Objective:To investigate the risk factors associated with mortality in patients with severe traumatic liver injury (TLI) and to establish and validate an early prediction model for mortality.Methods:A retrospective cohort study was conducted to analyze the clinical data of 273 patients with severe TLI admitted to the ICU from the medical information mart for the intensive care-IV (MIMIC-IV) database. The cohort consisted of 176 males and 97 females, with age ranging from 18 to 83 years [35.6 years(25.7,57.5)years]. The patients were divided into two groups based on in-hospital mortality: the survival group (253 patients, 92.7%) and the death group (20 patients, 7.3%). The two groups were compared with regards to gender, age, cause and type of injury, treatment method, massive blood transfusion, comorbidities as well as vital signs and laboratory tests measured within 24 hours of ICU admission. Univariate analysis was used to screen for risk factors associated with mortality in severe TLI patients. Independent risk factors for mortality were determined using multivariate Logistic regression analysis. Lasso regression was used to screen for predictors of mortality, and a nomogram prognostic model was then established through a multivariate Logistic regression analysis. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the discrimination of the model, while the Hosmer-Lemeshow goodness-of-fit test and calibration curve were used to evaluate the calibration of the model. The model′s clinical applicability was evaluated through decision curve analysis (DCA). Internal validation was performed by the 200 Bootstrap samples, and external validation was performed by using 163 patients with severe TLI from the emergency ICU collaborative research database (eICU-CRD). Finally, the predictive efficacy of the nomogram model was compared to other trauma or severity scores.Results:Univariate analysis showed that the age, cause of injury, massive blood transfusion, chronic liver disease and laboratory tests measured within 24 hours of ICU admission, including temperature, systolic blood pressure, diastolic blood pressure, mean arterial pressure, shock index, platelets, red blood cell distribution width (RDW), mean red blood cell hemoglobin concentration (MCHC), blood glucose, blood urea nitrogen, creatinine, anion gap, bicarbonate, prothrombin time (PT), activated partial thromboplastin time (APTT) and international normalized ratio (INR) were associated with the mortality of severe TLI patients ( P<0.05 or 0.01). Multivariate Logistic regression analysis revealed that age ( OR=1.08, 95% CI 1.03, 1.12, P<0.01), body temperature <36 ℃ ( OR=8.00, 95% CI 2.17, 29.53, P<0.01), shock index ( OR=9.59, 95% CI 1.76, 52.18, P<0.01) and anion gap ( OR=1.32, 95% CI 1.15, 1.53, P<0.01) were significantly associated with mortality in severe TLI patients. Lasso regression analysis selected 7 predictors, including age, body temperature<36 ℃, shock index, anion gap, chronic liver disease, creatinine and APTT. Based on these 7 predictors, a nomogram prediction model was developed. The AUC of the nomogram for predicting mortality was 0.96 (95% CI 0.94, 0.99), and the Hosmer-Lemeshow goodness-of-fit test indicated a good fit ( P>0.05). The calibration curve demonstrated excellent consistency between the predicted and actual probabilities, and DCA demonstrated that the model had good clinical net benefit at all risk threshold probability ranges. Internal validation confirmed the stability of the model ( AUC=0.96, 95% CI 0.92, 0.98), and external validation demonstrated good generalization ability ( AUC=0.95, 95% CI 0.91, 0.98). Moreover, the nomogram exhibited superior predictive efficacy compared with injury severity score (ISS), revised trauma score (RTS), trauma injury severity score (TRISS), sequential organ failure score (SOFA), acute physiological score III (APS III), Logistic organ dysfunction score (LODS), Oxford acute severity of illness score (OASIS) and simplified acute physiological score II (SAPS II). Conclusions:Age, body temperature <36 ℃, shock index and anion gap are independent risk factors for mortality in severe TLI patients. A nomogram prognosis model based on 7 predictors, namely age, body temperature <36 ℃, shock index, anion gap, chronic liver disease, creatinine and APTT exhibits good predictive efficacy and robustness, and is contributive to accurately assess the risk of mortality in severe TLI patients at an early stage.

Objective:To investigate CK19 and COX-2 expression in papillary thyroid carcinoma (PTC) and their relationship with clinicopathologic parameters.Methods:Retrospective study of 120 consecutive patients with PTC who underwent resection from May. 2017 to Dec. 2020 was conducted. The expression of CK19 and COX-2 in 120 pieces of primary PTC tissue and 30 pieces of adjacent carcinoma tissue were detected by EliVision TM plus two-step immunohistochemical method. The relationship between the expression of CK19 and COX-2 and the clinicopathologic parameters including patient age, TI-RADS classification, TNM staging, carcinomatous infiltration, lymph node metastasis was studied. The analysis was performed using SPSS 22.0 software. The numerical data were presented as numbers and percentages, and chi-test ( χ2 test) and Pearson’s correlation were used to analyze the difference and association between two groups. P<0.05 was considered statistically significant. Results:The positive immunostaining of CK19 and COX-2 were mainly localized in the cytoplasm. The positive rates of CK19 and COX-2 were 87.50% (105/120) and 72.50% (87/120) in cancer tissues and 10.00% (3/30) and 3.33% (1/30) in paracancerous tissues, respectively, with statistically significant differences (both P<0.05 by χ2 test) . In the groups with patients aged <45 years versus ≥45 years, the CK19 positive rates were 88.16% (67/76) and 86.36% (38/44) , and the COX-2 positive rates were 69.74% (53/76) and 77.27% (34/44) , respectively. In the groups of TI-RADS (grade 4 and 5) versus grade 6, the CK19 positive rates were 85.26% (81/95) and 96.00% (24/25) , and the COX-2 positive rates were 69.47% (66/95) and 84.00% (21/25) , respectively, with no statistically significant differences between the two groups (both P>0.05) . In the groups of TNM (stage T1 and T2) versus stage T3, the CK19 positive rates were 82.28% (65/79) and 97.56% (40/41) , and the COX-2 positive rates were 65.82% (52/79) and 85.36% (35/41) , respectively. In the groups with versus without cancer infiltration, the CK19 positive rates were 94.44% (68/72) and 77.08% (37/48) , and the COX-2 positive rates were 83.33% (60/72) and 56.25% (27/48) , respectively. In the groups with versus without lymph node metastasis, the CK19 positive rates were 95.59% (65/68) and 76.92% (40/52) , and the COX-2 positive rates were 83.82% (57/68) and 57.69% (30/52) , respectively, and the differences between the above groups were statistically significant (all P<0.05 by χ2 test) . The co-positive and co-negative expression rates of CK19 and COX-2 in 120 patients were 70.83% (85/120) and 10.83% (13/120) , respectively, with a positive correlation ( r=0.45, P<0.05 by Pearson’s correlation) . Conclusions:The positive rates of CK19 and COX-2 expressions are not related to patient’s age or TI-RADS classification, but closely related to TNM stage, cancer invasion and lymph node metastasis. The up-regulation of both CK19 and COX-2 expressions predicts higher tumor stage, more aggressive invasion and more prone to lymph node metastasis.

Objective:To investigate the correlation between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and central lymph node metastasis (CLNM) in patients with cN0 papillary thyroid microcarcinoma (PTMC).Methods:The clinicopathological data of PTMC patients confirmed by surgery and pathology in the 81 st Military Hospital of People′s Liberation Army from 2016 to 2019 were collected, and the relationship between preoperative NLR, PLR levels and postoperative PTMC CLNM were analyzed. Logistic regression analysis was used for multivariate analysis. Receiver operating characteristic (ROC) curve was used to determine the cutoff value of NLR and PLR. The interaction relative excess risk was used to analyze the relationship between NLR, PLR and CLNM. Results:Among 220 patients with cN0 stage PTMC, 92 were CLNM. The ROC curve showed that when the cutoff value of NLR was 2.5 and the cutoff value of PLR was 175, the highest Youden index was 0.318 and 0.264, respectively. NLR and PLR were both related to CLNM ( P<0.05). The tumor long diameter, multifocality, NLR≥2.5 and PLR≥175 were independent impact factors of CLNM ( P<0.05). The results of the interaction showed that the relative excess risk of the interaction was 5.531 (95% CI: 0.160, 10.901, P=0.016), the attribution ratio was 0.512 (95% CI: 0.230, 0.794, P=0.009), and the synergy index was 2.294 (95% CI: 1.492, 4.579, P=0.022), suggested that NLR and PLR had an interactive effect, and these two synergistically promoted CLNM. Conclusions:NLR and PLR are independent risk factors for cN0 stage PTMC CLNM. When NLR≥2.5 and PLR≥175, preventive central lymph node dissection should be routinely performed.

Objective:To investigate the correlation between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and central lymph node metastasis (CLNM) in patients with cN0 papillary thyroid microcarcinoma (PTMC).Methods:The clinicopathological data of PTMC patients confirmed by surgery and pathology in the 81 st Military Hospital of People′s Liberation Army from 2016 to 2019 were collected, and the relationship between preoperative NLR, PLR levels and postoperative PTMC CLNM were analyzed. Logistic regression analysis was used for multivariate analysis. Receiver operating characteristic (ROC) curve was used to determine the cutoff value of NLR and PLR. The interaction relative excess risk was used to analyze the relationship between NLR, PLR and CLNM. Results:Among 220 patients with cN0 stage PTMC, 92 were CLNM. The ROC curve showed that when the cutoff value of NLR was 2.5 and the cutoff value of PLR was 175, the highest Youden index was 0.318 and 0.264, respectively. NLR and PLR were both related to CLNM ( P<0.05). The tumor long diameter, multifocality, NLR≥2.5 and PLR≥175 were independent impact factors of CLNM ( P<0.05). The results of the interaction showed that the relative excess risk of the interaction was 5.531 (95% CI: 0.160, 10.901, P=0.016), the attribution ratio was 0.512 (95% CI: 0.230, 0.794, P=0.009), and the synergy index was 2.294 (95% CI: 1.492, 4.579, P=0.022), suggested that NLR and PLR had an interactive effect, and these two synergistically promoted CLNM. Conclusions:NLR and PLR are independent risk factors for cN0 stage PTMC CLNM. When NLR≥2.5 and PLR≥175, preventive central lymph node dissection should be routinely performed.

Objective To investigate the expression and clinical significance of HGF and C-Met in cholangiocarcinoma .Meth-ods The levels of HGF and C-Met were measured by ELISA ,the expression of HGF and C-Met in cholangiocarcinoma and health control was detected by immunohistochemistry .Results The preoperative levels of HGF and C-Met in cholangiocarcinoma were higher than the health control(P< 0 .05) .Compared with the preoperative state ,the levels of HGF and C-Met in cholangiocarcino-ma on the 3rd day after operation did not change significantly .However ,the levels of HGF and C-Met on the postoperative 7th and 10th day decreased obviously .In addition ,the expression of HGF and C-Met in cholangiocarcinoma was 76 .2% ,81 .0% ,respective-ly ,which is higher than that in normal tissue ( P < 0 .01) .Conclusion There is an abnormal expression of HGF and C-Met in cholangiocarcinoma ,which may be related to the incidence and development of cholangiocarcinoma .

Objective To investigate the expression of calcium-binding protein S100A4 in pancreatic carcinoma and its clinical significannce.Methods Immunohistochemistry EliVisionTM Plus method was used to examine the expression of S100A4 in 70 surgical specimens of primary pancreatic carcinoma and 15 patients with noncarcinoma pancreatic tissues.The correlation between the expression of S100A4 and the clinicopathological parameters was analyzed.Results S100A4 was positive in 52(52/70,74.3％) specimens of primary pancreatic carcinoma according to immunohistochemistry detection.No expression of S100A4 in adjacent noncarcinoma pancreatic tissues was detected.The expression of S100A4 did not correlated with gender,age or tumor site while it was significantly correlated with tumor size,grade of differentiation,TNM stages,lymph node metastasis and survival.Disease-free survival and overall survival of the negative group were significantly longer than the positive group.The difference had statistical significance.Conclusion The study shows that over expression of S100A4 protein is closely related with clinicopathological parameters of pancreatic cancer patients,indicating poor prognosis for pancreatic cancer patients.

ObjectiveTo investigate the expression of adhesion molecules cyclooxygenase-2 (COX-2)and survivin protein in elderly patients with gastric cancer and their relationship with the pathological behavior and prognosis,MethodsImmunohistochemical staining was used to detect the expression of COX-2 and survivin protein in 60 cases of elderly patients with gastric carcinoma,30 cases of gastric epithelial dysplasia and 20 cases of normal gastric mucosa.The study was also combinedwith analysis of the pathological behavior and clinical follow-up survey of elderly patients with gastric carcinoma.ResultsThe positive expression rates of COX2 and survivin protein in elderly patients with gastric carcinoma were 63.3％(38/60) and 70.0％(42/60),respectively.The positive rates of COX-2 and survivin in elderly patients with gastric carcinoma were higher than that in epithelial dysplasia and normal gastric mucosa( P ＜0.05).The expression of COX-2 and survivin were closely related to the infiltration of serosa,metastasis of lymph node and prognosis of patients ( P ＜ 0.05 ).ConclusionThe expression of COX-2 and survivin are closely related to carcinogenesis,metastasis and survival time in elderly patients with gastric carcinoma.Detecting the expression of COX-2 and survivin may be prognostic indicators of elderly patients with gastric carcinoma.

Objective To investigate the correlation between the expression of cyclooxygenase-2 (COX-2),vascular endothelial growth factor(VEGF) protein,and metastasis in human papillary thyroid carcinoma (PTC).Methods lmmunohistochemical method was used to detect the expression of COX-2 and VEGF protein in 66 cases of PTC,20 cases of thyroid adenoma (TA),20 cases of nodular goiter (NG) and 15 cases of adjacent noncancerous (AN) tissues.Results The positive expression rate of COX-2 (72.7％,48/66)and VEGF (59.1％,39/66) was significantly higher in PTC than in TA( 10.0％,15.0％ ),NG( 15.0％,20.0％ )and AN (0.0％,13.3％ ) (P ＜0.05).The expression of COX-2 and VEGF was closely related to invasion,metastasis,and survival duration of PTC patients (P ＜0.05).Conclusion The expression of COX-2 and VEGF is closely related to biological behaviors of PTC patients and can be taken as prognostic indicators for PTC patients.

ObjectiveTo explore the correlation of expression of galetin-3 (Gal-3) and epidermal growth factor receptor (EGFR) with the biological behaviors in esophageal squamous carcinoma(ESC). MethodsImmunohistochemical method was used to examine the expression of Gal-3 and EGFR in 80 specimens of ESC. ResultsThe positive rates of Gal-3 and EGFR was 73.8％ (59/80)and 56. 3％ (45/80)respectively. The positive rates of Gal-3 and EGFR expression in the patients with poor differentiation, deep infiltration and lymph node metastasis was significantly higher than those with well differentiation, shallow infiltration and without lymph node metastasis ( P ＜ 0. 05 ). The high expression of Gal-3 and EGFR was correlated with higher percentage of death and lower survival rate ( P ＜ 0.05 ). ConclusionThe abnormal expression of Gal-3 and EGFR is closely related with the pathological biology behaviors of ESC. Gal-3 and EGFR can be regarded as objective indicators for forecasting metastasic potential of ESC and estimating prognosis of patients with ESC.

Objective To investigate the expression of matrix metalloproteinases-7 (MMP-7) in benign and malignant thyroid tissues and its clinical significance. Methods The expression of MMP-7 in 50 thyroid cancers, 45 adenoma and 20 adjacent noncancerous portion tissues were studied by microwave-LSAB immunohistochemical method. Results The positive rate of MMP-7 in thyroid cancer was 64. 0%, which was significantly higher than 37. 0% in adenoma and 25.0% in adjacent noncancerous portion(X_2=8. 72,6. 52, P < 0.01 ). No correlation was observed between the expression of MMP-7 and histological grading of thyroid cancer. The expression of MMP-7 in lymph node metastasis and Grade Ⅲ～Ⅳ were both higher than that in negative cases and in Grade Ⅰ～Ⅱ ( P < 0. 05 ). The percentage of recurrence and death in MMP-7 positive cases were notably higher than that in negative cases( P <0. 05). Conclusion The expression of MMP-7 can be regarded as a parameter for evaluating the degree of malignancy, biological behavior and prognosis of thyroid cancer.