Serum Albumin Research Articles

Hypercalcemia: A Practice Overview of its Diagnosis and Causes

Hypercalcemia is defined as a serum calcium concentration higher than 10.5 mg/gL or 2.6 mmol/L. Only 50% of serum calcium is active, presented as ionized calcium. The remaining half is bound to albumin, phosphate, and other serum anions, and their changes can affect the serum calcium concentration. Thus, to discriminate true hypercalcemia from pseudo hypercalcemia, an ionized calcium concentration higher than 1.3 mmol/L might be more appropriate. Many variables can lead to hypercalcemia, and managing them is necessary to treat this ion disorder. Indeed, it can be caused by malignancies, hematologic disorders, or genetic diseases such as familial hypocalciuric hypercalcemia, or it can be related to hormone disorders involving parathormone or vitamin D. For this condition, the correct diagnostic algorithm should be followed. In this review, we summarize the diagnostic steps to follow and detail each clinical pathway is involved in hypercalcemia.

Preparing a Liposome-Aided Drug Delivery System: The Entrapment and Release Profiles of Doxorubicin and 9-(N-Piperazinyl)-5-methyl-12(H)-quino [3,4-b][1,4]benzothiazinium Chloride with Human Serum Albumin

Background/Objectives: The principal aim of this work was to prepare a liposomal drug delivery system based on the commercial drug doxorubicin (DOX) and a budding agent with promising anticancer activity, 9-(N-piperazinyl)-5-methyl-12(H)-quino [3,4-b][1,4]benzothiazinium chloride (9-PBThACl). Methods: A spectrophotometric methodology was used to meticulously investigate the drug entrapment and release characteristics of the new liposomal complexes (L) based on dipalmitoylphosphatidylcholine (DPPC) with human serum albumin (HSA) and its defeated analog (dHSA). Results: The impact of the operational parameters (temperature and pH) on the liposome/drug(s)/(d)HSA, namely [LDPPC/9-PBThACl/DOX ]:(d)HSA] systems, as well as the polarity of the phospholipid bilayer, was examined. In order to compare the experimental findings, mathematical models were employed to specify the analytical factors controlling the process of drug release/potential drug release from liposomes. The observed variations in the drug encapsulation and release profiles were due to the combination of liposomal conjugates with human plasma protein. Conclusions: It was proven that changes in the environmental pH directly affect the percentage of drug entrapment in liposomes and the medicine release efficiency. Moreover, the grouping tendency of the liposomal combinations was investigated using a principal component analysis (PCA) and a hierarchical clustering analysis (HCA). Finally, an analysis of variance (ANOVA) confirmed the statistical impact of pH buffering and changing temperature factors on the drug release characteristics of liposomal conjugates.

Mortality Risk Prediction in Patients With Antimelanoma Differentiation-Associated, Gene 5 Antibody-Positive, Dermatomyositis-Associated Interstitial Lung Disease: Algorithm Development and Validation.

Patients with antimelanoma differentiation-associated gene 5 antibody-positive dermatomyositis-associated interstitial lung disease (anti-MDA5+DM-ILD) are susceptible to rapidly progressive interstitial lung disease (RP-ILD) and have a high risk of mortality. There is an urgent need for a reliable prediction model, accessible via an easy-to-use web-based tool, to evaluate the risk of death. This study aimed to develop and validate a risk prediction model of 3-month mortality using machine learning (ML) in a large multicenter cohort of patients with anti-MDA5+DM-ILD in China. In total, 609 consecutive patients with anti-MDA5+DM-ILD were retrospectively enrolled from 6 hospitals across China. Patient demographics and laboratory and clinical parameters were collected on admission. The primary endpoint was 3-month mortality due to all causes. Six ML algorithms (Extreme Gradient Boosting [XGBoost], logistic regression (LR), Light Gradient Boosting Machine [LightGBM], random forest [RF], support vector machine [SVM], and k-nearest neighbor [KNN]) were applied to construct and evaluate the model. After applying inclusion and exclusion criteria, 509 (83.6%) of the 609 patients were included in our study, divided into a training cohort (n=203, 39.9%), an internal validation cohort (n=51, 10%), and 2 external validation cohorts (n=92, 18.1%, and n=163, 32%). ML identified 8 important variables as critical for model construction: RP-ILD, erythrocyte sedimentation rate (ESR), serum albumin (ALB) level, age, C-reactive protein (CRP) level, aspartate aminotransferase (AST) level, lactate dehydrogenase (LDH) level, and the neutrophil-to-lymphocyte ratio (NLR). LR was chosen as the best algorithm for model construction, and the model demonstrated excellent performance, with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.866, a sensitivity of 84.8%, and a specificity of 84.4% on the validation data set and an AUC of 0.90, a sensitivity of 85.0%, and a specificity of 83.9% on the training data set. Calibration curves and decision curve analysis (DCA) confirmed the model's accuracy and clinical applicability. Moreover, the model showed strong predictive performance in the external validation cohorts (cohort 1: AUC=0.836, 95% CI 0.754-0.916; cohort 2: AUC=0.915, 95% CI 0.871-0.959), indicating good generalizability. This model was integrated into a web-based tool to predict the 3-month mortality for patients with anti-MDA5+DM-ILD. We successfully developed a robust clinical prediction model and an accompanying web tool to estimate the 3-month mortality risk for patients with anti-MDA5+DM-ILD.

Real-world interpatient variability in the pharmacokinetics of levetiracetam.

Levetiracetam (LEV) is an antiepileptic drug (AED) used to treat a variety of seizures in adult and pediatric populations. It is an ideal AED due to its favorable pharmacokinetic (PK) and pharmacodynamic profile and lack of interactions with other AEDs. This retrospective cohort study was designed to identify covariates that affect LEV clearance and volume of distribution and to generate a population PK model. Adults with a seizure history receiving LEV during hospital admission with a minimum of one serum LEV concentration available were included in the study. Population PK modeling and covariate testing was performed with MONOLIX Suite 2020R1 (Lixoft, France). A total of 162 serum concentrations were collected from 143 patients. Age, sex, body weight descriptors, serum creatinine, creatinine clearance (CrCL), serum albumin, liver enzymes, and total bilirubin were evaluated. Body surface area (BSA) was a significant covariate for the apparent volume of distribution (V/F). The exclusion of BSA as a covariate of V/F increased the objective function value (OFV) 5.6. CrCL was a significant covariate of apparent plasma clearance (CL/F). The exclusion of CrCL increased the OFV by 18.16 and significantly increased the root square error (RSE) % of the between-subject variabilities of the parameters. LEV clearance is an effective predictor of serum concentration. CrCL was a significant covariate influencing LEV clearance, and BSA was found to influence the volume of distribution. Further studies are needed to determine the effect of body weight descriptors on LEV clearance and, ultimately, outcomes.

Column Chromatography-Free Synthesis of Spirooxindole and Spiroindanone-Based Naphthalimides as Potent c-MYC G4 Stabilizers and HSA Binders for Elevating Anticancer Potential.

G-quadruplex (G4) DNA plays a pivotal regulatory role in fundamental biological processes, integral for governing cellular functions such as replication, transcription, and repair in living cells. Within cancer cells, G4 DNA exerts an impact on the expression of crucial genes such as c-MYC, effectively repressing its activity when structured within its promoter region. Therefore, employing molecular scaffolds to target these structures offers an attractive strategy for altering their functions. In our pursuit of potent and selective G-quadruplex binders, herein we report a series of spironaphthalimide-pyrrolidine analogues that demonstrate the ability to stabilize c-MYC G4 formation and subsequently inhibit c-MYC expression. These analogues are evaluated for their anticancer activity against 60 human cancer cell lines at 10 μM. The most potent analogues 8j and 21c underwent additional testing at five dose concentrations (10-4-10-8 M) where low MG-MID GI50 values are observed for both the analogues 8j (9.98 μM) and 21c (2.49 μM). To correlate with the antiproliferative activity, the mechanism is explored in vitro by performing Pu27 DNA binding studies through multispectroscopic techniques, and the results are compared with Pu22, human telomere, and calf thymus DNA. Additionally, insights from molecular docking suggested stacking over the G-tetrad of G4 structures of both analogues, with quantum mechanical studies further reinforcing the rationale for the stability of this quadruplex secondary structure. The analogues are also evaluated for their binding affinity to human serum albumin, revealing their robust capability to effectively bind and potentially facilitate targeted delivery to specific sites. Amidst the abundance of G4s across the human genome, the above findings underscore the significance of spiro analogues, with potent multitargeting anticancer attributes, marking a transformative leap forward in G4-ligand innovation, promising frontiers in the quest for effective anticancer modalities.

Stent as a bridge to surgery for malignant colonic obstruction: a retrospective study on survival and outcomes

BackgroundIn cases of malignant colonic obstruction (MCO), self-expandable metallic stents (SEMS) are used as a bridge to surgery, offering an alternative to emergency surgery. However, the long-term oncologic outcomes remain debated, particularly in developing countries where the cost of SEMS is a concern. This study aimed to evaluate overall survival (OS) and outcomes associated with SEMS as a bridge to surgery (SBTS) compared to direct emergency surgery (ES) in patients with acute MCO.MethodsA retrospective study was conducted, including patients with potentially curable obstructed colon cancer who were treated with either SBTS or ES at a university hospital in Thailand from 2015 to 2022. We compared OS, 5-year OS rate, disease-free survival (DFS), postoperative morbidity, and complications between the SBTS and the ES groups.ResultsA total of 106 patients were eligible, 29 underwent SBTS, and 77 underwent ES. Baseline characteristics were similar except for ASA classification and chemotherapy rates. The median OS was 56.1 months, with no significant differences in OS (51.4 vs. 61.0 months, p = 0.67) or 5-year DFS (53.8% vs. 59.9%, p = 0.32) between the two groups. The SBTS group had higher rates of minimally invasive surgery (MIS) (65.5% vs. 16.9%, p < 0.001) and shorter postoperative stays (POS) (7 vs. 9 days, p = 0.026). Stage IV cancer and low serum albumin were poor prognostic factors for OS.ConclusionSEMS placement as a bridge to surgery had no significant impact on OS compared to ES, but it was associated with shorter hospital stays and higher rates of MIS.

Effect of an Ultra-Diluted Complex on Health, Growth Performance, and Blood Parameters of Pre-Weaned Dairy Calves

This study aimed to evaluate the effects of an ultra-diluted complex on the health status, growth performance, and blood parameters of dairy calves during the preweaning phase in a double-blind, placebo-controlled trial. During a 75-period trial, thirty-four Holstein newborn calves at the second day of life were completely randomized individually into two treatments: (1) control (CON), oral saline supplementation (5 mL/d); and (2) oral supplementation with 5 mL/d of a ultra-diluted complex (UD): Sulfur: 1060 + Viola tricolor: 1014 + Caladium seguinum: 1030 + Zincum oxydatum: 1030 + Phosphorus: 1060 + Cardus marianus: 1060 + Colibacillinum: 1030 + Podophyllum: 1030 + Vehicle: alcohol. Free access to water and a starter was ensured during the trial period. Feed intake and fecal and health scores were monitored daily. Calves were weighed and measured weekly. Blood samples were collected at enrollment on the first day and every 21 days until the 75th day, 2 h after morning milk feeding, and tested for hematology, blood urea nitrogen, aspartate aminotransferase, gamma-glutamyl transferase, total protein albumin, globulin, and creatinine. At 70 days of age, calves were disbudded following the standard management practices of the farm. The inflammatory profile, including Immunoglobulin A, Immunoglobulin G, ceruloplasmin, transferrin, albumin, and haptoglobin, was quantified in serum samples. The ultra-diluted complex was ineffective in reducing the incidence of diseases, starter feed intake, daily weight gain, and body measurements and inflammatory profile. Blood parameters were also not affected. Thus, the ultra-diluted complex was inefficient in reducing the incidence of diseases and did not affect the performance and metabolites of pre-weaned Holstein calves.

Subclinical systolic dysfunction in children with steroid-resistant nephrotic syndrome identified by speckle tracking echocardiography.

Steroid resistant nephrotic syndrome (SRNS) is a clinical phenotype of nephrotic syndrome (NS) that does not respond to steroid therapy and usually results in kidney failure. The aim of this study was to determine whether children with SRNS have subclinical left ventricular systolic dysfunction and, if so, to identify the risk factors for myocardial involvement in those children. This prospective case-control study included of 35 children with SRNS, 40 children in the healthy control group, and 40 children with NS during the initial episode as the diseased control group. Conventional echocardiography, tissue Doppler imaging (TDI), and speckle tracking echocardiography (STE) were performed on all the studied children. No statistically significant difference in conventional echocardiography's parameters were detected between the patient and control groups. TDI revealed that the E/E' ratio was significantly greater in the SRNS group than in both the healthy and diseased control groups (P = 0.001). The left ventricle global longitudinal strain (LV GLS) was markedly lower in children with SRNS than in healthy controls and NS patients (the diseased controls) (P = 0.001). Multiple binary regression analysis for the predictors of systolic dysfunction in SRNS patients revealed that the serum albumin is the only variable that predicts systolic dysfunction in these children. Subclinical systolic and diastolic LV dysfunction should be screened in NS especially SRNS children.

Theranostic Near-Infrared Monoamine Oxidase Inhibitor (NMI) Protein Binding Interactions with MAOA and Albumin.

The protein binding interactions of near-infrared monoamine oxidase inhibitor (NMI) are reported here. NMI-bound proteins were examined by fluorescent SDS-PAGE and mass spectrometry using tumor tissues from brain and colon cancer mouse models. This study shows protein interactions with NMI, a chemical conjugate of MAOA inhibitor clorgyline and tumor-seeking dye, MHI-148. NMI fluorescence in MAOA knock-out (KO) mice was significantly lower compared to WT mice, including whole animal, organs, and tissue lysates which indicated that NMI binds to MAOA. Pure recombinant MAOA protein was detectable as a single fluorescent band that migrated at ~ 65kD. NMI inhibited MAOA activity (IC50 1-5µM). In a glioma mouse model, NMI targeted specifically to tumor with high contrast to adjacent normal brain, shown by a 65 kD protein band. Recent studies demonstrated heptamethine cyanine dyes (e.g., MHI-148) interact with serum albumin, contributing to tumor uptake and cancer cell internalization. Our study shows NMI binds to albumin but highly prefers MAOA, providing a plausible mechanism for systemic drug delivery via serum albumin to the tumor target and subsequent MAOA inhibition. Further studies in a colon cancer mouse model found the ~ 65 kD SDS-PAGE band, bound to NMI, contained both MAOA and albumin proteins by mass spectrometry. NMI was shown to interact with MAOA and the blood carrier protein, albumin. This study provides insights for drug delivery and protein target specificity of NMI to image and treat cancer.

Clinical and biochemical characteristics for patients with polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes syndrome: a pilot observational study

BackgroundPolyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes (POEMS) syndrome is rare life-threatening condition associated with a clonal plasma cell neoplasm.ObjectiveThe aim of this study is to investigate the clinical and biochemical features in patients with POEMS syndrome before and post-therapy.MethodsCharacteristics of demographic information, underlying diseases, clinical manifestations, laboratory indicators, and imaging examination were retrospectively collected when diagnosed and post-therapy in the patients POEMS syndrome between 2018 and 2024.ResultsNineteen newly-diagnosed, treatment-naïve patients with POEMS syndrome were enrolled. The diagnosis of POEMS syndrome was re-analyzed and matched the diagnostic criteria updated in 2023. All patients presented the symptoms of polyneuropathy and positive for M-protein. Most patients suffered with hyperpigmentation (n = 18), organomegaly (n = 18), elevated vascular endothelial growth factor (VEGF) (n = 17), extravascular volume overload (n = 15), sclerotic bone lesions (n = 11), and hypothyroidism (n = 10). Serum alanine aminotransferase, aspartate aminotransferase, total bilirubin, total protein, and albumin levels were down-regulated, while uric acid level was up-regulated in patients with POEMS syndrome. Reduced triiodothyronine, thyroxine, free triiodothyronine levels were negatively correlated with urea nitrogen, creatinine, and uric acid levels in patients with POEMS syndrome. VEGF level, which was negatively correlated with Ca2+ level (r = −0.56), was reduced in most patients with POEMS syndrome receiving bortezomib/ixazomib and lenalidomide/thalidomide therapy. Aspartate aminotransferase, total protein, and estimated glomerular filtration rate levels were increased, while creatinine and uric acid levels were reduced post-therapy in patients with POEMS syndrome.ConclusionPatients with POEMS syndrome had impaired liver and renal function, and effective therapy might partly repair the liver and renal dysfunction.

Sustained Nitric Oxide Release Using Hybrid Magnetic Nanoparticles for Targeted Therapy: An Investigation via Electron Paramagnetic Resonance

This research describes the development and thorough characterization of a novel, versatile, and biocompatible hybrid nanocarrier of the NO-releasing agent NOC-18, with a specific focus on optimizing the purification process. In this study, we focused on the sustained release of NO using biocompatible and diagnostic hybrid magnetic nanoparticles (hMNPs) containing cerium-doped maghemite (CM) NPs, embedded within human serum albumin (HSA) protein. A comprehensive study was conducted using electron paramagnetic resonance (EPR) alongside the Griess assay to evaluate NO release from the chosen NO donor, NOC-18, and to assess the limitations of the molecule under various reaction conditions, identifying the optimal conditions for binding NOC-18 with minimal NO loss. Two types of particles were designed: In-hMNPs, where NOC-18 is encapsulated within the particles, and Out-hMNPs, where NOC-18 is attached onto the surface. Our results demonstrated that In-hMNPs provided a sustained and prolonged release of NO (half-life, 50 h) compared to the rapid release for the Out-hMNPs, likely due to the strong bonds formed with cerium, which helped to stabilize the NO molecules. These results represent a promising approach to designing a dual-function agent that combines contrast properties for tumor MRI with the possibility of increasing the permeability of tumor vasculature. The employment of this dual-function agent in combination with nanotherapeutics could improve the latter’s efficacy by facilitating their access to the tumor.

Factors Predicting Major Complications and Mortality in Percutaneous Endoscopic Gastrostomy: 8 Years of Experience of a Tertiary Surgery Center.

Percutaneous endoscopic gastrostomy (PEG) is a safe method of choice for patients who need long-term nutritional support. However, complications and high mortality rates have been reported. Based on 8 years of experience in tertiary care hospitals, we aimed to identify risk factors associated with major complications and 30-day mortality after PEG. Patients who underwent PEG in the General Surgery clinic of Tokat Gaziosmanpaşa University, Faculty of Medicine between January 2014 and March 2022 were included in the study. Data regarding patient demographics, comorbidities, laboratory data, drugs used together, and indications for PEG tube placement were collected. There were 429 patients. The mean age of the patients was 66.9±16.75 years, and 180 (44%) patients were female. The mean follow-up period was 8.84±6.75 months. Twenty patients (4.9%) had major complications. Female sex [Odds Ratio (OR) 0.33, 95% CI, CI=1.23-8.87, P=0.02] and diabetes mellitus (DM) (OR=0.23, 95% CI=1.93-6, P=0.002) were the independent variables associated with major complications. The all-cause 30-day mortality rate was 5.9% (n=24). Malignancy, DM, corticosteroid use, low albumin, and platelet values were associated with increased mortality in multivariate analysis as indications for PEG. Female sex and patients with DM may potentially face major complications. The patients with cancer, diabetes, and corticosteroid use were associated with higher mortality. In addition, low serum albumin and platelet levels were an effective factor for survival in patients undergoing PEG, and this should be taken into account in decision-making.

Enhancement of Antibacterial and Hydrophilic Properties of LDPE Surfaces by Benzoxazine‐Chitosan Coatings: Structure and Performances

ABSTRACTAlthough low‐density polyethylene (LDPE) proved its efficacy in alleviating biliary obstruction stemming from biliopancreatic conditions as biliary stents, the problem of stent occlusion resulting from insufficient antibacterial and hydrophilic properties remains worth investigating. In this study, polydopamine (PDA) and poly(ethylene glycol) bis(carboxymethyl) ether (PEGb) were used as anchors on the LDPE surface, and then chitosan‐benzoxazine (CSxBzy) coatings were grafted with PEGb to obtain an innovative surface to enhance the antimicrobial and hydrophilic features of LDPE. The antimicrobial abilities of PE‐CSxBzy were evaluated by co‐culture and plate coating techniques, demonstrating a remarkable inhibitory effect of up to 99.3% against Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli). The field emission scanning electron microscopy (SEM) and the laser confocal scanning microscope further demonstrated that the PE‐CSxBzy has excellent anti‐bacterial adhesion properties. Compared to pristine LDPE, the amount of adherent bovine serum albumin (BSA) and the number of bile proteins on the PE‐CSxBzy surface were reduced by up to 64.56% and 80.26%, respectively. PE‐CSxBzy exhibited excellent and stable hydrophilicity, with a water contact angle of approximately 50°, which only increased by 18.84% even after 30 days of immersion. PE‐CSxBzy also showed complete biocompatibility with human biliary epithelial cells (BECs) and anticipation for biliary stent materials considering its exceptional hydrophilicity and antibacterial abilities. Moreover, the molecular dynamics simulations further demonstrated that the antibacterial properties and hydrophilic capabilities arise from the synergistic effect of chitosan‐benzoxazine coating structures. This study, we suggest, presents recommendations for regulating the antimicrobial and hydrophilic properties associated with LDPE materials utilized in biliary stent applications.

Biomimetic Chromatography/QSAR Investigations in Modeling Properties Influencing the Biological Efficacy of Phenoxyacetic Acid-Derived Congeners

A hybrid method—combining liquid biomimetic chromatography techniques (immobilized artificial membrane chromatography and biopartitioning micellar chromatography) and Quantitative Structure–Activity Relationships—was used to derive helpful models for predicting selected biological properties such as penetration through the plant cuticle, the skin and the blood–brain barrier, and binding to human serum albumin of phenoxyacetic acid-derived congeners regarded as potential herbicides. Reliable, high-concept models were developed indicating the lipophilicity, polarizability, and sum of hydrogen bond donors and acceptors as properties that determine the biological efficacy of the title compounds. These models were validated by leave-one-out cross-validation. Modeling the toxicity of phenoxyacetic acid-derived congeners to red blood cells allowed the identification of the most toxic substances as well as those molecular descriptors that determine their hemolytic properties.

Associations between depressive and anxiety symptoms and incident kidney failure in patients with diabetic nephropathy

ObjectiveThis study aimed to analyze the associations between depressive and anxiety symptoms and risk of incident kidney failure in patients with biopsy-proven diabetic nephropathy (DN).MethodsThis retrospective study enrolled 241 type 2 diabetic patients with biopsy-proven DN. Huaxi Emotional-Distress Index (HEI) was used to evaluate the depression and anxiety status of patients on admission. According to the HEI score, DN patients were divided into HEI score ≤ 8 group (without depression and anxiety) and HEI score > 8 group (with depression and anxiety). The study endpoint was defined as progression to kidney failure. The cox proportional hazard analysis was performed to investigate the risk factors for progression to kidney failure in DN patients.ResultsTwenty-three patients had HEI score > 8, accounting for about 9.5% of all patients. Compared with HEI score ≤ 8 group, those with HEI score > 8 had more severe proteinuria, higher systolic blood pressure, and lower baseline eGFR and serum albumin levels. During a median follow-up of 28 months, the outcome event occurred in 89 (36.9%) of all the patients. After multivariable adjustment, HEI score > 8 (HR 1.825, 95% CI 1.050–3.172) was associated with an increased risk of progression to kidney failure.ConclusionDepressive and anxiety symptoms might be associated with an increased risk of progression to kidney failure in patients with DN, which implied psychosocial issues should be early screened, assessed and intervened to delay the progression of DN.

Clinical evaluation of platelet-to-albumin ratio as a predictor of surgical site infection in pediatric patients with ulcerative colitis.

This study explored the predictive factors for surgical site infection (SSI) in a pediatric ulcerative colitis (UC) population. Data from 35 patients with UC who underwent surgery before 15years at Mie University Hospital between January 2000 and December 2022 were retrospectively reviewed. Potential preoperative and intraoperative predictors of SSI, including various demographic and clinical variables, were analyzed using the Mann-Whitney U test and logistic regression analysis. The optimal cutoff value for the variables was determined by examining the receiver operating characteristic curve. Of the 35 patients, 8 (22.9%) experienced SSI. The platelet-to-albumin ratio (PAR) is a more accurate predictor of SSI occurrence than the serum albumin level, platelet count, or C-reactive protein level. The sensitivity and specificity of PAR were 75.0% and 77.8%, respectively, with an area under the curve (AUC) of 0.782 (p = 0.018). A multivariable analysis revealed that preoperative PAR was the only significant independent predictor (cutoff value: 115,000, p = 0.047) when the optimal cutoff value was applied rather than the median value. This study demonstrated the value of the preoperative PAR in the management of pediatric patients with UC. Assessing the patient's PAR before surgery allows proactive treatment to reduce the risk of SSI.

Lower time-averaged serum uric acid was associated with increased mortality in peritoneal dialysis patients.

The relationship between time-averaged serum uric acid (TA-SUA) levels and prognosis in peritoneal dialysis (PD) patients are rarely discussed. This was a retrospective cohort study. PD patients recruited from January 1, 2011, to December 31, 2020, were included. Baseline and follow-up uric acid levels over 1 year were collected to calculate time-averaged serum uric acid (TA-SUA) levels. Patients were divided into four groups based on TA-SUA quartiles: Q1 (<5.1 mg/dl), Q2 (5.1-5.8 mg/dl), Q3 (5.8-6.8 mg/dl), and Q4 (>6.8 mg/dl). A total 487 PD patients with a mean age of 52.0 ± 14.2 were enrolled, including114 (23.4%) diabetes. Q1 (n = 121, 24.8%), Q2 (n = 118, 24.2%), Q3 (n = 125, 25.7%), and Q4 (n = 123, 25.3%). The Q1 group exhibited characteristics of increased age, malnutrition, and a higher prevalence of diabetes. During the 48.1 months follow-up time, 197 (35.8%) died, 109 (55.3%) cardiovascular disease (CVD), 38 (19.3%) infections. Kaplan-Meier analysis revealed that both all-cause mortality and cardiovascular mortality were significantly higher in the Q1 and Q4 groups (log-rank = 24.373, p < 0.001). COX regression analysis showed that decreased TA-SUA level was an independent risk factor for all-cause mortality in PD patients after adjustment for confounding factors. Each 1 mg/dl decrease in TA-SUA level was associated with a 23.46% increase in all-cause mortality (HR = 0.81, 95% CI, 0.71-0.94; p = 0.004*). Lower serum albumin level was associated with increased all-cause mortality. PD patients with lower TA-SUA were older and had a higher proportion of diabetes and malnourishment than those with higher TA-SUA. Long-term exposure to low TA-SUA levels was an independent predictor of all-cause and cardiovascular mortality in PD patients.

The Efficacy and Safety of Continuous Veno-Venous Hemodiafiltration With High Cutoff Membrane Versus High Flux Membrane in Septic Acute Kidney Injury: A Randomized Controlled Study.

The application of high cutoff (HCO) membranes for continuous renal replacement therapy remains unclear in septic acute kidney injury (S-AKI) patients. S-AKI patients who received continuous veno-venous hemodiafiltration (CVVHDF) were randomly assigned to the experimental group (HCO membrane) and the control group (high flux membrane, HF membrane). Interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in serum and waste fluid were measured at 0, 2, 12, and 24 h after CVVHDF initiation and the 28-day mortality. Eleven patients were randomized to the HCO group, and 9 patients in the HF group, with a mean age of 54.9 ± 3.2 years and 6 patients (30%) being female. After 24 h of treatment with CVVHDF, there were significant reductions in serum IL-6 and TNF-α concentrations in the HCO group (p = 0.001, 0.015) and HF group (p = 0.004, 0.031). The serum IL-6 reduction rate of the HCO group was significantly higher than that of the HF group (79.21% vs. 42.69%, p = 0.025), while serum TNF-α reduction rates were comparable between the 2 groups. There were no significant changes in serum albumin after 24 h using either HCO membrane (28.7 ± 1.7 g/L vs. 32.7 ± 1.6 g/L, p = 0.138) or HF membrane (29.6 ± 1.1 g/L vs. 32.6 ± 1.3 g/L, p = 0.055). The two groups had similar 24-h filter clotting rates and 28-day mortality. While CVVHDF with the HCO membrane and HF membrane both achieved significant reductions in serum cytokine levels, the HCO membrane was associated with a greater reduction rate in IL-6 but not in TNF-α. No difference was observed in serum albumin, mortality, or filter clotting. Registry number: ChiCTR2000039725.

Hospital malnutrition and stroke: a study of nutritional risk and patient outcomes.

Introduction: Hospital malnutrition is a prevalent issue among stroke patients, with significant impacts on immune function and clinical outcomes. Malnutrition is associated with poor outcomes such as increased complications, prolonged recovery, and higher mortality. This study aims to assess the prevalence of malnutrition using the Malnutrition Screening Tool (MST) and its association with clinical outcomes, including length of stay (LOS), inflammatory markers, and mortality. Methods: A retrospective cohort study was conducted, including 230 stroke patients who were admitted between January 2022 and January 2024. Nutritional status was assessed using the MST, with key outcomes including LOS, Total Lymphocyte Count (TLC), Neutrophil-to-Lymphocyte Ratio (NLR), serum albumin, Prognostic Nutritional Index (PNI), and mortality. Statistical analyses were performed using chi-square tests for categorical variables and t-tests or Mann-Whitney U tests for continuous variables, with a p-value of &lt;0.05 considered statistically significant. Result: The study found that 26.5% of patients had an MST score of 2 or higher, indicating a high risk of malnutrition. Patients with high MST scores had significantly lower TLC (p = 0.017), indicating a weakened immune response. No significant differences were observed in LOS (p = 0.63), mortality (p = 0.404), or other inflammatory markers such as NLR, albumin, and PNI between the high-risk and low-risk groups. Conclusion: Malnutrition is common among stroke patients and is associated with impaired immune function, as evidenced by lower TLC in malnourished patients. Although no significant differences were observed in LOS or mortality, the findings underscore the importance of routine nutritional screening and timely intervention to improve patient outcomes.

Comparison between patients who have undergone cancer surgery based on MST value: a retrospective study.

Abstract Introduction: Malnutrition is a prevalent concern in oncologic surgery patients, often exacerbated by the effects of cancer and its treatments. Malnutrition is associated with poor clinical outcomes, including higher mortality rates, longer hospital stays, and increased complications. The Malnutrition Screening Tool (MST) is a valuable method for identifying malnutrition risk at hospital admission. This study aims to assess the prevalence of malnutrition using the MST and evaluate its prognostic value in relation to clinical outcomes, such as length of stay (LOS), inflammatory markers, and mortality in oncologic surgery patients. Methods: A retrospective cohort study was conducted at Dr. Wahidin Sudirohusodo Hospital in Makassar, Indonesia, from January 2022 to January 2024. Nutritional status was assessed using the MST, and key clinical outcomes—LOS, inflammatory markers (Neutrophil-to-Lymphocyte Ratio [NLR]), serum albumin, total lymphocyte count (TLC), and Prognostic Nutritional Index (PNI)—were analyzed. Statistical comparisons were performed using chi-square tests and t-tests, with statistical significance set at p &lt; 0.05. Results: Among the 284 patients, 33.8% were classified as malnourished (MST ≥2). Patients with higher MST scores had significantly worse clinical outcomes, including higher mortality (33.3% vs. 12.3% for MST &lt;2, p &lt; 0.001). Malnourished patients exhibited poorer inflammatory and nutritional markers, with higher NLR (6.13 vs. 4.68, p = 0.05), lower albumin (3.0 g/dL vs. 3.3 g/dL, p = 0.004), and lower PNI (36.4 vs. 41.8, p &lt; 0.001). No significant difference was found in LOS between the two groups (median 10 days vs. 9 days, p = 0.732). Conclusion: Malnutrition, as identified by the MST, is strongly associated with increased mortality and worsened inflammatory and nutritional markers in oncologic surgery patients. These findings underscore the need for routine nutritional screening and timely interventions to improve clinical outcomes in this high-risk population.