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BACKGROUND The purpose of the study was to examine the association between white blood cell count (WBCc) on admission and early outcome in patients with the acute Stanford type A aortic dissection (TAAD). METHODS From January 2012 to December 2018, we retrospectively evaluated a series of 331 consecutive patients underwent surgery for TAAD in Tongji Hospital. The patients were divided into 2 groups based on the WBCc, i.e. the normal WBCc group (WBCc≤11 × 109/L) and leukocytosis group (WBCc> 11 × 109/L). The perioperative data were compared between the 2 groups. The in-hospital mortality and the compositive adverse event including multi-organ dysfunction syndrome, postoperative stroke, tracheotomy, and re-exploration for stopping bleeding were set as end points. Cox regression were used to assess the potential risk factors. RESULTS The in-hospital mortality was nearly 3 time higher in the leukocytosis group than in the normal WBCc group (20.9% vs.8.1%, P = 0.001), and 15.1% overall. For the circulatory arrest, there was significant higher mortality in patients with leukocytosis than normal WBCc group (26.1%vs.8.9%, P = 0.001). After adjustment for confounding factors, the leukocytosis was found to be a strong independent predictor of in-hospital mortality (odds ratio = 3.10; 95% confidence interval 1.38 to 6.97, P = 0.006). The leukocytosis was also a risk factor of adverse events (odds ratio = 1.80; 95% confidence interval 1.07 to 3.04, P = 0.027). CONCLUSIONS The WBCc within 24 h of admission for TAAD is a strong and independent predictor of in-hospital mortality as well as short-term clinical events. The results of this study have important clinical implications for risk-stratifying patients with TAAD.BACKGROUND For studying the effectiveness of treatment, it is important to check whether a new treatment is performed as originally described in the study-protocol. OBJECTIVES To evaluate whether an interdisciplinary graded exposure program, for adolescents with chronic musculoskeletal pain reporting pain-related fear, was performed according to protocol, and whether it is feasible to implement the program in rehabilitation care. METHODS A process evaluation where quantitative and qualitative data on participant characteristics (adolescents, parents and therapists), attendance and participants' opinion on the program were collected, by means of registration forms, questionnaires and group interviews. To evaluate treatment fidelity, audio and video recordings of program sessions were analyzed. RESULTS Thirty adolescents were offered the program, of which 23 started the program. Adolescents attended on average 90% of the sessions. At least one parent per adolescent participated in the program. Analysis of 20 randomly selected recordings of treatment sessions revealed that treatment fidelity was high, since 81% of essential treatment elements were offered to the adolescents. The program was considered client-centered by adolescents and family-centered by parents. Treatment teams wished to continue offering the program in their center. CONCLUSION The interdisciplinary graded exposure program was performed largely according to protocol, and therapists, adolescents and their parents had a favorable opinion on the program. selleck chemicals Implementation of the program in rehabilitation care is considered feasible. TRIAL REGISTRATION Clinicaltrials.gov ID NCT02181725 (7 February 2014).BACKGROUND Conventional trial design and analysis strategies fail to address the typical challenge of immune-oncology (IO) studies only a limited percentage of treated patients respond to the experimental treatment. Treating non-responders, we hypothesize, would in part drive non-proportional hazards (NPH) patterns in Kaplan-Meier curves that violates the proportional hazards (PH) assumption required by conventional strategies. Ignoring such violation incurred from treating non-responders in the design and analysis strategy may result in underpowered or even falsely negative studies. Hence, designing innovative IO trials to address such pitfall becomes essential. METHODS We empirically tested the hypothesis that treating non-responders in studies of inadequate size is sufficient to cause NPH patterns and thereby proposed a novel strategy, p-embedded, to incorporate the dichotomized response incurred from treating non-responders, as measured by the baseline proportion of responders among treated patients p%, into the design and analysis procedures, aiming to ensure an adequate study power when the PH assumption is violated. RESULTS Empirical studies confirmed the hypothetical cause contributes to the manifestation of NPH patterns. Further evaluations revealed a significant quantitative impact of p% on study efficiency. The p-embedded strategy incorporating the properly pre-specified p% ensures an adequate study power whereas the conventional design ignoring it leads to a severe power loss. CONCLUSION The p-embedded strategy allows us to quantify the impact of treating non-responders on study efficiency. Implicit in such strategy is the solution to mitigate the occurrence of NPH patterns and enhance the study efficiency for IO trials via enrolling more prospective responders.BACKGROUND Recent studies showed that dyslipidemia could be a critical factor in the progression of cardiovascular disease in systemic lupus erythematosus (SLE). The aim of the present study was to describe the relationship between serum lipid profile and SLE disease activity in young female adults with SLE. METHODS Seventy-one female subjects diagnosed with SLE aged 20~30 years were enrolled. Serum lipid profile including TC, TG, HDL-C, LDL-C, VLDL-C, Apo A, Apo B, and Apo E were evaluated between control and young female SLE patients. Univariate correlation analyses were performed to explore the correlation between serum lipid levels and SLE disease activity. RESULTS Our results showed that TG and VLDL-C levels were significantly increased in young female SLE as compared to control, with TC, HDL-C, LDL-C, Apo A, and Apo B significantly reduced. Meanwhile, univariate correlation analyses showed negative correlations between SLE disease activity index and HDL-C, LDL-C, Apo A, and Apo B; with positive correlations between SLE disease activity index and TG and VLDL-C.