Biomarkers for heart failure: small molecules with high clinical relevance

Heart failure (HF) is a rising epidemic due to the ageing population and progress in all areas of medicine. Thus, research efforts are made to ensure a timely diagnosis, to improve prognosis and treatment of the disease and to facilitate risk prediction at the population level. Because of their noninvasive determination with mostly high sensitivity and accuracy, circulating blood biomarkers are becoming increasingly important for daily clinical practice. Natriuretic peptides, especially B‐type natriuretic peptide (BNP), N‐terminal pro‐B‐type natriuretic peptide (Nt‐proBNP) and midregional pro‐atrial natriuretic peptide (MR‐proANP) and cardiac troponins are established blood biomarkers in HF diagnosis and prognosis of HF‐related outcomes. Inflammatory molecules as C‐reactive protein (CRP) may have added value in anti‐inflammatory therapy guidance. Next‐generation biomarkers including soluble source of tumorigenicity 2 (sST2), growth differentiation factor‐15 (GDF‐15), galectin‐3 (Gal‐3) and diverse microribonucleic acids (miRNAs) may have additional benefit in assessment of cardiac remodeling or differentiation of HF subtypes. Multimarker approaches containing different combinations of established and novel biomarkers might improve HF risk prediction at the population level once they are used on top of clinical variables.     

TP53 mutations predict decitabine‐induced complete responses in patients with myelodysplastic syndromes

To identify the molecular signatures that predict responses to decitabine (DAC ), we examined baseline gene mutations (28 target genes) in 109 myelodysplastic syndrome (MDS ) patients at diagnosis. We determined that TP 53 mutations predicted complete response (CR ), as 10 of 15 patients (66·7%) who possessed TP 53 mutations achieved a CR . Univariate and multivariate analyses showed that TP 53 mutations are the only molecular signatures predictive of a CR to DAC in MDS . Among the ten patients with TP 53 mutations who achieved a CR , nine presented with complex karyotypes due to abnormalities involving chromosome 5 and/or chromosome 7, and eight possessed monosomies. Although TP 53 mutations were associated with a higher frequency of CR s, they were not associated with improved survival. Poor outcomes were attributed to early relapses and transformation to acute myeloid leukaemia after CR . Post‐DAC therapy patient gene mutation profiles showed that most CR patients exhibited fewer gene mutations after achieving a CR . It seems that suppression of these gene mutations was facilitated by DAC , resulting in a CR . In summary, TP 53 mutations might predict decitabine‐induced complete responses in patients with MDS . DAC ‐induced responses may result from partial suppression of malignant clones containing mutated TP 53 genes.     

巨大儿的产前预测及对母婴结局的影响

目的观察分析巨大儿产期预测对母婴结果的影响。方法选取我院从2011年3月至2012年3月收治的巨大儿共120例。随机将患者分为预测组和非预测组。其中预测组患者共55例产妇,非预测组共65例产妇。结果预测组产妇的剖宫产率为41.8%,明显要低于未预测组的53.8%,两组对比有显著性差异(P<0.01)。另外,两组产妇在分娩过程中,预测组发生的并发症明显要少于未预测组,其中预测组发生胎儿宫内窘迫、肩难产、产后出血以及产后尿潴留等均明显要少于未预测组产妇,两组对比有显著性差异(P<0.01)。结论产期预测能有效减少剖宫产率,防止分娩过程中母婴发生各种的并发症,减少非产妇以及胎儿的影响。     

Trends in the surgical treatment for spinal metastasis and the in-hospital patient outcomes in the United States from 2000 to 2009

Background contextSurgical treatment for spinal metastasis is still controversial. However, with the improvements in treatment for primary tumors, the survival rate of patients with spinal metastasis is enhanced. At the same time, surgical technique for spinal metastasis has also improved.PurposeThe purpose of this study was to examine trends in the surgical treatment for spinal metastasis and in-hospital patient outcomes on a national level.Study design/settingThis was an epidemiologic study using national administrative data from the Nationwide Inpatient Sample (NIS) database.Patient sampleAll discharges in the NIS with a diagnosis code of secondary malignant neoplasm of the spinal cord/brain, meninges, or bone who also underwent spinal surgery from 2000 to 2009 were included.Outcome measuresTrends in the surgical treatment for spinal metastasis, in-hospital complications and mortality, and resource use were analyzed.MethodsThe NIS was used to identify patients who underwent surgical treatment for spinal metastasis from 2000 to 2009, using the International Classification of Diseases, Ninth revision, Clinical Modification codes. Trends in the surgical treatment for spinal metastasis and in-hospital patient outcomes were analyzed.ResultsFrom 2000 to 2009, there was an increasing trend in the population growth–adjusted rate of surgical treatment for spinal metastasis (1.15–1.77 per 100,000; p<.001). Average Elixhauser comorbidity score increased over time (2.6–3.8; p<.001), and the overall in-hospital complication rate increased over time (14.8%–27.7%; p<.001), whereas in-hospital mortality rate and length of hospital stay remained stable over time (5.2%–4.6%, p=.413; 10.6–10.8 days, p=.626). Inflation-adjusted mean hospital charges increased more than two-fold over time ($50,390–$110,173; p<.001).ConclusionsDuring the last decade, surgical treatment for spinal metastasis has increased in the United States. The overall in-hospital complication rate and hospital charges increased, whereas the in-hospital mortality rate and length of hospital stay remained stable.     

Development and validation of a brief dementia screening indicator for primary care

BackgroundDetection of “any cognitive impairment” is mandated as part of the Medicare annual wellness visit, but screening all patients may result in excessive false positives.MethodsWe developed and validated a brief Dementia Screening Indicator using data from four large, ongoing cohort studies (the Cardiovascular Health Study [CHS]; the Framingham Heart Study [FHS]; the Health and Retirement Study [HRS]; the Sacramento Area Latino Study on Aging [SALSA]) to help clinicians identify a subgroup of high-risk patients to target for cognitive screening.ResultsThe final Dementia Screening Indicator included age (1 point/year; ages, 65–79 years), less than 12 years of education (9 points), stroke (6 points), diabetes mellitus (3 points), body mass index less than 18.5 kg/m² (8 points), requiring assistance with money or medications (10 points), and depressive symptoms (6 points). Accuracy was good across the cohorts (Harrell's C statistic: CHS, 0.68; FHS, 0.77; HRS, 0.76; SALSA, 0.78).ConclusionsThe Dementia Screening Indicator is a simple tool that may be useful in primary care settings to identify high-risk patients to target for cognitive screening.     

Non-invasive prediction of development of hepatocellular carcinoma using transient elastography in patients with chronic liver disease

Prognosis of patients with chronic liver disease is determined by the extent and progression of liver fibrosis, which may ultimately lead to hepatocellular carcinoma (HCC). Liver biopsy (LB) is regarded as the gold standard to estimate the extent of liver fibrosis. However, because LB has several limitations, the foremost being its invasiveness, several non-invasive methods for assessing liver fibrosis have been proposed. Of these, transient elastography (TE) provides an accurate representation of the extent of liver fibrosis. Furthermore, recent studies have focused on the usefulness of TE for assessing the risk of HCC development and HCC recurrence after curative treatment, and developed novel models to calculate the risk of HCC development based on TE findings. These issues are discussed in this expert review.     

住院癌症患者衰弱风险预测模型的构建与验证

目的 调查住院癌症患者发生衰弱的危险因素，构建风险预测模型并检验预测效果。方法 选取广州市2所三级甲等医院住院癌症患者570例，分为建模集422例和验证集148例。采用一般资料调查表、Fried衰弱表型、安德森症状评估量表、医院焦虑抑郁量表、中文版失志量表、营养风险筛查2002、Barthel指数量表进行调查，同期收集患者的白细胞介素-6、C-反应蛋白等实验室指标，应用logistic回归分析筛选衰弱的独立危险因素，构建风险预测模型。结果 住院癌症患者衰弱发生率为33.7%,衰弱的影响因素分别为：造口、营养状况、抑郁、神经心理症状群、消化道症状群、D-二聚体、白细胞介素-6。建模集和验证集ROC曲线下面积为0.788、0.735;Brier得分为0.205,校准斜率为0.625,决策曲线分析表明模型具有一定的临床可用性。结论 住院癌症患者衰弱发生率较高，构建的列线图预测模型具有较好的风险预测价值，可有效识别和筛选住院癌症衰弱高危人群。     

应用回归法预测石家庄市细菌性痢疾发病

目的 预测石家庄市细菌性痢疾(菌痢)的流行趋势,为进一步制订防治对策提供参考依据.方法 运用Excel软件对该地区2001-2009年的菌痢发病率进行二次多项式拟合,并根据所建立的预测方程对2010年的菌痢发病进行外推预测,分析其变化趋势.结果 建立的石家庄市2001-2009年的菌痢发病预测模型为:y=0.4748x...     

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??The position of lips directly affects facial beauty. In orthodontic treatment process??clinicians always choose incisor retraction to adjust lip protrusion?? reshaping the soft tissue beauty. However??with the retraction of incisors??the change of lip soft tissue is not in a simple same-size ratio. To ideally rebuild lip shape??the exact prediction of retraction extent of incisor is a widely-concerned problem. This study investigated the response of lip position to incisor position??aiming to provide a reference for further clinical treatment.