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by Ping Guo, Yuwen Liu, Xiaomi Huang, Yanfang Zeng, Zhonglan Cai, Guang Tu
BackgroundAcute pulmonary edema is a severe clinical condition with high mortality. The anion gap, reflecting metabolic acid-base disturbances, is often elevated in critically ill patients. However, its relationship with outcomes in acute pulmonary edema remains unclear.
ObjectiveTo explore the association between admission anion gap levels and 28-day all-cause mortality in patients with acute pulmonary edema.
MethodsThis retrospective cohort study utilized data from the MIMIC-IV database (2008–2019) and included adult patients with acute pulmonary edema. Patients were categorized into quartiles based on anion gap levels. Cox regression models analyzed the relationship between anion gap and mortality, with restricted cubic spline (RCS) curves, Kaplan-Meier analysis, and subgroup analyses.
ResultsA total of 1094 patients were included. Univariate Cox regression showed a positive correlation between anion gap levels and 28-day mortality (HR = 1.13, 95%CI: 1.09–1.17, P P P Conclusion
Admission anion gap levels predict 28-day all-cause mortality in acute pulmonary edema patients, particularly in younger patients and those without renal disease. Clinically, anion gap monitoring should be emphasized, and individualized prognostic and treatment strategies should be developed with factors like age and renal status to improve outcomes.
by Lucie Ancel, Jules Gueguen, Guillaume Thoër, Jules Marçais, Aïda Chemloul, Bernard Le Guen, Marc Benderitter, Radia Tamarat, Maâmar Souidi, Mohamed Amine Benadjaoud, Stéphane Flamant
The threat of nuclear or radiological events requires early diagnostic tools for radiation induced health effects. Localized radiation injuries (LRI) are severe outcomes of such events, characterized by a latent presymptomatic phase followed by symptom onset ranging from erythema and edema to ulceration and tissue necrosis. Early diagnosis is crucial for effective triage and adapted treatment, potentially through minimally invasive biomarkers including circulating microRNAs (miRNAs), which have been correlated with tissue injuries and radiation exposure, suggesting their potential in diagnosing LRI. In this study, we sought to identify early miRNA signatures for LRI severity prognosis before clinical symptoms appear. Using a mouse model of hindlimb irradiation at 0, 20, 40, or 80 Gy previously shown to lead to localized injuries of different severities, we performed broad-spectrum plasma miRNA profiling at two latency stages (day 1 and 7 post-irradiation). The identified candidate miRNAs were then challenged using two independent mouse cohorts to refine miRNA signatures. Through sparse partial least square discriminant analysis (sPLS-DA), signatures of 14 and 16 plasma miRNAs segregated animals according to dose groups at day 1 and day 7, respectively. Interestingly, these signatures shared 9 miRNAs, including miR-19a-3p, miR-93-5p, miR-140-3p, previously associated with inflammation, radiation response and tissue damage. In addition, the Bayesian latent variable modeling confirmed significant correlations between these prognostic miRNA signatures and day 14 clinical and functional outcomes from unrelated mice. This study identified plasma miRNA signatures that might be used throughout the latency phase for the prognosis of LRI severity. These results suggest miRNA profiling could be a powerful tool for early LRI diagnosis, thereby improving patient management and treatment outcomes in radiological emergency situations.by Lin Chen, Jiayao Chen, Jindong Wan, Muqing Shao, Caiyu Chen, Shuo Zheng, Fuwei Zhang, Jian Yang
The angiotensin converting enzyme 2/angiotensin-(1–7)/Mas receptor axis plays an important role in the regulation of blood pressure. G protein-coupled receptor kinase 4 (GRK4) has attracted more attentions by modulating G protein-coupled receptors and blood pressure. However, it remains unknown whether renal Mas receptor is regulated by GRK4 and its role in the pathogenesis of hypertension. Compared with Wistar-Kyoto (WKY) rats, spontaneously hypertensive rats (SHRs) exhibited impaired Mas receptor-mediated diuresis and natriuresis, which was accompanied with increased phosphorylation levels of Mas receptors. Similarly, the phosphorylation of renal Mas receptor was increased and its-induced renal effects were decreased in human (h) GRK4γ 142V transgenic mice relative to wild-type littermates. There was a colocalization and a direct interaction of renal Mas receptor and GRK4, which were increased in SHRs and confirmed by rigid protein–protein docking. In vitro studies found that treatment with the Mas receptor agonist AVE0991 inhibited Na+-K+-ATPase activity in WKY renal proximal tubule (RPT) cells, which was failed in SHR cells. GRK4 silencing decreased the phosphorylation of Mas receptor and improved the impaired Mas receptor-mediated inhibition of Na+-K+-ATPase activity in SHR RPT cells. Further study showed that ultrasound-targeted microbubble destruction-targeted renal GRK4 depletion decreased Mas receptor phosphorylation and improved its-induced diuresis and natriuresis in SHRs. These suggest that GRK4 contributes to increased renal Mas receptor phosphorylation and dysfunction in hypertension, indicating that targeting GRK4 may be a viable therapeutic approach for hypertension.by Shuangyan Tu, Menglin Jiang, Rong Yang, Zhiqiang Deng, Cairong Zhu, Muke Zhou, Zhangyan Peng, Lihong Zhao
PurposeTo identify the scale that is more suitable for oral health assessment in stroke patient population with indwelling gastric tubes.
MethodsA total of 198 patients with indent gastric tubes were selected from 1250 stroke patients to evaluate their oral health using both the BOAS and the OHAT scales. The scores obtained from both scales were then compared to evaluate the feasibility, reliability, and validity of each scale in assessing oral health among stroke patients with indwelling gastric tubes.
ResultsThe results showed that both the BOAS and OHAT scales exhibited good reliability and validity in stroke patients with indwelling gastric tubes. The Cronbach’s alpha coefficients of BOAS and OHAT in stroke patients with indwelling gastric tubes were 0.89 and 0.91, respectively. In the exploratory factor analysis, one and two common factors were extracted from the two scales, with cumulative variance contributions of 65.89% and 71.85%, respectively. In addition, potential influencing factor correlation analysis found that gender and marital status had a significant correlation with the BOAS score(P Conclusions
The BOAS and OHAT have demonstrated good reliability and validity and in their ability to assess the oral health of stroke patients with indwelling gastric tubes. Therefore, it is recommended that the selection of oral assessment scales should be further refined in different disease stages of stroke patients to assess the oral health status of patients more accurately and personalized.
by Xi Cao, Bi-ting Zhu, Cai-peng Xie, Jing-yue Cai, Ding-guo Dong, Miao-ting Chen, Cheng-zhao Huang, Yong-chun Lin
To explore the risk factors influencing vancomycin trough concentration (Cvg−min) overexposure in critically ill patients with mechanical ventilation and rank the factors, the medical records of 194 mechanically ventilated critically ill patients hospitalized from 12/10/2021–06/10/2024 were analyzed. Among 194 critically ill patients, 77.83% were male and 22.17% were female. Univariate analysis showed that oxygenation index (OI), activated partial thromboplastin time (APTT), urea nitrogen (UN), septic shock, heart disease, congestive heart failure (CHF), moderate/severe chronic kidney disease (CKD), etc. were statistically different (P P P CI) and consistency ratio (CR) of analytic hierarchy process (AHP) was 0.0796 and 0.0885, respectively, which meets the consistency test standard. The contributions of APTT, OI, CHF and moderate to severe CKD to the overexposure of Cvg−min were 0.0584, 0.1899, 0.1614 and 0.5902, respectively. The overexposure rates of Cvg−min in patients with moderate/severe CKD and CHF were 95.12% and 95.23%, respectively. With regard to OI, when the cutoff value of OI was less than 245, the Cvg−min overexposure rate was 83%, otherwise, the overexposure rate was 60.97%. The risk factors for excessive exposure of Cvg−min in critically ill patients with mechanical ventilation were ranked as follows: moderate/severe CKD > OI > CHF > APTT.by Jiangfa Li, Wenxiang Song, Jixue Li, Lv Cai, Zhao Jiang, Mengxiao Wei, Boming Nong, Meiyu Lai, Yiyi Jiang, Erbo Zhao, Liping Lei
ObjectiveTo develop a predictive model for microvascular invasion (MVI) in hepatocellular carcinoma (HCC) through radiomics analysis, integrating data from both enhanced computed tomography (CT) and magnetic resonance imaging (MRI).
MethodsA retrospective analysis was conducted on 93 HCC patients who underwent partial hepatectomy. The gold standard for MVI was based on the histopathological diagnosis of the tissue. The 93 patients were randomly divided into training and validation groups in 7:3 ratio. The imaging data of patients, including CT and MRI, were collected and processed using 3D Slicer to delineate the region of interest (ROI) for each tumor. Radiomics features were extracted from CT and MRI of patients using Python. Lasso regression analysis was used to select optimal radiomics features for MVI in the training group. The optimal radiomics features of CT and MRI were selected to establish the prediction model. The predictive performance of the model was evaluated using the receiver operator characteristic curve (ROC), calibration curve, and decision curve analysis (DCA).
ResultsAfter univariate and multivariate analyses, it was found that tumor diameter was significantly different between the MVI positive and negative groups. After extracting 2153 imaging phenotyping features from the CT and MRI images of the 93 patients using Python, ten standardized coefficient non-zero imaging phenotyping features were finally determined by Lasso regression analysis in the CT and MRI images. A comprehensive predictive model with clinical variable and optimal radiomics features was established. The area under the curve (AUC) of the training group was 0.916 (95%CI: 0.843–1.000), sensitivity: 95.2%, specificity: 79.2%. In the validation group, the predictive model diagnosed MVI with AUC = 0.816 (95%CI: 0.642–0.990), sensitivity: 84.2%, and specificity: 75.0%.
ConclusionThe joint model that integrated the optimal radiomics features with clinical variables has good diagnostic performance for MVI of HCC and specific clinical applicability.
by Fengying Wei, Ruiyang Zhou, Zhen Jin, Yamin Sun, Zhihang Peng, Shaojian Cai, Guangmin Chen, Kuicheng Zheng
The differences of SARS-CoV-2 variants brought the changes of transmission characteristics and clinical manifestations during the prevalence of COVID-19. In order to explore the evolution mechanisms of SARS-CoV-2 variants and the impacts of variant evolution, the classic SIR (Susceptible-Infected-Recovered) compartment model was modified to a generalized SVEIR (Susceptible-Vaccinated-Exposed-Infected-Recovered) compartment model with age-group and varying variants in this study. By using of the SVEIR model and least squares method, the optimal fittings against the surveillance data from Fujian Provincial Center for Disease Control and Prevention were performed for the five epidemics of Fujian Province. The main epidemiological characteristics such as basic reproduction number, effective reproduction number, sensitivity analysis, and cross-variant scenario investigations were extensively investigated during dynamic zero-COVID policy. The study results showed that the infectivities of the variants became fast from wild strain to the Delta variant, further to the Omicron variant. Meanwhile, the cross-variant investigations showed that the average incubation periods were shortened, and that the infection scales quickly enhanced. Further, the risk estimations with the new variants were performed without implements of the non-pharmaceutical interventions, based on the dominant variants XBB.1.9.1 and EG.5. The results of the risk estimations suggested that non-pharmaceutical interventions were necessary on the Chinese mainland for controlling severe infections and deaths, and also that the regular variant monitors were still workable against the aggressive variant evolution and the emergency of new transmission risks in the future.
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