Summary Background Characterisation of the severity profile of human infections with influenza viruses of animal origin is a part of pandemic risk assessment, and an important part of the assessment ...of disease epidemiology. Our objective was to assess the clinical severity of human infections with avian influenza A H7N9 virus, which emerged in China in early 2013. Methods We obtained information about laboratory-confirmed cases of avian influenza A H7N9 virus infection reported as of May 28, 2013, from an integrated database built by the Chinese Center for Disease Control and Prevention. We estimated the risk of fatality, mechanical ventilation, and admission to the intensive care unit for patients who required hospital admission for medical reasons. We also used information about laboratory-confirmed cases detected through sentinel influenza-like illness surveillance to estimate the symptomatic case fatality risk. Findings Of 123 patients with laboratory-confirmed avian influenza A H7N9 virus infection who were admitted to hospital, 37 (30%) had died and 69 (56%) had recovered by May 28, 2013. After we accounted for incomplete data for 17 patients who were still in hospital, we estimated the fatality risk for all ages to be 36% (95% CI 26–45) on admission to hospital. Risks of mechanical ventilation or fatality (69%, 95% CI 60–77) and of admission to an intensive care unit, mechanical ventilation, or fatality (83%, 76–90) were high. With assumptions about coverage of the sentinel surveillance network and health-care-seeking behaviour for patients with influenza-like illness associated with influenza A H7N9 virus infection, and pro-rata extrapolation, we estimated that the symptomatic case fatality risk could be between 160 (63–460) and 2800 (1000–9400) per 100 000 symptomatic cases. Interpretation Human infections with avian influenza A H7N9 virus seem to be less serious than has been previously reported. Many mild cases might already have occurred. Continued vigilance and sustained intensive control efforts are needed to minimise the risk of human infection. Funding Chinese Ministry of Science and Technology; Research Fund for the Control of Infectious Disease; Hong Kong University Grants Committee; China–US Collaborative Program on Emerging and Re-emerging Infectious Diseases; Harvard Center for Communicable Disease Dynamics; US National Institute of Allergy and Infectious Disease; and the US National Institutes of Health.
Background Chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP) is reported to be different in inflammatory patterns of the sinonasal mucosa in white patients. ...Studies in nonwhite populations may further be helpful to understand the pathogenic mechanisms of CRS. Objective To investigate the immunopathologic profiles of CRSwNP and CRSsNP in adult Chinese. Methods Histologic characteristics of surgical samples were analyzed in 50 controls, 94 CRSsNP patients, and 151 CRSwNP patients. Tissue samples from 17 controls, 36 CRSsNP patients, and 45 CRSwNP patients were stained for CD3, CD4, CD8, CD20, CD68, myeloperoxidase, and dendritic cell lysosome-associated membrane protein. Expression profiles of transcription factors of T-cell subsets in relation to cytokines and a marker of natural killer T cell (Vα24) were examined by means of quantitative RT-PCR. Results Over half of CRSwNP patients presented noneosinophilic inflammation. CRSwNP had a higher number of eosinophils, plasma cells, and CD3+ , CD8+ , CD20+ , and CD68+ cells and a lower myeloperoxidase expression rate than CRSsNP. Expression levels of transcription factors and cytokines of TH 1/TH 2/TH 17 were increased, whereas the expression rate of Forkhead box p3 and TGF-β1 was decreased in both CRSsNP and CRSwNP compared with controls. Comparing CRSsNP and CRSwNP, CRSsNP had higher levels of IFN-γ expression, whereas only eosinophilic CRSwNP demonstrated an enhanced expression of GATA-3 and IL-5. Compared with noneosinophilic CRSwNP, an exaggerated TH 2/TH 17 reaction and Vα24 expression were found in eosinophilic CRSwNP. Conclusion Both Chinese CRSsNP and CRSwNP patients demonstrate impaired regulatory T cell function and enhanced TH 1/TH 2/TH 17 responses. CRSsNP is confirmed to be a predominant TH 1 milieu, whereas TH 2 skewed inflammation with predominant TH 17 reactions, and infiltration of natural killer T cells can be demonstrated only in eosinophilic CRSwNP, but not in noneosinophilic CRSwNP.
Background Locally produced IgE contributes to the initiation and development of eosinophilic inflammation in eosinophilic nasal polyps independent of systemic atopy. However, whether CXCR5+ CD4+ T ...follicular helper (TFH ) cells are involved in local IgE production at mucosal sites remains unexplored. Objective We sought to explore the presence, phenotype, and function of CXCR5+ CD4+ TFH cells in eosinophilic nasal polyp tissues compared with noneosinophilic nasal polyp and control normal nasal tissues. Methods TFH cell-surface phenotypes and subsets and B-cell subsets in nasal tissues and peripheral blood were studied by means of flow cytometry. Immunohistochemistry was used to detect the tissue location of TFH cells. Sorted nasal TFH cells and CXCR5− T cells were cultured with autologous naive B cells purified from blood. Results Nasal TFH cells expressed inducible costimulator, programmed cell death protein 1, and the transcription factor B-cell lymphoma 6 (Bcl-6) at an intermediate level when compared with bona fide TFH cells in tonsils and circulating TFH cells. Although counts of total TFH cells and IL-21+ , IFN-γ+ , and IL-17+ TFH cells were increased in both eosinophilic and noneosinophilic nasal polyp tissues compared with those in normal nasal tissues, IL-4+ TFH cell counts were only increased in eosinophilic polyp tissues. IL-4 and IL-21 were involved in polyp TFH cell–induced IgE production from naive B cells, and nasal IL-4+ TFH cell counts correlated highly with local IgE levels in vivo . IL-4+ Bcl-6+ CD4+ TFH cells were identified in ectopic lymphoid structures in eosinophilic nasal polyps. TFH cells also positively correlated with germinal center B cells and plasma cells in nasal tissues. Conclusion Nasal IL-4+ TFH cells might be involved in local IgE production in eosinophilic nasal polyps.
Tubular adenoma of common bile duct (CBD) is an extremely rare benign extrahepatic bile duct adenoma. We report a case of surgery and histopathological proved CBD tubular adenoma. A 69-year-old man ...was admitted to the hospital for yellow urine for one month. Clinical, radiological and laboratory results were analyzed. Medical literature in PubMed pertaining to similar cases was reviewed. A solid mass was detected in the distant part of CBD, with dilation of the extrahepatic and intrahepatic bile duct by ultrasound, contrast enhanced ultrasound (CEUS), computer tomography (CT) and magnetic resonance imaging (MRI). It showed heterogeneous enhancement both in contrast-enhanced CT, MRI and CEUS. After operation, pathological findings indicated a tubular adenoma of CBD. Our case highlighted the fact that tubular adenoma of CBD was demonstrated as a homogeneous mass in the distant part of CBD.
Abstract Objectives This study aimed to explore the hemodynamic index–guided hydration method for patients with congestive heart failure (CHF) and chronic kidney disease (CKD) to reduce the risk of ...contrast-induced nephropathy (CIN) and at the same time to avoid the acute heart failure. Background Patients at moderate or high risk for CIN should receive sufficient hydration before contrast application. Methods This prospective, randomized, double-blind, comparative clinical trial enrolled 264 consecutive patients with CKD and CHF undergoing coronary procedures. These patients were randomly assigned to either central venous pressure (CVP)-guided hydration group (n = 132) or the standard hydration group (n = 132). In the CVP-guided group, the hydration infusion rate was dynamically adjusted according to CVP level every hour. CIN was defined as an absolute increase in serum creatinine (SCr) >0.5 mg/dl (44.2 μmol/l) or a relative increase >25% compared with baseline SCr. Results Baseline characteristics were well-matched between the 2 groups. The total mean volume of isotonic saline administered in the CVP-guided hydration group was significantly higher than the control group (1,827 ± 497 ml vs. 1,202 ± 247 ml; p < 0.001). CIN occurred less frequently in CVP-guided hydration group than the control group (15.9% vs. 29.5%; p = 0.006). The incidences of acute heart failure during the hydration did not differ between the 2 groups (3.8% vs. 3.0%; p = 0.500). Conclusions CVP-guided fluid administration can safely and effectively reduce the risk of CIN in patients with CKD and CHF. (Central Venous Pressure Guided Hydration Prevention for Contrast-Induced Nephropathy; NCT02405377 )
Abstract Background Monocyte and monocyte to high-density lipoprotein ratio (MHR) recently emerged as markers of inflammation and have been reported to be novel prognostic indicators of ...cardiovascular diseases. We investigated the association of monocyte and MHR with hospital discharge and 3-month outcome after acute intracerebral hemorrhage (ICH). Methods A total of 316 patients with acute ICH were enrolled from November 2011 to March 2014. Demographic characteristics, lifestyle risk factors, medical history, admission laboratory parameters, and monocyte level were recorded. Clinical outcome was disability or death (defined as having a modified Rankin Scale score ≥ 2)
upon discharge or at 3 months. Results 202 patients (63.9%) experienced disability or death at hospital discharge, and 176 patients (55.7%) at 3 months post-ICH. Admission monocyte level was associated with clinical outcome at 3 months (adjusted OR, 4.17; 95% CI, 1.45
–
12.00; P -trend = 0.028) when highest and lowest quartiles were compared. However, no significant association was found between monocyte and discharge outcome ( P -trend = 0.102). Compared to the lowest category of MHR, the highest category was associated with a 3.87-fold increase in the odds of disability or death at discharge (95% CI, 1.17
–
12.76; P -trend = 0.045) and 3.08-fold increased odds of disability or death at 3-month (95% CI, 1.05
–
9.08; P -trend = 0.024). Conclusions In patients with acute ICH, higher MHR was associated with increased risk of disability or death at discharge and at 3 months post-ICH, however higher monocyte was only associated with increased risk of 3-month disability or death.
Abstract Background Neutrophil to lymphocyte ratio (NLR) serves as a powerful inflammatory marker for predicting cardiovascular events. Here, we investigate whether admission NLR is associated with ...hematoma volume, stroke severity, and 3-month outcomes in patients with acute intracerebral hemorrhage
(ICH). Methods 352 patients with acute ICH were prospectively identified in this study. Demographic characteristics, lifestyle risk factors, NIHSS score, hematoma volumes, and other clinical features were recorded for all participants. Patients was divided into quartiles based on the admission NLR levels (Q1: < 2.78; Q2: 2.78
–
4.08; Q3: 4.08
–
7.85; Q4: ≥ 7.85). Multivariable linear regression models and logistic regression models were used to evaluate the association between NLR and hematoma volume, admission severity, or the outcomes after ICH. Results Median NIHSS scores for each quartile (Q1 to Q4) were 6.0, 6.0, 6.0, and 11.0 (P = .001), and median hematoma volumes were 9.5, 9.3, 9.1, and 15.0 ml (P = .005), respectively. After adjusting the age, sex, and other potential risk factors, the patients in Q4 had higher NIHSS scores (P = .042) and larger hematoma volume (P = .014). After 3-month follow-up, 148 poor outcomes (mRS, 3–6) and 47 all-cause deaths were documented. There were more patients with poor outcomes in Q4 than Q1. However, compared with the patients in Q1, those in Q4 were not associated with poor outcomes ( P -trend = 0.379), and all-cause mortality ( P -trend = 0.843) after adjust for other risk factors. Conclusions Higher admission NLR are associated with larger hematoma volume and more serious stroke, but not 3-month outcomes in patients with acute ICH.
Background Convergent evidence suggests dysfunction within the prefrontal cortex (PFC) and amygdala, important components of a neural system that subserves emotional processing, in individuals with ...major depressive disorder (MDD). Abnormalities in this system in the left hemisphere and during processing of negative emotional stimuli are especially implicated. In this study, we used functional magnetic resonance imaging (fMRI) to investigate amygdala–PFC functional connectivity during emotional face processing in medication-naive individuals with MDD. Methods Individuals with MDD and healthy controls underwent fMRI scanning while processing 3 types of emotional face stimuli. We compared the strength of functional connectivity from the amygdala between the MDD and control groups. Results Our study included 28 individuals with MDD and 30 controls. Decreased amygdala–left rostral PFC (rPFC) functional connectivity was observed in the MDD group compared with controls for the fear condition ( p < 0.05, corrected). No significant differences were found in amygdala connectivity to any cerebral regions between the MDD and control groups for the happy or neutral conditions. Limitations All participants with MDD were experiencing acute episodes, therefore the findings could not be generalized to the entire MDD population. Conclusion Medication-naive individuals with MDD showed decreased amygdala–left rPFC functional connectivity in response to negative emotional stimuli, suggesting that abnormalities in amygdala–left rPFC neural circuitry responses to negative emotional stimuli might play an important role in the pathophysiology of MDD.
Background
There are few clinical symptoms in early colorectal cancer, so it is necessary to find a simple and economical tumor detection index for auxiliary diagnosis. This study aims to explore the ...diagnostic value of preoperative inflammation-related indicators, such as neutrophil, lymphocyte, platelet count, platelet to lymphocyte ratio (PLA), neutrophil to lymphocyte ratio (NLR), and systemic immune-inflammation index (SII), for early colorectal cancer, and determine whether inflammation-related indicators can provide more accurate diagnostic judgment for patients.
Methods
This study was a retrospective study. Patients who were first diagnosed with colorectal cancer or colorectal adenomatous polyp at Beijing Friendship Hospital from October 2016 to October 2017 were retrospectively collected. According to inclusion and exclusion criteria, a total of 342 patients were included, including 216 patients with colorectal cancer and 126 patients with colorectal adenomatous polyp. Fasting venous blood and other clinical features were collected to compare the differences between colorectal cancer and colorectal adenoma.
Results
There were statistically significant differences in age, carcinoembryonic antigen, albumin, hemoglobin, mean platelet volume, lymphocyte, monocyte, NLR, PLA, SII, and mean platelet volume to platelet count ratio between colorectal cancer group and colorectal adenoma group (P < .05), and a Nomogram model was established. Using inflammatory markers to differentiate colorectal and colorectal polyps produced greater AUC than using tumor markers alone (.846 vs .695).
Conclusion
Inflammation-related indicators, such as lymphocyte, monocyte, and mean platelet volume, may serve as potential indicators to assist in the diagnosis of early colorectal cancer.
Background:
The NCCN clinical guidelines recommended core needle biopsy for breast lesions classified as Breast Imaging Reporting and Data System (BI-RADS) 4, while category 4A lesions are only 2-10% ...likely to be malignant. Thus, a large number of biopsies of BI-RADS 4A lesions were ultimately determined to be benign, and those unnecessary biopsies may incur additional costs and pains. However, it is important to emphasize that the current risk prediction model focuses primarily on the details and complex risk features of US or MG findings, which may be difficult to apply in order to benefit from the model. To stratify and manage BI-RADS 4A lesions effectively and efficiently, a more effective and practical predictive model must be developed.
Methods:
We retrospectively analyzed 465 patients with BI-RADS ultrasonography (US) category 4A lesions, diagnosed between January 2019 and July 2019 in Tianjin Medical University Cancer Institute and Hospital and National Clinical Research Center for Cancer. Univariate and multivariate logistic regression analyses were conducted to identify risk factors. To stratify and predict the malignancy of BI-RADS 4A lesions, a nomogram combining the risk factors was constructed based on the multivariate logistic regression results. In order to determine the predictive performance of our predictive model, we used the concordance index (C-index), calibration curve, and receiver operating characteristic (ROC), and the decision curve analysis (DCA) to assess the clinical benefits.
Results:
Based on our analysis, 16.3% (76 out of 465) of patients were pathologically diagnosed with malignant lesions, while 83.6% (389 out of 465) were diagnosed with benign lesions. According to univariate and multivariate logistic regression analysis, age (OR = 3.414, 95%CI:1.849-6.303), nipple discharge (OR = .326, 95%CI:0.157-.835), palpable lesions (OR = 1.907, 95%CI:1.004-3.621), uncircumscribed margin (US) (OR = 1.732, 95%CI:1.033-2.905), calcification (mammography, MG) (OR = 2.384, 95%CI:1.366-4.161), BI-RADS(MG) (OR = 5.345, 95%CI:2.934-9.736) were incorporated into the predictive nomogram (C-index = .773). There was good agreement between the predicted risk and the observed probability of recurrence. Furthermore, we determined that 153 was the best cutoff score for distinguishing between patients in the low- and high-risk groups. Malignant lesions were significantly more prevalent in high-risk patients than in low-risk patients.
Conclusion:
Based on clinical, US, and MG features, we present a predictive nomogram to reliably predict the malignancy risk of BI-RADS(US) 4A lesions, which may assist clinicians in the selection of patients at low risk of malignancy and reduce the number of false-positive biopsies.
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