Prognostic factors and scoring model of hematological malignancies patients with bloodstream infections

Purpose

Patients with hematological malignancies (HMs) are at a higher risk for bloodstream infections (BSIs), which pose significant burden on morbidity and mortality. Better risk stratification helps in medical decision making, increasing efficiency and reducing economic burden. The aim of this study was to develop and validate a reliable prediction model which can be used to identify HM patients at higher risk for BSIs.

Methods

We conducted a retrospective cohort study in three university-affiliated hospitals in Hunan Province, China, from January 2010 to April 2015. A total of 521 HMs patients with BSIs were finally included in this study and were divided into the derivation set and validation set. Survivors and non-survivors were compared to identify the predictors of 30-day mortality.

Results

The multivariate analysis yielded the following significant mortality-related risk factors: age?>?60 years (95% CI 1.047–5.474), relapsed or uncontrolled malignancy (95% CI 2.043–14.029), Pitt bacteremia score?>?3 (95% CI 1.614–6.35), prolonged neutropenia (95% CI 1.181–5.824), use of vasopressors (95% CI 3.009–12.210), acute respiratory failure (95% CI 3.061–14.911), fungemia (95% CI 1.334–12.121), inadequate antibiotic treatment (95% CI 1.682–7.591), albumin?<?30 g/L (95% CI 1.030–3.446), TBil?>?34.2 µmol/L (95% CI 1.109–5.438). In both derivation and validation sets, our model showed reliable prediction value with areas under the receiver operating curve of 0.876 and 0.873.

Conclusions

The risk factors in this study have the ability to identify patients with HMs and BSIs at high risk for mortality. Our model provides an excellent foundation for predicting 30-day morality in HM patients suffering from BSI and helps target high-risk patients for management decision making.

     

Clinical observation on hearing conditions of centenarians in northern district of China

Conclusion: The hearing conditions of the centenarians were quite poor as regards hearing thresholds and speech detection ability. Objective: To investigate hearing conditions of centenarians. Methods: A total of 54 centenarians in Rizhao and Linyi Districts in Shandong Province were investigated to assess hearing conditions of centenerians comprehensively by questionnaire investigation, pure-tone audiometry, acoustic immitance, intelligence evaluation, and speech detection scores. Also, 135 individuals were recruited as controls and divided into four groups according to their age: 45–59 years, 60–69 years, 70–79 years, and 80–89 years. Results: The hearing thresholds of the centenarians were dramatically higher than those of the control group (p < 0.05) and all centenarians suffered moderate to profound hearing loss according to the World Health Organization (WHO) criteria. Few centenarians had normal level of speech detection scores. All centenarians showed descending hearing curve, and the hearing threshold of the male centenarians at 8000 Hz was higher than that of the females (p = 0.047). There was a significant air–bone conduction gap in the centenarians (p < 0.05).     

Assessment of the value of carcinoembryonic antigen reduction ratio as a prognosis factor in rectal cancer

Background

Carcinoembryonic antigen (CEA) is the most widely used tumor marker for colorectal cancer. This study aimed to investigate the role of CEA reduction ratio after preoperative chemoradiotherapy (CRT).

Methods

We enrolled 284 patients who underwent preoperative CRT followed by radical surgical resection. Patients were divided into 3 groups: serum CEA levels before CRT (pre-CRT CEA) less than 5 ng/mL (group 1); pre-CRT CEA of 5 ng/mL or more with CEA reduction ratio of 50% or more (group 2); and pre-CRT CEA of 5 ng/mL or more with CEA reduction ratio less than 50% (group 3).

Results

The 5-year disease-free survival (DFS) rate was not different between groups 1 (71.8%) and 2 (69.4%) but was signi?cantly lower in group 3 (49.5%). CEA group, lymph node status after CRT (ypN) stage, and histologic type were independent prognostic factors for DFS on multivariate analysis.

Conclusions

CEA reduction ratio might be an independent prognostic factor for DFS in rectal cancer patients treated with preoperative CRT and radical surgery.     

Predictive utility of cyclo-oxygenase-2 expression by colon and rectal cancer

Background

Cyclo-oxygenase-2 (COX-2), an inducible enzyme expressed in areas of inflammation, is a target of interest for colorectal cancer therapy. Currently, the predictive significance of COX-2 in colorectal cancer remains unclear.

Methods

Tissue microarrays were constructed using 118 colon cancer and 85 rectal cancer specimens; 44 synchronous metastatic colon cancer and 22 rectal cancer lymph nodes were also evaluated. COX-2 expression was assessed by immunohistochemistry. Univariate analysis was used to determine the predictive significance of clinicopathologic variables. Overall survival, disease-specific survival, and disease-free survival were the main outcomes examined.

Results

COX-2 was found to be expressed in 93% of colon cancers and 87% of rectal cancers. Decreased COX-2 expression was related to decreased disease-specific survival (P = .016) and decreased disease-free survival (P = .019) in the rectal cancer cohort but not in the colon cancer cohort.

Conclusions

COX-2 expression has predictive utility for management of rectal but not colon cancer.     

Cephalosporin Induced Disulfiram-Like Reaction: A Retrospective Review of 78 Cases

Concomitant ingestion of alcohol and cephalosporin may cause a disulfiram-like reaction; however its fatal outcomes are not commonly known. We retrospectively reviewed 78 patients who had cephalosporin induced disulfiram-like reaction (CIDLR). The patients who had a negative skin test to cephalosporin prior to intravenous antibiotics were included, and those who were allergic to either alcohol or antibiotics were excluded. The average age of 78 patients was 37.8±12.2 (21–60) years. Of the 78 patients, 93.58% of the patients were males, 70.51% of the patients consumed alcohol after use of antibiotics, and 29.49% patients consumed alcohol initially, followed by intravenous antibiotics; however, no significant difference of morbidity was observed in these two groups. All patients were administered antibiotics intravenously. Five of 78 patients (6.41%) developed severe CIDLR too urgently to be rescued successfully. In conclusion, it is important for clinicians to educate patients that no alcohol should be used if one is taking cephalosporin. Also, clinicians should keep in mind that cephalosporin should not be prescribed for any alcoholics.Key words: Alcohol, Cephalosporin, Disulfiram-like reactionConsuming alcohol is so common a daily social activity that some people become addicted to it, which can lead to chronic alcoholism. For management of chronic alcoholism, disulfiram has been widely used since its approval by the US Food and Drug Administration in 1951.¹ After consumption of alcohol, it is converted into acetaldehyde by alcohol dehydrogenate and subsequently metabolized into acetate by aldehyde dehydrogenase in the body.^1,2 Disulfiram can irreversibly inhibit aldehyde dehydrogenase and prevent metabolism of acetaldehyde. The accumulated high serum level of acetaldehyde causes an unpleasant histamine-like reaction called disulfiram-like reactions.² The manifestation of CIDLR (cephalosporin-induced disulfiram-like reaction) varies from mild reaction like facial flushing, nausea or vomiting, to a severe reaction including angioedema, hypotension, shock, or death.In addition to disulfiram, some antibiotics can cause similar reaction as disulfiram-like reactions. A variety of antibiotics containing the fused β-lactam/dihydrothiazine ring system have been known as cephalosporin, and it was reported initially to adversely affect the metabolism of alcohol in 1980.^3–6 Since then several medications with similar reaction have been reported. These medications include cefamandole, cefoperazone, moxalactam, longer-acting hypoglycemics (e.g., chlorpropamide, tolbutamide), and nitrates. As the widespread abuse of alcohol and or cephalosporin, CIDLR is not rare, it is still not well understood. A delayed diagnosis and management is not rare and can cause severe conditions or even death. We retrospectively studied CIDLR cases from January 2006 to December 2011 to characterize early diagnosis, management and prevention of CIDLR.     

Acrylamide exposure impairs blood-cerebrospinal fluid barrier function

Previous studies show that chronic acrylamide exposure leads to central and peripheral neu- ropathy. However, the underlying mechanisms remained unclear. In this study, we examined the permeability of the blood-cerebrospinal fluid barrier, and its ability to secrete transthyretin and transport leptin of rats exposed to acrylamide for 7, 14, 21 or 28 days. Transthyretin levels in cerebrospinal fluid began to decline on day 7 after acrylamide exposure. The sodium fluorescein level in cerebrospinal fluid was increased on day 14 after exposure. Evans blue concentration in cerebrospinal fluid was increased and the cerebrospinal fluid/serum leptin ratio was decreased on days 21 and 28 after exposure. In comparison, the cerebrospinal fluid/serum albumin ratio was increased on day 28 after exposure. Our findings show that acrylamide exposure damages the blood-cerebrospinal fluid barrier and impairs secretory and transport functions. These changes may underlie acrylamide-induced neurotoxicity.