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The aim of this study was to investigate the clinical significance of serum homocysteine (Hcy) as a biomarker for early diagnosis of diabetic nephropathy (DN) in type 2 diabetes mellitus (T2DM) patients.

AIM: To evaluate the effectiveness of heparin-binding protein (HBP) in combination with organ function indicators for early diagnosis and prognosis prediction in patients with severe trauma complicated with sepsis. METHODS: A retrospective analysis was conducted on 184 patients with multiple injuries who were admitted to the Emergency Medicine Department of the Second Affiliated Hospital of Zhejiang University Medical College between January 2019 and September 2020 and underwent HBP testing. Patients were classified according to the SEPSIS 3. 0 diagnostic criteria into a sepsis group (n=89) and a non-sepsis group (n=95). Clinical outcomes were tracked, dividing patients into a deceased group (n=43) and a survival group (n=141). HBP levels were continuously measured, and the peak values of the two groups were compared to assess the efficacy of diagnosing sepsis. Further analysis on the correlation of HBP peak value median with clinical prognosis was conducted. The effectiveness of HBP alone and in combination with total bilirubin (TBil) and white blood cell (WBC) count in prognosis assessment was evaluated. RESULTS: (1) No significant difference was found in the peak level of HBP between the sepsis group (n=89) and the non-sepsis group (n=95) (71. 7± 68. 6 vs 52. 5±56. 1, P=0. 051). (2) Among the 184 patients, the peak level of HBP was positively correlated with WBC count (r=0. 244, P<0. 01) and TBil levels (r=0. 241, P<0. 01). (3) The area under curve (AUC) for independent diagnosis of sepsis using TBil levels, WBC count, and PCT levels were 0. 618, 0.631, and 0. 718, respectively, and the combined AUC was 0. 684, with a diagnostic sensitivity of 60. 7% and specificity of 71. 6% (P<0. 05). (4) Prognostic analysis of mortality showed that patients in the high HBP level group had a significantly higher mortality rate than those in the low-level group (30. 4% vs 16. 3%, P<0. 05). The WBC count was also significantly higher in the deceased group than in the survival group (17. 5±6. 9 vs 12. 8±4. 7, P<0. 01), especially in those with sepsis (P<0. 01). The AUCs for predicting sepsis mortality prognosis using HBP peak level, TBil levels, WBC count, SOFA score, and APACHE-II score were 0. 618, 0. 603, 0. 719, 0. 823, and 0. 811, respectively. The combined AUC of HBP with TBil and WBC for assessing sepsis prognosis was 0. 750, with a sensitivity of 74. 4% and specificity of 74. 5%, showing statistically significant differences (P<0. 05). (5) The combined assessment of these three indicators showed no statistically significant difference from artificial scoring systems in predicting sepsis prognosis (P>0. 05). CONCLUSION: The combination of HBP, TBil, and WBC is highly effective in predicting the risk of sepsis in patients with multiple injuries and has significant clinical value in predicting the mortality risk of trauma patients with sepsis. [ABSTRACT FROM AUTHOR]

Combined treatment with caspofungin and trimethoprim/ sulfamethoxazole (TMP/SMZ) as salvage therapy in non-HIV positive patients with severe pneumocystis pneumonia (PCP) yields poor outcomes. It remains unknown whether the use of this combination strategy as a first-line therapy would improve patient outcomes. The present study aimed to assess the efficacy of caspofungin combined with TMP/SMZ as a first-line therapy in non-HIV positive patients with severe PCP. A retrospective cohort study was conducted between March 2016 and February 2017. Patient clinical characteristics and outcomes were compared between two groups receiving first-line and second-line therapy respectively. In addition, similar cases from previous studies were assessed. A total of 14 patients were included in the present study (mean age, 58.79±14.41 years); including 9 patients receiving caspofungin and TMP/SMZ as a first-line therapy and 5 that received it as a second-line therapy. The overall positive response rate was 71.43% (10/14), with 88.89 (8/9) and 40.00% (2/5) in the first-line and second-line therapy groups, respectively (P=0.095). The positive response rates of patients requiring invasive mechanical ventilation differed significantly between the first-line (5/6, 83.33%) and the second-line (0/3, 0%) therapy groups (P=0.048). All-cause hospital mortality was 42.86% (6/14), with mortality rates of 33.33 (3/9) and 60.00% (3/5) in the first-line and second-line therapy groups, respectively (P=0.580). Combined with previously reported cases (n=27), the positive response rate was significantly greater in the first-line therapy group (11/12, 91.67%) than in the second-line therapy group (8/15, 53.33%, P=0.043). No significant differences were in all-cause mortality rates between the two groups (25.00 vs. 46.67%, P=0.424) were identified, despite the fact that all-course mortality in the first-line therapy group was ***50% that of the second-line therapy group. Therefore, the results of the present study indicate that combined caspofungin and TMP/SMZ as first-line therapy may be a promising and effective strategy to treat non-HIV positive patients with severe PCP, particularly for those requiring invasive mechanical ventilation. [ABSTRACT FROM AUTHOR]