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Background: Rimegepant, a small molecule calcitonin gene-related peptide (CGRP) receptor antagonist, is indicated for acute and preventive migraine treatment in the United States and other countries. However, there is a lack of prospective real-world evidence for the use of rimegepant in Chinese migraine patients. Methods: This was a single-arm, prospective, real-world study. While taking rimegepant to treat migraine attacks as needed, eligible participants were asked to record their pain intensity, functional ability, and accompanying symptoms for a single attack at predose and 0.5, 1, 2, 24, and 48 h postdose via a digital platform. Adverse events (AEs) during the rimegepant treatment period were recorded and analysed. The percentages of participants who experienced moderate to severe pain at predose and 0.5, 1, 2, 24, and 48 h postdose were assessed. Additionally, the percentages of participants who reported better/good outcomes in terms of pain intensity, functional ability, and accompanying symptoms at 0.5, 1, 2, 24, and 48 h postdose were analysed. In addition, the total cohort (full population, FP) was stratified into a prior nonresponder (PNR) group to observe the effectiveness and safety of rimegepant for relatively refractory migraine and a rimegepant and eptinezumab (RE) group to observe the effectiveness and safety of the combination of these drugs. Results: By November 24th, 2023, 133 participants (FP, n = 133; PNR group, n = 40; RE group, n = 28) were enrolled, and 99 participants (FP, n = 99; PNR group, n = 30; RE group, n = 23) were included in the analysis. Rimegepant was effective in treating migraine in the FP and both subgroups, with a significant decreasing trend in the percentages of participants experiencing moderate to severe pain postdose (p < 0.05) and a marked increase in the percentages of participants who reported better/good outcomes in terms of pain intensity, functional ability, and accompanying symptoms at 0.5, 1, 2, 24, and 48 h postdose compared with predose. AEs were reported by 6% of participants in the FP, and all AEs were mild. Conclusions: In the real world, rimegepant is effective in the acute treatment of migraine patients in China. The low incidence rate of AEs highlighted the favourable tolerability profile of rimegepant. Trial registration: Clinicaltrials.gov NCT05709106. Retrospectively registered on 2023-02-01. [ABSTRACT FROM AUTHOR]

To explore the usefulness of neutrophil-to-lymphocyte count ratio (NLR), procalcitonin (PCT), and interleukin-6 (IL-6) for the severity assessment of bacterial sepsis. This study enrolled 100 patients with bacterial sepsis (disease group) who presented to Jinhua Central Hospital between March 2022 and March 2023 and 90 healthy individuals (control group). The patients were categorized into sepsis (64 cases), severe sepsis (18 cases), and septic shock (18 cases) groups according to the disease severity. The groups were compared in terms of the NLR, PCT, and IL-6, as well as the usefulness of these parameters, both alone and in combination, for the severity assessment of bacterial sepsis. The NLR, PCT, and IL-6 levels were significantly different among the three groups, with increasing values corresponding with disease aggravation. The area under the curve (AUC) values of the combinations of NLR, PCT, and IL-6 levels were higher than those of single markers. The sensitivity and AUC value of the combination of PCT and IL-6 levels were the highest (0.87), with a similar AUC value of the combination of NLR, PCT, and IL-6 (0.865); however, the specificity was significantly improved with the latter (0.938 vs. 0.859). NLR, PCT, and IL-6 levels are significantly increased in bacterial sepsis, and the combination of PCT, and IL-6 levels can improve the sensitivity of the evaluation ability for severe sepsis, and is more economical. [ABSTRACT FROM AUTHOR]

Background: To understand the clinical characteristics and prognosis of respiratory syncytial virus (RSV)-related encephalopathy in children. Methods: A retrospective analysis of the data of children who were diagnosed with RSV-related encephalopathy and admitted to the paediatric intensive care unit (PICU) of Beijing Children's Hospital between November 2016 and November 2023 was performed. Results: Four hundred and sixty-four children with RSV infection were treated in the PICU, and eight of these patients (1.7%) were diagnosed with RSV-related encephalopathy. The mean age of the patients was 24.89 (5.92 ∼ 36.86) months. Two patients had underlying diseases. The time from the onset of illness to impaired consciousness was 3 (1.88–3.75) days. Five patients had convulsions, and three patients had an epileptic status. The serum procalcitonin (PCT) level was 1.63 (0.24, 39.85) ng/ml for the eight patients, and the cerebrospinal fluid (CSF) protein level was 232 (163 ∼ 848) g/L. Among the 8 patients, four patients underwent electroencephalogram (EEG) monitoring or examination. One patient showed continuous low-voltage, nonresponsive activity, and another patient displayed persistent slow waves, the remaining two patients had negative results. One patient had a combination of acute necrotizing encephalopathy (ANE) and acute encephalopathy with biphasic seizures and late reduced diffusion (AESD). Additionally, one patient had ANE, and another had acute brain swelling (ABS). One patient died in the hospital, and the other seven patients were discharged with improvement. Routine follow-up was conducted for 4.58(0.5 ∼ 6.50) years, and all patients fully recovered. Conclusions: RSV-related encephalopathy could have varying clinical manifestations, and some types, such as ANE and ABS, are dangerous and can lead to death. [ABSTRACT FROM AUTHOR]

Background: Currently, the treatment and prevention of migraine remain highly challenging. Mendelian randomization (MR) has been widely used to explore novel therapeutic targets. Therefore, we performed a systematic druggable genome-wide MR to explore the potential therapeutic targets for migraine. Methods: We obtained data on druggable genes and screened for genes within brain expression quantitative trait locis (eQTLs) and blood eQTLs, which were then subjected to two-sample MR analysis and colocalization analysis with migraine genome-wide association studies data to identify genes highly associated with migraine. In addition, phenome-wide research, enrichment analysis, protein network construction, drug prediction, and molecular docking were performed to provide valuable guidance for the development of more effective and targeted therapeutic drugs. Results: We identified 21 druggable genes significantly associated with migraine (BRPF3, CBFB, CDK4, CHD4, DDIT4, EP300, EPHA5, FGFRL1, FXN, HMGCR, HVCN1, KCNK5, MRGPRE, NLGN2, NR1D1, PLXNB1, TGFB1, TGFB3, THRA, TLN1 and TP53), two of which were significant in both blood and brain (HMGCR and TGFB3). The results of phenome-wide research showed that HMGCR was highly correlated with low-density lipoprotein, and TGFB3 was primarily associated with insulin-like growth factor 1 levels. Conclusions: This study utilized MR and colocalization analysis to identify 21 potential drug targets for migraine, two of which were significant in both blood and brain. These findings provide promising leads for more effective migraine treatments, potentially reducing drug development costs. [ABSTRACT FROM AUTHOR]

Introduction: Sepsis, a syndrome of organ dysfunction caused by an unregulated host response to infection. This study aimed to develop a novel sepsis diagnostic model of hematological parameters and evaluate its effectiveness in the early identification and prognosis of sepsis in emergency departments. Methods: A retrospective study was conducted in Emergency Department. Cell population data parameters related to monocytes and neutrophils were obtained using the Mindary BC‐6800 plus hematology analyzer. Receiver operating characteristic (ROC) curve analysis, logistic regression analysis was performed to assess the performance of the parameters and establish a diagnostic and prognostic model of sepsis, which was then verified with a validation cohort. Results: Mon_XW exhibited the best diagnostic performance (area under the ROC curve [AUC] = 0.848, 95% confidence interval [CI]: 0.810–0.885, p < 0.001), followed by Neu_Y and Neu_YW (AUC = 0.777 95% CI: 0.730–0.824, p < 0.001). Logistic regression analysis identified Mon_XW and Neu_Y as independent predictors, which were used to establish a diagnostic model named hematological parameter for sepsis (HPS). HPS demonstrated the best diagnostic performance with an AUC of 0.862 (95% CI: 0.826–0.898, p < 0.001), sensitivity of 70.0%, and specificity of 87.1%, compared to C‐reactive protein (CRP) and procalcitonin (PCT). The validation cohort also found that the positive predictive value of HPS was 70.4% and the negative predictive value was 92.2%. Conclusion: The developed HPS model showed promising diagnostic efficacy for sepsis in the emergency department, which outperformed CRP and PCT in terms of sensitivity and specificity. By enabling early identification and prognosis of sepsis, that contributes to reducing sepsis‐related mortality. [ABSTRACT FROM AUTHOR]

Background: Azvudine has been approved in China for the treatment of COVID-19 patients. Previous studies have suggested a correlation between high levels of lactate dehydrogenase (LDH) and the severity of COVID-19. However, the impact of LDH levels in COVID-19 patients receiving Azvudine treatment remains unclear. Methods: In this retrospective cohort study, we analyzed the data of 351 hospitalized COVID-19 patients who were consecutively treated with Azvudine, with or without high LDH levels. The clinical features, treatment strategies and prognosis data were collected and analyzed. Results: Among the 351 hospitalized patients with COVID-19 treated with Azvudine (119 with high-LDH levels), the median age was 69 years (range 58-78), and 213 (60.7%) were male. Common symptoms included cough (86.0%), expectoration (73.5%), fever (69.8%), polypnea (47.6%) and poor appetite (46.4%). Patients with high LDH levels exhibited significantly elevated leucocyte and neutrophil counts, elevated level of myocardial enzymes, as well as higher levels of inflammatory markers such as interleukin-6, interleukin-10, procalcitonin, C reactive protein, ferritin, and prolonged erythrocyte sedimentation rate upon admission. COVID-19 patients with high-LDH levels had higher rates of corticosteroid therapy, non-invasive and invasive mechanical ventilation, worsened and death (2.5% vs. 0%). The Cox proportional hazard model demonstrated that high LDH levels (adjusted hazard ratio = 5.27; 95% confidence interval: 1.19, 14.50) were associated with a more unfavorable composite disease progression outcome among COVID-19 patients treated with Azvudine, after accounting for potential confounding variables. Conclusion: High-LDH levels predict a worse composite disease progression outcome in COVID-19 patients treated with Azvudine. [ABSTRACT FROM AUTHOR]

The plasma procalcitonin (PCT) concentration and red blood cell distribution (RDW) value after severe burns can be used as prognostic indicators, but at present, it is difficult to give consideration to sensitivity and specificity in diagnosing the prognosis of severe burns with a single indicator. This study analysed the diagnostic value of plasma PCT concentration and RDW value at admission on the prognosis of severe burn patients to improve its sensitivity and specificity. A total of 205 patients with severe burns who were treated in the First Affiliated Hospital of Anhui Medical University from November 2017 to November 2022 were retrospectively analysed. The optimal cut‐off values of plasma PCT concentration and RDW were analysed and counted through the subject curve (ROC curve). According to the cut‐off value, patients were divided into high PCT group and low PCT group, high RDW group and low RDW group. The independent risk factors of severe burns were analysed by single‐factor and multiple‐factor COX regression. Kaplan–Meier survival was used to analyse the mortality of high PCT group and low PCT group, high RDW group and low RDW group. The area under the curve of plasma PCT concentration and RDW value at admission was 0.761 (95% CI, 0.662–0.860, P <.001), 0.687 (95% CI, 0.554–0.820, P =.003) respectively, and the optimal cut‐off values of serum PCT concentration and RDW were 2.775 ng/mL and 14.55% respectively. Cox regression analysis found that age, TBSA, and RDW were independent risk factors for mortality within 90 days after severe burns. Kaplan–Meier survival analysis showed that there was a significant difference in the 90‐day mortality rate of severe burns between the PCT ≥ 2.775 ng/mL group and the PCT < 2.775 ng/mL group (log‐rank: 24.162; P <.001), with the mortality rate of 36.84% versus 5.49%, respectively. The 90‐day mortality rate of severe burns was significantly different between the RDW ≥ 14.55% group and the RDW < 14.55% group (log‐rank: 14.404; P <.001), with the mortality rate of 44% versus 12.2% respectively. The plasma PCT concentration and RDW value at admission are both of diagnostic value for the 90‐day mortality of severe burns, but the plasma PCT concentration has higher sensitivity and the RDW value has higher specificity. Age, TBSA, and RDW were independent risk factors for severe burns, and then plasma PCT concentration was not independent risk factors. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the computed tomography (CT) findings of SARs-CoV-2 Omicron variant in relation to respiratory viral loads determined by cycle threshold values in reverse-transcription polymerase chain reaction (RT-PCR).Materials and Methods: From October 2022 to November 2022, 74 hospitalized patients with Omicron were included in this retrospective study. The radiological features, CT involvement scores in relation to the respiratory viral load, and factors associated with imaging progression (IP) after the RT-PCR results turned negative were analyzed.Results: The most common CT patterns of Omicron were multiple round-like or patchy ground-glass opacity (GGO) or mixed GGO in the peripheral or diffuse areas. The grading of CT involvement scores exhibited an inverse pattern compared to viral loads from day 1 to day 8 and from day 13 to day 20 after diagnosis. Among the 65 patients with complete imaging data, 45 (69.23%) showed IP with clinical warning indicators of disease exacerbation negative in 34 and positive in 11. Patients with IP were older than those with non-IP (NIP); the erythrocyte sedimentation rates, procalcitonin levels, and D-dimer levels on admission of patients with IP were significantly higher than those of patients with NIP, whereas the immunoglobulin (Ig) G antibody level on admission and CT involvement score on initial CT of patients with IP were significantly lower than those of patients with NIP (all P < 0.05).Conclusion: For patients with Omicron, the IP of lung abnormalities is common when the viral load decreases. Under these circumstances, paying attention to clinical warming indicators of disease progression may contribute to better patient management and the mitigation of severe pneumonia. [ABSTRACT FROM AUTHOR]

Background: The phase 3 randomized PERSIST study demonstrated the efficacy and tolerability of galcanezumab, a humanized anti-calcitonin gene-related peptide (CGRP) monoclonal antibody for prevention of episodic migraines. We present findings from the open-label extension (OLE) of PERSIST, which evaluated the long-term efficacy and safety of galcanezumab in patients from China, India, and Russia. Methods: Patients completing the 3-month double-blind period of PERSIST were eligible for the 3-month OLE. Patients previously randomized to galcanezumab (GMB/GMB group) continued to receive galcanezumab 120 mg at all three visits during the OLE whereas patients randomized to placebo received a 240 mg loading dose of galcanezumab and then two 120 mg doses (PBO/GMB group). The primary outcome was the mean change (from double-blind baseline) in the number of monthly migraine headache days (MHDs) to month 6. Other endpoints included percent reduction in monthly MHDs from double-blind baseline to month 6, functional outcomes, safety and tolerability. Results: Overall, 99% of patients completing the double-blind period entered the OLE, and 96% completed through month 6. Patients in the GMB/GMB group achieved continued improvements in efficacy, with the reduction from baseline in the mean number of monthly MHDs, and slightly increasing from 4.01 days at the end of the double-blind period to 4.62 at the end of the OLE. Of patients who were ≥ 50% responders to galcanezumab at month 3, 66% maintained this response through to month 6. Patients in the PBO/GMB group experienced a rapid reduction in the number of monthly MHDs after initiation of galcanezumab, with a mean reduction from baseline of 4.56 days by month 6. The long-term benefits of galcanezumab were also supported by improvements in other efficacy and functional endpoints. All safety findings were consistent with the known long-term safety profile of galcanezumab; no patients experienced a treatment-related serious adverse event. Conclusions: Galcanezumab was efficacious and well-tolerated in patients with episodic migraine from China, India and Russia, for up to 6 months. Trial registration: ClinicalTrisABSTRACT_pals.gov NCT03963232, registered May 24, 2019. [ABSTRACT FROM AUTHOR]

Objective: To investigate the application of heparin-binding protein along with albumin (HBP+ALB) in evaluating the severity of community-acquired pneumonia (CAP) and compares it with single HBP, white blood cells (WBCs), C-reactive protein (CRP), and procalcitonin (PCT). Methods: A total of 226 patients with CAP admitted to the Emergency Department of Zhujiang Hospital, Southern Medical University, Guangdong, China, between March 1, 2021, and March 1, 2022, were enrolled. The patients were grouped into two groups: mild CAP (n=175) and severe CAP (sCAP)(n=51). Patients' characteristics and laboratory data were obtained. ROC curve and the value of the area under the curve (AUC) were used to evaluate the predictive values of HBP, ALB, WBC, CRP, and PCT. Results: WBC count, CRP, PCT, HBP, creatinine, and D-dimer were higher in the sCAP group, while ALB was lower in the sCAP group (P<0.05) than those in the mild CAP group. The AUCs of WBC, CRP, PCT, HBP, and HBP+ALB were 0.633 (95% CI: 0.545-0.722, P<0.05), 0.635 (95% CI: 0.542-0.729, P<0.05), 0.705 (95% CI: 0.619-0.791, P<0.05), 0.809 (95% CI: 0.736-0.883, P<0.05), and 0.889 (95% CI: 0.842-0.936, P<0.05), respectively. Conclusions: HBP+ALB has a higher predictive value than single HBP, PCT, CRP and WBC used alone for the early assessment of CAP. [ABSTRACT FROM AUTHOR]

Background: The treatment of hypertensive nephropathy has remained unchanged for many years. Salvianolate is the main active component extracted from Salvia Miltiorrhiza. The current studies seem to suggest that salvianolate has a certain therapeutic effect on hypertensive nephropathy. Objective: The purpose of this meta-analysis is to evaluate the effect and safety of salvianolate on hypertensive nephropathy under the condition of standardized use of valsartan. Methods: We conducted a systematic search (unlimited initial date to 22 October 2022) in PubMed, Web of Science, the Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang Data knowledge service platform, China Science and Technology Journal Database, China Biomedical Literature Service System. Searching for the study of salvianolate on hypertensive nephropathy. Two reviewers independently included the study that met the inclusion criteria, and extracted data, evaluated the quality of the study. We use RevMan5.4 and stata15 software for this meta-analysis. We use GRADEprofiler 3.2.2 software for evidence quality assessment. Results: This meta-analysis included seven studies (525 patients). Compared with the use of valsartan combined with conventional treatment, salvianolate combined with valsartan and conventional treatment can further improve the efficacy (RR = 1.28, 95%CI:1.17 to 1.39), reduce blood pressure [systolic blood pressure (MD = 8.98, 95% CI:-12.38 to -5.59); diastolic blood pressure (MD = 5.74, 95%CI:-7.20 to -4.29)], serum creatinine (MD = -17.32, 95%CI:-20.55 to -14.10), blood urea nitrogen (MD = -1.89, 95%CI:-3.76 to -0.01), urine microalbumin (MD = -23.90, 95%CI: -26.54 to -21.26), and urinary protein to creatinine ratio (MD = -1.92, 95%CI: -2.15 to -1.69), cystatin C (MD = -1.04, 95%CI: -1.63 to -0.45) and increase calcitonin gene-related peptide (MD = 18.68, 95%CI:12.89 to 24.46) without increasing adverse reactions (RR = 2.20, 95%CI:0.52 to 9.40). But it has no additional effect on endothelin-1 and malondialdehyde. The quality of evidence ranged from moderate to very low. Conclusion: This meta-analysis shows that the salvianolate can further improve renal function of hypertensive nephropathy patients based on valsartan was used. Therefore, salvianolate can be used as a clinical supplement for hypertensive nephropathy. However, the quality of the evidence is not high due to the uneven quality of the included studies and the insufficient sample size, we still need a lot of large sample size studies with more perfect design to confirm these results. [ABSTRACT FROM AUTHOR]

To explore the diagnostic value of combined detection of serum amyloid A (SAA), C-reactive protein (CRP) and procalcitonin (PCT) in children with bacteria or non-bacterial respiratory tract infection. 200 children with respiratory tract infections diagnosed in our hospital were included in the study. According to the results of the aetiological examination, they were divided into bacterial infection group and non-bacterial infection group. At the same time, 100 healthy children admitted to the hospital for physical examination during the same period were selected as the healthy subjects control group. Changes in serum SAA, PCT and CRP in three groups were compared. Comparison of a positive rate of the single index and combined detection were performed. Children with bacterial infections were treated with conventional antibiotics. The changes in serum SAA, PCT and CRP in the infection group before and after treatment were compared. The efficacy of SAA, PCT and CRP alone and in combination was compared. The serum SAA, PCT and CRP levels in the bacterial infection group were higher than those in the non-bacterial infection group and healthy children, and the differences were statistically significant. The positive detection rates and combined detection rates of serum SAA, PCT and CRP in the bacterial infection group were higher than those in the non-bacterial infection group and the healthy subject's control group. After conventional antibiotic treatment, serum SAA, PCT and CR levels in children with bacterial infection were significantly decreased. The combined detection based on SAA, CRP and PCT can effectively identify and diagnose respiratory tract infection in children, providing a certain reference for the promotion of the diagnostic scheme. Serum SAA, PCT and CRP were highly expressed in children with respiratory tract infection, and the expression level was the highest in children with bacterial pneumonia. The combined detection of serum SAA, CRP and PCT indicators have higher diagnostic efficiency and can effectively make a differential diagnosis of respiratory tract infection in children. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

To identify laboratory diagnostic indicators of hepatic encephalopathy (HE), the present study established a HE diagnostic model to explore the diagnostic value of serum homocysteine, lactic acid, procalcitonin, and bile acid levels in HE identification. 371 patients with liver cirrhosis were selected as research objects, who were admitted to the Department of Hepatic Diseases, Affiliated Hospital of Northwest Minzu University from August 2019 to August 2020. The Spearman correlation results indicated that between lactic acid, procalcitonin, bile acid, serum homocysteine, and HE, the coefficients were -0.15, 0.41, 0.29, and -0.19, respectively. Univariate and multivariate analysis methods were adopted for inpatient analysis to identify the influencing factors of HE occurrence, and the diagnosis of the HE identification model was subsequently constructed. The univariate logistic regression showed that risk of developing HE increased as bile acid level (P = 0.00434) and serum homocysteine (P = 0.058) increased. Multivariate logistic regression diagnostic model of bile acid level and serum homocysteine revealed that the AUC value of the area under the ROC curve was 0.7201, indicating that the diagnostic model produced a satisfactory evaluation effect. The model formula referred logistic P = − 2.4544 + 0.0117 bile acid levels + 0.0198 serum homocysteine. In this study, the HE diagnostic model was established using logistic regression analysis, which could benefit patients in early HE differential diagnosis. Particularly, combined detection of serum homocysteine and bile acid levels was considered to be more significant. [ABSTRACT FROM AUTHOR]

This study aimed to analyze the clinical significance of serum ferritin, procalcitonin (PCT), and C-reactive protein (CRP) in patients with hemorrhagic fever with renal syndrome (HFRS). The demographical, clinical, and laboratory data of 373 patients with HFRS in northeastern China were retrospectively analyzed. The levels of serum ferritin and PCT in severe patients (n = 108) were significantly higher than those in mild patients (n = 265, p < 0.001) and associated with HFRS severity. The area under the receiver operating characteristic curve (AUC) values of serum ferritin and PCT for predicting the severity of HFRS were 0.732 (95% CI 0.678–0.786, p < 0.001) and 0.824 (95% CI 0.773–0.875, p < 0.001), respectively, showing sensitivity and specificity of 0.75 and 0.88 for serum ferritin, and 0.76 and 0.60 for PCT. The CRP level in HFRS with bacterial co-infection (n = 115) was higher than that without bacterial co-infection (n = 258, p < 0.001). The AUC value of CRP for predicting bacterial co-infection was 0.588 (95% CI 0.525–0.652, p < 0.001), showing sensitivity and specificity of 0.43 and 0.76, respectively. The serum ferritin level in non-survivors (n = 14) was significantly higher than in survivors (n = 359, p < 0.001). The AUC value of serum ferritin for predicting mortality was 0.853 (95% CI 0.774–0.933, p < 0.001), showing sensitivity and specificity of 0.933 and 0.739. Serum ferritin and PCT have a robust association with HFRS severity and mortality, which may be promising predictors, and CRP is an effective biomarker to assess bacterial co-infection in HFRS. [ABSTRACT FROM AUTHOR]

Objective. To examine the clinical efficacy of budesonide/glycopyrronium bromide/formoterol (Breztri Aerosphere) as an adjunct to acute respiratory distress syndrome (ARDS). Methods. A prospective study enrolled 120 patients with pulmonary endogenous ARDS admitted to the Department of Critical Care Medicine at the Fourth Hospital of Baotou from January 2017 to January 2020, and all enrollments were assigned (1 : 1) to receive conventional treatment (control group) or Breztri Aerosphere (study group). Results. Breztri Aerosphere was associated with a significantly higher total efficacy versus conventional treatment. Breztri Aerosphere resulted in significantly lower acute physiology and chronic health evaluation scoring system (APACHE II) scores and Murray lung injury scores versus conventional treatment. Both groups saw an increase in the partial pressure of carbon dioxide (PCO2), partial pressure of oxygen (PO2), and oxygen saturation (SaO2) after treatment, with higher levels seen in patients given Breztri Aerosphere. After treatment, systemic vascular resistance (SVR) in both groups rose markedly, with greater elevation witnessed in the study group. The patients given Breztri Aerosphere showed significantly lower levels of pulmonary vascular resistance (PVR), mean pulmonary arterial pressure (MAPA), pulmonary artery wedge pressure (PAWP), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-α), and procalcitonin (PCT) versus those receiving conventional treatment. The patients experienced shorter mechanical ventilation time and intensive care unit (ICU) time after treatment of Breztri Aerosphere versus conventional treatment. Conclusion. Adjuvant therapy with Breztri Aerosphere in ARDS can significantly lower APACHE II scores and Murray lung injury scores, improve blood gas indexes and pulmonary circulation function indexes, and shorten mechanical ventilation time and ICU time, which may be attributed to its improvement of organism inflammation status and reduction of inflammatory factors. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) first appeared in China in December 2019, and has become a global pandemic. Because the clinical progression of the disease is highly variable, better prediction of prognosis and mortality is important. In the present study, we investigated the role of procalcitonin/albumin ratio (PAR) as a new biomarker in predicting mortality in patients with COVID-19 infection. Methods: In this study, patients with COVID-19 diagnosis were enrolled from Sakarya Yenikent State Hospital and Ayancık State Hospital between 09.11.2020 and 04.05.2021. The demographic characteristics, biochemical and hematological parameters such as age, gender, length of hospital stay, and comorbidities of the patients were collected retrospectively from medical records. Results: Of the 105 patients, 51 were mild and 54 were critically ill. Between mild and critical cases, age, lymphocyte count, red cell distribution width, neutrophile count, mean corpuscular volume (MCV), monocyte count, albumin, C-reactive protein, ferritin, procalcitonin, D-dimer, and PAR were statistically different (p<0.001 for all). All patients in the critical group and only 2% of the mild group died. PAR showed the largest area under the curve (0.949) for the prediction of mortality (p<0.001). Conclusion: We report that PAR, a simple, cheap, and easily accessible biomarker, can be used to predict the prognosis in patients with COVID-19 infection. [ABSTRACT FROM AUTHOR]

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Objective. Respiratory failure is the leading cause of mortality in COVID-19 patients, characterized by a generalized disbalance of inflammation. The aim of this study was to investigate the relationship between immune-inflammatory index and mortality in PSI IV-V patients with COVID-19. Methods. We retrospectively reviewed the medical records of COVID-19 patients from Feb. to Apr. 2020 in the Zhongfa Xincheng Branch of Tongji Hospital, Wuhan, China. Patients who presented high severity of COVID-19-related pneumonia were enrolled for further analysis according to the Pneumonia Severity Index (PSI) tool. Results. A total of 101 patients diagnosed with COVID-19 were identified at initial research. The survival analysis revealed that mortality of the PSI IV-V cohort was significantly higher than the PSI I-III group (p = 0.0003). The overall mortality in PSI IV-V patients was 32.1% (9/28). The fatal cases of the PSI IV-V group had a higher level of procalcitonin (p = 0.022) and neutrophil-to-lymphocyte ratio (p = 0.033) compared with the survivors. Procalcitonin was the most sensitive predictor of mortality for the severe COVID-19 population with area under receiver operating characteristic curve of 0.78, higher than the neutrophil-to-lymphocyte ratio (0.75) and total lymphocyte (0.68) and neutrophil (0.67) counts. Conclusion. Procalcitonin and neutrophil-to-lymphocyte ratio may potentially be effective predictors for mortality in PSI IV-V patients with COVID-19. Increased procalcitonin and neutrophil-to-lymphocyte ratio were associated with greater risk of mortality. [ABSTRACT FROM AUTHOR]

Background: This study aims to explore the correlation between procalcitonin (PCT), 25-hydroxyvitamin D3 (25(OH)D), pentraxin-3 (PTX-3), amylase (AMS) levels and severity of diabetic ketoacidosis complicated by pancreatitis. Methods: A retrospective analysis of 198 patients with diabetic ketoacidosis admitted to our hospital from January 2015 to February 2020 were included. According to whether the patients with pancreatitis, subjects were divided into diabetic ketoacidosis with pancreatitis (DKA-AP) group and diabetic ketoacidosis (DKA) group. Healthy controls admitted to the hospital for physical examinations were included as a control group. Clinical outcomes were collected. Results: On the first day after admission, the levels of PCT, PTX-3, and AMS in DKA-AP group were significantly higher than those in DKA group and control group, and 25(OH)D levels in DKA-AP group were lower than those in DKA group and control group. PCT, PTX-3, and AMS levels were significantly increased, and 25(OH)D levels were decreased in the DKA group compared with the control group. Furthermore, the levels of PCT, 25(OH)D, PTX-3, and AMS in the DKA-AP group were correlated with the disease severity of of diabetic ketoacidosis complicated by pancreatitis. The levels of PCT, PTX-3, and AMS in the DKA-AP group on day 1 were significantly higher and 25(OH)D levels were significantly lower than those on days 3–7 after admission. The levels of PCT, PTX-3, and AMS in the DKA group on day 1 were significantly higher and 25(OH)D levels were significantly lower than those on days 2–7 after admission. The levels of these indicators returned to normal levels on day 3 or day 7 in DKA or DKA-AP group, respectively. PCT, PTX-3, and AMS levels in the DKA-AP group were significantly increased, while 25(OH)D levels in the DKA-AP group were decreased compared with DKA group on days 1–6 after admission. The duration of hospital stay, patients of ICU care, duration of ICU stay, and cost in DKA-AP group were all higher than those in the DKA group. Conclusion: Blood levels of PCT, 25(OH)D, PTX-3, and AMS were correlated with diabetic ketoacidosis complicated by pancreatitis, and have certain application value in assessment of the disease severity. [ABSTRACT FROM AUTHOR]

Background Patients with coronavirus disease 2019 (COVID-19) experience a wide clinical spectrum, with over 2% developing fatal outcome. The prognostic factors for fatal outcome remain sparsely investigated. Methods A retrospective cohort study was performed in a cohort of patients with confirmed COVID-19 in one designated hospital in Wuhan, China, from 17 January–5 March 2020. The laboratory parameters and a panel of cytokines were consecutively evaluated until patients' discharge or death. The laboratory features that could be used to predict fatal outcome were identified. Results Consecutively collected data on 55 laboratory parameters and cytokines from 642 patients with COVID-19 were profiled along the entire disease course, based on which 3 clinical stages (acute stage, days 1–9; critical stage, days 10–15; and convalescence stage, day 15 to observation end) were determined. Laboratory findings based on 75 deceased and 357 discharged patients revealed that, at the acute stage, fatality could be predicted by older age and abnormal lactate dehydrogenase (LDH), urea, lymphocyte count, and procalcitonin (PCT) level. At the critical stage, the fatal outcome could be predicted by age and abnormal PCT, LDH, cholinesterase, lymphocyte count, and monocyte percentage. Interleukin 6 (IL-6) was remarkably elevated, with fatal cases having a more robust production than discharged cases across the whole observation period. LDH, PCT, lymphocytes, and IL-6 were considered highly important prognostic factors for COVID-19–related death. Conclusions The identification of predictors that were routinely tested might allow early identification of patients at high risk of death for early aggressive intervention. [ABSTRACT FROM AUTHOR]

Objective: To provide reference for prevention and control of SARS-CoV-2 infection through analysis of related factors of patients diagnosed and suspected with COVID-19. Methods: Data of 40 confirmed cases and 24 suspected cases of COVID-19 admitted from January to February 2020 in the Second People's Hospital of Jingzhou City were collected, and the differences in indicators and related factors between the confirmed and suspected groups were compared. Results: There was no significant difference in patients age and APACHE II score between the two groups (P> 0.05). Compared with the suspected group, WBC and Neut decreased in the diagnosed group, and the difference was statistically significant (p <0.05). PCT, Lymph, hs-CRP, ALT, IL-6, LDH, CK and other indicators including; gender, fever, dry cough, limb soreness, fatigue, underlying disease, were not statistically significant (p> 0.05). There was no significant difference in the factors such as single lung lobe lesions and multiple lobe lesions (P> 0.05). Conclusion: There is no significant difference between the common COVID-19 patients and the suspected patients in terms of population characteristics, clinical manifestations and most laboratory tests. [ABSTRACT FROM AUTHOR]

Background: This study is aimed at reviewing the published literature on the prognostic role of serum procalcitonin (PCT) in COVID-19 cases. Data retrieval: We systematically reviewed the literature available on PubMed, MEDLINE, LitCovid NLM, and WHO: to assess the utility of PCT in prognosis of coronavirus disease. Scrutiny for eligible studies comprising articles that have evaluated the prognostic utility of PCT and data compilation was undertaken by two separate investigators. Original articles in human subjects reporting the prognostic role of PCT in adult COVID-19 patients were included. The Quality in Prognosis Studies (QUIPS) tool was utilized to assess the strength of evidence. Results were reported as narrative syntheses. Results: Out of the total 426 citations, 52 articles passed through screening. The quality of evidence and methodology of included studies was overall acceptable. The total sample size of the studies comprised of 15,296 COVID-19-positive subjects. Majority of the studies were from China, i.e., 40 (77%). The PCT cut-off utilized was 0.05 ng/mL by 18 (35%) studies, followed by 0.5 ng/mL by 9 (17.5%). Eighty five percent (n = 44) studies reported statistically significant association (p value < 0.05) between PCT and severity. Conclusion: Procalcitonin appears as a promising prognostic biomarker of COVID-19 progression in conjunction with the clinical context. [ABSTRACT FROM AUTHOR]

What is known and objective: Since the December 2019 discovery of several cases of coronavirus disease 2019 (COVID‐19) in Wuhan, China, the infection has spread worldwide. Our aim is to report on the clinical characteristics, treatments and prognoses of COVID‐19. Methods: This was a retrospective, single‐centre, case series of 136 patients who were diagnosed with COVID‐19 at Wuhan Third Hospital in Wuhan, China, between 28 January 2020 and 12 February 2020. The clinical characteristics, laboratory tests, treatment features and prognoses were summarized. Results and discussion: The 136 patients were divided into a moderate (M) group (n = 103, 75.7%) and a severe and critical (SC) group (n = 33, 24.3%). There were significant differences in the incidences of concomitant chronic medical illnesses (eg, hypertension, diabetes and cardiovascular disease), fever, dry cough and dyspnoea among the two groups (P <.05). Compared with those in the M group, lymphocyte count (LYM) decreased significantly in the SC group, while the serum levels of C‐reactive protein (CRP), procalcitonin (PCT), creatinine (Cre), D‐dimer, lactic dehydrogenase (LDH), myoglobin (MB) and troponin I (cTnl) increased significantly in the SC group (P <.05). The main therapeutic drugs were antivirals, antibiotics, glucocorticoids, immunomodulators, traditional Chinese medicine preparations and symptomatic support drugs. There were significant differences in the incidences of shock, myocardial injury, acute respiratory distress syndrome (ARDS) and renal injury among the two groups (P <.05). Among the 136 patients, 99 (72.7%) were cured, 14 (10.3%) were transferred to other hospital and 23 (16.9%) died. What is new and conclusion: Elderly patients with chronic diseases are more likely to develop severe or critical COVID‐19 with multiple organ damage or systemic injuries. The improvement of LYM and CRP may be associated with the prognoses of COVID‐19. The combined use of three or more antiviral drugs is to be avoided. The combination of broad‐spectrum antibacterial drugs is not recommended and the risk of drug‐induced liver injury should be monitored. Throughout a patient's hospitalization, their treatment plan should be evaluated and adjusted according to their vital signs, clinical symptoms, laboratory tests and imaging changes. Patients should receive effective psychological counselling. [ABSTRACT FROM AUTHOR]

Purpose. The aim of this work was to analyze clinical features and laboratory findings of children with adenovirus pneumonia and guide clinical diagnosis, treatment, and assessment of disease severity. Material and Methods. Retrospective analysis of clinical data of 285 children with adenoviral pneumonia who were hospitalized in Wuhan Children's Hospital from December 2018 to October 2019. According to the assessment criteria for severe pneumonia, it was divided into the severe group (92 cases) and the nonsevere group (193 cases). Collected clinical manifestations, complications, and laboratory test indicators in two groups of children and conducted all statistical analyses. Results. The risk of fever and wheezing was significantly higher in the severe group than in the nonsevere group. The difference was statistically significant (P < 0.05). The risk of complications in the severe group was significantly higher than that in the nonsevere group. The difference was statistically significant (P < 0.05). The levels of AST, LDH-L, PCT, ferritin, and D-dimer in the severe group were significantly higher than those in the nonsevere group. The difference was statistically significant (P < 0.05). Conclusion. Children with severe adenovirus pneumonia have severe clinical manifestations and many complications. AST, LDH-L, PCT, ferritin, and D-dimer levels have important clinical implications for assessing disease severity. [ABSTRACT FROM AUTHOR]

BACKGROUND: Long-acting antimicrobial material is a new polymer activator of organosilicon quaternary ammonium salt and has obvious advantages in anti-infection. OBJECTIVE: To investigate the effects of Jieyoushen, a long-acting antimicrobial material, on pathogenic distribution and serum inflammatory factors in patients with indwelling catheters. METHODS: A total of 200 male patients with indwelling catheter who received treatment during January 2014 to January 2018 in Hainan West Central Hospital, China were included in this study. These patients were aged 35-55 years and were randomly divided into two groups: a control group (n=100) and an observation group (n=100). Patients in the control group were given routine urethral orifice nursing. Patients in the observation group were sprayed with long-acting antimicrobial material 'Jieyoushen" on the urethral orifice, catheter and catheter bag interface. Infection was detected at 1, 3, 5 and 7 days after catheterization. The changes of pathogenic bacteria and serum intlammatory factors in two groups were analyzed at 7 days after catheterization. This study was approved by the Medical Ethics Committee, Hainan West Central Hospital, China (approval No. 2013120602). RESULTS AND CONCLUSION: Compared with the control group, the infection rates of the patients in the observation group decreased significantly at 1, 3, 5 and 7 days after catheterization (P < 0.05). Twenty pathogenic bacteria were isolated in patients of the control group, including 13 Gram-positive bacteria (65.0%) and 7 Gram-negative bacteria (35.0%). Seven pathogenic bacteria were isolated in patients of the observation group, including 5 Gram-positive bacteria (71.4%) and 2 Gram-negative bacteria (28.6%). Compared with before indwelling catheter, serum levels of interleukin-1β, interleukin-2, homocysteine, and procalcitonin increased significantly in each group after catheterization (P < 0.05). After catheterization, serum levels of above-mentioned factors in the control group were significantly higher than those in the observation group (P < 0.05). These results suggest that long-acting antimicrobial material 'Jieyoushen" can effectively reduce the infection rate of pathogenic bacteria and lower serum levels of inflammatory factors in patients with indwelling catheter. [ABSTRACT FROM AUTHOR]

Aim: To establish reference intervals (RIs) for maternal blood and umbilical cord blood procalcitonin (PCT) in healthy Chinese women in late pregnancy. Methods: One hundred and twenty‐seven healthy Chinese women in late pregnancy, including 70 vaginal deliveries and 57 cesarean section deliveries, were retrospectively analyzed. These pregnant women gave birth to 58 male infants and 69 female infants. Another 127 age‐matched healthy women who were not pregnant were enrolled as the control group. PCT levels in maternal blood, umbilical cord blood and control blood were determined using electrochemiluminescence immunoassay. The RIs of PCT were defined using an intermediate 95% interval. Results: The RIs for maternal blood and umbilical cord blood PCT were 0.020–0.075 ng/mL and 0.020–0.159 ng/mL, respectively. The cord blood PCT level was not significantly different between different delivery methods (P > 0.05). In contrast, the umbilical cord blood PCT in female newborns was higher than that in male newborns (0.088 ± 0.046 ng/mL vs 0.072 ± 0.030 ng/mL, P < 0.05). Conclusion: Maternal blood and umbilical cord blood PCT of Chinese women in late pregnancy have different RIs, and umbilical cord blood PCT level is affected by the gender of newborns. [ABSTRACT FROM AUTHOR]

Background: During a migraine attack, trigeminal activation results in the release of calcitonin gene-related peptide (CGRP), which stimulates the release of inflammatory cytokines playing an important role in migraine. Objective: We analyze the relation between CGRP and cytokines during attacks to explore the possible mechanism of migraine. Materials and Methods: Migraine patients and healthy control were recruited at the Department of Neurology, the Sixth People's Hospital of Fuyang City, between March 2018 and July 2018. The protein levels of interleukin (IL)-1β, IL-2, IL-6, IL-10, tumor necrosis factor-alpha (TNF-α), and CGRP were determined from the sera of patients with migraine and control subjects by enzyme-linked immunosorbent assay kits. Spearman's rank correlation coefficient was also determined to calculate the correlation between CGRP and inflammatory factors levels. Results: The level of IL-1β, IL-6, TNF-α, and CGRP in migraine group were significantly higher than normal group (P < 0.05). The level of CGRP was significantly correlated with IL-1 β (r = 0.30, P < 0.05) and IL-6 (r = 0.94, P < 0.05), but not significantly correlated with IL-2 (r =-0.047, P = 0.75), IL-10 (r = 0.12, P = 0.43), and TNF-α (r = 0.05, P = 0.72). Conclusions: In our study, we found migraine patients had a higher IL-6, IL-1β, and TNF level than healthy controls and the level of CGRP was related significantly with the level of IL-1β and IL-6. In conclusion, our results suggest that IL-1β and IL-6 may be involved in the pathogenesis of migraine attacks and CGRP related with the secretion of cytokines. [ABSTRACT FROM AUTHOR]

Aim: Procalcitonin (PCT) has predictive value for patients with infectious diseases, but has not been studied in frailty. The purpose of this study was to compare PCT to two other inflammatory biomarkers [interleukin-6 (IL-6)] and C-reactive protein (CRP) in their association with frailty among older hospitalized patients.Methods: Retrospective study of inpatients (June-December, 2016), who had all three biomarkers measured within 24 h of admission. Frailty was defined according to the Chinese version of a validated frailty scale. Due to the association of biomarkers with infection, we divided patients into “non-infected” (no pneumonia or other infections) and “pneumonia” (using standard criteria) groups.Results: Of 435 patients (mean age 81.6 ± 8.6 years), 181 (41.6%) were designated the non-infected group and 254 (58.4%) the pneumonia group. Prevalence of frailty in the non-infected group was 32.0% (58/181) and frailty (univariate analysis) was associated with higher PCT and IL-6 levels but not CRP. Prevalence of frailty in the pneumonia group was 40.2% (102/254) and frailty was associated with all three biomarkers. In multivariable analysis adjusting for age, gender, smoking, alcohol use, hemoglobin, albumin, neutrophils and creatinine, PCT (not IL-6 and CRP) was associated with frailty in the non-infected group (OR = 5.244; 95% CI, 1.622-16.947; P = 0.006) and none of the biomarkers were associated with frailty in the pneumonia group.Conclusions: Although the study is limited due to the retrospective methods, PCT but not IL-6 or CRP, was associated with frailty among older inpatients without infection. None of these biomarkers were associated with frailty among patients with pneumonia. [ABSTRACT FROM AUTHOR]

Background: Although the role of serum procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP) in the diagnosis of sepsis and septic shock is well studied, it has not been investigated among oldest old patients. The aim of our study is to determine the role of PCT and hs-CRP in the assessment of sepsis and septic shock in this specific group of patients in the ICU.Methods: This is a prospective observational study. Patients >85 years of age admitted to the ICU from May 1st, 2016 to February 1st, 2017 were evaluated. Patients were divided into a sepsis and septic shock group(sepsis/SS) and a non-sepsis group. Serum levels of PCT, hs-CRP and the WBC were measured within 12 h of admission.Results: A total of 70 patients aged 85 years and older were enrolled in this study. Fifty patients were labelled as sepsis/SS and the other 20 were labelled non-sepsis. A ROC analysis showed that the area under the curves (AUC) of hs-CRP and PCT for the discrimination of sepsis/SS patients were 0.825 (95% confidence interval[CI]: 0.73-0.92; P < 0.001) and 0.819 (95%CI:0.72-0.92; p < 0.001), respectively. In a subgroup analysis of the sepsis/SS group, 27 patients had sepsis, while the other 23 patients had septic shock. The ROC analysis showed that the AUCs of hs-CRP and PCT for the discrimination of septic shock patients from sepsis patients were 0.751 (95% CI: 0.62-0.88; P = 0.002) and 0.719 (95% CI:0.57-0.86; p = 0.007), respectively.Conclusion: For the oldest old patients, hs-CRP is not inferior to PCT in the diagnosis of sepsis and septic shock. [ABSTRACT FROM AUTHOR]

Background: Pyogenic liver abscesses have become common in emergency departments (EDs) in recent years in Shanghai, China due to a variety of risk factors contributory to the disease.Objective: To review our experience in managing pyogenic liver abscesses to aid in the current management of this complex condition.Methods: This retrospective study was conducted to collect and analyze information from adult patients diagnosed with liver hepatic abscesses who were admitted to Ren Ji Hospital during the period from January 1, 2010 to December 31, 2015. The demographic data, etiology, underlying diseases, clinical presentation, imaging features, laboratory examinations, microbiological tests, treatment, and clinical outcomes were analyzed.Results: The data of a total 105 patients were retrospectively analyzed. The mean age of the patients was 62.0 ± 13.5 years. The etiology was predominantly hepatobiliary disease (43/105, 40.1%) or diabetes mellitus (42/105, 40.0%). During hospitalization, 12 patients (11.4%) with septic shock required intensive care. One patient died, yielding a 0.9% fatality rate. In addition to empiric antimicrobial therapy, 66/105 (62.9%) patients underwent ultrasound-guided percutaneous drainage of the liver abscess at diagnosis. Only 3 patients required surgical intervention. Bacterial culture of pyogenic fluids revealed 25 positive results of 66 cases (37.9%). Among them, Klebsiella pneumoniae was the primary pathogen detected in 15 cases (60.0%).Conclusions: Pyogenic liver abscesses have become common in EDs in Shanghai, China. The early recognition of the disease, prompt use of empirical antimicrobial therapy, initiation of drainage in the appropriate patients, and controlling the underlying conditions were crucial for preventing severe sepsis and improving the outcome. [ABSTRACT FROM AUTHOR]

Objective. To investigate whether prior treatment of atorvastatin reduces the frequency of hospital acquired pneumonia (HAP). Methods. Totally, 492 patients with acute ischemic stroke and Glasgow Coma Scale ≤ 8 were enrolled in this study. Subjects were assigned to prior atorvastatin treatment group (n=268, PG) and no prior treatment group (n=224, NG). All the patients were given 20 mg atorvastatin every night during their hospital stay. HAP frequency and 28-day mortality were measured. Levels of inflammatory biomarkers [white blood cell (WBC), procalcitonin (PCT), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6)] were tested. Results. There was no significant difference in the incidence of HAP between PG and NG (25.74% versus. 24.55%, p>0.05) and 28-day mortality (50.72% versus 58.18%, p>0.05). However, prior statin treatment did modify the mortality of ventilator associated pneumonia (VAP) (36.54% versus 58.14%, p=0.041) and proved to be a protective factor (HR, 0.564; 95% CI, 0.310~0.825, p=0.038). Concentrations of TNF-α and IL-6 in PG VAP cases were lower than those in NG VAP cases (p<0.01). Conclusions. Prior atorvastatin treatment in patients with ischemic stroke was associated with a lower concentration of IL-6 and TNF-α and improved the outcome of VAP. This clinical study has been registered with ChiCTR-ROC-17010633 in Chinese Clinical Trial Registry. [ABSTRACT FROM AUTHOR]

Objective To investigate the treatment given to osteoporotic fracture patients by orthopaedists at major hospitals in China. Methods A 25-item quantitative questionnaire survey, categorized into five domains, including primary purpose of osteoporosis treatment, anti-osteoporosis therapy, calcium and vitamin D supplement, monitoring of osteoporosis, and knowledge of osteoporosis treatment, was designed to elicit information on orthopaedists' views on the treatment of osteoporotic fracture. A pre-survey test was conducted with a sample of 40 orthopaedic specialists to confirm the reliability and validity of the questionnaire. Each interview of the survey took approximately 15 min and did not directly involve any patients. The survey was conducted through face-to-face interviews at 119 tier 3 hospitals in 28 cities across Mainland China. Results A total of 484 valid responses were received. Seven in ten respondents have ≥10 years of professional practice. While two-thirds believed that osteoporosis treatment was to prevent fractures or re-fractures, 95.0% agreed that anti-osteoporosis medication should be administered to patients with a history of fragility fractures. Three in four would prescribe anti-osteoporosis medication perioperatively. Of these, 79.0% regarded bisphosphonates as the first-line drug. Approximately 86.0% of the 21-30 years cohort chose bisphosphonates compared to 71.4% for those with ≤10 years. More of the younger (≤10 years) cohort chose calcitonin compared to their older (21-30 years) colleagues (25.7% vs 11.6%). The most commonly prescribed daily dose is 800 IU for vitamin D supplements and 600 mg/day for calcium. Conclusions Our respondents generally adhered to guidelines for the treatment and management of osteoporosis. A significant number had recommended lower dosages of vitamin D and calcium. Some differences exist between the younger cohort and their older colleagues in the prescription of pharmacological therapies. The criteria for initiating therapy should be more holistic and include other factors besides bone mineral density ( BMD). Our results demonstrated that more comprehensive guidelines for osteoporosis management and a greater awareness of these guidelines by orthopaedists are needed to enable them to better manage their patients. [ABSTRACT FROM AUTHOR]

Background Procalcitonin (PCT) has been recognized as a biomarker in severe inflammation, infection and sepsis. PCT detection in serum requires sensitive and specific antibodies. In this study, we generated monoclonal antibodies (mAbs) and developed fluorescent immunochromatographic assay for PCT detection. Methods Human recombinant PCT was used as immunogen. mAbs against PCT were developed and applied to fluorescent immunochromatographic assay for PCT detection in clinical samples. Results Out of 35 hybridoma cell lines secreting antibodies against the recombinant PCT, five sensitive and specific cell lines were selected and designated as F6, G2, C2, D2 and E5. All these antibodies have no cross reaction with calcitonin or calcitonin gene-related peptides (CGRP). After screening for pairing, mAb F6 was labeled with fluorescent microspheres and C2 was coated on a nitrocellulose membrane for immunochromatographic test. All 35 clinical samples were detected by the mAb F6–C2 test strips and the bioMérieux PCT assay. The test strips showed high specificity and sensitivity for PCT. Good correlation was observed between our immunochromatographic test strips and the bioMérieux PCT assay (R 2 :0.986). Conclusions These newly developed anti-PCT mAbs and fluorescent immunochromatographic assay can serve as important diagnostic tools for a fast, reliable and point-of-care testing for easy determination of PCT in serum and diagnosis of bacterial infection, inflammation or sepsis. [ABSTRACT FROM AUTHOR]

Purpose: The International Society on Thrombosis and Haemostasis (ISTH) scoring system is a useful tool to diagnosis overt disseminated intravascular coagulation in clinical practice. The main purposes of this study were to investigate the prognostic value of the ISTH score in emergency department (ED) sepsis and compare the ISTH score with two established scoring systems, the Sequential Organ Failure Assessment (SOFA) score and Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and two biomarkers,procalcitonin (PCT) and C-reactive protein (CRP). Methods: Septic patients were consecutively enrolled from the ED of Beijing Chaoyang Hospital, China. The ISTH score, SOFA score and APACHE II score were calculated, and PCT and CRP levels were measured on enrollment. A 30-day follow-up was performed. Results: A total of 680 septic patients were enrolled in this study. The Cox regression analysis showed that the ISTH score had a greater effect on 30-day mortality prediction, and the receiver operating characteristic curve analysis showed that the accuracy of the ISTH score in prediction of 30-day mortality was better than the SOFA score, the APACHE II score, PCT and CRP. Combination of the ISTH score and CRP can enhance the predictive accuracy of 30-day mortality. Conclusion: The ISTH score is a valuable scoring system in the prognosis evaluation in ED sepsis. [ABSTRACT FROM AUTHOR]

Objectives: Context: Osteoporosis is a systemic disease with a strong genetic component. Calcitonin receptors (CTR) are involved in maintaining calcium homeostasis. There is no consensus whether CTR gene polymorphism plays a role in affecting pathogenesis of osteoporosis. Objective: The objective of this study was to investigate genetic susceptibility of calcitonin receptor gene polymorphism (genotypes and allele frequencies) to primary osteoporosis between Han and Uygur patients and healthy controls in the Chinese Xinjiang region. Design: This was a cross-sectional study conducted in an academic hospital. Subjects: Between 2010 and 2012 a total of 404 female patients with primary osteoporosis (200 Han and 204 Uygur) and 316 healthy control subjects (160 Han and 156 Uygur) were recruited to determine the distribution of C/T single nucleotide polymorphism of the CTR gene. PCR-restriction fragment length polymorphism was used at the 1377-bp site. Results: The frequency of polymorphic C/T alleles of the calcitonin receptor gene in each group fit the Hardy-Weinberg equilibrium model. There was no statistically significant difference in genotypes (P = 0.922) or allele frequency (P = 0.654) between the Xinjiang Han postmenopausal osteoporosis patients and the controls. Similarly, there was no difference in genotypes (P = 0.897) or allele frequency (P = 0.825) between Xinjiang Uygur postmenopausal osteoporosis patients and the controls. Moreover, there was no significant difference (P = 0.86) between the combination of both ethnic groups and controls. In contrast, compared to these two ethnic groups, Han CC type accounted for 67.8%, CT 30.0%, and TT 2.2%, whereas Uighur CC type accounted for 55.6%, CT 33.3%, and TT 11.2%, which is statistically significant between Han and Uygur CTR genotypes (P = 0.006). Allele frequency of C accounted for 82.8% and T for 17.2% in Han, whereas C accounted for 72.2% and T for 27.8% in Uygur (P = 0.001). Conclusion: There was no statistically significant difference in CTR gene nucleotide sequence polymorphisms at 1377-bp between Chinese Xinjiang Han and Uygur patients with primary osteoporosis, suggesting that this CTR gene polymorphism may not affect incidence of osteoporosis. However, there was a significant difference in CTR gene nucleotide sequence polymorphism at the 1377-bp site between Chinese Xinjiang Han and Uygur, but the importance of this difference needs further study. [ABSTRACT FROM AUTHOR]

Background and Objective: Vitamin D-binding protein (DBP) is a multifunctional and highly expressed plasma protein. Among its diverse roles, including those in the immune and inflammatory responses, it is the primary carrier of vitamin D, which has been implicated in periodontitis. We hypothesized that there is a correlation between systemic DBP levels and generalized aggressive periodontitis (GAgP). Material and Methods: Forty-four patients with GAgP and 32 healthy controls were recruited. Clinical parameters were examined, including the mean bleeding index, probing depth, attachment loss and percentage of severely affected sites. Blood chemistry analyses were performed for each subject. Plasma levels of DBP, interleukin-6 (IL-6) and procalcitonin (PCT) were measured using ELISAs, and plasma levels of 25-hydroxy-vitamin D3 (25(OH)D3) were detected using a radioimmunoassay. Results: Significantly higher levels of plasma DBP, IL-6, PCT and 25(OH)D3, as well as leukocyte counts, neutrophil counts and neutrophil percentages were found in patients with GAgP compared with healthy controls ( p < 0.05 for all). Multiple linear regression analysis showed that the plasma DBP levels were significantly correlated with GAgP, plasma PCT levels and smoking status ( p < 0.05 for all). In the GAgP group, the plasma DBP levels in smokers were significantly higher than those in nonsmokers ( p < 0.001). Conclusion: Elevated plasma vitamin DBP levels are associated with GAgP. [ABSTRACT FROM AUTHOR]

Background Timely diagnosis and prognostic assessment of ventilator-associated pneumonia remain major challenges in critical care. Objective To explore the value of soluble triggering receptor expressed on myeloid cells 1, procalcitonin, and the Clinical Pulmonary Infection Score in the diagnosis and prognostic assessment of ventilator-associated pneumonia. Methods For 92 patients, bronchoalveolar lavage fluid was cultured for detection of microorganisms, serum levels of the receptor and procalcitonin and levels of the receptor in exhaled ventilator condensate were measured, and the Clinical Pulmonary Infection Score was calculated. Results On the day of diagnosis, patients who had pneumonia had higher serum levels of the receptor, procalcitonin, and C-reactive protein; higher white blood cell counts; and higher pulmonary infection and Sequential Organ Failure Assessment scores than did patients without pneumonia. White blood cell count (odds ratio, 1.118; 95% CI, 1.139-1.204) and serum levels of the receptor (odds ratio, 1.002; 95% CI, 1.000-1.005) may be risk factors for VAP. Serum levels of the receptor plus the pulmonary infection score were the most reliable for diagnosis; the area under the receiver operating characteristic curve was 0.972 (95% CI, 0.945-0.999), sensitivity was 0.875, and specificity was 0.95. For 28-day survival, procalcitonin level combined with pulmonary infection score was the most reliable for prognostic assessment (area under the curve, 0.848; 95% CI, 0.672-1.025). Conclusions In patients with ventilator-associated pneumonia, serum levels of the receptor plus the pulmonary infection score are useful for diagnosis, and procalcitonin levels plus the pulmonary infection score are useful for prognostic assessment. [ABSTRACT FROM AUTHOR]

Study design:Prospective, nonrandomized, observational cohort study.Objectives:To analyze procalcitonin (PCT) level in acute traumatic spinal cord injury patients with and without postoperative infectious complications, and to determine whether PCT is a prognostic parameter of infectious complications in the early postoperative period compared with other inflammatory markers.Setting:Spine center of Chongqing, China; Trauma center of Chinese People's Liberation Army, China.Methods:A total of 339 consecutive patients with acute spinal cord injury undergone surgery were evaluated. All patients underwent measurement of leukocyte count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum PCT preoperatively and 24-48 h postoperatively.Results:In all, 26 (7.7%) of 339 participants experienced postoperative infectious complication. Patients with infection exhibited significantly higher PCT and CRP levels compared with noninfection (both P<0.01). Multivariate logistic regression analysis showed that PCT and CRP levels were independent predicators for postoperative infection. The area under the receiver operating characteristics curve of PCT and CRP were 0.82 (95% confidence intervals (CI) 0.74-0.91) and 0.68 (95%CI, 0.57-0.78), respectively. A PCT cutoff of 0.1 ng ml−1 had a reasonable sensitivity of 92% to exclude an infection and antibiotics can be initially withheld. However, in patients with PCT level above 0.5 ng ml−1, a rapid initiation of antibiotics may be warranted.Conclusions:Serum PCT is a more reliable biologic marker for the early prediction of postoperative infectious complications in patients with acute traumatic spinal cord injury compared with CRP. PCT can early identify postoperative infections for establishing effective antibiotic therapy. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to examine the interactive effect of fluoride burden with calcitonin receptor (CTR) gene polymorphisms on the risk of fluoride (F) bone injury and provide the basis for determination of F bone injury risk factors. Methods: In this case-control study, a total of 119 cases and 126 controls were enrolled from 2 aluminum plants in Hubei province. F burden (UF) was measured by F ion-selective electrode method. The CTR gene polymorphisms were determined using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Logistic regression analysis was used to estimate multivariate-adjusted odds ratios, 95% confidence intervals (CI). Results: The odds of developing F bone injury for participants in the moderate F burden group versus the mild F burden group were 4.1 (95% CI: 1.9, 8.7); the heavy F burden group versus the mild F burden group were 14.1 (95% CI: 6.5, 30.6). The odds of developing F bone injury for participants with the TC & TT genotypes versus the CC genotype were 2.6 (95% CI: 1.4, 4.7). The interactions between TC & TT genotypes and moderate, heavy F burden were significant (OR = 14.4; OR = 40.3). Conclusion: The interactive effect of F burden and CTR genotype was significant, which increased the F bone injury risk. [ABSTRACT FROM AUTHOR]

Summary: Alendronate (ALO) and calcitonin (CT), as commonly used antiosteoporosis drugs in current clinical practice, have been experimentally confirmed to produce the effectiveness of promoting osseointegration at the interface between prosthesis and host bone and enhancing the long-term stability of the prosthesis. Our current study compared these two drugs' effects on the osseointegration of prosthesis and found that both of them could promote bone attachment between prosthesis and host bone; moreover, ALO produced more pronounced effectiveness. Introduction: A series of findings confirmed that ALO and CT improved bone attachment of implant in animals. However, which one shows stronger effectiveness has not yet been reported by previous researches. Our study compared the effects of the two commonly used antiosteoporosis drugs on the bone-prosthesis osseointegration so as to provide valuable reference for current clinical options of medication. Methods: Forty female SD rats aged 5 months were randomly set into A, B, C, and D groups. Except for group A, the others were ovariectomized to establish osteoporosis model (lumbar bone mineral density (BMD) decreased by 20% 4 weeks after ovariectomy). All the rats received prosthesis implantation at their tibial plateau. Then, the rats in groups C and D were given ALO (7 mg/kg/ w) orally and CT (5 IU/kg/day) subcutaneously for 12 weeks, respectively. Prior to the execution, application of tetracycline hydrochloride for staining in vivo was done. After harvesting and embedding, the tibia with implants were cut into thin slides, then the bone histomorphometry was measured to observe the new bone around prosthesis and to calculate the osseointegration rate of the implants. By comparison, the effect of the two drugs on osseointegration was evaluated. Results: (1) Both ALO and CT can effectively enhance the volume of bone mass surrounding the hydroxyapatite (HA) prosthesis and also significantly lever up osseointegration rate to 63.7% and 45.7%, respectively ( p < 0.05). However, ALO produced more periprosthesis osseointegration rate than CT, with difference of 18% ( p < 0.05). (2) The rats' lumber BMD increased in both ALO and CT groups, from 0.081 ± 0.009 and 0.078 ± 0.009 to 0.116 ± 0.008 and 0.109 ± 0.010 g/cm, respectively. Moreover, the effect of ALO was observed more pronounced than that of CT. Conclusions: In osteoporotic conditions, both administration of ALO orally and CT subcutaneously can enhance periprosthesis bone mass and the effects on osseointegration between host bone and prosthesis. Compared with CT, the effect of ALO is more pronounced. [ABSTRACT FROM AUTHOR]

Excessive fluoride intake has been shown to affect dentin and cementum mineralization throughout life. Some studies indicated that a HindIII polymorphism, of osteocalcin (OC) gene, was associated with bone metabolism-related diseases. Therefore, it is possible that the variation in OC genotypes will be associated with dental fluorosis (DF) status and/or serum caciotropic hormone level. A case-control study was conducted among children aged 8–12 years in Henan Province, PR China to investigate the association between dental fluorosis, serum calciotropic hormone level, and polymorphisms in the OC gene. HindIII polymorphism in OC gene was genotyped using the PCR-RFLP procedure. OC and calcitonin (CT) level in serum was detected using radioimmunoassay. No significant difference was observed for OC HindIII genotypes among the cases with dental fluorosis, the controls from endemic fluorosis area (EFA) and the controls from non-endemic fluorosis area (NEFA). A significant negative correlation was observed between serum calcium and OC level. No significant relationship was found between OC HindIII polymorphisms and the level of OC and CT. In conclusion, OC HindIII polymorphisms may not be a useful genetic marker for differential risk of dental fluorosis among children in PR China. [Copyright &y& Elsevier]

Background: Procalcitonin (PCT) has been recommended and widely used for the prognosis, diagnosis, and monitoring of sepsis. Currently, a majority of PCT detection products are limited to using serum samples, which requires the tedious pre-treatment process, as well as a large sample volume for analysis. Hence, there is an increasing need to replace serum with plasma or whole blood samples. In this work, we evaluated the effects of different blood sample types on PCT quantitative detection by measuring PCT levels in clinically homogenous whole blood, plasma, and serum samples, in hope of extending the application of PCT detection in more sample types., Methods: Ninety patients from Tong Ren Hospital of Shanghai Jiao Tong University, School of Medicine with different PCT levels volunteered for this study. Clinically homogenous samples, including EDTA- K2 anticoagulant whole blood, centrifuged serum and procoagulant plasma, were collected and analyzed using i-Reader S automatic immunoanalyzer and its supporting reagent kits. Passing and Bablok regression analysis, Bland-Altman plotting, and Kappa test were used for consistency analysis and the determination of consistency intensity, respectively., Results: Correlation analysis showed that PCT concentrations measured from EDTA-K2 anticoagulated plasma samples had a good linear regression relationship with PCT from serum samples, with a slope of 0.8741, r = 0.958, p < 0.05. A similar correlation was observed between whole blood and serum, with a slope of 0.9234, r = 0.965, p < 0.05. A good correlation was found from the quantitative results of different sample types obtained from the same patient. In detail, PCT levels in EDTA-K2 anticoagulant whole blood and plasma are well correlated with that in the serum (r = 0.831, p < 0.05; r = 0.814, p < 0.05). There was no significant difference among different sample types (p > 0.05). Variation in PCT quantification induced by different sample types has no statistical influence on positive/negative decision (p > 0.05). Bland-Altman analysis for assessing PCT concentration agreement showed there was no outlier ratio between whole blood and plasma within the range of the detection system, as well as no outlier between serum and plasma. Kappa coefficient of PCT concentration between serum and homologous EDTA-K2 anticoagulated plasma was 0.8942 (p < 0.001), and for serum and homologous whole blood it was 0.6954 (p < 0.001)., Conclusions: We concluded that quantitative PCT detection can be conducted in different sample types with good correlation and consistency, which means that it is feasible to replace serum samples with whole blood and/or plasma samples for PCT detection in clinical use. These findings reduce the sample volume and turnover time of PCT detection in clinical labs, greatly improving the process of PCT detection and promoting the application of PCT as an important inflammatory biomarker for disease diagnosis.

Identification of risk factors for antibiotic treatment failure is urgently needed in acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Here we investigated the relationship between sputum microbiome and clinical outcome of choice of initial antibiotics during hospitalization of AECOPD patients. Sputum samples of 41 AECOPD patients and 26 healthy controls were collected from Guangzhou Medical University, China. Samples were processed for 16S rRNA gene-based microbiome profiling. Thirty patients recovered with initial antibiotic treatment (antibiotic success or AS), while 11 patients showed poor outcome (antibiotic failure or AF). Substantial differences in microbiome were observed in AF versus AS patients and healthy controls. There was significantly decreased alpha diversity and increased relative abundances of Pseudomonas , Achromobacter , Stenotrophomonas and Ralstonia in AF patients. Conversely, Prevotella , Peptostreptococcus , Leptotrichia and Selenomonas were depleted. The prevalence of Selenomonas was markedly reduced in AF versus AS patients (9.1 % versus 60.0 %, P = 0.004). The AF patients with similar microbiome profiles in general responded well to the same new antibiotics in the adjusted therapy, indicating sputum microbiome may help guide the adjustment of antibiotics. Random forest analysis identified five microbiome operational taxonomic units together with C-reactive protein, procalcitonin and blood neutrophil count showing best predictability for antibiotic treatment outcome (area under curve 0.885). Functional inference revealed an enrichment of microbial genes in xenobiotic metabolism and antimicrobial resistance in AF patients, whereas genes in DNA repair and amino acid metabolism were depleted. Sputum microbiome may determine the clinical outcome of initial antibiotic treatment and be considered in the risk management of antibiotics in AECOPD. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) is an important and urgent threat to global health. Inflammation factors are important for COVID-19 mortality, and we aim to explore whether the baseline levels of procalcitonin (PCT), C-reaction protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) are associated with an increased risk of mortality in patients with COVID-19. A retrospective study was conducted and a total of 76 patients with confirmed COVID-19 were included between January 17, 2020 to March 2, 2020, of these cases, 17 patients were dead. After adjusting covariates, PCT (≥ 0.10 ng/mL) and CRP (≥ 52.14 mg/L) exhibited independent increasing risks of mortality were used hazard ratio (HR) of 52.68 (95% confidence interval [CI]: 1.77–1571.66) and 5.47 (95% CI: 1.04–28.72), respectively. However, NRL (≥ 3.59) was not found to be an independent risk factor for death in our study. Furthermore, the elevated PCT levels were still associated with increasing risk of mortality in the old age group (age ≥ 60 y), and in the critically severe and severe patients after adjustment for complications. Thu Baseline levels of PCT and CRP have been addressed as independent predictors of mortality in patients with COVID-19. [ABSTRACT FROM AUTHOR]

Objective: To explore diagnostic values of sCD163 with PCT and HS-CRP in diagnosing infection among patients with gynecological malignant tumors and fever., Study Design: Cross-sectional, observational study., Place and Duration of Study: Huzhou Maternity & Child Health Care Hospital, China, from May 2018 to February 2020., Methodology: A total of 119 patients with gynecological malignant tumors and fever were divided into infected group (70 cases) and non-infected group (49 cases), according to the blood bacterial culture results and clinical symptoms. Serum PCT, HS-CRP, sCD163 level were compared. Pearson correlation was performed to analyse correlation of sCD163 with PCT and HS-CRP. The area under the curve (AUC) score was calculated from receiver operating characteristic curve (ROC)., Results: Serum sCD163, PCT and HS-CRP levels in infected group were all elevated compared to non-infected group (all p <0.001). Pearson correlation analysis showed that sCD163 was positively correlated with PCT and HS-CRP (r = 0.596, p <0.001; r = 0.744, p <0.001, respectively). The AUC of sCD163 + PCT + HS-CRP combined detection for predicting early infection in patients with gynecological malignant tumors and fever was 0.905 (95% CI: 0.855-0.956), which was greater than sCD163, PCT, and HS-CRP detected alone., Conclusion: Combined detection of sCD163 with PCT and HS-CRP has a high diagnostic efficiency for early infection in patients with gynecological malignant tumors and fever, which is better than that of sCD163, PCT or HS-CRP alone. It can be used as an effective auxiliary examination method and an indicator for differential diagnosis. Key Words: sCD163, PCT, HS-CRP; Gynecology, Tumor, Infection, Diagnosis.

This article discusses research on the safety and efficacy of using procalcitonin to initiate or discontinue antibiotics in patients with acute respiratory tract infections. It references the study "Procalcitonin to Initiate or Discontinue Antibiotics in Acute Respiratory Tract Infections" by P. Schuetz and colleagues published in "Cochrane Database Systematic Reviews" in 2012. The nursing implications of the study are also described.