Objective:To investigate the predictive value of acute gastrointestinal injury (AGI) score for the severity of acute pancreatitis (AP), infectious pancreatic necrosis and patients′ death.Methods:Clinical data of 719 patients with AP were collected from the AP database of the National Clinical Research Center for Digestive System Diseases from January 2016 to June 2018. According to the severity of the disease, they were divided into MAP group (506 cases), MSAP group (112 cases) and SAP group (101 cases). AGI, APACHEⅡ, MCTSI and BISAP scores were calcululated in the three groups. Receiver operating characteristic curve (ROC) was drawn and the area under the curve (AUC) was calculated. The predictive value of the above four scoring systems for the hospitalization days, disease severity, infectious pancreatic necrosis and death was analyzed, respectively.Results:There were no cases of infectious pancreatic necrosis or death in the MAP group, but there were 9 cases of infectious pancreatic necrosis and 2 deaths in the MSAP group and 19 cases of infectious pancreatic necrosis and 8 deaths in the SAP group. There was a strong correlation between AGI score and AP patients′ hospitalization days ( r=0.619). AUC of AGI, APACHEⅡ, MCTSI and BISAP score in predicting the AP patients′ severity (MSAP+ SAP) was 0.967 (95% CI 0.951-0.982), 0.769(95% CI 0.720-0.899), 0.842(95% CI 0.809-0.875), 0.862 (95% CI0.832-0.893). AUC for forecasting infectious pancreatic necrosis was 0.803, 0.677, 0.692, 0.724, and the 95% CI was 0.724-0.882, 0.573-0.781, 0.582-0.636, 0.801-0.812. AUC for predicting death in patients with AP were 0.915, 0.597, 0.659, 0.812, and the 95% CI were 0.843-0.986, 0.444-0.751, 0.498-0.698 and 0.882-0.926. AGI score had the highest predictive value, followed by BISAP score, and the correlation between these two scores was the closest. The predictive value of AGI combined with BISAP score for infectious pancreatic necrosis and patient death (AUC were 0.837, 0.942, 95% CI were 0.770-0.903, 0.897-0.987) was better than that of AGI and BISAP score alone. Conclusions:AGI score combined with BISAP score is more effective in predicting the severity of AP, the occurrence of infectious pancreatic necrosis or patient death.

Objective: To explore the predictive value of acute gastrointestinal injury(AGI) grading system in assessing the severity, infectious pancreatic necrosis and death of patients with moderate severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP). Methods: The clinical data of 344 patients with MSAP or SAP admitted in Changhai Hospital Affiliated to Navy Medical University from June 2011 to June 2015 were collected. ROC curve was used and the area under ROC curve (AUC) was calculated. The predictive value of AGI grade for the severity, infectous pancreatic necrosis and death was compared with those of different clinical scores(APACHEⅡ score, MCTSI and Marshal score). Results: Of 344 patients, 81 patients were classified into high AGI grade group (Grade Ⅲ, Ⅳ), while 263 patients were in low AGI grade group(Grade Ⅰ, Ⅱ). The mortality and the number of patients with organ failure were obviously higher in high AGI grade group than those in low AGI grade group (25/81 vs 0/263, 36/45 vs 32/231), and the difference was statistically significant (all PCI 0.916-0.972) and0.779(95% CI 0.723-0.836), respectively, which was higher than those of APACHEⅡ and Marshall score. Conclusions AGI grading system can be applied to better assess the severity of acute pancreatitis, and its predictive value for death and infectious pancreatic necrosis was higher than that of APACHEⅡ, MCTSI and Marshall score.

Objective:To investigate mutations in the KRT5 gene in a pedigree with Dowling-Degos disease.Methods:Clinical data were collected from the proband, and a survey was conducted in 12 members in 3 generations of the family. Peripheral blood samples were obtained from the proband, 8 family members and 50 unrelated healthy individuals, genomic DNA was extracted for whole-exome sequencing, and sequencing results were compared with the published sequences of human KRT5, POFUT1 and POGLUT1 genes.Results:There were 3 patients in this family, including the proband, his father and deceased grandmother. The proband and his father clinically presented with reticular pigmentation in the skinfolds, especially the chest and abdomen skinfolds. A novel heterozygous nonsense mutation c.165T>A was identified in exon 1 of the KRT5 gene in the proband and his father, but not in other family members or healthy controls. No abnormality was found in the POFUT1 or POGLUT1 gene in any subjects.Conclusion:A novel heterozygous nonsense mutation c.165T>A was identified in the KRT5 gene, and may contribute to the clinical phenotype of the proband and his father with Dowling-Degos disease.

OBJECTIVEThis study aims to analyze the independent risk factors of acute respiratory dysfunction (ARD) in children with airway foreign body and to assess possible prevention and treatment option in the future.

METHODSClinical data of 456 cases of children with airway foreign body were retrospectively collected and analyzed by cluster sampling, including 246 males and 210 females, who received operation in our hospital between July, 2009 and December, 2012, aged 0.5-11 years old, onset to treatment time was 0.15-14 days. Clinical characteristics including age, gender, past medical history, time of onset, temperature, location of the foreign body, category of foreign bodies, complicated by pneumonia, complicated by subcutaneous and mediastinal emphysema were gathered. Temperature, respiratory rate, heart rate, cyanosis, transcutaneous oxygen saturation or arterial blood analysis were assayed before operation. Risk factors with statistical significance were screened with univariate logistic regression analysis, independent risk factors of ARD were determined with multivariate logistic regression analysis.

RESULTSAcute respiratory dysfunction occurred in 78 (17.1%) patients. The foreign bodies in 455 cases were successfully removed brochoscopically in the first time. One case received chest surgery for foreign body removal. Total of 452 cases were successfully extubated and ventilator weaned 4-6 h after brochoscopy. In 2 cases, the ventilator was weaned 2-4 d after brochoscopy in ARD group, and 2 cases with severe pneumonia died. Age, location of the foreign body, temperature, complicated by pneumonia, complicated by subcutaneous and mediastinal emphysema did not show significant difference between acute respiratory dysfunction group and non- acute respiratory dysfunction group (P < 0.05). Multivariate logistic regression analysis showed location of the foreign body and complicated by pneumonia, complicated by subcutaneous and mediastinal emphysema were independent risk factors for ARD.

CONCLUSIONEarly judgement of the risk factors of acute respiratory dysfunction in children with airway foreign body can provide a reference for the operation and perioperation period treatment.

Child ; Female ; Foreign Bodies ; complications ; epidemiology ; Humans ; Male ; Respiratory System ; Respiratory Tract Diseases ; epidemiology ; etiology ; Retrospective Studies ; Risk Factors

OBJECTIVE: To establish logistic regression model for prostate cancer and provide basis for prostate biopsy.
 METHODS: A total of 117 cases of prostate biopsy were retrospectively analyzed in chronological sequence. All cases were assigned into a model group (n=78) and a validation group (n=39). Logistic regression model was established and its value was estimated by receiver operating characteristic (ROC) curve. 
 RESULTS: Digital rectal examination(DRE), transrectal ultrasound(TRUS), MRI, prostate-specific antigen density (PSAD), and free PSA/total PSA (fPSA/tPSA) were the influential factors for prostate biopsy (P<0.01). The established logistic regression model for prostate cancer by regression coefficient was: logit P=-2.362+2.561×DRE+1.747×TRUS+2.901×MRI+1.126×PSAD-
2.569×fPSA/tPSA and area under curve was 0.907. When the cutoff aimed at 0.12, the sensitivity and specificity were 81.80% and 89.30%, respectively.
 CONCLUSION Logistic regression model for prostate cancer can provide sufficient basis for prostate biopsy. Prostate biopsy should be performed when P value is more than 0.12.
Biopsy ; Humans ; Logistic Models ; Male ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; diagnosis ; pathology ; ROC Curve ; Retrospective Studies ; Sensitivity and Specificity ; Urologic Surgical Procedures

Metabolic-associated fatty liver disease (MAFLD), which is previously known as non-alcoholic fatty liver disease (NAFLD), represents a major health concern worldwide with limited therapy. Here, we provide evidence that ferroptosis, a novel form of regulated cell death characterized by iron-driven lipid peroxidation, was comprehensively activated in liver tissues from MAFLD patients. The canonical-GPX4 (cGPX4), which is the most important negative controller of ferroptosis, is downregulated at protein but not mRNA level. Interestingly, a non-canonical GPX4 transcript-variant is induced (inducible-GPX4, iGPX4) in MAFLD condition. The high fat-fructose/sucrose diet (HFFD) and methionine/choline-deficient diet (MCD)-induced MAFLD pathologies, including hepatocellular ballooning, steatohepatitis and fibrosis, were attenuated and aggravated, respectively, in cGPX4-and iGPX4-knockin mice. cGPX4 and iGPX4 isoforms also displayed opposing effects on oxidative stress and ferroptosis in hepatocytes. Knockdown of iGPX4 by siRNA alleviated lipid stress, ferroptosis and cell injury. Mechanistically, the triggered iGPX4 interacts with cGPX4 to facilitate the transformation of cGPX4 from enzymatic-active monomer to enzymatic-inactive oligomers upon lipid stress, and thus promotes ferroptosis. Co-immunoprecipitation and nano LC-MS/MS analyses confirmed the interaction between iGPX4 and cGPX4. Our results reveal a detrimental role of non-canonical GPX4 isoform in ferroptosis, and indicate selectively targeting iGPX4 may be a promising therapeutic strategy for MAFLD.