Background: The patient suffering from urinary sepsis is often accompanied by elevated serum procalcitonin (PCT) levels and a decline in the average platelet count (PLT), which could result in a poor prognosis. This study aimed to evaluate the value of PCT and PLT in determining the severity of urinary sepsis. Methods: A total of 120 urosepsis patients enrolled were divided into a survival group and a death group, respectively, according to their status within 14 days after admission. Changes in PCT and PLT levels between the 2 groups were compared at different time points. A receiver operating characteristic (ROC) curve was eventually obtained to predict the prognostic value of PCT and PLT. Results: The PCT levels in the survival group declined gradually after admission, and the PLT decreased at first but increased rapidly in subsequence. The PCT level in the death group, however, declined in a flat-slope trend or was hardly noticeable together with the number of PLT reduced significantly. In particular, it is on the 3rd day that PCT tended to positively correlate with acute physiological and chronic health score II (APACHE II) score ( r = 0.730, P < .05), but negatively with PLT ( r = 0.472, P < .05). The APACHE II score and PLT ( r = 0.612, P < .05) were also negatively correlated with each other. As indicated by the ROC curve, the PCT level on the 3rd day after admission was of great value for the clinical mortality prognosis, and the area under the curve was 0.858. Moreover, PLT also has a high predictive value for prognosis. Area under the curve is 0.951. When the PLT was more than 51 × 10 9 /L, the sensitivity was up to 90%, and the specificity was 90%. Conclusion: PLT and PCT levels are closely related to the APACHE II score, which could indicate the severity of urosepsis in patients. The contribution of this study was to confirm that dynamic monitoring of the changes in PCT and PLT helps determine the prognosis of urosepsis patients.

Because of a much higher dynamic range of flat panel detectors, patient dose can vary without change of image quality being perceived by radiologists. This condition makes optimization (OT) of radiation protection undergoing digital radiography (DR) more complex, while a chance to reduced patient dose also exists. In this study, we evaluated the difference of patient radiation and image rejection before and after OT to identify if it is necessary to carry out an OT procedure in a routine task with DR. The study consisted of a measurement of the dose area product (DAP) and entrance surface dose (ESD) received by a reference group of patients for eight common radiographic procedures using the DR system before and after OT. Meanwhile image rejection data during two 2-month periods were collected and sorted according to reason. For every radiographic procedure, t tests showed significant difference in average ESD and DAP before and after OT (p < 0.005). The ESDs from most examinations before OT were three times higher than that after OT. For DAPs, the difference is more significant. Image rejection rate after OT is significantly lower than that before OT (χ (2) = 36.5, p < 0.005). The substantial reductions of dose after OT resulted from appropriate mAs and exposure field. For DR patient dose, less than recommended diagnostic reference level can meet quality criteria and clinic diagnosis.

To cite this article: Shao-Hua Lin, Ying-ping He, Jun-Jie Lian & Cun-Kun Chu (2021) Procalcitonin kinetics to guide sequential invasive-noninvasive mechanical ventilation weaning in patients with acute exacerbation of chronic obstructive pulmonary disease and respiratory failure: procalcitonin's adjunct role,

Purpose. To calculate and evaluate postimplant dosimetry (PID) with CT-MR fusion technique after brain tumor brachytherapy and compare the result with CT-based PID. Methods and Materials. 16 brain tumor patients received MR-guided intervention with Iodine-125 (125I) seed implantation entered this preliminary study for PID evaluation. Registration and fusion of CT and MR images of the same patients were performed one day after operation. Seeds identification and targets delineation were carried out on CT, MR, and CT-MR fusion images, each. The number and location of seeds on MR or CT- MR fusion images were compared with those of actually implanted seeds. Clinical target volume (CTV) and dosimetric parameters such as %D90, %V100 and external V100 were measured and calculated. In addition, the correlation of the fusion to CT CTV ratio and other factors were analyzed. Results. The numbers of fusion seeds were not significantly different compared with reference seeds (t =1.76, p >0.05). The difference between reference seeds numbers and truly extracted MR seeds numbers was statistically significant (t =3.91, p <0.05). All dosimetric parameters showed significant differences between the two techniques (p <0.05). The mean CTV delineated on fusion images was 34.3 ± 33.6, smaller than that on CT images. The mean values of external V100, %V100 and %D90 on fusion images were larger than those on CT images. Correlation analysis showed that the fusion-CT V100 ratio was positively and significantly correlated with the fusion-CT volume ratio. Conclusions. This preliminary study indicated that CT-MR fusion-based PID exhibited good accuracy for 125I brain tumor brachytherapy dosimetry when compared to CT-based PID and merits further research to establish best-outcome protocols.

Objective. To evaluate the effectiveness of transarterial chemoembolization (TACE) combined with lenvatinib and sintilimab in treating patients with midstage hepatocellular carcinoma (HCC). Methods. Sixty-two patients with midstage HCC were enrolled in this study. All of them were firstly treated in our hospital between September 1, 2019, and March 1, 2020. According to different treatment regimens, they were divided into the control group (31 cases, TACE group) and the observation group (31 cases, TACE combined with lenvatinib and sintilimab group). Each patient was followed up for at least 30 months to compare the short-term clinical efficacy and survival rate between the two groups. Results. The objective response rate (ORR) and disease control rate (DCR) of the observation group at 3 months were 77.4% and 93.5%, respectively, which were higher than those of the control group ( P < 0.05 ). The 2-year cumulative overall survival rate of the observation group was 64.5%, which was significantly higher than that of the control group ( P < 0.05 ). The survival curve of the disease-free survival rate in the observation group was higher than that in the control group, and the difference was statistically significant ( X 2 = 4.313 , P < 0.05 ). Conclusion. TACE combined with lenvatinib and sintilimab in the treatment of Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma can effectively control the tumor progression and prolong the survival time of patients. Those preliminary findings need validation in larger studies, with a prospective design and longer follow-up.