infection of various etiologies.Objective:The aims of this study were to investigate the long-term outcomes of childhood acute central nervous system infection and to examine possible prognostic factors.Methods:Of 172 children who were treated for acute central nervous system infection from January 2009 through December 2009,139 were eligible for follow-up evaluations.A structured interview was conducted with the parents 3.8-4.7 years after hospital discharge.The global outcome was determined in all patients using the Pediatric Version of the Glasgow Outcome Scale-Extended.Clinical features of the acute episode were retrieved from medical records.Results:The outcome was favorable in 109 of 139 patients (78%),38 (27%) were mildly impaired,six (4%) were moderately impaired,14 (10%) were severely impaired and two (1%) were in a vegetative state.There were eight deaths.The most frequent symptoms were difficulty concentrating (16%),epilepsy (12%),limb paralysis (12%),memory impairment (10%),speech disorders (9%),irritability (9%).Significant risk factors for epilepsy included the presence of recurrent seizures or status epilepticus,the existence of pure spikes in the electroencephalogram,brain parenchyma abnormalities on neuroimaging and herpes simplex virus encephalitis (HSVE).A multivariate analysis identified three factors that were independently associated with poor outcome:coma,brain parenchyma abnormalities on neuroimaging and HSVE.Interpretation:Most children with acute central nervous system infection experienced a favorable outcome 3.8-4.7 years after discharge from the hospital.Minor to severe disability persists in a high proportion of cases.Coma,brain parenchymal abnormalities on neuroimaging and HSVE may predict poor long-term outcome.