ObjectiveTo systematically review the accuracy of T-cell receptor excision circles (TRECs) in screening newborns for severe combined immunodeficiency (SCID). MethodsThe PubMed, EMbase, Cochrane Library, Web of Science, CBM, WanFang Data and CNKI databases were electronically searched to collect the diagnostic accuracy studies related to the objects from inception to October 26, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies using the QUADAS-2 scale. Meta-analysis was performed using Stata 15.0 and Meta-Disc 1.4 software. ResultsA total of 18 studies involving 6 243 718 neonates were included. The results of meta-analysis showed that the pooled sensitivity (SEN), specificity (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnosis odds ratio (DOR) were 0.97 (95%CI 0.92 to 0.99), 1.00 (95%CI 1.00 to 1.00), 1447.05 (95%CI 528.49 to 3962.11), 0.13 (95%CI 0.08 to 0.22) and 11698.21 (95%CI 2853.44 to 47958.98), respectively. The area under the summary receiver operating characteristic curve (SROC) was 0.97. ConclusionThe application of TRECs in screening neonatal SCID has high accuracy, which is helpful for early diagnosis of SCID. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective To explore independent risk factors for 30-day mortality in critical patients with pulmonary infection and sepsis, and build a prediction model. Methods Patients diagnosed with pulmonary infection and sepsis in the MIMIC-Ⅲ database were analyzed. The CareVue database was the training cohort (n=934), and the Metavision database was the external validation cohort (n=687). A COX proportional hazards regression model was established to screen independent risk factors and draw a nomogram. We conducted internal cross-validation and external validation of the model. Using the receiver operator characteristic (ROC) curve, Calibration chart, and decision curve analysis, we detected the discrimination, calibration, and benefit of the model respectively, comparing with the SOFA scoring model. Results Age, SOFA score, white blood cell count≤4×109/L, neutrophilic granulocyte percentage (NEU%)>85%, platelet count (PLT)≤100×109/L, PLT>300×109/L, red cell distribution width >15%, blood urea nitrogen, and lactate dehydrogenase were independent risk factors. The areas under the ROC curve of the model were 0.747 (training cohort) and 0.708 (external validation cohort), respectively, which was superior to the SOFA scoring model in terms of discrimination, calibration, and benefit. Conclusion The model established in this study can accurately and effectively predict the risk of the disease mortality, and provide a visual assessment method for early identification of high-risk patients.
Objective The purpose of this study, which focuses on the number of the Cochrane Systematic Review’s (CSR) full texts, protocols and registered titles from Chinese authors, is to show the development of evidence-based medicine (EBM) and promote EBM’s further development in China. Methods On the basis of The Cochrane Library (Issue 1, 2009) and the Cochrane Collaboration (March 2009) periodicals, we performed statistical analysis of different countries that released CSR’s full texts, protocols and registered titles, as well as the time, authors and distribution of the CSR’s full texts, protocols and registered titles in China. Results The publishing rates of the CSR’s full texts, protocols and registered titles in China ranked the seventh, fifth and second, respectively. Although the number of CSR’s full texts and protocols showed an increased annual trend in China, the development of area distribution was unbalanced. Moreover, China’s published articles contained 47 Cochrane collaboration groups, without effective practice and health care groups, consumers and communication groups, and methodology and multiple stenosis groups. Conclusions The current Chinese EBM situation has a great potential in writing CSR. However, there are still many problems that need to be resolved.
ObjectiveTo investigate the quality of life (QoL) of patients with differentiated thyroid cancer (DTC) after surgery and analyze its relevant influencing factors. MethodsThe patients with DTC who underwent surgical resection in the First Affiliated Hospital of Zhengzhou University from December 1, 2021 to October 1, 2023 were investigated through the postoperative follow-up platform and follow-up management group. The postoperative QoL of DTC patients were evaluate using the Chinese version of the Thyroid Cancer Specific Quality of Life Questionnaire (THYCA-QoL) specific scale and the Chinese version of the European Organization for Research and Treatment of Cancer (EORTC) developed a quality of life questionnaire consisting of 30 items (QLQ-C30). The higher overall average score of THYCA-QoL scale, the more clinical symptoms of patients, namely the negative QoL. The higher the EORTC QLQ-C30 overall health status score, the better QoL. In addition, multiple linear regression was used to explore the risk factors affecting the postoperative specific QoL score of DTC patients. ResultsA total of 1 076 patients’ questionnaires were collected. The EORTC QLQ-C30 overall health status score of 1 076 patients was 67±22 and the THYCA-QoL overall score was 22±13. The results of multivariate linear regression analysis showed that the early postoperative period (<6 months), male, age, without postoperative lifetime medication and without postoperative iodine-131 radiotherapy had negative effects on the overall score of THYCA-QoL scale (P<0.05), meanwhile the early postoperative period (<6 months) or later (≥12 months), without postoperative lifetime medication and without postoperative iodine-131 radiotherapy had positive effects on the overall health status score of EORTC QLQ-C30 (P<0.05). ConclusionsEORTC QLQ-C30 combined with THYCA-QoL can evaluate not only the common symptoms of cancer, but also the specific symptoms of thyroid cancer after surgery. And understanding the factors affecting the QoL of patients with thyroid cancer after surgery could provide targeted and supportive treatment and nursing for discharged patients to improve the QoL of patients with thyroid cancer after surgery.
Objective To understand breast cancer 1 (BRCA1) gene and relationship between BRCA1 gene and breast cancer, and analyze its effect on clinical comprehensive therapy of breast cancer. Method The domestic and international studies relevant BRCA1 and breast cancer in recent years were reviewed and summarized. Results BRCA1, a tumor suppressor gene, its mutations caused structural changes and functional abnormalities, which were closely related to breast cancer. And the expression situation and mutation of BRCA1 were associated with the therapeutic effect. Conclusions Mutation of BRCA1 is closely related to occurrence and development of breast cancer in female. Comprehensive therapy ideas should be found in clinical therapy according to expression or mutation of BRCA1. Further research on BTCA1 is beneficial to explore gold standard for treatment of breast cancer.
ObjectiveTo detect the expressions of p27Kip1, RalA, and SPOCK1 in the cancer tissues of the elderly patients with colorectal cancer (CRC) and explore the relations between their expressions and clinical pathological characteristics as well as prognosis. MethodsThe clinicopathologic data of elderly CRC patients treated and underwent surgical resection in the Kailuan General Hospital Linxi Hospital from May 2019 to May 2022 were retrospectively collected. The immunohistochemistry was used to detect the expressions of p27Kip1, RalA, and SPOCK1 proteins in the CRC tissues and the corresponding adjacent tissues. The Kaplan-Meier method was applied to analyze the survival of CRC patients with p27Kip1, RalA, and SPOCK1 positive and negative expressions. The multivariate Cox proportional hazards regression model was applied to analyze the influencing factors of prognosis in the patients with CRC. The test level was set as α=0.05. ResultsA total of 149 elderly CRC patients were enrolled. All patients were followed up for 2 years, and 45(30.2%) cases died during the follow-up period. The positive rate of p27Kip1 protein expression in the CRC tissues was lower than that in the corresponding adjacent tissues (P<0.05), while the positive rates of RalA and SPOCK1 protein expressions were higher than those in the corresponding adjacent tissues (P<0.05). The proportions of mucinous carcinoma, TNM stages Ⅲ–Ⅳ, low differentiation, lymph node metastasis, and T staging T2–T4 in the patients with negative p27Kip1 and positive RalA and SPOCK1 expressions were higher than those in the patients with positive p27Kip1 and negative RalA and SPOCK1 expressions (P<0.05). The proportions of patients with TNM stages Ⅲ–Ⅳ, negative p27Kip1 and positive RalA and SPOCK1 expressions in the death patients were higher than those in the survival patients (P<0.05). The survival curves plotted by the Kaplan-Meier method showed that the survival curves of patients with positive expression of p27Kip1 and negative expression of RalA and SPOCK1 in the cancer tissues were significantly better than those with positive expression of p27Kip1 and negative expression of RalA and SPOCK1 (respectively: log-rank χ2=11.678, P=0.001; log-rank χ2=10.836, P=0.001; log-rank χ2=10.792, P=0.001). The multivariate Cox proportional hazards regression model analysis revealed that the negative expression of p27Kip1 [HR (95%CI)=2.807 (1.490, 5.287), P=0.001], positive expressions of RalA and SPOCK1 [HR (95%CI)=2.769 (1.493, 5.134), P=0.001; HR (95%CI)=3.075 (1.610, 5.871), P=0.001] were the risk factors for postoperative mortality in the CRC patients. ConclusionsThe results of this study suggest that the positive rate of p27Kip1 protein expression is low in the cancer tissues of elderly CRC patients, while the positive rates of RalA and SPOCK1 proteins are high. In addition, the negative expression of p27Kip1 protein and the positive expression of RalA and SPOCK1 proteins in elderly CRC tissues are associated with clinical characteristics such as poor tissue type, late TNM staging, and low degree of differentiation. Moreover, the negative expression of p27Kip1 and the positive expressions of RalA and SPOCK1 are unfavorable for prognosis of elderly CRC patients.
Objective To construct recombinant lentiviral expression vectors of porcine transforming growth factor β1 (TGF-β1) gene and transfect bone marrow mesenchymal stem cells (BMSCs) so as to provide TGF-β1 gene-modified BMSCs for bone and cartilage tissue engineering. Methods The TGF-β1 cDNA was extracted and packed into lentiviral vector, and positive clones were identified by PCR and gene sequencing, then the virus titer was determined. BMSCs were isolated frombone marrow of the 2-month-old Bama miniature pigs (weighing 15 kg), and the 2nd and 3rd generations of BMSCs wereharvested for experiments. BMSCs were then transfected by TGF-β1 recombinant lentiviral vectors (TGF-β1 vector group)respectively at multi pl icity of infection (MOI) of 10, 50, 70, 100, and 150; then the effects of transfection were detected bylaser confocal microscope and Western blot was used to determine the optimal value of MOI. BMSCs transfected by empty vector (empty vector group) and non-transfected BMSCs (non-transfection group) were used as control group. RT-PCR, immunocytochemistry, and ELISA were performed to detect the expressions of TGF-β1 mRNA, TGF-β1 protein, and collagen type II. Results Successful construction of recombinant lentiviral vectors of porcine TGF-β1 gene was identified by PCR and gene sequencing, and BMSCs were successfully transfected by TGF-β1 recombinant lentiviral vectors. Green fluorescence was observed by laser confocal microscope. Western blot showed the optimal value of MOI was 70. The expression of TGF-β1 mRNA was significantly higher in TGF-β1 vector group than in empty vector group and non-transfection group (P lt; 0.05). Immunocytochemistry results revealed positive expression of TGF-β1 protein and collagen type II in BMSCs of TGF-β1 vector group, but negative expression in empty vector group and non-transfection group. At 21 days after transfection, high expression of TGF-β1 protein still could be detected by ELISA in TGF-β1 vector group. Conclusion TGF-β1 gene can be successfully transfected into BMSCs via lentiviral vectors, and long-term stable expression of TGF-β1 protein can be observed, prompting BMSCs differentiation into chondrocytes.
Objective To explore the association between C-reactive protein (CRP) change and the prognosis of patients with stroke. Methods Individuals who were diagnosed with stroke from the 2011 China Health and Retirement Longitudinal Study (CHARLS) registry were included. The baseline characteristics in 2011, blood tests in 2011 and 2015, and follow-up data in 2018 were collected. The patients were divided into three groups according to their CPR change from 2011 to 2015, and the cut-off values of CRP change were 0 and 5 mg/L. Logistic regression analysis was performed to evaluate the association between CRP change and the risk of death after stroke. Results A total of 1065 participants diagnosed in 2011 were enrolled. There were 383 participants in the CRP decreased group (CRP change ranging from –74.30 to –0.01 mg/L), 584 participants in the CRP stable group (CRP change ranging from 0 to 4.98 mg/L), and 98 participants in the CRP increased group (CRP change ranging from 5.00 to 79.27 mg/L). By 2018, the numbers (rates) of deaths in CRP decreased group, CRP stable group, and CRP increased group were 25 (6.53%), 33 (5.65%), and 13 (13.27%), respectively, and the difference in the mortality among the three groups was statistically significant (P=0.020). Logistic regression analysis showed that the CRP change≥5 mg/L was associated with a higher risk of death after stroke [odds ratio=2.332, 95% confidence interval (1.099, 4.946), P=0.027]. Conclusions Increasing CRP levels over time may indicate an increased risk of death in stroke patients. A 4-year increase in CRP greater than 5 mg/L may be an independent predictor of the risk of long-term death in stroke patients.
ObjectiveTo systematically evaluate the potential value of C-reactive protein to albumin ratio (CAR) as an indicator of prognosis and survival in patients with pancreatic cancer. MethodsThe literatures were searched comprehensively in the PubMed, Embase, Web of Science, Cochrane Library, CBM, Wanfang, CNKI, and CQVIP databases from the establishment of the databases to May 20, 2021. The combined hazard ratio (HR) and 95% confidence interval (95%CI) were used to evaluate the correlation between the CAR and the overall survival (OS), progression-free survival (PFS), or disease-free survival (DFS) in the patients with pancreatic cancer. The Newcastle-Ottawa scale (NOS) was used to evaluate the quality of the non-randomized controlled studies, and the Stata SE 15.0 software was used for meta-analysis. ResultsA total of 2 985 patients with pancreatic cancer were included in this meta-analysis of 15 studies. The results of meta-analysis showed that the higher CAR value, the shorter OS [effect size (ES)=0.60, 95%CI (0.50, 0.69), Z=12.04, P<0.001], DFS [ES=0.63, 95%CI (0.47, 0.78), Z=3.61, P<0.001], and PFS [ES=0.41, 95%CI (0.19, 0.63), Z=7.91, P<0.001] in the patients with pancreatic cancer. The results of subgroup analysis of OS according to different countries, sample size, mean age, follow-up time, CAR cut-off value, and NOS score showed that the higher CAR value was related to the shorter OS (P<0.05). The result of linear regression analysis showed that there was no correlation between the CAR cut-off value and lnHR of OS (r2=0.947, P=0.455). Conclusion From results of this study, CAR is closely related to OS of patients, and it is expected to be used as a new reference index for monitoring and judging prognosis of patients with pancreatic cancer.