Objective To investigate the clinical characteristics and prognosis of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis with acute kidney injury (AKI) as the first manifestation, and provide new ideas for the prevention and treatment of this disease. Methods A retrospective analysis was performed on 144 patients diagnosed with ANCA-associated vasculitis in Affiliated Hospital of Southwest Medical University between August 2013 and March 2020. The patients were divided into AKI group and non-AKI group according to whether they were complicated with AKI at admission, and the differences in clinical characteristics were analyzed. The risk factors were screened by multiple logistic regression analysis. Results Among the 144 patients with ANCA-associated vasculitis, 30 cases (20.8%) were complicated with AKI at admission, and 70 cases (48.6%) died by the end of follow-up. There were 16 death cases (53.3%) in the AKI group, and 54 death cases (47.4%) in the non-AKI group, but the difference was not statistically significant (P>0.05). Single-factor analyses showed that in the AKI group, the pre-admission incidence of hematuria, neutrophil count, serum creatinine, systolic blood pressure, and Birmingham Vasculitis Activity Score were higher than those in the non-AKI group, while the red blood cell count and estimated glomerular filtration rate (eGFR) were lower than those in the non-AKI group, and the differences were statistically significant (P<0.05). Multiple logistic regression analysis showed that the neutrophil count [odds ratio (OR)=1.172, 95% confidence interval (CI) (1.003, 1.371), P=0.046] and eGFR [OR=0.942, 95%CI (0.907, 0.979), P=0.002] were independent influencing factors for AKI. Conclusions Elevated neutrophil count is an independent risk factor for ANCA-associated vasculitis complicated with AKI. It has certain guiding significance for clinical work. Early identification and intervention of these patients may contribute to reduce the case fatality rate and improve prognosis.
Objective To compare the clinical characteristics and prognosis of patients who received two different intraventricular repair. Methods We retrospectively analyzed the clinical data of 24 complete transposition of the great arteries (TGA)/left ventricular outflow tract obstruction (LVOTO) patients who all received intraventricular repair. The patients were allocated into two groups including a REV group and a Rastelli group. There were 13 patients with 9 males and 4 females at median age of 25.2 (6, 72) months in the REV group. There were 11 patients with 10 males and 1 female at median age of 47.9 (14, 144) months in the Rastelli group. Results The age at operation (P=0.041), pulmonary valve Z value (P=0.002), and LVOT gradient (P=0.004), rate of multiphase operation between the REV group and the Rastelli group was statistically different. The mean follow-up time was 17.3 months. And during the follow-up, 1 patient had early mortality, 2 patients had early reintervention, 7 patients had postoperative RVOTO, and received Rastelli and larger VSD inner diameter were associated with postoperative RVOTO. Conclusion As the traditional surgery for TGA/LVOTO patients, the intraventricular repair has a low early mortality and low early reintervention. Modified REV is associated with postoperative peripheral pulmonary vein isolation (PVIS). Patients who received Rastelli operation and with larger VSD inner diameter are more likely to have postoperative RVOTO, but the reintervention for PVI and RVOTO during follow up is very low.
Objective To investigate whether predicted heart mass (PHM) ratio can predict the prognosis of adult heart transplant patients. MethodsClinical data of 309 heart transplant patients in the 7th People’s Hospital of Zhengzhou from May 2018 to July 2024 were retrospectively analysed. The cut-off value of the PHM ratio was calculated, grouping was conducted according to the cut-off value, and the baseline data and prognosis data of the two groups were compared. ResultsA total of 249 adult heart transplant recipients were included in this study according to the inclusion and exclusion criteria. Cut-off value of the PHM ratio was –0.01. There were 63 patients in the PHM ratio>–0.01 group and 186 patients in the PHM ratio≤–0.01 group. The results of univariate analysis revealed that there were statistically significant differences between the two groups in terms of recipient gender, age, physical indicators, donor gender, and several other aspects (all P<0.05). There was no statistical difference in primary disease, recipient blood type, infectious disease, emergency status, preoperative intra-aortic balloon pump (IABP), preoperative extracorporeal membrane oxygenation (ECMO), preoperative continuous renal replacement therapy, preoperative mechanical ventilation, and preoperative blood creatinine (P>0.05). In terms of prognosis, there were statistical differences between the two groups in postoperative ECMO (P=0.048), and postoperative IABP (P=0.027). Survival rate was significantly lower in the PHM ratio≤–0.01 group than that in the PHM ratio>–0.01 group (HR=1.748 0, 95%CI 1.007 0-3.035 0, P=0.047). Multifactorial Cox regression showed that PHM ratio was significantly associated with survival after heart transplantation (HR=0.000 3, 95%CI 0.000 1-0.001 2, P<0.001); recipient sex, donor sex, donor BMI, donor BSA, recipient BMI, recipient BSA did not significantly correlate with post cardiac transplantation survival. ConclusionPHM ratios can predict the prognosis of adult heart transplantation, and donor hearts with PHM ratios>–0.01 should be selected as much as possible when performing heart donor evaluation.
Objective To compare the differences in clinicopathological features, molecular phenotypes, and prognosis between atypical type A thymoma (AAT) and classic type A thymoma (TAT), and to clarify the aggressive nature of AAT. Methods The data of AAT patients (AAT group) and classic TAT patients (TAT group) who underwent surgical resection for thymoma at West China Hospital of Sichuan University between January 2016 and November 2024 were retrospectively collected. Comparisons on the clinical data, histopathology, immunohistochemistry (CD20, Ki67), GTF2I mutation status, and survival outcomes were performed between the two groups. Results A total of 53 patients were enrolled, including 22 in the AAT group and 31 in the TAT group. There was no significant difference in age, sex, or initial presenting symptoms between the two groups (P>0.05). Compared with the TAT group, the AAT group had larger tumors [(5.6±2.7) vs. (4.1±2.0) cm, P=0.043], a lower proportion of Masaoka stage Ⅰ (31.6% vs. 61.3%, P=0.041), and worse survival outcomes [progression-free survival: hazard ratio (HR)=0.046, 95% confidence interval (CI) (0.23, 0.89), P=0.004; overall survival: HR=0.36, 95%CI (0.19, 0.69), P=0.013]. Pathologically, the AAT group showed more mitotic figures (mean 6/2 mm2), and tumor necrosis was observed in 45.5% of cases. There was no statistically significant difference in the CD20 expression rate (20.0% vs. 41.9%), Ki67 index [(11.0±6.0)% vs. (8.0±6.9)%], or GTF2I mutation rate (86.7% vs. 92.3%) between the two groups (P>0.05). Conclusions AAT is a subtype of TAT with distinct aggressive pathological features, including higher mitotic activity, a tendency for necrosis, and a greater propensity for recurrence and metastasis. Pathological diagnosis should integrate morphology and molecular testing to guide more aggressive treatment and follow-up strategies.
ObjectiveTo investigate the correlation between different RAS/BRAF mutation sites and the clinicopathological characteristics, metastatic sites, and prognosis of patients with colorectal cancer. MethodsA retrospective analysis was conducted on the clinicopathological data of 415 patients with stage Ⅰ –Ⅲ microsatellite stability (MSS) colorectal cancer who underwent radical surgery at the Department of Colorectal Surgery, The First Affiliated Hospital of Zhejiang University, and the Department of General Surgery, Gansu Provincial People’s Hospital, from March 1, 2017, to October 1, 2022, and had next-generation sequencing data. According to the presence and sites of RAS/BRAF mutations, patients were divided into five groups: RAS/BRAF wild-type group, KRAS G12 codon mutation group, KRAS G13 codon mutation group, BRAFV600E mutation group, and other RAS codon mutation group. The clinicopathological characteristics and prognostic differences between the four groups of RAS/BRAF mutant colorectal cancer patients and the RAS/BRAF wild-type colorectal cancer patients were compared. ResultsAmong stage Ⅰ –Ⅲ MSS colorectal cancer patients, there were 166 cases (40.0%) of wild-type RAS/BRAF without mutation, 124 cases (29.9%) of KRAS G12 mutation, 55 cases (13.3%) of KRAS G13 mutation, 23 cases (5.5%) of BRAFV600E mutation, and 47 cases (11.3%) of other RAS codon mutations. Clinicopathological characteristics analysis revealed that BRAFV600E mutation was associated with mucinous adenocarcinoma (P=0.033). Compared with the wild-type group, KRAS G12 mutation could increase the probability of metachronous lung metastasis (P=0.003) and reduce the probability of metachronous liver metastasis (P=0.013); the KRAS G13 mutation and other RAS mutations could increase the probability of metachronous lung metastasis (P=0.004, P=0.006). Univariate and multivariate Cox proportional hazards regression analysis showed that among the RAS/BRAF codon mutations, only KRAS G13 mutation was an independent prognostic factor for poor prognosis in stage Ⅰ –Ⅲ colorectal cancer. ConclusionsDifferent RAS/BRAF gene codon mutations are associated with distinct clinicopathological characteristics and organ metastatic sites in colorectal cancer. KRAS G13 codon mutation is an independent prognostic factor for poor prognosis in stage Ⅰ –Ⅲ colorectal cancer. It is recommended that routine detection of RAS/BRAF gene site mutations should be performed in stage Ⅰ –Ⅲ colorectal cancer patients to guide the follow-up management and help clinicians make rational clinical decisions after tumor recurrence.