Summary Background Human infections with different avian influenza viruses—eg, H5N1, H9N2, and H7N9—have raised concerns about pandemic potential worldwide. We report the first human infection with a ...novel reassortant avian influenza A H10N8 virus. Methods We obtained and analysed clinical, epidemiological, and virological data from a patient from Nanchang City, China. Tracheal aspirate specimens were tested for influenza virus and other possible pathogens by RT-PCR, viral culture, and sequence analyses. A maximum likelihood phylogenetic tree was constructed. Findings A woman aged 73 years presented with fever and was admitted to hospital on Nov 30, 2013. She developed multiple organ failure and died 9 days after illness onset. A novel reassortant avian influenza A H10N8 virus was isolated from the tracheal aspirate specimen obtained from the patient 7 days after onset of illness. Sequence analyses revealed that all the genes of the virus were of avian origin, with six internal genes from avian influenza A H9N2 viruses. The aminoacid motif GlnSerGly at residues 226–228 of the haemagglutinin protein indicated avian-like receptor binding preference. A mixture of glutamic acid and lysine at residue 627 in PB2 protein—which is associated with mammalian adaptation—was detected in the original tracheal aspirate samples. The virus was sensitive to neuraminidase inhibitors. Sputum and blood cultures and deep sequencing analysis indicated no co-infection with bacteria or fungi. Epidemiological investigation established that the patient had visited a live poultry market 4 days before illness onset. Interpretation The novel reassortant H10N8 virus obtained is distinct from previously reported H10N8 viruses. The virus caused human infection and could have been associated with the death of a patient. Funding Emergency Research Project on human infection with avian influenza H7N9 virus, the National Basic Research Program of China, and the National Mega-projects for Infectious Diseases.
Cervical pregnancy is a rare variety of ectopic pregnancy. The success of conservative treatment for cervical pregnancy depends on early and accurate diagnosis of ultrasound. We found ...Contrast-enhanced ultrasonography (CEUS) to be an accurate diagnosis approach for cervical pregnancy. In cervical pregnancy, CEUS showed rapid enhancement of the wall of the gestational sac during the early enhancement phase with the performance of hyper-enhanced. Enhancement sustained at a high level of intensity through the early enhancement phase, with the sign of doughnut-shaped in the wall of the gestational sac, and washed out slowly during the late enhancement phase. While the wall of the gestational sac showed no enhancement during the whole phase in aborting intrauterine pregnancy residing in the cervical canal.
Background Extracorporeal membrane oxygenation (ECMO) has been utilized for patients in critical condition, including life-threatening respiratory failure and postcardiotomy cardiogenic shock. This ...study analyzed the outcomes of patients with acute respiratory distress syndrome (ARDS) treated by ECMO and identified the relationship between prognosis and urine output (UO) obtained on the first day of ECMO support. Methods This study reviewed the medical records of 81 ARDS patients after ECMO support on a specialized cardiovascular surgery intensive care unit of a tertiary care university hospital between May 2006 and December 2011. Demographic, clinical, and laboratory variables were retrospectively collected as survival predictors. Results The overall mortality rate was 55.5%. A multiple logistic regression analysis indicated that the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, mean arterial pressure, platelet count, and UO on day 1 of ECMO support were independent risk factors for hospital mortality. By using the areas under the receiver operating characteristic (AUROC) curve, UO obtained on the first day of ECMO support demonstrated good discriminative power (AUROC 0.754 ± 0.056, p < 0.001). Urine output had the best discriminative power, the best Youden index, and the highest overall correctness of prediction. Cumulative survival rates at the 6-month follow-up differed significantly ( p < 0.001) for UO 1,432 mL or greater on day 1 of ECMO support versus those with UO less than 1,432 mL on day 1 of ECMO support. Conclusions In ARDS patients receiving ECMO support, UO obtained on the first day of ECMO support showed good prognostic ability in predicting hospital mortality.
Acute kidney injury (AKI) is a significant complication after hematopoietic stem cell transplantation (HSCT) and frequently limits treatment success. Patients suffering complications with AKI often ...have high mortality. This investigation analyzed the outcomes of patients receiving allogeneic HSCT and identified the association between prognosis and RIFLE (risk of renal failure, injury to kidney, failure of kidney function, loss of kidney function and end-stage renal disease) classification. This study reviewed the medical records of 101 patients receiving allogeneic HSCT during an 8-year period at a specialized hematology ward in a university hospital in Taiwan. Demographic, clinical and laboratory variables were retrospectively gathered as predicators. Overall 6-month mortality was 36.6% (37/101). Mortality progressively and significantly increased (χ for trend, P < 0.001) based on RIFLE classification severity. Multiple variable Cox regression analysis identified maximum RIFLE score on day 7 to 14 post-HSCT, occurrence of hepatic veno-occlusive disease and respiratory failure during admission as independent risk factors for 6-month mortality. Using the area under the receiver operating characteristic curve, the RIFLE classification on day 7 to 14 post-HSCT has the best discriminative power (area under the receiver operating characteristic curve: 0.696 ± 0.057, P < 0.001) compared with day 0 to 7, 14 to 30 and 30 to 60 post-HSCT. Cumulative survival rates at 6-month follow-up differed significantly (P < 0.05) among non-AKI, RIFLE-R versus RIFLE-I and RIFLE-F. Hepatic veno-occlusive disease, respiratory failure and severity of maximum RIFLE score on day 7 to 14 post-HSCT were independent predictors for 6-month mortality. RIFLE classification on day 7 to 14 post-HSCT can improve the accuracy of 6-month mortality in patients who received allogeneic HSCT.
ObjectiveTo develop an inflammation-based risk stratification tool for operative mortality in patients with acute type A aortic dissection. MethodsBetween January 1, 2016 and December 31, 2021, 3124 ...patients from Beijing Anzhen Hospital were included for derivation, 571 patients from the same hospital were included for internal validation, and 1319 patients from other 12 hospitals were included for external validation. The primary outcome was operative mortality according to the Society of Thoracic Surgeons criteria. Least absolute shrinkage and selection operator regression were used to identify clinical risk factors. A model was developed using different machine learning algorithms. The performance of the model was determined using the area under the receiver operating characteristic curve (AUC) for discrimination, calibration curves, and Brier score for calibration. The final model (5A score) was tested with respect to the existing clinical scores. ResultsExtreme gradient boosting was selected for model training (5A score) using 12 variables for prediction-the ratio of platelet to leukocyte count, creatinine level, age, hemoglobin level, prior cardiac surgery, extent of dissection extension, cerebral perfusion, aortic regurgitation, sex, pericardial effusion, shock, and coronary perfusion-which yields the highest AUC (0.873 95% confidence interval (CI) 0.845-0.901). The AUC of 5A score was 0.875 (95% CI 0.814-0.936), 0.845 (95% CI 0.811-0.878), and 0.852 (95% CI 0.821-0.883) in the internal, external, and total cohort, respectively, which outperformed the best existing risk score (German Registry for Acute Type A Aortic Dissection score AUC 0.709 95% CI 0.669-0.749). ConclusionThe 5A score is a novel, internally and externally validated inflammation-based tool for risk stratification of patients before surgical repair, potentially advancing individualized treatment. Trial Registrationclinicaltrials.gov Identifier: NCT04918108.
Summary Background Hepatocellular carcinoma (HCC) is prevalent worldwide and improvements in timely and effective diagnosis are needed. We assessed whether measurement of Dickkopf-1 (DKK1) in serum ...could improve diagnostic accuracy for HCC. Methods We analysed data for patients with HCC, chronic hepatitis B virus (HBV) infection, liver cirrhosis, and healthy controls, recruited from two Chinese centres between December, 2008, and July, 2009. A validation cohort matched for age and sex was recruited from another centre in China between February, 2009, and June, 2011. DKK1 was measured in serum by ELISA by independent researchers who had no access to patients' clinical information. We used receiver operating characteristics (ROC) to calculate diagnostic accuracy. Findings We assessed serum DKK1 in 831 participants: 424 with HCC, 98 with chronic HBV infection, 96 with cirrhosis, and 213 healthy controls. The validation cohort comprised 453 participants: 209 with HCC, 73 with chronic HBV infection, 72 with cirrhosis, and 99 healthy controls. Levels of DKK1 in serum were significantly higher in patients with HCC than in all controls. ROC curves showed the optimum diagnostic cutoff was 2·153 ng/mL (area under curve AUC 0·848 95% CI 0·820–0·875, sensitivity 69·1%, and specificity 90·6% in the test cohort; 0·862 0·825–0·899, 71·3%, and 87·2% in the validation cohort). Similar results were noted for early-stage HCC (0·865 0·835–0·895, 70·9%, and 90·5% in the test cohort; 0·896 0·846–0·947, 73·8%, and 87·2% in the validation cohort). Furthermore, DKK1 maintained diagnostic accuracy for patients with HCC who were α-fetoprotein (AFP) negative (0·841 0·801–0·882, 70·4%, and 90·0% in the test cohort; 0·869 0·815–0·923, 66·7%, and 87·2% in the validation cohort), including for patients with early-stage HCC (0·870 0·829–0·911, 73·1%, and 90·0% in the test cohort; 0·893 0·804–0·983, 72·2%, and 87·2% in the validation cohort), compared with all controls. Raised concentrations of DKK1 in serum could differentiate HCC from chronic HBV infection and cirrhosis (0·834 0·798–0·871, 69·1%, and 84·7% in the test cohort; 0·873 0·832–0·913, 71·3%, and 90·6% in the validation cohort). Moreover, measurement of DKK1 and AFP together improved diagnostic accuracy for HCC versus all controls compared with either test alone (0·889 0·866–0·913, 73·3%, and 93·4% in the test cohort; 0·888 0·856–0·920, 78·5%, and 87·2% in the validation cohort). Interpretation DKK1 could complement measurement of AFP in the diagnosis of HCC and improve identification of patients with AFP-negative HCC and distinguish HCC from non-malignant chronic liver diseases. Funding National Key Basic Research Programme of China, National Key Sci-Tech Special Projects of Infectious Diseases, National Natural Science Foundation of China, Research Fund for the Doctoral Programme of Higher Education of China.
Klippel-Trenaunay syndrome (KTS) is a rare congenital disorder. In this case study, we reported prenatal ultrasound study on a 33-year-old pregnant woman at the gestation of 26 weeks and 3 days, ...whose fetus was suspected of KTS associated with enlarged right thigh and dilated inferior vena cava. Additionally, we comprehensively reviewed literatures of prenatal KTS published on Medline to further understanding of the prenatal ultrasonographic manifestations of KTS.
Summary α -Thalassemia/mental retardation syndrome X-linked protein ( ATRX ) and death domain–associated protein ( DAXX ) genes are tumor suppressors whose mutations have been identified in sporadic ...pancreatic neuroendocrine tumors as well as in patients with MEN1. However, it is unknown whether ATRX and DAXX alterations are specific for pancreatic neuroendocrine tumor. In addition, the association of ATRX/DAXX protein loss with tumor cell proliferation has not been examined. We, therefore, immunostained ATRX and DAXX in 10 gastric, 15 duodenal, 20 rectal, 70 pancreatic, and 22 pulmonary neuroendocrine tumors with 15 nonneoplastic pancreases and 27 pancreatic adenocarcinomas to elucidate the site-specific roles of ATRX/DAXX abnormalities. At least 1 loss of ATRX and DAXX immunoreactivity was detected in all neuroendocrine tumor cases but not in any of nonneoplastic pancreatic tissues or pancreatic adenocarcinomas. The loss of DAXX protein was correlated with the Ki-67 index (ATRX, P = .904; DAXX, P = .044). The status of DAXX immunoreactivity correlated positively with World Health Organization histologic grade ( P = .026). These results suggest that the status of ATRX or DAXX protein loss in neuroendocrine tumor differed among the organs in which these tumors arose, and these proteins may play site-specific roles in the development of these tumors.
Background Many studies have demonstrated that patients with metachronous second primary lung cancer (MSPLC) benefit from surgery. Owing to the lack of uniform criteria and prospective randomized ...trials, the extent of resection remains controversial, and prognostic factors are still not fully clear. The present study aimed to assess surgical treatment of MSPLC and identify prognostic factors of outcome. Methods This retrospective analysis included 143 patients who underwent surgical resection of MSPLC in our department from January 2006 to December 2011. Predictors of postoperative complications were analyzed with the binary logistic regression method. Survival was analyzed with Kaplan-Meier and Cox regression methods. Results Operative mortality was 1.4%, and the complication rate was 34.3%. Age more than 70 years was an independent risk factor for postoperative complications. The overall 5-year survival after resection of MSPLC was 54.5%. TNM stage II or higher ( p = 0.025), 20 or more pack-years of smoking ( p = 0.037), and tumor size greater than 2 cm ( p = 0.033) were independent negative prognostic factors for survival. For stage I disease, completion pneumonectomy had a lower 5-year survival rate than others, 44.8% and 65.9, respectively ( p = 0.039); lobectomy and sublobar resection have a 5-year survival of 77.1% and 56.7%, respectively ( p = 0.203). Conclusions Surgical treatment of MSPLC is safe and effective. TNM stage I, tumor size 2 cm or less, or less than 20 pack-years smoking are predictors of improved survival. Sublobar resection is acceptable. For stage I disease, lobectomy tends to be associated with better survival than sublobar resection, although the difference is not significant, and completion pneumonectomy is not recommended. Long-term follow-up is necessary even after curative resection of lung cancer.
Abstract Background It has been demonstrated that advanced interatrial block (IAB) is associated with an increased risk of atrial fibrillation (AF); however, the impact of advanced IAB on recurrence ...of paroxysmal AF after catheter ablation is not clear. Methods 204 consecutive patients with paroxysmal AF who underwent index circumferential pulmonary vein (PV) isolation were prospectively enrolled. In all patients, a resting electrocardiogram in sinus rhythm was evaluated for the presence of advanced IAB, defined as a P-wave duration >120 ms and biphasic (±) morphology in the inferior leads. Advanced IAB was detected in 20.1% of patients. AF recurrence was defined as the occurrence of confirmed atrial tachyarrhythmia lasting more than 30 s beyond 3 months after the catheter ablation in the absence of any antiarrhythmic treatment. Results During the mean follow-up period of 13.9 ± 6.2 months (range, 3–27 months), 62 patients (30.4%) developed recurrence of AF. The recurrence rate was higher in patients with advanced IAB than those without advanced IAB (46.3% vs. 26.4%, p = 0.006). Cox regression analysis with adjustment for age, P-wave duration, CHADS2 score, and PV isolation identified advanced IAB (hazard ratio, 2.111; 95% confidence interval, 1.034–4.308; p = 0.040) and left atrial diameter (hazard ratio, 1.051; 95% confidence interval, 1.004–1.100; p = 0.034) as two independent predictors of recurrence of AF. Conclusions Patients with advanced IAB were at an increased risk of AF recurrence after catheter ablation.
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