Validation of modified albumin-bilirubin-TNM score as a prognostic model to evaluate patients with hepatocellular carcinoma

BACKGROUND An ideal staging system for hepatocellular carcinoma(HCC) should rely on the hepatic reserve function and tumor burden. With the improvement in diagnostic and treatment strategies for HCC, in addition to recent treatment of viral hepatitis, finding a suitable assessment tool for hepatic reserve has become mandatory.AIM To validate a recently proposed modified albumin-bilirubin-TNM(mALBI-T)grade as a prognostic model for patients with HCC in Egypt.METHODS For patients diagnosed with HCC, Child-Turcotte-Pugh(CTP) score, Barcelona Clinic Liver Cancer(BCLC) stage, albumin-bilirubin(ALBI), plateltetalbumin–bilirubin(PALBI), ALBI-based BCLC, ALBI-T and mALBI-T grades were estimated. Patients were followed from time of diagnosis to date of death or date of data collection if they remained alive. Overall survival and received treatments were determined. Survival data were analyzed.RESULTS A total of 1910 patients were included(mean age, 57 years; 1575 males). At presentation, 50.6% had CTP A, 36.1% had CTP B and 13.4 % had CTP C; 12%had ALBI grade 1, 62.3% had ALBI grade 2 and 24.7% had ALBI grade 3. Overall median survival was 13 mo; survival was better in patients with ALBI 1 than in those with ALBI 2 and 3(28.6 vs 14 and 5.8 mo, respectively, P 0.001). Patients with ALBI-T grades 0 and 1 had better survival than those with ALBI-T grades 2,3, 4 and 5(P 0.001). The modified ALBI-T showed better stratification and significant improvement in prediction of survival.CONCLUSION ALBI-T grade is a superior prognostic tool that selects patients with HCC who have better liver reservoir and tumor stage. mALBI-T is a better prognostic model in patients with HCC.     

蛋白质组学及其相关技术在运动人体科学中的应用

目的:对蛋白组学及蛋白芯片技术发展现状进行综述,为该技术在运动医学中的应用提供参考资料。资料来源:应用计算机检索PubMed2003-01/2006-12期间相关蛋白组学及蛋白芯片技术方面的文章,检索词“exercise AND protein chip,protein microarray”,并限定文章语言种类为English。同时计算机检索万方数据库2003-01/2006-12期间相关蛋白组学及蛋白芯片技术方面的文章,检索词“蛋白质,运动锻炼,运动医学”,并限定文章语言种类为中文。资料选择:对资料进行初审,并查看每篇文献后的引文。纳入标准:文章所述内容应与蛋白质组学及蛋白质芯片技术的研究相关。排除标准:重复研究或Meta分析类文章。资料提炼:共收集到312篇相关文献,32篇文献符合纳入标准,排除的280篇文献为内容陈旧或重复。资料综合:蛋白组学研究已成为基因组学研究后生命科学发展的大方向之一。它研究的主要内容包括:蛋白质分离与鉴定、蛋白质功能的确定、蛋白质翻译后修饰及相互作用、各种疾病或疲劳标志物的筛选与疾病诊断、生物信息学及药物开发等方面。文章在对蛋白质组学的发展及其相关技术在运动人体科学中的应用现状进行综述的基础上,对运动人体科学未来的发展方向进行了展望。由于蛋白质组学的建立以及蛋白质芯片技术的逐步完善,对运动人体科学的研究及其发展将起到很好的促进作用。结论:未来将从分子水平上阐明运动与人体适应的分子生物学机制,研究热点将集中于从运动营养蛋白质组学、反兴奋剂的蛋白质芯片技术、运动员机能评定的蛋白质芯片研究等方面。     

Efficacy of adaptive servoventilation in treatment of complex and central sleep apnea syndromes

BACKGROUND: Complex sleep apnea syndrome (CompSAS) is recognized by the concurrence of mixed or obstructive events with central apneas, the latter predominating on exposure to continuous positive airway pressure (CPAP). Treatment of CompSAS or central sleep apnea (CSA) syndrome with adaptive servoventilation (ASV) is now an option, but no large series exist describing the application and effectiveness of ASV. METHODS: Retrospective chart review of the first 100 patients who underwent polysomnography using ASV at Mayo Clinic Sleep Center. RESULTS: ASV titration was performed for CompSAS (63%), CSA (22%), or CSA/Cheyne Stokes breathing patterns (15%). The median diagnostic sleep apnea hypopnea index (AHI) was 48 events per hour (range, 24 to 62). With CPAP, obstructive apneas decreased, but the appearance of central apneas maintained the AHI at 31 events per hour (range, 17 to 47) [p = 0.02]. With bilevel positive airway pressure (BPAP) in spontaneous mode, AHI trended toward worsening vs baseline, with a median of 75 events per hour (range, 46 to 111) [p = 0.055]. BPAP with a backup rate improved the AHI to 15 events per hour (range, 11 to 31) [p = 0.002]. Use of ASV dramatically improved the AHI to a mean of 5 events per hour (range, 1 to 11) vs baseline and vs CPAP (p < 0.0001). ASV also resulted in an increase in rapid eye movement sleep vs baseline and CPAP (18% vs 12% and 10%, respectively; p < 0.0001). Overall, 64 patients responded to the ASV treatment with a mean AHI < 10 events per hour. Of the 44 successful survey follow-up patients contacted, 32 patients reported some improvement in sleep quality. CONCLUSION: The ASV device appears to be an effective treatment of both CompSAS and CSA syndromes that are resistant to CPAP.     

A clinical decision support system using multi-layer perceptron neural network to predict quality of life in diabetes

BackgroundIn diabetes mellitus, quality of life is recognized to be an integral outcome measure of management. We have developed a neural network system which is trained to predict the measurements of quality of life in diabetes, using data generated in real life.MethodsWe developed a multi-layer perceptron neural network (NN) model, which had been trained by back propagation algorithm. Data was obtained from a cohort of 241 individuals with diabetes, which has been published. We used age, gender, weight, fasting plasma glucose as a set of inputs and predicted measures of quality of life (satisfaction, impact, social and diabetes worry).ResultsUsing the NN model, men reported significantly higher levels of satisfaction with the treatment being provided to them than women. Women had greater social and diabetes worry. The results have been considered based on the observation of the normalized system error (NSE) values of the neural network and are consistent with results obtained from traditional statistical methods.ConclusionWe have developed a prototype neural network model to measure the quality of life in diabetes, when biological or biographical variables are given as inputs.     

Distinguishing craniomorphometric characteristics and severity in metopic synostosis patients

The decision about which metopic synostosis patients should undergo surgery remains controversial. Multiple measures for radiographic severity have been developed in order to determine the optimal criteria for treatment. The aim of this study was to perform an extensive craniomorphometric analysis of patients who underwent surgery for metopic synostosis to validate and compare the various severity scales developed for this non-syndromic craniosynostosis. A comparative morphometric analysis was performed using computed tomography scans of preoperative metopic synostosis patients (n = 167) and normal controls (n = 44). Measurements included previous and newly developed metopic severity indices. Volumetric and area analyses were used to determine the degree of anterior cranial area and potential volume restrictions. Of the severity indices measured, the frontal angle, endocranial bifrontal angle (EBF), adjusted EBF (aEBF), anterior cranial fossa angle, horizontal cone angle, and bitemporal/biparietal distance ratio were significantly different in the metopic subjects relative to controls overall. However, metopic index, orbital rim angle, foramen ovale distance, and cranial volume exhibited no significant difference from controls. Only the frontal angle and aEBF correlated with the changes in anterior cranial dimensions observed in metopic synostosis. In conclusion, the frontal angle and aEBF provide the most accurate measures of severity in metopic synostosis.     

The value of flow cytometric analysis of platelet glycoprotein expression of CD34+ cells measured under conditions that prevent P- selectin-mediated binding of platelets

In the present study, we show by adhesion assays and ultrastructural studies that platelets can bind to CD34+ cells from human blood and bone marrow and that this interaction interferes with the accurate detection of endogenously expressed platelet glycoproteins (GPs). The interaction between these cells was found to be reversible, dependent on divalent cations, and mediated by P-selectin. Enzymatic characterization showed the involvement of sialic acid residues, protein(s). The demonstration of mRNA for the P-selectin glycoprotein ligand 1 (PSGL-1) in the CD34+ cells by polymerase chain reaction (PCR) analysis suggests that this molecule is present in these cells. Under conditions that prevent platelet adhesion, a small but distinct subpopulation of CD34+ cells diffusely expressed the platelet GPIIb/IIIa complex. These cells were visualized by immunochemical studies. Furthermore, synthesis of mRNA for GPIIb and GPIIIa by CD34+ cells was shown using PCR analysis. The semiquantitative PCR results show relatively higher amounts of GPIIb mRNA than of PF4 mRNA in CD34+CD41+ cells in comparison with this ratio in platelets. This finding is a strong indication that the PCR results are not caused by contaminating adhering platelets. MoAbs against GPIa GPIb alpha, GPV, P- selectin, and the alpha-chain of the vitronectin receptor did not react with CD34+ cells. The number of CD34+ cells expressing GPIIb/IIIa present in peripheral blood stem cell (PBSC) transplants was determined and was correlated with platelet recovery after intensive chemotherapy in 27 patients. The number of CD34+CD41+ cells correlated significantly better with the time of platelet recovery after PBSC transplantation (r = .83, P = .04) than did the total number of CD34+ cells (r = .55). Statistical analysis produced a threshold value for rapid platelet recovery of 0.34 x 10(6) CD34+CD41+ cells/kg. This study suggests that if performed in the presence of EDTA the flow cytometric measurement of GPIIb/IIIa on CD34+ cells provides the most accurate indication of the platelet reconstitutive capacity of the PBSC transplant.