Clinically defined chemotherapy-associated bowel syndrome predicts severe complications and death in cancer patients

Background

Neutropenic patients are at risk of abdominal complications and yet the incidence and impact of these complications on patients’ morbidity and mortality have not been sufficiently evaluated. We aimed to assess a clinical rule for early detection of abdominal complications leading to death or transfer to intensive care in patients with chemotherapy-associated neutropenia.

Design and Methods

This observational multicenter study was carried out in seven German hematology-oncology departments. For inclusion, neutropenia of at least 5 consecutive days was required. Risk factors for “transfer to intensive care” and “death” were assessed by backward-stepwise binary logistic regression analyses. Chemotherapy-associated bowel syndrome was defined as a combination of fever (T ≥37.8 °C) and abdominal pain and/or lack of bowel movement for 72 hours or more. Five hundred and twenty-one neutropenic episodes were documented in 359 patients.

Results

The incidence of chemotherapy-associated bowel syndrome was 126/359 (35%) in first episodes of neutropenia. Transfer to intensive care occurred in 41/359 (11%) and death occurred in 17/359 (5%) first episodes. Chemotherapy-associated bowel syndrome and duration of neutropenia were identified as risk factors for transfer to intensive care (P<0.001; OR 4.753; 95% CI 2.297–9.833, and P=0.003; OR 1.061/d; 95% CI 1.021–1.103). Chemotherapy-associated bowel syndrome and mitoxantrone administration were identified as risk factors for death (P=0.005; OR 4.611; 95% CI 1.573–13.515 and P=0.026; OR 3.628; 95% CI 1.169–11.256).

Conclusions

The occurrence of chemotherapy-associated bowel syndrome has a significant impact on patients’ outcome. In future interventional clinical trials, this definition might be used as a selection criterion for early treatment of patients at risk of severe complications.     

Direct-coupling analysis of residue coevolution captures native contacts across many protein families

The similarity in the three-dimensional structures of homologous proteins imposes strong constraints on their sequence variability. It has long been suggested that the resulting correlations among amino acid compositions at different sequence positions can be exploited to infer spatial contacts within the tertiary protein structure. Crucial to this inference is the ability to disentangle direct and indirect correlations, as accomplished by the recently introduced direct-coupling analysis (DCA). Here we develop a computationally efficient implementation of DCA, which allows us to evaluate the accuracy of contact prediction by DCA for a large number of protein domains, based purely on sequence information. DCA is shown to yield a large number of correctly predicted contacts, recapitulating the global structure of the contact map for the majority of the protein domains examined. Furthermore, our analysis captures clear signals beyond intradomain residue contacts, arising, e.g., from alternative protein conformations, ligand-mediated residue couplings, and interdomain interactions in protein oligomers. Our findings suggest that contacts predicted by DCA can be used as a reliable guide to facilitate computational predictions of alternative protein conformations, protein complex formation, and even the de novo prediction of protein domain structures, contingent on the existence of a large number of homologous sequences which are being rapidly made available due to advances in genome sequencing.     

Control of peptide nanotube diameter by chemical modifications of an aromatic residue involved in a single close contact

Supramolecular self-assembly is an attractive pathway for bottom-up synthesis of novel nanomaterials. In particular, this approach allows the spontaneous formation of structures of well-defined shapes and monodisperse characteristic sizes. Because nanotechnology mainly relies on size-dependent physical phenomena, the control of monodispersity is required, but the possibility of tuning the size is also essential. For self-assembling systems, shape, size, and monodispersity are mainly settled by the chemical structure of the building block. Attempts to change the size notably by chemical modification usually end up with the loss of self-assembly. Here, we generated a library of 17 peptides forming nanotubes of monodisperse diameter ranging from 10 to 36 nm. A structural model taking into account close contacts explains how a modification of a few Å of a single aromatic residue induces a fourfold increase in nanotube diameter. The application of such a strategy is demonstrated by the formation of silica nanotubes of various diameters.     

应用ARIMA模型预测嘉峪关市痢疾发病率的可行性

目的 探讨应用ARIMA模型进行痢疾发病率预测的可行性,为甘肃省嘉峪关市痢疾防治提供参考依据。 方法 应用Eviews 5.0软件对2000-2008年嘉峪关市痢疾发病率进行模型拟合,所得到的模型对2009年1-6月痢疾发病率进行预测,并与实际值进行比较。 结果 ARIMA(2,1,3)(1,1,1)12模型拟合效果总体较好,其对2009年1-6月痢疾发病率预测值符合实际值的变化趋势。 结论 ARIMA模型可以模拟嘉峪关市痢疾的发病率,并能够预测痢疾的变动趋势,为该市痢疾防治提供一定帮助。     

Prognostic value of the Geneva prediction rule in patients in whom pulmonary embolism is ruled out

Abstract. Bertoletti L, Le Gal G, Aujesky D, Roy P‐M, Sanchez O, Verschuren F, Bounameaux H, Perrier A, Righini M. (University of Geneva, Geneva, Switzerland; Université De Saint‐Etienne, Jean Monnet, Saint‐Etienne; Brest University Hospital, Brest, France; Bern University Hospital, Bern, Switzerland; Angers University Hospital, Angers; Paris Descartes University, Paris, France; Saint‐Luc University Hospital, Bruxelles, Belgium; and University of Geneva, Geneva, Switzerland). Prognostic value of the Geneva prediction rule in patients in whom pulmonary embolism is ruled out. J Intern Med 2011; 269 : 433–440. Objectives. The prognosis of patients in whom pulmonary embolism (PE) is suspected but ruled out is poorly understood. We evaluated whether the initial assessment of clinical probability of PE could help to predict the prognosis for these patients. Design. Retrospective analysis of data obtained during a prospective multicentre management study. Setting. Six general and teaching hospitals in Belgium, France and Switzerland. Subjects. In 1334 patients in whom PE was ruled out, 3‐month mortality data were available (hospital readmission status was unknown for three patients) and clinical probability was evaluated with the revised Geneva score (RGS). Main outcome measures. Three‐month mortality and readmission rates. Results. Three‐month mortality and readmissions rates were 3% and 19%, respectively and differed significantly depending on the RGS‐determined PE probability group (P < 0.001). When compared with patients presenting with a low probability, the risk of death after 3 months was higher in cases of intermediate or high RGS‐based probability {odds ratio: 8.7 [95% confidence interval (CI): 2.7–28.5] and 22.6 (95%CI: 2.1–241.2), respectively}. The readmission risk increased with PE probability group (P < 0.001). The main causes of death were cancer, respiratory failure and cardiovascular failure. In total, 86% of patients with low RGS‐based probability were alive and had not been readmitted to hospital, whereas other patients had a twofold increased risk of death or readmission during the 3‐month follow‐up. The simplified Geneva score, calculated a posteriori, gave similar results. Conclusions. Initial assessment of clinical probability may help to stratify prognosis of patients in whom PE has been ruled out. Patients with a low probability of PE have a good prognosis. Whether patients with higher probability might benefit from more vigilant care should be evaluated.     

胎儿纤维连接蛋白检测在早产预测中临床价值的研究

目的研究胎儿纤维连接蛋白(fFN)在广州地区孕妇早产预测中的应用价值。方法随机选择2008年2月至2009年1月于中山大学孙逸仙纪念医院门诊产检或住院的中晚期妊娠孕妇124例为研究对象。取阴道后穹窿分泌物,应用胎儿纤维连接蛋白快速测试条进行检测,同时取样检测白带常规和细菌性阴道病、支原体、衣原体。记录7d、14d、34周、37周内分娩的情况,追踪妊娠结局。分析敏感性、特异性、阳性预测值、阴性预测值。结果 124例患者中,7d、14d、34周、37周内分娩分别为2、4、10、18例,其对应敏感性、特异性、阳性预测价值、阴性预测价值分别为(7d)100%、77.8%、6.9%、100%,(14d)75%、78.3%、10.3%、98.9%,(34周)50%、78.9%、17.2%、94.7%,(37周)33.3%、78.3%、20.7%、87.4%。排除18例早产后,fFN阳性者23例,其中下生殖道感染者17例,占73.9%;fFN阴性83例,其中下生殖道感染者18例,占21.7%,两者比较差异具有统计学意义(P<0.05)。对出现fFN阳性、有先兆早产症状的患者给予宫缩抑制剂及促胎肺成熟的治疗,取得良好效果。实际发生早产的孕妇18例,约占全部分娩孕妇的14.5%,其中34周内分娩的孕妇10例,占8%,除2例由于分娩时孕周不足28周外,其余分娩的患儿全部存活。结论中晚孕行fFN检测可预测早产,预测早产的阴性预测价值和近期预测价值均较高,但其阳性预测价值和远期预测价值低,其原因与生殖道感染的干扰有关,对fFN检测阴性者避免过度处理,fFN检测阳性者结合临床及时处理。在整个妊娠期间,需连续监测fFN的变化,及早发现异常,对早产进行早诊断,早治疗,减少围产儿的致病率和死亡率。     

Discriminating preictal and interictal states in patients with temporal lobe epilepsy using wavelet analysis of intracerebral EEG

Objective

Identification of consistent distinguishing features between preictal and interictal periods in the EEG is an essential step towards performing seizure prediction. We propose a novel method to separate preictal and interictal states based on the analysis of the high frequency activity of intracerebral EEGs in patients with mesial temporal lobe epilepsy.

Methods

Wavelet energy and entropy were computed in sliding window fashion from preictal and interictal epochs. A comparison of their organization in a 2 dimensional space was carried out using three features quantifying the similarities between their underlying states and a reference state. A discriminant analysis was then used in the features space to classify epochs. Performance was assessed based on sensitivity and false positive rates and validation was performed using a bootstrapping approach.

Results

Preictal and interictal epochs were discriminable in most patients on a subset of channels that were found to be close or within the seizure onset zone.

Conclusions

Preictal and interictal states were separable using measures of similarity with the reference state. Discriminability varies with frequency bands.

Significance

This method is useful to discriminate preictal from interictal states in intracerebral EEGs and could be useful for seizure prediction.     

阴道超声在诊断前置胎盘及并发症中的应用价值

目的:探讨经阴道超声(TVS)在诊断前置胎盘及并发症中的应用价值。方法:对55例临床怀疑前置胎盘孕妇TVS检查进行定位并观察是否有并发症的存在与产时及病理结果相比较。结果:TVS检查对前置胎盘的诊断与产时相比其准确率为95.8%,检查后无出血增多及感染,前置胎盘伴有并发症的大出血风险预测率73%。结论:TVS对前置胎盘的诊断安全且准确率高,其风险预测为临床提供充分的处理依据。