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BACKGROUND: Delay from surgery to adjuvant chemotherapy causes impaired survival among patients undergoing radical resection for stage III colon cancer, and the underlying mechanism for this is incompletely clarified. It is established that prolonged postoperative hospital length of stay (LOS) is associated with delayed initiation of the adjuvant treatment driving the assumption that prolonged LOS is prognostically unfavorable due to this fact and case mix factors. We hypothesize that prolonged LOS after surgery is a valuable marker for susceptibility to relapse that is not detected in established prognostic factors and, alone, associated with a shorter disease-free survival (DFS). MATERIALS AND METHODS: A total of 690 consecutive patients undergoing elective radical resection for stage III colon cancer in 2000-2015 were identified in a prospective detailed facility database. Univariate and multivariate analyses were performed using Cox proportional hazards model in the evaluation of LOS as an independent prognostic factor. RESULTS: Short postoperative LOS, low comorbidity, and few complications were associated with longer DFS (p < 0.01). Fewer patients in the short and intermediate LOS groups had a relapse in their disease (28% and 33%, respectively), compared to the patients with longer LOS (40%, p < 0.05). LOS was a prognostic factor for DFS in the unadjusted univariate model (HR 1.04 per unit change) and remained statistically significant in the adjusted multivariate analysis, with a HR of 1.03 per hospital day (p < 0.01). CONCLUSIONS: Postoperative LOS independently correlates with the risk of recurrence and DFS, regardless of if adjuvant chemotherapy is given, along with the factors such as age, comorbidity, complications, and tumor features. We propose a further investigation into the causal mechanisms based on tumor and host biology linking LOS to DFS beyond established risk factors.

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Neoplasias del Colon , Recurrencia Local de Neoplasia , Neoplasias del Colon/patología , Humanos , Tiempo de Internación , Recurrencia Local de Neoplasia/cirugía , Pronóstico , Estudios Prospectivos , Factores de Riesgo

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BACKGROUND: Idiopathic sudden sensorineural hearing loss (ISSNHL) presents with emergent hearing impairment and is mainly treated with steroids. However, limited data exist regarding the prognostic factors among elderly patients (>65 years old) who receive an intra-tympanic steroid injection (ITSI). Therefore, we investigated the prognostic factors in these patients. METHODS: Between July 2016 and March 2022, we retrospectively enrolled 105 elderly patients (>65 years old) with unilateral ISSNHL who were treated with an ITSI, and recorded their clinical and audiological variables. RESULTS: The patients had a mean age of 72.03 ± 6.33 years and mean hearing level gain of 22.86 ± 21.84 dB, speech reception threshold (SRT) gain of 15.77 ± 35.27 dB, and speech discrimination score (SDS) gain of 19.54 ± 27.81 %. According to Siegel's criteria, 5 (4.76 %), 44 (41.91 %), 46 (43.81 %), and 10 (9.52 %) patients had complete recovery, partial recovery, slight improvement, and no improvement, respectively. In the univariate analysis, vertigo (odds ratio [OR] = 0.290, 95 % confidence interval [CI]: 0.130-0.651, p = 0.002) and profound hearing loss on pure tone audiometry (PTA; OR = 0.233, 95 % CI: 0.101-0.536, p = 0.004) were negative prognostic factors among elderly ISSNHL patients. In the multivariate analysis, vertigo (OR = 0.300, 95 % CI: 0.128-0.705, p = 0.005) and profound pure tone audiometry (OR = 0.240, 95 % CI: 0.101-0.570, p = 0.001) were independent adverse prognostic factors among elderly ISSNHL patients. CONCLUSIONS: We demonstrated the treatment outcomes of 105 elderly ISSNHL patients after an ITSI. Vertigo and profound PTA are independent adverse risk factors among elderly ISSNHL patients, and patients with these risk factors require active treatment.

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Pérdida Auditiva Sensorineural , Pérdida Auditiva Súbita , Anciano , Audiometría de Tonos Puros , Glucocorticoides , Pérdida Auditiva Sensorineural/diagnóstico , Pérdida Auditiva Sensorineural/tratamiento farmacológico , Pérdida Auditiva Sensorineural/etiología , Pérdida Auditiva Súbita/complicaciones , Pérdida Auditiva Súbita/diagnóstico , Pérdida Auditiva Súbita/tratamiento farmacológico , Humanos , Inyección Intratimpánica , Pronóstico , Estudios Retrospectivos , Esteroides/uso terapéutico , Resultado del Tratamiento , Vértigo/tratamiento farmacológico

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AIMS: Microalbuminuria is an indicator of adverse cardiovascular events and chronic kidney disease. Studies have described an elevated resting heart rate as a risk factor for microalbuminuria in people with cardiovascular disease, but none have clarified its role in microalbuminuria development in people with type 2 diabetes. Therefore, this study investigated the relationship between resting heart rate and new-onset microalbuminuria in type 2 diabetes. METHODS: A total of 788 people from a glycaemic control trial in Taiwan were enrolled. Microalbuminuria was defined as a fasting urine albumin-to-creatinine ratio ≥30 mg/g in two consecutive urine tests. Resting heart rate and other covariates were measured at baseline. The quartile of resting heart rates, categorized as <70, 70-74, 75-80 and >80 beats/min, was used for analysis. Cox proportional hazard models were used to evaluate the association between resting heart rate and risk of microalbuminuria. RESULTS: During the follow-up period, 244 people (31%) developed microalbuminuria. Those who developed microalbuminuria had a longer diabetes duration (median = 3.0 vs. 2.0 years, p < 0.001), higher rate of hypertension (77% vs. 66%, p = 0.003), higher rate of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker treatment (50% vs. 38%, p = 0.001) and higher baseline HbA1c level (70 vs. 64 mmol/mol, 8.6 vs. 8.0%, p < 0.001). After adjusting for demographics, metabolic profiles and inflammatory markers, developing microalbuminuria was significantly associated with baseline resting heart rate of 70-74, 75-80 and >80 beats/min (with hazard ratios [95% CI] of 2.05 [1.32, 3.18], 2.10 [1.32, 3.32] and 1.62 [1.01, 2.59], respectively) compared to resting heart rates <70 beats/min. An average increased risk of microalbuminuria for increment of 10 beats/min was about 24% among those with hypertension (with hazard ratios of 1.24 [1.05, 1.47] in the multivariable Cox model). CONCLUSIONS: This prospective cohort study showed that resting heart rate may be an associative risk factor for developing microalbuminuria in type 2 diabetes.

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Albuminuria/fisiopatología , Diabetes Mellitus Tipo 2/fisiopatología , Nefropatías Diabéticas/fisiopatología , Adulto , Anciano , Albuminuria/epidemiología , Albuminuria/etiología , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Estudios de Cohortes , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Angiopatías Diabéticas/epidemiología , Angiopatías Diabéticas/etiología , Nefropatías Diabéticas/epidemiología , Nefropatías Diabéticas/etiología , Femenino , Estudios de Seguimiento , Frecuencia Cardíaca , Humanos , Hipertensión/complicaciones , Hipertensión/epidemiología , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Taiwán/epidemiología

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BACKGROUND: Infection and necrosis are common acute complications of diabetic foot ulcer (DFU). Amputation is the last resort treatment to control severe diabetic foot infection. Many risk factors for progression of infection that lead to amputation are disclosed. However, the prediction for the amputation necessity is clinically important to stratify risk and target intervention for limb salvage. Accordingly, this study investigates the predictive risk factors for amputation need in diabetic patients with foot ulcer. METHODS: We retrospectively studied the medical records of the DFU patients from January to December in 2017. The patients wereclassifi ed as the non-amputation and amputation groups. Patient characteristics, clinical features of vasculopathy and neuropathy (ankle brachial index [ABI] and monofilament test), and laboratory features (hemoglobin A1C [HbA1C], C-reactive protein [CRP], and white blood cell [WBC] counts) were analyzed, using the univariate and multivariate analyses. RESULTS: Of the eligible 73 cases (age 41 to 76 years), 14 (19.2%) underwent lower limb amputation. Using the multivariate model, significate risk factors included low ABI (< 0.8; adjusted odds ratio [OR] = 17.9; p = 0.003), the presence of neuropathy (adjusted OR = 5.6; p = 0.005), and HbA1C > 8.0% (adjusted OR = 4.7; p = 0.016). CONCLUSIONS: Several predictors, such as vasculopathy, neuropathy, higher HbA1C and CRP, were associated with amputation necessities in DFU patients. Of note, the vasculopathy was found to be the most important powerful. Therefore, identification and correction of these predictors would improve the quality care and patient prognosis.

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Multiple sclerosis (MS) is the leading cause of chronic neurological disability in young adults. The clinical disease course of MS varies greatly between individuals, with some patients progressing much more rapidly than others, making prognosis almost impossible. We previously discovered that cytotoxic CD4+ T cells (CD4+ CTL), identified by the loss of CD28, are able to migrate to sites of inflammation and that they contribute to tissue damage. Furthermore, in an animal model for MS, we showed that these cells are correlated with inflammation, demyelination, and disability. Therefore, we hypothesize that CD4+ CTL drive progression of MS and have prognostic value. To support this hypothesis, we investigated whether CD4+ CTL are correlated with worse clinical outcome and evaluated the prognostic value of these cells in MS. To this end, the percentage of CD4+CD28null T cells was measured in the blood of 176 patients with relapsing-remitting MS (=baseline). Multimodal evoked potentials (EP) combining information on motoric, visual, and somatosensoric EP, as well as Kurtzke expanded disability status scale (EDSS) were used as outcome measurements at baseline and after 3 and 5 years. The baseline CD4+CD28null T cell percentage is associated with EP (P = 0.003, R2 = 0.28), indicating a link between these cells and disease severity. In addition, the baseline CD4+CD28null T cell percentage has a prognostic value since it is associated with EP after 3 years (P = 0.005, R2 = 0.29) and with EP and EDSS after 5 years (P = 0.008, R2 = 0.42 and P = 0.003, R2 = 0.27). To the best of our knowledge, this study provides the first direct link between the presence of CD4+ CTL and MS disease severity, as well as its prognostic value. Therefore, we further elaborate on two important research perspectives: 1° investigating strategies to block or reverse pathways in the formation of these cells resulting in new treatments that slow down MS disease progression, 2° including immunophenotyping in prediction modeling studies to aim for personalized medicine.

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BACKGROUND & AIMS: Hy's Law, which states that hepatocellular drug-induced liver injury (DILI) with jaundice indicates a serious reaction, is used widely to determine risk for acute liver failure (ALF). We aimed to optimize the definition of Hy's Law and to develop a model for predicting ALF in patients with DILI. METHODS: We collected data from 771 patients with DILI (805 episodes) from the Spanish DILI registry, from April 1994 through August 2012. We analyzed data collected at DILI recognition and at the time of peak levels of alanine aminotransferase (ALT) and total bilirubin (TBL). RESULTS: Of the 771 patients with DILI, 32 developed ALF. Hepatocellular injury, female sex, high levels of TBL, and a high ratio of aspartate aminotransferase (AST):ALT were independent risk factors for ALF. We compared 3 ways to use Hy's Law to predict which patients would develop ALF; all included TBL greater than 2-fold the upper limit of normal (×ULN) and either ALT level greater than 3 × ULN, a ratio (R) value (ALT × ULN/alkaline phosphatase × ULN) of 5 or greater, or a new ratio (nR) value (ALT or AST, whichever produced the highest ×ULN/ alkaline phosphatase × ULN value) of 5 or greater. At recognition of DILI, the R- and nR-based models identified patients who developed ALF with 67% and 63% specificity, respectively, whereas use of only ALT level identified them with 44% specificity. However, the level of ALT and the nR model each identified patients who developed ALF with 90% sensitivity, whereas the R criteria identified them with 83% sensitivity. An equal number of patients who did and did not develop ALF had alkaline phosphatase levels greater than 2 × ULN. An algorithm based on AST level greater than 17.3 × ULN, TBL greater than 6.6 × ULN, and AST:ALT greater than 1.5 identified patients who developed ALF with 82% specificity and 80% sensitivity. CONCLUSIONS: When applied at DILI recognition, the nR criteria for Hy's Law provides the best balance of sensitivity and specificity whereas our new composite algorithm provides additional specificity in predicting the ultimate development of ALF.

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Algoritmos , Enfermedad Hepática Inducida por Sustancias y Drogas/complicaciones , Enfermedad Hepática Inducida por Sustancias y Drogas/epidemiología , Ictericia/complicaciones , Ictericia/epidemiología , Fallo Hepático Agudo/epidemiología , Modelos Estadísticos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Alanina Transaminasa/metabolismo , Fosfatasa Alcalina/metabolismo , Aspartato Aminotransferasas/metabolismo , Bilirrubina/metabolismo , Biomarcadores/metabolismo , Enfermedad Hepática Inducida por Sustancias y Drogas/metabolismo , Niño , Estudios de Cohortes , Comorbilidad , Femenino , Humanos , Ictericia/metabolismo , Fallo Hepático Agudo/metabolismo , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Factores de Riesgo , Sensibilidad y Especificidad , Factores Sexuales , Adulto Joven

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Objective To compare the characteristics and risk factors of prognosis between elder and young patients with acute respiratory distress syndrome(ARDS)in intensive care unit(ICU). Methods The data of 150 patients meeting ARDS Berlin guideline who admitted to ICU of Affiliated First Hospital of Dalian Medical University from August 2011 to November 2013 were retrospectively analyzed. The patients over 65 years old were served as elderly group(n=78),and those younger than 65 years old were served as young group(n=72),and the patients were subdivided into survivors and non-survivors groups. The characteristics of patients at admission was recorded to investigate the characteristics of elder and young patients by univariate analysis. The univariate analysis was also conducted between different prognosis groups,and the risk factors of mortality were demonstrated by multivariate logistic analysis. Results Compared with the young group,the hospital length of stays〔days:27.0 (16.0,36.0)vs. 15.0(8.0,21.0),P=0.000〕,ICU length of days〔days:25.0(15.0,32.0)vs. 13.0(7.0,19.00), P=0.000〕,mechanical ventilation days〔days:19.0(11.0,27.0)vs. 8.0(5.0,15.0),P=0.000〕,the proportion of tracheotomy:〔39.74%(31/78)vs. 18.06%(13/17),P=0.003〕,the number of organ dysfunction(3.78±0.49 vs. 1.97±1.03,P=0.043)and creatinine(μmol/L:153.85±16.89 vs. 108.26±9.14,P=0.017)of elderly group were significantly increased. The mortality〔67.95%(53/78)vs. 59.72%(43/72),P=0.190〕and acute physiology and chronic health evaluationⅡ(APACHEⅡ)score(17.94±6.04 vs. 15.99±6.93,P=0.068)in the elderly group were higher than those in the young group but without the significant differences. The causes of death in elderly patients were mainly with respiratory failure;the mainly causes in young and middle-aged patients were complex with multiple organ dysfunction syndrome,circulatory failure and other reasons. APACHEⅡscore,the number of organ dysfunction,and maximum positive end-expiratory pressure(PEEP)in the non-survivors of the elderly group were significantly higher than those of the survivors〔APACHEⅡ score:19.45±6.00 vs. 14.72±4.83,the number of organ dysfunction:4.13±0.88 vs. 2.16±1.01,maximum PEEP(cmH2O,1 cmH2O=0.098 kPa):13.93±4.16 vs. 9.72±3.72, all P<0.01〕,and the proportion of tracheotomy and pH value were significantly lower than those of the survivors〔the proportion of tracheotomy:32.08%(17/53)vs. 56.00%(14/25),pH value:7.35±0.14 vs. 7.42±0.08,both P<0.05〕. Logistic analysis showed that APACHEⅡ score〔odds ratio(OR)=7.068,95% confidence interval (95%CI)=1.358-3.273,P=0.023〕,the number of organ dysfunction(OR=2.328,95%CI=1.193-4.520,P=0.029)were related with prognosis in elderly patients with ARDS. APACHEⅡscore,the number of organ dysfunction, blood lactate,maximum PEEP in non-survivors of the young group were significantly higher than those of the survivors〔APACHEⅡ score:18.12±6.88 vs. 12.83± 5.80,the number of organ dysfunction:3.16±1.23 vs. 2.55±1.29, blood lactate(mmol/L):4.84± 4.07 vs. 2.56±1.86,maximum PEEP(cmH2O):13.93±5.50 vs. 10.54±4.05, P<0.05 or P<0.01〕,and the pH value,hospital length of stays,ICU length of days were significantly lower than those of the survivors〔pH value:7.30±0.16 vs. 7.41±0.10,hospital length of stays(days):11.09±10.97 vs. 25.17±19.05,ICU length of days(days):8.0(5.0,13.0)vs. 20.0(12.0,31.0),all P<0.01〕. Multivariate logistic analysis showed that APACHEⅡ score was related with the prognosis in young patients with ARDS(OR=5.735, 95%CI=1.921-3.310,P=0.004). Conclusions Higher APACHEⅡscore and the number of organ dysfunction were independent predictors of worse outcome in elder ARDS patients. Higher APACHEⅡscore was the independent predictor of worse outcome in young ARDS patients.

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Objective To explore the risk factors of the occurence and 28-day death of acute respiratory distress syndrome (ARDS) in intensive care unit (ICU). Methods A prospective multicentral cohort study was conducted. The patients from five ICUs of grade A tertiary hospitals in Beijing from July 2009 to March 2014, including sepsis,septic shock,trauma,pneumonia,aspiration,massive blood transfusion,bacteremia and pulmonary contusion,were enrolled. Researchers in each center reported the records with uniform tables,which included demographic,systemic conditions,the primary disease,and the severity within 24 hours,past history and so on. According to the admission diagnosis in ICU,these patients were divided into ARDS group and other severe disease control group. The risk factors of occurence and prognosis of ARDS were analyzed by univariate analysis,multivariate logistic regression and multivariate COX regression analysis. Kaplan-Meier method was applied to draw the 28-day survival curves of the two groups. Results There were 343 critical patients included in this prospective multicenter cohort study,of which 163 patients who developed ARDS were considered as ARDS group(2 case lost to follow-up, and 49 died)and 180 patients who did not developed ARDS regarded as severe control group(1 case lost to follow-up, and 34 died). The 28-day mortality of ARDS group was significantly higher than that of severe control group〔30.43%(49/161)vs. 18.99%(34/179),χ2=6.013,P=0.014〕. Multivariate logistic analysis showed that aspiration〔odds ratio(OR)=6.390,95% confidence interval(95%CI)=2.046-19.953,P=0.001〕,history of alcohol (OR=4.854,95%CI=1.730-13.617,P=0.003),sepsis(OR=2.859,95%CI=1.507-5.425,P=0.001), pneumonia(OR=2.822,95%CI=1.640-4.855,P30 beats/min(OR=3.305,95%CI=1.910-5.721,P100 beats/min(OR=2.101,95%CI=1.048-4.213,P=0.037)happened in critically ill patients, it highly suggested ARDS would happen. The proportion of the patients whose serum creatinine>176.8 μmol/L in ARDS group was lower than that in control group(OR=0.387,95%CI=0.205-0.733,P=0.004). Multivariate COX regression analysis showed that old age and septic shock were significantly associated with the increased risk of in 28-day death of ARDS〔advanced age:hazard ratio(HR)=1.040,95%CI=1.018-1.064,P30 beats/min and heart rate>100 beats/min could predict the occurrence of ARDS in critical patients. Old age and septic shock were the risk factors of 28-day death of ARDS.