Basic Disease Research Articles

Are Primary Outcomes Really Primary? An Exploratory Cross-Sectional Nationwide Web-Based Survey Study for Outcomes Reflecting Real Symptoms and Needs of Patients with Lumbar Disc Herniation.

As primary outcomes differ among clinical lumbar disc herniation (LDH) studies, this study aimed to explore outcomes reflecting real-world patient experiences through an exploratory questionnaire survey. Those diagnosed with LDH having radiating leg pain in South Korea in November of 2022 (N = 500) were administered a questionnaire including basic characteristics, disease onset, symptoms and severity, priority symptoms for improvement, and important treatment factors. Outcome measures included the identification of priority symptoms and disabilities. Most common symptoms were numbness in the leg (N = 435, 87.0%) and back pain (N = 406, 81.2%); most common disabilities were discomfort in sitting (N = 323, 64.6%) and lifting (N = 318, 63.6%). The highest priority symptom was back pain (N = 242, 48.4%). A satisfactory degree of symptom improvement was a decrease of at least 3 points on the numeric rating scale. The majority of respondents preferred improvement in disability over pain (N = 270, 55.8%), a stable effect over a rapid effect (N = 391, 78.2%), and safety over treatment efficacy (N = 282, 56.4%). Safety (N = 129, 25.8%) and cost (N = 111, 22.2%) were the most important treatment factors. Improvements in back pain, leg pain, sitting, and sleeping were prioritized, and safety, stable treatment effect, and functional recovery were desired. Clinical trials for LDH should be designed to reflect this real-world patient need. Further study to examine the patients' symptoms and needs in details is needed.

Acid-Base Status & Electrolyte Imbalance in Critically ill Ventilated Infants

Introduction: Children who are critically ill typically suffer from a disease process that impacts many organ systems. To improve the outcome, these children are treated in a pediatric intensive care unit. The primary focus of intensive care medicine is the care of patients who are facing immediate life-threatening conditions. The aim of this study was to determine the acid- base status & electrolyte imbalance in critically ill ventilated infants. Methods: This was a prospective observational study and was conducted in the Department of Intensive Care Unit (ICU) of Bangladesh Shishu Hospital & Institute, Dhaka, Bangladesh during the period from January 2020 to December 2020. In our study, we included 50 critically ill ventilated young infants in ICU of Bangladesh Shishu Hospital & Institute. Results: In our study, we found that almost three fourth (74.0%) patients died and 13(26.0%) patients survived. Majority of our patients were ≤ 15 days and male. We found 22(59.5%) patients had PH level <7.25 in death group and 6(46.2%) in survival group and PH level ≥7.15 was (81.1%) in death group and 10(76.9%) in survival group. Before extubation & death metabolic acidosis was 19(51.4%) in dead group and 2(15.4%) in survival group. Significant relation was found between serum sodium level <135 and outcome of ventilated patients [p=0.039, OR=0.19(0.04-0.89)]. Imbalance of single & more than one electrolyte was found 43.24% & 56.76% in death group and 61.5% & 38.5% in survival group respectively. Conclusion: We found that arterial blood gas analysis & serum electrolytes level provide valuable information for correction of acid–base imbalance associated with a pathological condition. Electrolyte imbalance, regardless of the basic disease etiology, is a significant prognostic indicator that must be rapidly treated in critically ill children to get a good outcome.

Innovative micellar-UPLC approach for concomitant determination of favipiravir and remdesivir with four co-administered cardiovascular drugs in their pharmaceuticals and spiked plasma: Greenness and whiteness assessment

Many COVID-19 patients have pre-existing cardiovascular diseases, which are strongly linked to the high incidence of severe COVID-19. The experts advised such patients to prioritize drug treatments as per the physician's recommendations to avoid aggravation of the basic diseases. Hence, the development of an analytical approach for the concurrent determination of drugs prescribed for the co-treatment of COVID-19 and cardiovascular diseases acquires significant importance in QC units and bioavailability centers. Herein, a micellar-UPLC approach was first devised for the concomitant analysis of aspirin, atenolol, atorvastatin, losartan, favipiravir, and remdesivir as co-administered drugs, either with or without salicylic acid. On ACQUITY UPLC C18 column, the aforesaid drugs were isocratically separated employing a micellar eluent system. This system consisted of 0.03 M Brij-35, 0.15 M sodium dodecyl sulfate, and 0.02 M sodium dihydrogen phosphate (pH 5.0) as the mobile phase A (90%) and n-propanol as the mobile phase B (10%). The eluent system was pumped at a flow rate of 0.50 mL.min−1 for 5.50 min, which was suddenly increased to 0.80 mL.min−1 for 2.50 min. The separated peaks were scanned at 240 nm. The suggested approach was validated following ICH requirements for linearity, robustness, accuracy, specificity, precision, and detection and quantitation limits. The suggested approach was applied successfully to commercial products and human plasma without any intrusion from excipients or plasma matrices. The suggested approach’s greenness was appraised employing five metrics namely: eco-scale, GAPI, NEMI, Raynie and Driver, and AGREE. Furthermore, the suggested approach’s whiteness features were investigated using the recently unveiled RGB12 model. The suggested approach outperformed the reported approaches in terms of greenness and whiteness. The sensitivity, high sample throughput, and short runtime (7.40 min) of the suggested approach assert its aptness for routine determination of the aforesaid drugs.

Longitudinal Transcriptomic Analysis of Human Cortical Spheroids Identifies Axonal Dysregulation in the Prenatal Brain as a Mediator of Genetic Risk for Schizophrenia

BackgroundSchizophrenia (SCZ) has a known neurodevelopmental etiology, but limited access to human prenatal brain tissue hampers the investigation of basic disease mechanisms in early brain development. Here, we elucidate the molecular mechanisms contributing to SCZ risk in a disease-relevant model of the prenatal human brain. MethodsWe generated induced pluripotent stem cell–derived organoids, termed human cortical spheroids (hCSs), from a large, genetically stratified sample of 14 SCZ cases and 14 age- and sex-matched controls. The hCSs were differentiated for 150 days, and comprehensive molecular characterization across 4 time points was carried out. ResultsThe transcriptional and cellular architecture of hCSs closely resembled that of fetal brain tissue at 10 to 24 postconception weeks, showing strongest spatial overlap with frontal regions of the cerebral cortex. A total of 3520 genes were differentially modulated between SCZ and control hCSs across organoid maturation, displaying a significant contribution of genetic loading, an overrepresentation of risk genes for autism spectrum disorder and SCZ, and the strongest enrichment for axonal processes in all hCS stages. The two axon guidance genes SEMA7A and SEMA5A, the first a promoter of synaptic functions and the second a repressor, were downregulated and upregulated, respectively, in SCZ hCSs. This expression pattern was confirmed at the protein level and replicated in a large postmortem sample. ConclusionsApplying a disease-relevant model of the developing fetal brain, we identified consistent dysregulation of axonal genes as an early risk factor for SCZ, providing novel insights into the effects of genetic predisposition on the neurodevelopmental origins of the disorder.

Research on the psychological status of medical staff during the COVID-19 epidemic in China: A longitudinal study.

An online questionnaire, including the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS), was used to assess the psychological status of medical staff in Wuhan during the COVID-19 epidemic. Lasso-Logistic regression analysis was performed to analyze the risk factors of abnormal psychological status (anxiety or depression). 36.6% of the study subjects experienced anxiety, and 41.5% experienced depression. Female (OR [odds ratio] = 7.22, 95% CI [confidence interval]: 0.58-89.33), basic diseases (OR = 17.95, 95% CI: 1.59-202.49), suspected exposure history (OR = 9.63, 95% CI: 1.40-66.29), smoking (OR = 6.07, 95% CI: 0.38-96.78) were risk factors for anxiety. Female (OR = 5.00, 95% CI: 0.45-55.91), basic diseases (OR = 37.19, 95% CI: 2.70-512.73), suspected exposure history (OR = 5.10, 95% CI: 0.78-33.10), drinking wine (OR = 6.27, 95% CI: 0.38-103.85) were risk factors for depression. The results of the re-sampling evaluation after 2 years showed that some medical staff still showed anxiety (42.4%) and depression (27.3%), and the proportion of females was higher. Early intervention should be carried out, and short-term and long-term intervention plans should be formulated.

Quantitative magnetic resonance mapping of the myelin bilayer reflects pathology in multiple sclerosis brain tissue.

Multiple sclerosis (MS) is a neuroinflammatory disease characterized by loss of myelin (demyelination) and, to a certain extent, subsequent myelin repair (remyelination). To better understand the pathomechanisms underlying de- and remyelination and to monitor the efficacy of treatments aimed at regenerating myelin, techniques offering noninvasive visualizations of myelin are warranted. Magnetic resonance (MR) imaging has long been at the forefront of efforts to visualize myelin, but it has only recently become feasible to access the rapidly decaying resonance signals stemming from the myelin lipid-protein bilayer itself. Here, we show that direct MR mapping of the bilayer yields highly specific myelin maps in brain tissue from patients with MS. Furthermore, examination of the bilayer signal behavior is found to reveal pathological alterations in normal-appearing white and gray matter. These results indicate promise for in vivo implementations of the myelin bilayer mapping technique, with prospective applications in basic research, diagnostics, disease monitoring, and drug development.

Pneumonia in newly diagnosed patients infected with the Omicron variant: a population-based study of Chinese patients in Chongqing

BackgroundPneumonia is the main complication of the Omicron variant of SARS-CoV-2; however, the incidence proportions and prognostic factors for Omicron-associated pneumonia have not been established. We conducted this study to...

Clinical significance of serum S100 calcium-binding protein A12 concentrations in patients with community-acquired pneumonia.

This study aimed to investigate the clinical significance of serum S100 calcium-binding protein A12 (S100A12) concentrations in patients with community-acquired pneumonia (CAP). This was a case-control study. We selected 120 patients with CAP treated in Xichang People's Hospital from January to June 2022 as the case group. Sixty healthy adults without a history of basic diseases were selected as the control group. The patients in the case group were divided into the low S100A12 and high S100A12 subgroups. Serum S100A12, C-reactive protein (CRP), and procalcitonin (PCT) concentrations, the leukocyte count, and other study parameters were compared. Serum S100A12, CRP, and PCT concentrations and the leukocyte count were higher in the case group than in the control group. The baseline confusion, urea, respiratory rate, blood pressure, and age ≥ 65 score, baseline pneumonia severity index score, and 30-day mortality rate were higher in the high S100A12 subgroup than in the low S100A12 subgroup. Serum CRP and PCT concentrations and the leukocyte count were higher in the high S100A12 subgroup than in the low S100A12 subgroup. Patients with high serum S100A12 concentrations have more severe CAP, a more serious inflammatory reaction, and higher 30-day mortality.

Association between salivary proteases and protease inhibitors linked with viral infections and oral inflammatory diseases

IntroductionDespite the role of transmembrane protease, serine 2 (TMPRSS2) in facilitating the entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the primary cause of the global COVID-19 pandemic, the interaction of extracellular and intracellular proteases in this process remains poorly elucidated. Thus, we monitored the salivary expression concentration (SEC) of TMPRSS2 and its inhibitor, alpha-1 antitrypsin (A1AT), and investigated whether oral inflammatory diseases affected the SEC of both proteins. Materials and methodsWe collected saliva samples before and after surgical treatment of inflammatory cystic diseases (radicular and inflammatory dentigerous cysts) in 25 patients. The SEC of TMPRSS2 and A1AT was measured using enzyme-linked immunosorbent assay. SEC in multiple patient status groups and subgroups of each status were investigated. Finally, the correlation between TMPRSS2 and A1AT SEC was analyzed. ResultsThe TMPRSS2 and A1AT SEC did not significantly change pre- or post-treatment. The TMPRSS2 SEC was significantly higher before and after treatment in patients aged >50 years, patients with radicular cysts, and patients with the basic disease. A1AT SEC was significantly decreased after treatment in the acute inflammation, large-sized, and patients without basic disease groups. No significant correlation was observed between the SEC of either protein before and after treatment. DiscussionIndividual-specific SEC for TMPRSS2 may be influenced by age, lesion type, and basic disease; however, oral inflammatory diseases may not have a direct effect. Moreover, the extent of oral inflammatory diseases and the presence of basic diseases may be associated with A1AT SEC. Furthermore, the SEC between the two proteins may be independent.

Integrative Plasma Metabolic and Lipidomic Modelling of SARS-CoV-2 Infection in Relation to Clinical Severity and Early Mortality Prediction.

An integrative multi-modal metabolic phenotyping model was developed to assess the systemic plasma sequelae of SARS-CoV-2 (rRT-PCR positive) induced COVID-19 disease in patients with different respiratory severity levels. Plasma samples from 306 unvaccinated COVID-19 patients were collected in 2020 and classified into four levels of severity ranging from mild symptoms to severe ventilated cases. These samples were investigated using a combination of quantitative Nuclear Magnetic Resonance (NMR) spectroscopy and Mass Spectrometry (MS) platforms to give broad lipoprotein, lipidomic and amino acid, tryptophan-kynurenine pathway, and biogenic amine pathway coverage. All platforms revealed highly significant differences in metabolite patterns between patients and controls (n = 89) that had been collected prior to the COVID-19 pandemic. The total number of significant metabolites increased with severity with 344 out of the 1034 quantitative variables being common to all severity classes. Metabolic signatures showed a continuum of changes across the respiratory severity levels with the most significant and extensive changes being in the most severely affected patients. Even mildly affected respiratory patients showed multiple highly significant abnormal biochemical signatures reflecting serious metabolic deficiencies of the type observed in Post-acute COVID-19 syndrome patients. The most severe respiratory patients had a high mortality (56.1%) and we found that we could predict mortality in this patient sub-group with high accuracy in some cases up to 61 days prior to death, based on a separate metabolic model, which highlighted a different set of metabolites to those defining the basic disease. Specifically, hexosylceramides (HCER 16:0, HCER 20:0, HCER 24:1, HCER 26:0, HCER 26:1) were markedly elevated in the non-surviving patient group (Cliff's delta 0.91-0.95) and two phosphoethanolamines (PE.O 18:0/18:1, Cliff's delta = -0.98 and PE.P 16:0/18:1, Cliff's delta = -0.93) were markedly lower in the non-survivors. These results indicate that patient morbidity to mortality trajectories is determined relatively soon after infection, opening the opportunity to select more intensive therapeutic interventions to these "high risk" patients in the early disease stages.

Comparison of advanced glycation end products concentration in the skin among patients with rheumatic diseases, with and without comorbid depression: a case-control study.

Patients with rheumatic diseases suffer depression at a far greater rate than the general population. Aside from evident mental health degradation, in this group of patients depression can often lead to failures in the treatment of the basic disease. The aim of the study was to assess the concentration of advanced glycation end-products (AGE) in the skin autofluorescence (SAF) exam in patients with select rheumatic diseases depending on depression concomitance. 139 patients with rheumatic diseases were enrolled into the study-43 (39F/4M) patients with RA, 31 (24F/7M) patients with PsA, 27 (22F/5M) patients with SLE and 38 (33F/5M) patients with SSc. In all patients, the concentration of AGE was assessed using the AGE Reader device (DiagnOptics BV Groningen, The Netherlands). The Beck Depression Inventory II was used to assess depression in the patients. Patients who scored 14 points or more in the BDI-II were diagnosed with depression. In the studied group, depression was identified in 73 (53%) patients-25 with RA, 21 with PsA, 11 with SLE and 16 with SSc. Mean SAF in patients with depression was 2.8 ± 0.4, and in the group with no depression-2.2 ± 0.5 (p < 0.001). The study results indicate that in the course of rheumatic diseases, the presence of depression may influence the increase in AGE concentration in the skin. Therefore, evaluating AGE levels in the skin may be clinically relevant as it can help identify patients who may be at risk of developing depression.

Successful Treatment of White Lung in Elderly Patients with COVID-19

Novel coronavirus (SARS-CoV-2, hereby known as COVID-19) has the characteristics of rapid variation and multiple variants, which has caused a huge impact on human health worldwide. At the end of 2022, the Omicron variant was widely spread in China, and the patients infected with COVID-19 were mainly concentrated in the elderly over 80 years old and people with serious basic diseases. Pathologically, diffuse lung injury can be seen in the advanced stage of severe and critical diseases, with a large number of inflammatory cells and fibrous mucus exudation, alveolar epithelial cells shedding and necrosis, severe pulmonary edema, hyaline membrane formation, and diffuse ground-glass shadow or consolidation on imaging, which is manifested as “white lung” [1], and its mortality rate has significantly increased. This study reported two cases of elderly patients admitted to the Affiliated Hospital of Hebei University for the treatment of COVID-19.

Survey on vaccination and infection of middle school students after the full liberalization of COVID-19

Objective To explore the situation of COVID-19 vaccination and infection among middle school students after the full liberalization of [the]COVID-19 restraciation, and to provide theoretical basis and support for health reflection after the epidemic. Methods On the basis of convenient sampling, A cluster sampling method was adopted. In February 2023, a survey was carried out among all the students in a town[A] level middle school in the southeast of Henan Province in China. Their general information, COVID-19 vaccination and infection data were obtained in the form of questionnaire stars. To explore the vaccination and infection of COVID-19 among middle scho[]ol students with different characteristics, and to conduct multifactor logistic regression analysis on the independent variables of different grades of middle school students, the length of sleep every day, daily exercise duration, whether they have underlying diseases, monthly families income , and the vaccination status as independen[independent ]t variables. and the dependent variables of infection such as those who have not been infected with COVID-19, who have been infected with COVID-19 once, who have been infected with COVID-19 twice, and who have symptoms but have not undergone nucleic acid testing. Results After the COVID-19 pandemic, there were 57 middle school students receiving the COVID-19 vaccine ≤1 dose, accounting for 4.54%. 794 people (63.32%) were inoculated with 2 doses; 403 patients received 3 doses, accounting for 32.14%. The number of people who were not infected was 413, accounting for 32.93%; The number of people who were infected for first-time was 697, accounting for 55.58%; 29 people were re-infected, accounting for 1.99%; There were 119 patients with unwell symptoms but no nucleic acid test, accounting for 9.49%.Through correlation test and multivariate logistic analysis, it was found that senior grades and underlying diseases were the possible factors that caused the infection and severity of COVID-19. Conclusion The overall vaccination of middle school students in the region is relatively good. Grade and whether there is a basic disease are related to whether they are infected with COVID-19, and whether there is a basic disease is related to reinfections. It is recommended to pay attention to the basic diseases of middle school students and maybe explore the opening of 12-year compulsory education in response to the severe infection situation in third grade.At the same time, we should carry out scientific, effective and dynamic closed-loop health management for middle school students.

Current issues of therapy in the scientific heritage of Academician Lyubov Trokhymivna Mala and her school (to the 20th anniversary of the death of L. T. Mala)

The review, dedicated to the 20th anniversary of the death of Academician Lyubov Trokhymivna Mala, provides data on her scientific, medical and pedagogical activities, focuses on the interests of this outstanding personality in the leading issues of internal medicine, including acute myocardial infarction, endothelial dysfunction, atherogenesis, heart failure, arterial hypertension, issues of gastroenterology, nephrology, pulmonology, pharmacotherapy. The authors highlight the achievements of students and followers of Academician Mala in the investigation of basic internal diseases from the standpoint of their comorbidity, and present information on the development of effective approaches to the diagnosis, treatment and prevention of leading therapeutic pathologies by the scientists of the Institute of Therapy.

Telenursing needs and influencing factors in patients with type 2 diabetes mellitus: A cross-sectional study.

This study aimed to determine the relationship between the demand for telenursing and the chronic illness resources available to patients with type 2 diabetes mellitus (T2DM), as well as the factors that affect this requirement. Cross-sectional. This study included 586 participants with T2DM. A telenursing needs questionnaire developed by the research team was used to assess the telenursing needs of patients with T2DM, and the Chinese version of the Chronic Illness Resources Survey was used to assess the participants' community chronic disease resources. A one-way ANOVA and multiple regression analysis were used to determine the factors influencing the demand for telenursing and to estimate the relationship between chronic illness resources and the need for telenursing. The STROBE checklist was followed. The patients' telenursing needs, ranked from high to low, are as follows: individualized skills and safety; basic disease care; psychological and spiritual needs; respect and social support; and high-level health management. The chronic disease resource score was 3.47 ± .02, which suggested that patients with T2DM have relatively rich disease resources. Multiple regression analyses showed that resources for chronic diseases, the course of diabetes and complications, family income and other chronic diseases accounted for 79.6% of the variance in T2DM patients' telenursing needs. The telenursing needs of patients with T2DM are prominent, and primarily focus on basic nursing needs for the disease. To some extent, chronic disease resources affect the telenursing needs of patients with T2DM. It is crucial to pay attention to research on telenursing for T2DM patients from the patients' perspective. Enhancing resources for chronic diseases may help meet the telenursing needs of T2DM patients. Parents and diabetes management specialists participated in designing the telenursing needs questionnaire.

#4758 IMPACT OF GENDER ON CHRONIC KIDNEY DISEASE IN ELDERLY

Abstract Background and Aims Men with chronic kidney disease (CKD) progress to end-stage CKD at a faster rate than women Data for the association of sex with chronic kidney disease (CKD) progression are conflicting, a relationship between the two especially among elderly population needs understanding . Method We conducted a prospective study among all elderly population with CKD attending Nephrology OPD between between Jan 2019-Jan 2022 in Tertiary care hospital, Lucknow and assessed for the stage of CKD and their fall in eGFR ie trajectory of fall in eGFR within a year's time. Results A total of 59 elder men and 34 females (&amp;gt;65 years) of age with estimated glomerular filtration rate (eGFR)&amp;lt;45mL/min/1.73 m2 followed up in renal clinics. They were looked for progression to ESRD and morbidity and mortality over time. The age, basic disease, systolic blood pressure, underlying cardiac status and use of rennin angiotensin blockers were similar between the two groups. Baseline eGFRs were 36.4±7.0 in men and 35.0±6.2 mL/min/1.73 m2 in women (P&amp;lt;0.001), the degree of proteinuria among men was found to be statically significant as compared to women in this cohort. During a median follow-up of 2.9 years, (22.3% men) developed ESRD while 7.2 % died. The adjusted risks for ESKD and mortality were higher in men as compared to the women in this cohort.The decline in eGFR was evident across all stages of CKD among men as compared to women. The slop of decline in eGFR and degree of proteinuria was rapid among men compared to women (−2.9; 95% CI, −2.9 to −1.66 mL/min/1.73 m2 per year) than in women (−1.7; 95% CI, −1.92 to −1.55 mL/min/1.73 m2 per year; P&amp;lt;0.001). Although sex differences in eGFR decline were not different across CKD stages (P=0.3), the difference in slopes between men and women was progressively larger with proteinuria &amp;gt;0.5g/d (P = 0.04) Conclusion Elderly men have a steeper decline in eGFR along with higher proteinuria as compared to women indicating that the decline in the mean GFR in women was slower than in men, independent of health status.

#3385 A STUDY OF CLINICAL SPECTRUM AND THE OUTCOME IN LIVE KIDNEY TRANSPLANT RECIPIENTS IN A TERTIARY CARE CENTRE OF INDIA

Abstract Background and Aims Kidney transplantation has become the treatment of choice for end-stage renal disease as it leads to longer survival and superior quality of life. There is a remarkable disparity in the access and outcome of kidney transplant across the world. Limited health care resources, difficulty in access or sometimes non availability of appropriate medications, difficulties with transportation, limited availability of Nephrologists are common challenges in developing countries and also within a country like India due to diverse socioeconomic and cultural backgrounds. We present the pattern of infection, various causative organisms, causes of allograft dysfunction and the clinical outcome of the admitted live kidney transplant recipients in Nephrology department of a tertiary care center from North-East India. Method This was a single center retrospective observational study carried out in Nephrology Department of Gauhati Medical College, Guwahati, India. The data were collected from the medical records. All the admissions of live renal allograft recipients during the period May 2017- May 2022, were included in the study. Results Out of a total of 156 admissions of renal transplant recipients, male to female ratio was 3.7: 1. Among the live KTRs basic disease, most common was chronic glomerulonephritis (44.8%) followed by CTID (23.9%). Infection related complications were present in 72 (46.1%) cases. Among infection UTI (n = 29, 16.6%) was most common followed by pneumonia (n = 24, 15.4%). Various causes of graft dysfunction (biopsy proven) were ATI (Acute tubular injury), CNI toxicity, chronic ABMR, acute ABMR, recurrence of basic disease, acute TCMR and chronic TCMR. NODAT was found in 14 (9%) of the cases. Out of theses 4 cases, 1 had bacterial pneumonia and 3 had UTI. Of 72 admissions with infection, total 8 patients succumbed to their illness with mortality rate of 11.1%. The most common cause of mortality was sepsis due to UTI. Conclusion The number of admissions of renal transplant cases has increased significantly in last 5 years, indicating the increased availability and affordability of renal transplantation in our country. Of 156 admitted live KTRs, infection was seen in 46.1% (n = 72) cases. UTI remained the most common infection (n = 29, 16.6%) followed by pneumonia (n = 24, 15.4%). Graft dysfunction was seen in 33.9% (n = 53) cases. Chronic ABMR was the most common cause (n = 30, 19.2%) for graft dysfunction. Neglect of necessary hygiene, ignorance of regular follow up and dysregulated immunosuppressive doses have contributed to high infection rate. Lack of regular follow up in post-transplant period due to logistic issues or lack of education and awareness, lack of access to immunosuppressive drugs, etc. are major contributing factors for graft dysfunction in our set up. The condition worsens with the difficult terrain, repeated floods, and lack of transportation from remote areas in Nort Eastern part of India.

Hardwiring tissue-specific AAV transduction in mice through engineered receptor expression

The development of transgenic mouse models that express genes of interest in specific cell types has transformed our understanding of basic biology and disease. However, generating these models is time- and resource-intensive. Here we describe a model system, SELective Expression and Controlled Transduction In Vivo (SELECTIV), that enables efficient and specific expression of transgenes by coupling adeno-associated virus (AAV) vectors with Cre-inducible overexpression of the multi-serotype AAV receptor, AAVR. We demonstrate that transgenic AAVR overexpression greatly increases the efficiency of transduction of many diverse cell types, including muscle stem cells, which are normally refractory to AAV transduction. Superior specificity is achieved by combining Cre-mediated AAVR overexpression with whole-body knockout of endogenous Aavr, which is demonstrated in heart cardiomyocytes, liver hepatocytes and cholinergic neurons. The enhanced efficacy and exquisite specificity of SELECTIV has broad utility in development of new mouse model systems and expands the use of AAV for gene delivery in vivo.

Diagnostic value of procalcitonin, interleukin-6, serum amyloid A and C-reactive protein in simple and strangulated intestinal obstruction

Objective To evaluate the value of single or combined detection of procalcitonin (PCT), interleukin-6 (IL-6), serum amyloid A (SAA) and c-reactive protein (CRP) in the differential diagnosis of simple and strangulated intestinal obstruction. Methods This retrospectively study collected 61 patients with intestinal obstruction. The patients were classified into the group of simple or strangulated intestinal obstruction according to operation. The age, sex, basic diseases, lesion sites and inflammatory indicators such as PCT, IL-6, SAA and CRP in two groups were collected and analyzed. The Students’ T-test and the Mann-Whitney U test were used to analyze normally and non-normally distributed data, respectively. The categorical variable was analyzed by the chi-square test. The receiver-operating characteristic (ROC) curve and the area under the curve (AUC) were used to predict the differential diagnostic value of single and combined detection of the above clinical inflammatory indicators. Results The serum levels of PCT, IL-6, SAA and CRP of the strangulated group were significantly higher than those of the simple group ( p &lt; .05). The areas under the ROC curve (AUC) were 0.907 for PCT, 0.712 for IL-6, 0.723 for SAA and 0.681 for CRP. With the cutoff values of PCT (0.24 ng/L), IL-6 (19.55 pg/L), SAA (282.50 mg/L) and CRP (63.00 mg/L), the sensitivity and specificity were 86.40% and 87.20% for PCT, 68.20% and 76.90% for IL-6, 59.10% and 87.20% for SAA, 63.60% and 87.20% for CRP, respectively. And the sensitivity and specificity were 86.40% and 89.70% for combined model. The differences between PCT and the combined model are tiny and neither clinically nor statistically significant. Conclusions For discriminating strangulated intestinal obstruction from simple intestinal obstruction, PCT alone may be the preferred approach due to its simplicity.

Symptom burden and end of life care in patients with acute myeloid leukemia undergoing intensive induction chemotherapy in a rural setting.

e24117 Background: Patients with acute myeloid leukemia (AML) who receive intensive induction chemotherapy (IC) face a prolonged hospitalization and a life-threatening illness. As a result, patients experience a high physical, psychological, and emotional symptom burden which can significantly affect their quality of life (QOL).1 There is also a high mortality rate associated with IC, with one study showing 12.3% chance of in-hospital death and 3.7% discharge to hospice.2 Early integration of palliative care (IPC) has shown improvements in QOL, decrease in psychological stress and improved end-of-life care.3 The aim of this study was to examine the historic use of IPC during IC and assess the symptom burden in a rural healthcare setting and to provide a rationale for early incorporation of palliative care into IC. Methods: We performed an IRB approved retrospective study of all patients with AML who were admitted to Gundersen Health System for IC from January 2013 to September 2021. Data collection included basic demographics, disease and treatment specific variables, and admission variables. Symptom burden was also assessed by reviewing daily progress notes. Statistical analysis included descriptive statistics, Wilcoxon signed-rank test, and Fisher’s exact test and was performed in SAS version 9.4 at a significance level of 0.05. Results: Our study included 33 patients with an average age of 62 years. Our sample was 100% white, 58% male, 82% married and 58% former smokers. Average length of stay was 29 days and 5 (15%) patients died during this time. Individuals experienced an average of 9.8 (range 4-17) of the 20 recorded symptoms, most commonly pain (97%), fevers (88%), edema (73%), anorexia (67%), rash (61%), and diarrhea (61%). Only 6 patients (18%) received a palliative care consultation during IC. For patients without a palliative care consultation during IC, advanced care planning (ACP) documents were found in only 37% during or before IC. However, when palliative care was consulted, ACP documentation increased to 83% demonstrating a trend towards significance (p = 0.07). There was a significant difference between the number of symptoms observed in those who received a palliative care consultation (median = 13 symptoms) and those who did not (median = 9 symptoms, p = 0.007). Conclusions: Despite our patients experiencing a high symptom burden and a significant chance of death, there was a low rate of early integration of palliative care. This retrospective study was unable to determine if IPC improved symptom burden, but we did find that IPC increased the rate of ACP documentation from 37% to 83%. The presence of ACP documentation has been shown to significantly reduce ICU utilization and improve the quality of care at the end of life.4 Given these findings; we plan to move forward with routine integration of palliative care into the management of patients undergoing IC for AML.