Sensitivity of diagnosis of spontaneous bacterial peritonitis is higher with the automated cell count method

BACKGROUND Spontaneous bacterial peritonitis(SBP)is one of the most important complications of patients with liver cirrhosis entailing high morbidity and mortality.Making an accurate early diagnosis of this infection is key in the outcome of these patients.The current definition of SBP is based on studies performed more than 40 years ago using a manual technique to count the number of polymorphs in ascitic fluid(AF).There is a lack of data comparing the traditional cell count method with a current automated cell counter.Moreover,current international guidelines do not mention the type of cell count method to be employed and around half of the centers still rely on the traditional manual method.AIM To compare the accuracy of polymorph count on AF to diagnose SBP between the traditional manual cell count method and a modern automated cell counter against SBP cases fulfilling gold standard criteria:Positive AF culture and signs/symptoms of peritonitis.METHODS Retrospective analysis including two cohorts:Cross-sectional(cohort 1)and case-control(cohort 2),of patients with decompensated cirrhosis and ascites.Both cell count methods were conducted simultaneously.Positive SBP cases had a pathogenic bacteria isolated on AF and signs/symptoms of peritonitis.RESULTS A total of 137 cases with 5 positive-SBP,and 85 cases with 33 positive-SBP were included in cohort 1 and 2,respectively.Positive-SBP cases had worse liver function in both cohorts.The automated method showed higher sensitivity than the manual cell count:80%vs 52%,P=0.02,in cohort 2.Both methods showed very good specificity(>95%).The best cutoff using the automated cell counter was polymorph≥0.2 cells×10^(9)/L(equivalent to 200 cells/mm^(3))in AF as it has the higher sensitivity keeping a good specificity.CONCLUSION The automated cell count method should be preferred over the manual method to diagnose SBP because of its higher sensitivity.SBP definition,using the automated method,as polymorph cell count≥0.2 cells×10^(9)/L in AF would need to be considered in patients admitted with decompensated cirrhosis.

卵巢癌临床和生物学预测因子研究

目的 :研究影响卵巢癌患者预后的临床和生物学因素。方法 :回顾分析卵巢癌患者 88例的临床资料 ,并检测肿瘤组织上皮中血管内皮生长因子 (VEGF)和胸苷磷酸化酶 (TP)的表达及肿瘤间质内微血管密度 (MVD) ,应用Cox比例风险模型评估临床因素包括年龄、临床分期、组织学类型、细胞分化级别、术后残余癌灶及生物学因子 :VEGF、TP、MVD与总生存期 (OS)和无进展生存期 (PFS)之间的相关性。结果 :(1)患者的年龄、临床分期和术后癌灶大小显著影响其生存期的长短 ;(2 )Cox模型未发现VEGF、TP和MVD与OS和PFS之间的相关性 ;(3)低分化 (G3、G4 )肿瘤细胞中VEGF的表达显著高于高分化(G1、G2 )者。结论 :(1)年龄、临床分期和术后残余癌灶是三个独立的临床预测因子 ,表明早期诊断和适宜治疗极为重要 ;对老年患者应密切监护 ;(2 )低分化肿瘤细胞比高分化肿瘤细胞具有更恶的基因型和表现型 ,更易诱导间质内微血管生成 ,促进肿瘤的复发、转移和快速生长 。

Correlation of MRI-determined small bowel Crohn’s disease categories with medical response and surgical pathology

AIM: To determine whether magnetic resonance imaging (MRI) can be used to categorize small bowel Crohn's disease (SB CD) into groups that correlate with response to medical therapy and surgical pathology.METHODS: Data was collected from all patients with MRI evidence of SB CD without significant colonic disease over a 32-mo period. Two radiologists, blinded to clinical findings, evaluated each MRI and grouped them based on bowel wall thickness and wall enhancement. These categories were: (1) "fibrosis", (2) "mild segmental hyper-enhancement and mild wall thickening", (3) "mild segmental hyper-enhancement and marked wall thickening", (4) "marked segmental transmural hyper-enhancement". Patient response to additional medical therapy post-MRI was prospectively determined at 8-wk. Non-responders underwent endoscopy and were offered therapeutic endoscopy or surgery. Surgical pathology was assessed against the MRI category. RESULTS: Fifty-five patients were included. Females and category "2" patients were more likely, and patients with luminal narrowing and hold-up less likely, to respond to medical therapy (P < 0.05). Seventeen patients underwent surgery. The surgical pathologicalfindings of fibrosis and the severity of inflammation correlated with the MRI category in all cases.CONCLUSION: Our fi ndings suggest that SB CD can be grouped by the MRI f indings and that these groups are associated with patients more likely to respond to continued medical therapy. The MRI categories also correlated with the presence and level of intestinal inflammation and fibrosis on surgical pathology, and may be of prognostic use in the management of CD patients.

Small bowel MRI enteroclysis or follow through:Which is optimal?

AIM： TO determine if a nasojejunal tube （NJT） is required for optimal examination of enteroclysis and if patients can be examined only in the supine position. METHODS： Data were collected from all patients undergoing small bowel （SB） magnetic resonance imaging （MRI） examination over a 32-mo period. Patients either underwent a magnetic resonance （MR） follow-through （MRFT） or a MR enteroclysis （MRE） in the supine position. The quality of proximal and distal SB distension as well as the presence of motion artefact and image quality were assessed by 2 radiologists. RESULTS： One hundred and fourteen MR studies were undertaken （MRFT-49, MRE-65） in 108 patients in the supine position only. Image artefact was more frequent in MRE than in MRFT （29.2% vs 18.4%）, but was not statistically significant （P = 0.30）. Adequate distension of the distal SB was obtained in 97.8% of MRFT examinations and in 95.4% of MRE examinations, respectively. Proximal SB distension was, however, less frequently optimal in MRFT than in MRE （P = 0.0036）, particularly in patients over the age of 50 years （P = 0.0099）. Image quality was good in all examinations. CONCLUSION： All patients could be successfully iraaged in the supine position. MRE and MRFT are equivalent for distal SB distension and artefact effects. Proximal SB distension is frequently less optimal in MRFT than in MRE. MRE is, therefore, the preferred MR examination method of the SB.

Effect of zinc treatment on clinical outcomes in patients with liver cirrhosis:A systematic review and meta-analysis

BACKGROUNDZinc is an essential trace element integral to many cellular and immune functions.Zinc deficiency is highly prevalent in patients with cirrhosis and related to diseaseseverity.AIMTo evaluate whether zinc supplementation improves clinical outcomes (diseaseseverity and mortality) in patients with cirrhosis.METHODSThis prospectively registered systematic review (PROSPERO reference:CRD42018118219) included all studies in Medline, Embase or Cochrane databasewith inclusion criteria of adult human studies, comparing zinc supplementationof at least 28 d with standard care or placebo in patients with cirrhosis. Mortalityand clinical severity score data were extracted. Random effects meta-analysescompared mortality at 6 mo and 2 years. Risk of bias was assessed using theNational Institutes of Health quality assessment tool.RESULTSSeven hundred and twelve articles were identified of which four were eligible.Zinc formulations and doses varied (elemental zinc 3.4-214 mg daily) for different intervention periods in patients with differing etiology and severity of cirrhosis.Two studies were considered to be at high risk of bias. There was no significantdifference in 6-mo mortality between patients treated with zinc versus controls[risk ratio 0.98 (0.90-1.05)]. Changes in severity scores were not reported in anystudy.CONCLUSIONZinc supplementation is not associated with reduced mortality in patients withcirrhosis. Findings are limited by the small number of eligible studies andsignificant heterogeneity in intervention and patient population.

Prognostic importance of lymph node yield after curative resection of gastroenteropancreatic neuroendocrine tumours

BACKGROUND The prognostic significance of lymph nodes(LNs)metastases and the optimum number of LN yield in gastroenteropancreatic neuroendocrine tumours(GEP NETs)undergoing curative resection is still debatable.Many studies have demonstrated that cure rate for patients with GEP NETs can be improved by the resection of the primary tumour and regional lymphadenectomy AIM To evaluate the effect of lymph node(LN)status and yield on relapse-free survival(RFS)and overall survival(OS)in patients with resected GEP NETs.METHODS Data on patients who underwent curative resection for GEP NETs between January 2002 and March 2017 were analysed retrospectively.Grade 3 tumours(Ki67>20%)were excluded.Univariate Cox proportional hazard models were computed for RFS and OS and assessed alongside cut-point analysis to distinguish a suitable binary categorisation of total LNs retrieved associated with RFS.RESULTS A total of 217 patients were included in the study.The median age was 59 years(21-97 years)and 51%(n=111)were male.Primary tumour sites were small bowel(42%),pancreas(25%),appendix(18%),rectum(7%),colon(3%),gastric(2%),others(2%).Median follow up times for all patients were 41 mo(95%CI:36-51)and 71 mo(95%CI:63–76)for RFS and OS respectively;50 relapses and 35 deaths were reported.LNs were retrieved in 151 patients.Eight or more LNs were harvested in 106 patients and LN positivity reported in 114 patients.Three or more positive LNs were detected in 62 cases.The result of univariate analysis suggested perineural invasion(P=0.0023),LN positivity(P=0.033),LN retrieval of≥8(P=0.047)and localisation(P=0.0049)have a statistically significant association with shorter RFS,but there was no effect of LN ratio on RFS:P=0.1 or OS:P=0.75.Tumour necrosis(P=0.021)and perineural invasion(P=0.016)were the only two variables significantly associated with worse OS.In the final multivariable analysis,localisation(pancreas HR=27.33,P=0.006,small bowel HR=32.44,P=0.005),and retrieval of≥8 LNs(HR=2.7,P=0.036)were independent prognostic factors for worse RFS.CONCLUSION An outcome-oriented approach to cut-point analysis can suggest a minimum number of adequate LNs to be harvested in patients with GEP NETs undergoing curative surgery.Removal of≥8 LNs is associated with increased risk of relapse,which could be due to high rates of LN positivity at the time of surgery.Given that localisation had a significant association with RFS,a prospective multicentre study is warranted with a clear direction on recommended surgical practice and follow-up guidance for GEP NETs.

Spatiotemporal patterns of burned areas,fire drivers,and fire probability across the equatorial Andes

Field-based fire studies in the equatorial Andes indicate that fires are strongly associated with biophysical and anthropogenic variables.However,fire controls and fire regimes at the regional scale remain undocumented.Therefore,this paper describes spatial and temporal burned-area patterns,identifies biophysical and anthropogenic fire drivers,and quantifies fire probability across 6°of latitude and 3°of longitude in the equatorial Andes.The spatial and temporal burned-area analysis was carried out based on 18 years(2001-2018)of the MCD64 A1 MODIS burned-area product.Climate,topography,vegetation,and anthropogenic variables were integrated in a logistic regression model to identify the significance of explanatory variables and determine fire occurrence probability.A total of 5779 fire events were registered during the 18 years of this study,located primarily along the western cordillera of the Andes and spreading from North to South.Eighty-eight percent of these fires took place within two fire hotspots located in the northwestern and southwestern corners of the study area.Ninety-nine percent occurred during the second part of the year,between June and December.The largest density of fires was primarily located on herbaceous vegetation and shrublands.Results show that mean monthly temperature,precipitation and NDVI during the prefire season,the location of land cover classes such as forest and agriculture,distance to roads and urban areas,slope,and aspect were the most important determinants of spatial and temporal fire distribution.The logistic regression model achieved a good accuracy in predicting fire probability(80%).Probability was higher in the southwestern and northern corners of the study area,and lower towards the north in the western and eastern piedmonts of the Andes.This analysis contributes to the understanding of fires in mountains within the tropics.The results here presented have the potential to contribute to fire management and control in the region.

Statistically Non-significant Papers in Environmental Health Studies included more Outcome Variables

Objective The number of analyzed outcome variables is important in the statistical analysis and interpretation of research findings. This study investigated published papers in the field of environmental health studies. We aimed to examine whether differences in the number of reported outcome variables exist between papers with non-significant findings compared to those with significant findings. Articles on the maternal exposure to mercury and child development were used as examples. Methods Articles published between 1995 and 2013 focusing on the relationships between maternal exposure to mercury and child development were collected from Medline and Scopus. Results Of 87 extracted papers, 73 used statistical significance testing and 38（43.7%） of these reported ＇non-significant＇（P〉0.05） findings. The median number of child development outcome variables in papers reporting ＇significant＇（n=35） and ＇non-significant＇（n=38） results was 4 versus 7, respectively（Mann-Whitney test P-value=0.014）. An elevated number of outcome variables was especially found in papers reporting non-significant associations between maternal mercury and outcomes when mercury was the only analyzed exposure variable. Conclusion Authors often report analyzed health outcome variables based on their P-values rather than on stated primary research questions. Such a practice probably skews the research evidence.

Arsenic variation in soil layers in Bandung Regency,Indonesia:A statistical approach for identifying potential sources

This research investigates the arsenic concentrations in 96 soil samples from a regency in Indonesia using a statistical approach.Soil samples were collected from three depth layers(topsoil[10e20 cm],subsoil[50e60 cm],and deep soil[90e100 cm]),with each layer consisting of 32 samples.Statistical analysis using SPSS was employed to analyze potential arsenic sources based on the proximity of study locations to geothermal system areas,land use,distance from industry,and the presence of study locations on fault lines.The findings indicate that the potential source of arsenic contamination in the soil are suspected to be associated with geothermal system activities and the presence of soil samples on fault lines.The arsenic concentration in locations near to the geothermal system(5-10 km)was 45 times higher(OR=45,95%CI=45e362.57,p<0.01).Arsenic was found to be 3.828 times higher in study areas situated on fault zones(OR=3.828,95%CI=1.507e9.719,p<0.01).Additionally,the research suggests that arsenic in the soil may also originate from anthropogenic activities,such as agriculture and industry,as the highest concentrations were found in subsoil or topsoil layers compared to deep soil.The variation in arsenic concentration from highest to lowest in agricultural soil layers was subsoil>topsoil>deep soil,whereas in residential soil,it was subsoil>deep soil>topsoil.The arsenic concentration variation at near distances from industrial areas was topsoil>subsoil>deep soil,contrasting with medium to far distances from industry(subsoil>deep soil>topsoil).Therefore,these findings can be utilized to prioritize remediation efforts and provide input for future research on arsenic contamination in the region.