Dead Group Research Articles

Abstract 4123371: Hyperoxia is not a significant predictor of ICU mortality and is likely a surrogate parameter for reduced native cardiac function in patients supported with VA-ECMO

Intro: Hyperoxia has been associated with adverse outcomes in VA-ECMO patients. Whether hyperoxia represents a mechanism of mortality or is a surrogate for worse cardiac function is unknown. Aim: To determine patient characteristics, lab values, and hemodynamic parameters associated with increased mortality in VA-ECMO patients. Methods: Single-center retrospective cohort study at UCSF in VA-ECMO patients (2020-2023). Patients were categorized into 3 groups: Dead, Advanced Therapy-Free Survivors, and Advanced Therapy Survivors (survived to ICU discharge with LVAD or heart transplant). Wilcox rank sum and two sample proportion tests were performed. In-hospital mortality was evaluated using multiple logistic regression. Results: Of 179 patients, 87 died and 92 survived to ICU discharge. Of the survivors, 22 received advanced therapies. Compared to Advanced Therapy-Free Survivors, Dead patients had higher PaO2 levels (297[95% CI,164-400], p = 0.01). Dead and Advanced Therapy Survivors groups had similarly high PaO2 levels, but the latter group showed less acidosis and were more likely to have HFrEF (59%; 13/22; p = 0.02). ECMO support and VIS scores were similar. The multivariate model showed PaO2 is not associated with mortality (adjusted OR, 1.002 [95% CI, 0.99-1.004]; p = 0.131). Conclusion: Hyperoxia was associated with both death and advanced therapies, but did not predict mortality in a multivariate model. Advanced therapy survivors and patients that died were more likely to have HFrEF, suggesting that high PaO2 at cannulation reflects a proximal mixing cloud due to weak native cardiac function. Future work will analyze ECHO parameters to examine the association between hyperoxia and reduced cardiac output in VA-ECMO patients.

Evaluation of cardiac biomarkers among dead and alive COVID-19 patients in Southwest Iran.

The need to understand the global burden of heart failure following the pandemic has arisen as a result of an increase in papers that support cardiac involvement in coronavirus disease 2019 (COVID-19). Therefore, the current study aims to provide a more thorough explanation of the function and use of cardiac biomarkers in dead and alive COVID-19 patients. All patients who were referred and admitted to Razi Hospital, Ahvaz, Iran, from March 2020 to March 2021 with a diagnosis of COVID-19 were included in this study. During the study period, 753 patients were hospitalized with a diagnosis of COVID-19. In total, 157 cases died from the disease (case fatality rate: 20.84%). Pre-existing cerebrovascular accidents (CVAs) were more frequent in dead cases (14% vs. 6.4%). It was observed that atrial fibrillation was normal in most of the alive cases in comparison to dead patients (P value = 0.014). Moreover, it was seen that CRP, IL-6, and procalcitonin were increased in dead patients. Also, an association was found between ejection fraction (EF) value and death rate (P value = 0.035). The higher frequency of positive troponin occurring in the dead group suggested a possible adverse effect on the mortality rate (22.3% vs. 16.4%). Adults with COVID-19 commonly have cardiac manifestations, including symptoms of myocardial damage. In light of the recognized utility of troponin, ejection fraction, procalcitonin, IL-6, and CRP in COVID-19 patients with suspected myocardial damage, we should develop a safe and precise diagnostic algorithm that may contain patients' clinical histories and additional variables that may facilitate the prediction of myopericarditis.

Acute nitrite exposure causes gut microbiota dysbacteriosis and proliferation of pathogenic Photobacterium in shrimp

Nitrite exposure has become a significant concern in the aquaculture industry, posing a severe threat to aquatic animals such as shrimp. While studies have reported the adverse effects of nitrite on shrimp growth, the part played by the gut microbiota in shrimp mortality resulting from nitrite exposure is poorly understood. Here, the effects of nitrite on shrimp gut bacterial community were investigated using 16S rRNA amplicon sequencing, bacterial isolation, genomic analysis, and infection experiments. Compared to the control_healthy group, changes in the bacterial composition of the nitrite_dead group were associated with reduced abundance of specific beneficial bacteria and increased abundance of certain pathogenic bacteria. Notably, members of the Photobacterium genus were found to be significantly enriched in the nitrite_dead group. Genomic analysis of a representative Photobacterium strain (LvS-8n3) revealed a variety of genes encoding bacterial toxins, including hemolysin, adhesin, and phospholipase. Furthermore, it was also found that LvS-8n3 exhibits strong pathogenicity, probably due to its high production of pathogenic factors and the ability to utilize nitrite for proliferation. Therefore, the proliferation of pathogenic Photobacterium species appears pivotal for driving shrimp mortality caused by nitrite exposure. These findings provide novel insights into the disease mechanism in shrimp under conditions of environmental change.

Prognostic factors of extracorporeal membrane oxygenation in the treatment of severe pediatric acute respiratory distress syndrome

Objective: To explore the factors affecting the prognosis of severe pediatric acute respiratory distress syndrome (ARDS) after receiving extracorporeal membrane oxygenation (ECMO) support. Methods: It was a multicenter prospective observational study. A total of 95 children with severe ARDS who were treated with ECMO salvage therapy from January 2018 to December 2022 in 9 pediatric ECMO centers in China were enrolled in the study. The general data, disease severity, organ function, comprehensive treatment and prognosis were recorded, and they were divided into survival group and death group according to the outcome at discharge. T test, chi-square test, multivariate Logistic regression and mixed linear model were used to analyze the relationship among baseline before ECMO treatment, some important indicators (pediatric critical scores, platelet count, albumin, fibrinogen, etc) during ECMO treatment and prognosis. Results: Among the 95 children with severe ARDS who received ECMO, 55 (58%) were males and 40 (42%) were females, aged 36.9 (0.5, 72.0) months. Twelve children (13%) were immunodeficient. Sixty-eight (72%) children were treated with venous artery (VA) mode and 27 (28%) with venous vein (VV) mode. The discharge survival rates of overall, VA, and VV mode children were 51% (48/95), 47% (32/68), and 59% (16/27), respectively. The number of immunodeficient children in the death group was higher, and there were lower pediatric critical scores, platelet count, albumin, fibrinogen and arterial oxygen partial pressure/fraction of inspired oxygen (PaO2/FiO2), higher ventilator driving pressure (ΔP), oxygenaion index (OI), and longer ARDS duration before ECMO (all P<0.05). There were no statistically significant differences in other indicators, including age, gender, weight, and ECMO mode among different prognostic groups (all P>0.05). High ΔP, high OI, low P/F, and low albumin were high-risk factors affecting prognosis(all P<0.05). After further grouping, it was found that ΔP≥25 cmH2O (1 cmH2O=0.098 kPa), P/F≤67 mmHg (1 mmHg=0.133 kPa) and OI≥35 were the thresholds for predicting poor prognosis (P<0.05). From 24 h after ECMO, there were significant differences in ΔP, P/F and OI between the dead group and the survival group (all P<0.05), and the differences gradually increased with the ECMO process. The platelet level was significant from 7 days after ECMO (P<0.05) and gradually expanded. Blood lactate levels showed a significant difference between the 2 groups on before and after ECMO (P<0.05) and gradually increased from 24 h after ECMO. Conclusions: The risk factors affecting the prognosis of severe ARDS in ECMO include high ΔP, high OI, low P/F and low albumin purification therapy before ECMO. The gradual decrease of ΔP, OI and increase of P/F from 24 h of ECMO predicted a good prognosis, while the gradual increase of lactate after ECMO application showed a poor prognosis.

#2900 Appetite changes as a predictor of mortality among end-stage renal disease patients (ESRD) on maintenance hemodialysis: one year survival analysis

Abstract Background and Aims End-stage renal disease (ESRD) has become a major health problem worldwide. Appetite loss is a dominant feature of the disease which plays an important role in protein energy wasting and malnutrition, with subsequent higher rates of mortality. The study aimed to examine appetite changes among patients with ESRD on maintenance hemodialysis and its association with one-year mortality. Method This is a prospective observational study that was conducted at Mansoura Nephrology and Dialysis Unit (MNDU), Mansoura University and Aga Hospital Dialysis Unit over a period of one-year Patients who fulfilled inclusion and exclusion criteria were included. The study was explained to all participants and informed consent was obtained. All demographic, clinical, and laboratory data were collected. Appetite was assessed using the following 4 scores: subjective assessment of appetite, the self-assessment of appetite changes for 30 days, The Visual Analog Scale (VAS), and The Functional Assessment of Anorexia/Cachexia Therapy (FAACT). All patients were followed up for one year to report the mortality events. Results The current study included 162 hemodialysis patients whose age (SD) was 48.72±12.64 years, and males constituted 57.4% of them. Around 44.4% of the cases reported having good appetite using the subjective assessment score, and 13% reported decreased appetite using the self-assessment of appetite score. The median VAS score was 80, and the FAACT score ranged from 7 to 32 with a mean value of 15.85. After one year of observation, death occurred in 24/162 (14.8%). There were statistically significant differences in mean values of three appetite scores among both dead and alive groups with lower values reported in the deceased one [self-assessment of appetite (p=0.019), VAS score (p=0.001), and FACCT (p=&amp;lt;0.001)]. The ROC analysis shows that FACCT &amp; VAS scores were able to determine patients who destinated to mortality with area under curve (AUC) of (0.774 &amp;0.704), at a cut-off point of (14.5%, and 75), with sensitivity of (83.3% &amp;and 66.7%) and specificity of (61.6%, and 53.6%), respectively. Kaplan Meier survival analysis demonstrated that VAS &amp; FACCT scores had a statistically significant effect on median survival time among studied cases. Lower median survival time was detected among cases with decreased appetite by self-assessment tool, VAS score less than 80, and FACCT score less than 15. Kaplan-Meier and hazard curves for the included sample showed lower Median survival time (95% CI) among patients with diminished appetite by the 4 scores: 311.67(265.98-357.36) by self-assessment score (p=0.008), 344.28 (329.57-358.9) days by subjective assessment of appetite (p=0.28), 342.33(330.46-354.19) days by VAS score (p=0.016), and 332.01(314.6-349.43) days by FAACT score (p&amp;lt;0.0001). Cox regression analysis demonstrated that VAS and FACCT scores were statistically significant predictors of median survival time among studied cases (p&amp;lt;0.001, &amp;lt;0.001) and hazard ratio (HR) of (0.968 &amp; 0.734), respectively. Conclusion Diminished appetite is prevalent among hemodialysis patients. Poor appetite is associated with higher mortality. Lower appetite score values can predict mortality among such patients.

Demographic and clinical factors correlated with clinical outcomes among people with HIV treated by antiretroviral therapy: a retrospective cohort study.

As is known, CD4 cell count is a significant parameter predicting HIV progression, opportunistic infections and death in HIV-infected individuals, as well was an important indicator for initiating antiretroviral therapy (ART). In China's National Free Antiretroviral Treatment Program, people with HIV (PWH) on ART can receive a CD4 count test at least once every six months. Importantly, the baseline CD4 count (before ART initiation) is significantly correlated with ART and even prognosis, but the influence of the peak CD4 cell count on ART and/or clinical outcomes is still unknown. A retrospective study was conducted among 7965 PWH who received ART from October 2003 to September 2022 at Yunnan Infectious Disease Hospital. Clinical features and laboratory data were collected and analyzed by Chi-square test, univariate and multivariate Cox regression analysis. After elimination of confounding variables, multivariate Cox regression analysis was performed to identify survival-related factors. Of a total of 7965 PWH in the ART treatment cohort who met the inclusion and exclusion criteria, 7939 were finally included in the subsequent analyses. First, it was found that the proportion of clinical variables, including sex, age distribution, interval from diagnosis to ART initiation, marital status, and others, was significantly different between the living and dead groups (P < 0.05). Impressively, significantly more PWH had the higher level of baseline, peak and recent CD4 cell counts in the living group compared to those in the dead group. Due to multicollinearity effect, after excluding confounders, the following factors were found to be significantly associated with mortality by multivariate Cox regression analysis: (1) male sex (hazard ratio (HR) = 1.268 [1.032, 1.559]; P = 0.024); (2) time from HIV confirmation to ART initiation ≥ 6 months (HR = 1.962 [1.631, 2.360]; P < 0.001); (3) peak CD4 cell count: Peak CD4 < 100cells/µL group (HR = 16.093 [12.041, 21.508]; P < 0.001), 100cells/µL ≤ x < 200cells/µL group (HR = 7.904 [6.148, 10.160]; P < 0.001), 200cells/µL ≤ x < 350cells/µL group (HR = 3.166 [2.519, 3.980]; P < 0.001), 350cells/µL ≤ x < 500cells/µL group (HR = 1.668 [1.291, 2.155]; P < 0.001). Interestingly, patients in male, time from HIV confirmation to ART initiation ≥ 6 months, or peak CD4 count < 500 cells/µl had inferior clinical outcomes, in other word, a lower peak CD4 cell count significantly increased the risk of death, and peak CD4 cell was independent in predicting the overall survival of PWH. It is important to promote "early diagnosis and treatment of HIV" and regularly monitor CD4 levels in HIV/AIDS to evaluate the efficacy of ART and immune reconstitution, and optimize the ART regimen in time to further reduce the mortality of PWH.

Lactate is Associated with Long-Term Mortality in Hospitalized Patients with COVID-19: A Retrospective Cohort Study

Introduction: A recent pandemic caused by Coronavirus 2019 (COVID-19) caused mild and severe systemic organ involvement that led to the death of enormous numbers of people. The prevalence of the disease has declined over the past years, but concerns about upcoming mutations remain. In this study, the relationship between lactate levels and mortality at different times was investigated. Methods: In the present retrospective study, 228 hospitalized patients with COVID-19 were included according to the inclusion and exclusion criteria. A modified National Early Warning Score 2 (NEWS2) was used to determine the severity of the patients' conditions. Follow-up of patients, if discharged alive, has been done from hospitalization until March, 2022. Data were analyzed using SPSS version 22, and p &lt; 0.05 was considered significant. Results: Lactate levels (2.88 ± 2.37 in the dead group versus 1.68 ± 1.33 in the living group) have a significant relationship with mortality at hospitalization (p &lt; 0.001). Furthermore, higher lactate levels during hospitalization (p &lt; 0.001, HR = 2.960, 95%CI =4.255-2.58) and follow-up (p &lt; 0.001, HR = 2.960, 95%CI =4.255 to 2.58) increased the mortality risk ratio by more than two-fold. Conclusion: This study reported that initial lactate levels at admission predict COVID-19 patients' mortality at hospitalization and follow-up. However, further research is needed in this area

Analysis of Correlation Between Serum Oncostatin-M and Disease Severity and Mortality in Hospitalized Patients with Community-Acquired Pneumonia.

The aim of this study was to investigate the level of serum tumor suppressor factor (Oncostatin-M, OSM) in patients with community-acquired pneumonia (CAP) and evaluate its predictive value for the severity and prognosis of pneumonia, so as to improve the ability to identify the risk of death in CAP patients. A total of 110 patients with CAP admitted to the hospital from November 2020 to November 2021 were enrolled in this prospective study. Clinical data of all patients were collected. According to the 2016 edition of "Guidelines for the Diagnosis and Treatment of Community-acquired Pneumonia in Chinese Adults", the patients were divided into non-severe CAP (NSCAP)(n=55) and severe CAP (SCAP)(n=55). At the same time, they were divided into a survival group (n=96) and a death group (n=14) by tracking the survival of patients in the hospital. The OSM concentration of CAP patients on the first day after admission was determined by enzyme-linked immunosorbent assay. All clinical data were statistically and graphed using SPSS V23.0 and Grahpad Prim 8. Compared with NSCAP, patients with SCAP had higher serum OSM concentration on the day of admission, which was negatively correlated with LYM and positively correlated with WBC, NEU, CRP, IL-6, IL-8, IL-10, CURB-65 score, and PSI score. The level of OSM in the dead patient group was significantly higher than that in the surviving patient group. OSM and PSI scores were independent risk factors for in-hospital mortality in CAP patients. Kaplan-Meier survival curve showed that OSM≥76pg/mL was more advantageous in predicting mortality in patients with CAP. The level of the OSM is closely related to the severity and prognosis of CAP and may be a new biomarker for the prognosis of CAP patients.

Comparison of the decompressive craniectomy results in patients with ischemic stroke and acute subdural hematoma and determination of prognostic markers

Aims: This study aimed to investigate the therapeutic effectiveness of decompressive craniectomy in patients with traumatic acute subdural hematoma and stroke patients and to determine the parameters that could predict the risk of mortality in these patients. Methods: Patients diagnosed and operated on with acute subdural hematoma (ASH) or stroke between January 2022 and September 2023 were grouped into the ASH group and the CVO group. The patients were also divided into DEAD and SURVIVED groups according to mortality. Age, gender, anisocoria, the area of the craniectomy field, length of stay in the intensive care unit (ICU), length of stay in the hospital, and Glasgow Outcome Scale scores were recorded. In addition, Glasgow Coma Scale (GCS) scores, the amount of midline shift, and the blood biochemistry results were recorded pre-and postoperatively. Results: This study consisted of 11 (5 male and 6 female) patients. Sex, preoperative GCS score, anisocoria, postoperative sedation anesthesia time, postoperative GCS score, duration of stay in the ICU, preoperative serum blood urine nitrogen, preoperative serum C-reactive protein (CRP), postoperative neutrophil-to-lymphocyte ratio, and postoperative CRP values were different between the ASH and CVO groups (p&lt;0.05). Furthermore, the preoperative GCS score, postoperative GCS score, postoperative sedation anesthesia duration, postoperative serum aspartate aminotransferase (AST), and postoperative serum CRP level values were different between the DEAD and SURVIVED groups (p&lt;0.05). The correlation analysis results revealed a positive correlation between mortality and preoperative GCS score and a negative correlation between mortality and anisocoria (p&lt;0.05). The ROC-curve analysis revealed that preoperative GCS and postoperative GCS score, postoperative midline shift, postoperative serum AST level value, and postoperative serum CRP level value could predict mortality risk (p&lt;0.05). However, Logistic Regression analysis showed that any study parameter could be used as the best marker for prediction of the postoperative mortality risk (p&gt;0.05). Conclusion: This study showed that decompressive craniectomy may offer more satisfactory results in severe head trauma patients. It was also argued that preoperative and postoperative GCS scores, postoperative midline shift values, and postoperative serum AST and CRP level values could be used to predict mortality risk.

Genome and proteomic analysis of risk factors for fatal outcome in children with severe community-acquired pneumonia caused by human adenovirus 7.

Human adenovirus 7 (HAdV-7) is an important viral pathogen of severe pneumonia in children and a serious threat to health. A cohort of 45 pediatric patients diagnosed with HAdV-7-associated severe pneumonia and admitted to the Pediatric Intensive Care Unit at the Children's Hospital of Chongqing Medical University from May 2018 to January 2020 were included. Risk factors of death were analyzed by the Cox proportional risk mode with Clinical data, serum, and nasopharyngeal aspirate adenovirus load, Genome analysis, Olink proteomics, and cytokine profile between dead and surviving patients were also analyzed. A total of 45 children with a median age of 12.0 months (interquartile range [IQR]: 6.5, 22.0) were included (female 14), including 14 (31.1%) who died. High serum viral load was an independent risk factor for mortality (hazard ratio [HR] = 2.16, 95% confidence interval [CI], 1.04-4.49, p = 0.039). BTB and CNC homology 1 (BACH1), interleukin-5 (IL-5), and IL-9 levels were significantly correlated with serum viral load (p = 0.0400, 0.0499, and 0.0290; r = 0.4663, 0.3339, and -0.3700, respectively), with significant differences between the dead and survival groups (p = 0.021, 0.001, and 0.021). Severe cytokine storm-associated high serum viral load after HAdV-7 infection may be the main mechanism responsible for poor prognosis in children.

Behavioral responses of wild chimpanzees toward a juvenile that suddenly lost its animacy due to a fall accident

Detailed observations of animal reactions to a collapsed individual in wild are rare but essential to debates about the perception of death by nonhuman animals, including chimpanzees. A male juvenile chimpanzee named Volta, a member of the M group in the Mahale Mountains National Park, fell from a tall tree and was temporarily incapacitated, suffering a severe concussion and nasal bone fracture. However, Volta showed signs of gradual recovery. We compared the behavior of other chimpanzees towards Volta with the previous reports on the behavior towards collapsed or recently dead group members. We found that behaviors towards Volta were similar to those observed towards collapsed or dead members. These included other-regarding behaviors and aggressive behaviors, and notably, licking of Volta’s blood, which has not been previously reported. Adult males tended to be in close proximity to Volta for longer periods than adult females. The social situation with adult males including alpha male, surrounding Volta likely influenced the behavior of other individuals. Exploring the state of recovery of the injured individual, by closely approaching, directing various behaviors, and observing the reactions of the victim, and demonstrate tolerance and consideration towards the victim.

Initial indicators for the prognosis of Acinetobacter Baumannii bacteremia in children

BackgroundRisk factors related to mortality due to Acinetobacter baumannii (AB) bacteremia have been unveiled previously, but early clinical manifestations of AB bacteremia based on prognosis remain uncovered.MethodsThe demographic characteristics, clinical features, antibiotic susceptibility, and outcomes of 37 hospitalized children with laboratory-confirmed AB bacteremia from Suzhou, China, were collected and analyzed retrospectively.ResultsOf the 37 children with AB bacteremia included in this study, 23 were males and 14 were females, with a median age of 4.83 (0.60 to 10.15) years. Among the children, 18 died (48.65%, 18/37) and 19 survived (51.35%, 19/37). The dead group had a significantly higher incidence of respiratory failure (p = 0.008), shock (P = 0.000), MODS (p = 0.000), neutropenia (< 1.5 × 109/L) (p = 0.000) and serious neutropenia (< 0.5 × 109/L) (p = 0.000) than those in the survival group. The death group had significantly more invasive procedures (2 or more) than that in the survival group at 2 weeks before onset (p = 0.005). The proportion of MDR-AB in the death group was significantly higher than that in the survival group (p = 0.000), while the PICS score was significantly lower in the survival group than that in the death group (p = 0.000). There was no significant difference in effective antibiotic use within 24 h between these two groups (p = 0.295). Among the 37 children with bloodstream infection of AB, 56.76% (21/37) of the underlying diseases were hematological diseases and oncology. Among them, 17 (81.00%) were died in the hospital. The proportion of white blood cells (p = 0.000), neutrophils (p = 0.042), eosinophils (p = 0.029), the ANC (p = 0.000) and lymphocyte (p = 0.000), the NLR(p = 0.011), hemoglobin (p = 0.001), platelets (p = 0.000), prealbumin (P = 0.000), LDH (p = 0.017), blood gas pH (p = 0.000), and serum potassium (p = 0.002) in the death group were significantly lower than those in the survival group. However, CRP (p = 0.000) and blood glucose(p = 0.036) were significantly higher in the death group than those in the survival group. By further multivariate analysis, CRP [OR (95% CI): 1.022(1.003, 1.041), p = 0.021] and neutropenia [OR (95% CI): 21.634 (2.05, 228.313, p = 0.011] within 24 h of infection were independent risk factors for death in children with AB bacteremia. When CRP was higher than 59.02 mg/L, the sensitivity of predicting mortality was 88.9%, and the specificity was 78.9%. And the sensitivity and specificity of neutropenia for predicting mortality were 83.3% and 84.2%.ConclusionsAB bacteremia has a high mortality in children, especially in patients with hematological diseases and oncology. Many early indicators were associated with poor prognosis, while elevated CRP and neutropenia were the independent predictors for the 30-day mortality of children with laboratory-confirmed AB bacteremia.

Malnutrition significantly affected centenarian prognoses: A prospective study with 5-year follow-up

The world is currently facing a much-needed conundrum, and population aging has become an important worldwide problem. Appropriate nutritional intervention could prolong survival time and reduce mortality rate. However, scarce study has involved the effects of nutrition on survival time in centenarians and evaluated the malnutrition with prognostic nutritional index (PNI) in relation to healthy aging. This prospective study was designed to investigate the effects of malnutrition through PNI assessment on mortality rate and survival time with 5-year follow-up in Chinese centenarians. A household survey was conducted on the centenarians in 18 cities and counties of Hainan province, and malnutrition was evaluated by PNI as an effective tool in 423 centenarians followed up for 5-year. Prevalence of malnutrition was 19.4%. Body mass index (BMI) was significantly lower and malnutrition was significantly more in the dead group than those in the survival group (all P<0.05). Multivariate Cox regression analysis indicated that BMI [Hazard ratio (HR): 0.913; 95%CI: 0.854-0.977] negatively affected mortality rate, whereas malnutrition (HR: 2.630; 95%CI:1.474-4.695) positively affected mortality rate in centenarians (all P<0.05). When BMI was <18.5kg/m2, malnutrition (HR: 4.401; 95%CI: 1.948-9.943) also positively affected mortality rate (P<0.05). This prospective study with 5-year follow-up demonstrated that malnutrition had positive effect on mortality rate, especially when BMI was lower than 18.5kg/m2, in Chinese centenarians. In order to reduce mortality rate and prolong survival time, it is essential to pay attention to malnutrition in elderly population.

Acid-Base Status &amp; 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 &amp; 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 &amp; 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 &amp; 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 &lt;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 &amp; 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 &lt;135 and outcome of ventilated patients [p=0.039, OR=0.19(0.04-0.89)]. Imbalance of single &amp; more than one electrolyte was found 43.24% &amp; 56.76% in death group and 61.5% &amp; 38.5% in survival group respectively. Conclusion: We found that arterial blood gas analysis &amp; 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.

The role of proadrenomedullin, interleukin 6 and CD64 in the diagnosis and prognosis of septic shock

IntroductionSepsis and septic shock are disorders of tissue perfusion and microcirculation associated with increased mortality. The role of biomarkers such as proadrenomedullin (PRO-ADM), interleukin 6 (IL-6) and neutrophil CD64 (CD64) in the diagnosis and prognosis of septic shock has been studied.MethodsGCS, SOFA score, APACHE 2 score, lactate, CRP, procalcitonin, PRO-ADM, IL-6, CD64 level and 28-day mortality were evaluated in patients with septic shock followed-up in the intensive care unit of Marmara University Hospital between July 2021 and December 2021. The study was planned as prospective, non-drug clinical research Committee.ResultsThere were no statistically significant differences between patient groups in gender, BMI, and presence of comorbidities (p > 0.05). The alive patient group had significantly higher GCS values and lower SOFA, APACHE 2, lactate and CD64 values than the dead patient group (p < 0.01). The cut-off values of laboratory parameters were determined using ROC analysis to predict mortality, SOFA and CD64 had high AUC. This is also a good indicator for mortality.The multivariate logistic regression model was estimated using the backward selection method. The mortality of ICU patients was predicted by a SOFA-value ≥ 12 (OR (95%CI) = 56.13 (5.44–578.64)), CD64 value ≥ 28.54 (OR (95% CI) = 23.78 (2.61–216.85)), and ADM-value ≥ 86.79 (OR (95% CI) = 15.86 (1.02–246.49)) (p < 0.05) .ConclusionIn conclusion, serum CD64 level, PRO-ADM level, and SOFA score proved to be effective parameters for predicting prognosis and mortality in septic shock. However, IL-6 proved to be a weak biomarker and failed to predict mortality. CD64, which is easier and more practical to use, can be used instead of the SOFA score.

A new scoring system to predict mortality in community-acquired pneumonia: CURB (S)-65.

The first decision to be made in the case of community-acquired pneumonia (CAP) is whether hospitalization of the patient is mandatory. In this study, we aimed to investigate whether the addition of oxygenation parameters to CURB-65 has diagnostic value in predicting mortality in CAP. A total of 903 CAP patients were included in the study. Patients with a CURB-65 score of 0 and 1 were classified as Group 1 and patients with a CURB-65 score of 2 or more were classified as Group 2. The prediction of mortality through Pneumonia Severity Index (PSI), CURB-65 and CURBS-65/CURBP-65 with the addition of SaO2 and PaO2 values; hence the four different models, was compared among all patient groups. As a result, 3.3% of the cases in Group 1 and 12.7% of the cases in Group 2 died. In both CURB-65 groups, it was noted that the frequency of patients with SaO2 <90% was significantly higher in the dead group than in the alive patient group (p=0.009 and p=0.001, respectively). In the univariate analysis, PaO2<60, and SaO2<90 were significantly associated with mortality. Model 2 (CURBS-65) and Model 3 (CURBP- 65) were examined, SaO2<90 (OR 2.08) was found to have an effect on death. In predicting mortality by the receiver operating characteristics (ROC) analysis, it was understood that the CURBS-65 score had a slightly higher area under the curve (AUC) value than CURB-65. As a result, it has been shown that the use of CURBS-65 scoring instead of CURB-65 clinical scoring may be more useful in predicting mortality.

Predictive Value of the Modified GRACE Scoring System for All-Cause Mortality in Patients with Acute Myocardial Infarction.

To establish a modified Global Registry of Acute Coronary Events (GRACE) scoring system with an improved predictive performance compared with the traditional GRACE scoring system. We identified 5512 patients who were hospitalized with a definite diagnosis of acute myocardial infarction (AMI) from January 1, 2015, to December 31, 2020, at the Heart Center of the First Affiliated Hospital of Xinjiang Medical University through the hospital's electronic medical record system. A total of 4561 patients were enrolled after the inclusion and exclusion criteria were applied. The mean follow-up was 51.8 23.4 months. The patients were divided into dead and alive groups by endpoint events. The differences between the two groups were compared using the two-sample t test and chi-square test. Adjusted traditional risk factors as well as LogBNP (B-type natriuretic peptide precursor, BNP) and the modified GRACE scoring system were included in a multifactorial COX regression model. The predictive performance of the traditional and modified GRACE scoring systems was compared by (Receiver Operating Characteristic) ROC curves. Significant differences in age, heart rate, creatinine, uric acid, LogBNP, traditional GRACE score, and modified GRACE score were found between the dead and alive groups by the two-sample t test. Comparison of the two groups by the chi-square test revealed that the dead group had a higher incidence of males; higher cardiac function class; a previous history of hypertension, diabetes, coronary artery disease (CAD), or cerebrovascular disease; a history of smoking; the need for intra-aortic balloon pump (IABP) support; and more patients taking aspirin, clopidogrel, ticagrelor, and -blockers. The results were analyzed by a multifactorial COX regression model, and after adjusting for confounders, age, cardiac function class, history of CAD, use of aspirin and -blockers, and the modified GRACE scoring system were found to be associated with all-cause mortality (ACM) in patients with AMI. The ROC curve was used to compare the predictive performance of the conventional GRACE scoring system with that of the modified GRACE scoring system, and it was found that the modified GRACE scoring system (Area Under Curve (AUC) = 0.809, p 0.001, 95% (Confidence Interval) CI (0.789-0.829)) was significantly better than the traditional GRACE scoring system (AUC = 0.786, p 0.001, 95% CI (0.764-0.808)), the comparison between the two scores was statistically significant (p 0.001). The change in the C statistic after 10-fold crossover internal validation of the modified GRACE score was not significant, and the integrated discrimination improvement (IDI) between the old and new models was calculated with IDI = 0.019 0, suggesting that the modified GRACE score has a positive improvement on the traditional GRACE score. The modified GRACE scoring system, established by combining B-type natriuretic peptide precursor (BNP) and the traditional GRACE scoring system, was independently associated with ACM in patients with AMI, with a larger AUC and higher predictive value than the traditional GRACE scoring system. NCT02737956.

Influence of sperm viability on uterine leukocyte chemotaxis

The immune system can differentiate live from dead microorganisms, generating a response as necessary; there has been limited study of equine sperm. We aimed to compare the uterine cellular immune response to artificial insemination (AI) with live versus dead equine sperm. Twenty mares in estrus (follicles ≥ 35 mm, uterine edema), without intrauterine fluid or polymorphonuclear leukocytes (PMNs) were selected from a population of horses sent to an abattoir during the breeding season. Their average age was 10.8 ± 0.9 years (range 6 - 20), body condition score > 3 (scale 1 - 5), and they were clinically healthy. Mares were randomly allocated into two groups. Frozen semen, a pool from two stallions, was inseminated into the uterine body: either LIVE (n = 10), 3.0 mL of 900 × 106 sperm (≥ 35% progressive motility), or DEAD (n = 10), 3.0 mL of 900 × 106 sperm killed by snap freezing in liquid nitrogen. Four hours post AI, mares were slaughtered; ex vivo uteri were subjected to a low-volume lavage (LVL) with 50 mL of PBS and three endometrial tissue samples were collected (both uterine horns and uterine body). The fluid recovered was analyzed in a Neubauer chamber. Endometrial samples were processed for histologicalevaluation using bright-field microscopy. For each mare, the three uterine samples were pooled for analysis. The number of PMNs in the stratum compactum (SC) and spongiosum (SS) was counted in 5 fields per uterine sample at 400x magnification, totaling 15 fields/stratum/mare. Groups were considered independent factors. Leukocyte concentrations in the LVL and PMN presence in both strata were considered dependent factors. Leukocyte concentrations in the LVL were analyzed with a Mann-Whitney test (median ± IQR) and the number of PMNs per field of each stratum using a t-test (mean ± SEM). The significance level was defined as p ≤ 0.05. Mares in the DEAD group presented a lower concentration of leukocytes in the LVL than in the LIVE group (33.2 × 106/mL ± 62.6 versus 63.2 × 106/mL ± 56.5; p = 0.05). Correspondingly, the mean PMN number per field in the SC (50.5 ± 5.2/field versus 69.0 ± 5.3/field; p = 0.02) and SS (32.8 ± 6.2/field versus 54.4 ± 5.7/field; p = 0.02) of mares in the DEAD group were lower than mares in the LIVE group. In conclusion, dead sperm elicited a less intense inflammatory response 4 hours after AI compared to live sperm, suggesting that as with bacteria, the immune system may differentiate sperm according to viability.

Skin microbiome of people living at the Dead Sea area – The lowest place on earth

The Dead Sea is a salt lake with surface water at about 430 m below sea level and considered the lowest place on Earth. The Dead Sea basin is characterized by relatively high temperatures, attenuated UV radiation and the air above it has a relatively high-salt aerosol content. When we compared the skin microbiome of individuals from the hot, salty and arid Dead Sea area with that of individuals from the humid Mediterranean regions we observed a significantly lower bacterial diversity in the Dead Sea group as well as distinct differences in the composition of bacterial species. Our results suggest that these factors have a profound effect on the skin microbiome. Further study is required to understand how the local environment influences the skin microbiome, as well as the functional implications of these effects.

Metabolic–related gene signatures for survival prediction and immune cell subtypes associated with prognosis in intrahepatic cholangiocarcinoma

ObjectivesOur study aimed to reveal the metabolic-related gene signatures for survival prediction and immune cell subtypes associated with IHCC prognosis. MethodsDifferentially expressed metabolic genes were identified between survival group and dead group which were divided according to survival at discharge. Recursive feature elimination (RFE) and randomForest (RF) algorithms were applied to optimize the combination of feature metabolic genes, which were used to generate SVM classifier. Performance of SVM classifier was evaluated by receiver operating characteristic (ROC) curves. Gene set enrichment analysis (GSEA) was conducted to uncover the activated pathways in high risk group, and differences in immune cell distributions were revealed. ResultsThere were 143 differentially expressed metabolic gens. RFE and RF identified 21 overlapping differentially expressed metabolic genes, and the constructed SVM classifier had excellent accuracy in training and validation dataset. RS survival prediction model was consisted of 10 metabolic genes. RS model had reliable predictive capability in the training and validation dataset. GSEA revealed 15 significant KEGG pathways that were relatively activated in the high risk group. High risk group had obviously lower counts of B cell naive and T cell CD4+ memory resting, while higher counts of B cell plasma and macrophage M2. ConclusionPrognostic prediction model of 10 metabolic genes could accurately predict the prognosis of IHCC patients.