the early detection and timely treatment are the most important factors for improving the outcome of patients with sepsis. Sepsis-related clinical score, such as SIRS, SOFA and LODS, were defined to identify patients with suspected infection and to predict severity and mortality. A few hematological parameters associated with organ dysfunction and infection were included in the score although various clinical pathology parameters (hematology, serum chemistry and plasma coagulation) in blood sample have been found to be associated with outcome in patients with sepsis. The investigation of the parameters facilitates the implementation of a complementary model for screening sepsis to existing sepsis clinical criteria and other laboratory signs. In this study, statistical analysis on the multiple clinical pathology parameters obtained from two groups, patients with sepsis and patients with fever, was performed and the complementary model was elaborated by stepwise parameter selection and machine learning. The complementary model showed statistically better performance (AUC 0.86 vs. 0.74-0.51) than models built up with specific hematology parameters involved in each existing sepsisrelated clinical score. Our study presents the complementary model based on the optimal combination of hematological parameters for sepsis screening in patients with fever.Sepsis, a dysregulated host response to infection, is a significant public health concern across the world, with more than >31 million cases annually and a mortality of 17% 1 . In the USA, the incidence rate of sepsis is 3 in 1000 individuals, which is 750,000 cases per year 2 . For each hour sepsis treatment is delayed, sepsis mortality increases by 7.6% 3 . Therefore, early intervention is important for patients with sepsis to increase the survival rates. However, the symptoms of sepsis are frequently non-specific, leading to a delay in diagnosis of sepsis. Fever, one of the symptoms, occurs in response to infection, inflammation and trauma. While it is often first manifestation of sepsis, it also is a sign of non-infectious etiology. Its non-specific response makes the early diagnosis of sepsis difficult. Given this difficulty with diagnosis, comparison study for two groups, patients with sepsis and patients with fever (abnormally high temperature), can therefore uncover set of (bio) markers which is sensitive and specific for sepsis screening in its early state.Studies on biomarkers, clinical criteria, and predictive models have been conducted for sepsis diagnosis. Many biomarkers have been evaluated for their utility in sepsis diagnosis. It was previously confirmed that procalcitonin (PCT), lactate, C-reactive protein (CRP), cytokines, D-dimer, and pro-adrenomedullin are elevated in patients
Breast tissue is an unusual site for metastatic disease, particularly for non-small cell lung cancer (NSCLC). Aside from contralateral breast cancer, the most common tumors metastasizing to the breast are malignant melanoma and hematopoietic malignances. We recently experienced a case of a 49-year-old female patient with solitary metastasis of NSCLC to ipsilateral breast tissue. She was diagnosed as NSCLC of left lung and underwent left upper lobectomy in 2001. She was then treated with etoposide/cisplatin chemotherapy and radiation therapy. After 35 months, she was referred to our breast clinic because of a nodular opacity in the left breast revealed by screening breast ultrasound, which proved to be of pulmonary origin. She was treated by wide excision and with docetaxel/cisplatin chemotherapy. However, 37 months after breast surgery, a metastatic lesion developed in the same breast and she received modified radical mastectomy. We report this case with a review of the literature.
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