Acid-base Balance Disorders Research Articles

Navigating the aftermath: Risk factors of recurrence following coronary bypass surgery in Indonesia

Coronary heart disease (CHD) remains a leading cause of mortality in Indonesia, and coronary artery bypass graft (CABG) surgery is frequently employed to manage arterial blockages. Despite its efficacy, the recurrence of heart disease post-surgery is a significant concern, highlighting the need for a deeper understanding of its influencing factors. The aim of this study was to examine the factors associated with the incidence of heart disease recurrence after coronary bypass surgery. This study employed a prospective observational design, analyzing hospital claim data from Indonesia's Social Security Agency for Health, known as Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan, from 2017 to 2022. The analysis included 5,947 patients who survived CABG surgery. Multivariable logistic regression was utilized to assess the relationship between patient demographics, comorbidities, socioeconomic status, and compliance with follow-up visits, as well as their impact on the recurrence of cardiovascular disease. The study found that 24.1% of patients experienced hospitalization recurrence. Patients with irregular follow-ups were less likely to experience recurrence (adjusted odds ratio (AOR): 0.63; 95%CI: 0.51–0.78). Other significant risk factors for recurrence included being self-employed (AOR: 2.09; 95%CI: 1.72–2.55), having comorbid conditions such as disorders of fluid, electrolyte, and acid-base balance (AOR: 3.55; 95%CI: 2.97–4.24), and experiencing cerebral infarction or stroke (AOR: 10.85; 95%CI: 8.24–14.29). In contrast, older age (AOR: 0.89; 95%CI: 0.88–0.91) and the presence of non-insulin-dependent diabetes mellitus (AOR: 0.35; 95%CI: 0.29–0.42) were associated with a lower risk of recurrence. Sex did not significantly influence the risk of recurrence (AOR: 1.18; 95%CI: 0.86–1.62). In conclusion, the study indicates a considerable rate of cardiovascular disease recurrence post-CABG in Indonesia, highlighting several key risk factors. Tailored postoperative management and strict adherence to follow-up protocols are essential for mitigating recurrence. These findings offer crucial insights for improving post-CABG health management strategies in Indonesia.

Risk factors for arrhythmias occurred in cancer patients after chemotherapy: An evidence-based systematic review and meta-analysis

ObjectivesThis study aimed to summarize the existing literature on risk factors for arrhythmias after chemotherapy in cancer patients. To provide reliable evidence for treating arrhythmias after chemotherapy in oncology patients by assessing multiple biasing factors in the literature and quantifying the risk factors. MethodsThe risk factors for arrhythmia following tumor chemotherapy were systematically collected from various reputable databases, including PubMed, Cochrane Library, MEDLINE, EMBASE, and multiple Chinese databases, covering the period from inception to May 2023. Two independent reviewers performed rigorous article screening, data extraction, and assessment of research quality. Data analysis was conducted using Review Manager 5.4 software, ensuring a standardized and robust approach to evaluate the gathered evidence. ResultsThe analysis of chemotherapy-induced arrhythmias included 16 articles, encompassing 14,785 cancer patients. Among the patients, 3295 belonged to the arrhythmia group, while 11,490 were in the non-arrhythmia group. These studies identified 12 significant risk factors associated with arrhythmias following chemotherapy in cancer patients. The findings of the analysis are as follows. General patient characteristicsThe incidence of post-chemotherapy arrhythmias was 14.33 times higher in oncology patients aged ≥60 years compared to patients <60 years of age [OR = 14.33, 95%CI (8.51, 24.13), P＜0.00001]. Patients with a smoking history exhibited a 1.67-fold higher risk of arrhythmia after chemotherapy [OR = 1.67, 95%CI (1.24, 2.25), P = 0.0007]. However, there was no significant correlation between gender and body mass index (BMI) with arrhythmia after chemotherapy in oncology patients (P = 0.52; P = 0.19) Disease-related factorsPatients with a history of hypertension, diabetes, and cardiovascular disease had a 1.93-fold, 1.30-fold, and 1.76-fold increased risk of arrhythmia after chemotherapy, respectively [OR = 1.93, 95%CI (1.66, 2.24), P＜0.00001; OR = 1.30, 95%CI (1.10, 2.52), P = 0.002; OR = 1.76, 95%CI (1.51, 2.05), P＜0.00001]. Additionally, the incidence of arrhythmia increased 1.97 times in patients with electrolyte and acid-base balance disorders following chemotherapy [OR = 1.97, 95%CI (1.41, 2.76), P＜0.00001] Chemotherapy-related factorsSeven articles examined the association between chemotherapy drugs and post-chemotherapy arrhythmias. The results indicated that oncology patients were 3.03 times more likely to develop arrhythmias with chemotherapy drugs compared to non-chemotherapy drugs [OR = 3.03, 95%CI (2.59, 3.54), P＜0.00001]. Notably, anthracyclines and fluorouracil chemotherapy demonstrated a 2.98-fold and 3.35-fold increased risk of arrhythmia after chemotherapy, respectively [OR = 2.98, 95%CI (2.51, 3.03), P＜0.00001; OR = 3.35, 95%CI (2.20, 5.10), P＜0.00001]. The risk of arrhythmia after chemotherapy was 1.72 times higher in patients with chemotherapy cycles longer than 4 weeks than those with cycles shorter than 4 weeks [OR = 1.72, 95%CI (1.30, 2.28), P = 0.0001] ConclusionThe occurrence of arrhythmia after chemotherapy in cancer patients was significantly associated with the patient's age, history of smoking, history of hypertension, history of diabetes, history of cardiovascular disease, chemotherapy drug use, and cycle. However, further high-quality evidence is needed to support these results.

#2477 Longitudinal serum bicarbonate and mortality risk in older patients with advanced chronic kidney disease: analyses from the EQUAL cohort

Abstract Background and Aims Serum bicarbonate (SBC) disorders have been consistently linked to mortality in chronic kidney disease (CKD) patients. Low SBC levels have been extensively associated with increased mortality in CKD patients, possibly due to the detrimental effects of acidosis on various organs and systems. Likewise, several studies have identified high levels of SBC as a risk factor for mortality in the CKD population. To date, most studies have focused on the association between SBC levels and patient survival during the pre-kidney replacement therapy (KRT) period or the period after KRT initiation, considered separately. None have explored this association across the continuum of CKD (e.g., from pre-KRT to post-KRT start), which is relevant since metabolic acidosis is expected to be managed through dialysis in the KRT population, and thus its clinical outcomes might change after KRT initiation. To provide new insights on this topic, we aimed to explore the relationship between SBC and mortality in advanced CKD during three distinct treatment periods: during the pre-KRT period, during the transition phase surrounding the start of KRT (transition-CKD), and during KRT. Method Using the European QUALity Study on treatment in advanced CKD (EQUAL) cohort, which includes patients aged ≥65 years and eGFR ≤20 ml/min per 1.73 m2 from six European countries, we explored the association between longitudinal SBC and all-cause mortality in three separate CKD populations: pre-KRT, transition-CKD and in the KRT populations, using multivariable time-dependent Cox regression models. The cumulative time-averaged, the cumulative exposure of SBC, and the slope of the SBC trajectory during the pre-KRT phase were calculated and evaluated for association with all-cause mortality in the transition-CKD population. Subgroup analysis were used to evaluate the effect modification by pre-specified variables on the relationship between SBC and mortality. Results We included 1485 patients with a median follow-up of 2.9 (IQR 2.7) years, during which 529 (35.6%) patients died. A U-shaped relationship between SBC levels and all-cause mortality was observed in the pre-KRT population (p = 0.03; Fig.). Low cumulative exposure, defined as the area under the SBC trajectory before KRT initiation, was associated with increased mortality risk after transitioning to KRT (p = 0.01). Similarly, in the KRT population, low SBC levels showed a trend towards increased mortality risk (p = 0.13). We observed effect modification on the relationship between SBC and mortality by subjective global assessment category (p-value for interaction = 0.02) and KRT initiation (p-value for interaction = 0.02). Conclusion Our study has provided important insights into the relationship between SBC and mortality in advanced CKD patients. A U-shaped relationship describes the association between SBC and mortality in the advanced CKD pre-KRT population, whereas in patients that initiate KRT only low SBC levels are associated with an increased mortality risk. Our findings suggest that the relationship between SBC and mortality varies across different stages of CKD and that this relationship is modified by KRT initiation. From this point of view, it would be appropriate to consider a personalized management of acid-base balance disorders based on a comprehensive evaluation of the clinical status of the patient.

Hospital Length of Stay and Associated Factors in Patients with Osteoarthritis from Germany: A Cross-Sectional Study.

Objective: There is a scarcity of data on hospital length of stay (LOS) in the osteoarthritis population. Therefore, this study aimed to investigate hospital LOS and associated factors in patients with osteoarthritis from Germany. Methods: The present cross-sectional study included patients hospitalized for osteoarthritis in one of fourteen hospitals in Germany between 2018 and 2023 (hospital database; IQVIA). The study outcome was the duration of hospital stay in days. Study covariables included age, sex, hospital department, osteoarthritis type, co-diagnosis, and hospitalization-related procedure. Associations between covariables and hospital LOS were analyzed using hierarchical linear regression models. Results: There were 8770 patients included in the study (mean [standard deviation] age 68.7 [10.8] years; 60.2% women). The mean (standard deviation) hospital LOS was 8.5 (5.0) days. Factors positively and significantly associated with hospital LOS were older age, female sex, orthopedic surgery and other medical specialty departments (compared with other surgery departments), knee and other and unspecified osteoarthritis (compared with hip osteoarthritis), multiple co-diagnoses (e.g., acute posthemorrhagic anemia, other disorders of fluid, electrolyte, and acid-base balance, and disorders of purine and pyrimidine metabolism), and several hospitalization-related procedures (i.e., geriatric rehabilitation, hip arthroplasty, and knee arthroplasty). Conclusions: The mean hospital LOS was higher than eight days in this osteoarthritis population from Germany, with a spectrum of demographic, clinical, and hospitalization-related factors associated with this hospital LOS. In this context, interventions are needed to reduce the LOS of hospitalizations for osteoarthritis in Germany.

Oxidative stress as one of the pathogenetic mechanisms of hepatopulmonary syndrome in patients with liver cirrhosis

Background. Hepatopulmonary syndrome is one of the most dangerous syntropies in case of liver cirrhosis. Consequently, it is important to determine the role of oxidative stress, acid-base balance and ventilation-perfusion disorders as factors of hepatopulmonary syndrome development in cirrhotic patients. Materials and methods. We included 44 cirrhotic patients with hepatopulmonary syndrome verified according to the patented Method for diagnosing degrees of hepatopulmonary syndrome severity in patients with liver cirrhosis. In addition to the traditional examinations, we determined the gas composition parameters in venous blood, acid-base balance parameters, catalase activity and malondialdehyde level in all the patients. The received material was processed on a personal computer using Excel 2010, Statistica 6.0, RStudio v. 1.1.442 and R Commander v. 2.4-4. Results. Analysis of blood gas parameters revealed the reliability of the difference for PCO2 (р = 0.03) depending on the class of liver cirrhosis severity. Also, with the liver cirrhosis severity increase, the malondialdehyde level increased, and catalase decreased. Moreover, significant inverse relationships between malondialdehyde content and PCO2 (p = 0.039), HCO3 (p = 0.039), TCO2 (p = 0.036), Beb (p = 0.049), BEecf (p = 0.043) were found resulting in hypocapnia and partially compensated metabolic acidosis. The found direct correlation between malondialdehyde level and AaDO2 (p = 0.044) indicates the arteriovenous pulmonary shunts, ventilation-perfusion disorders. The absence of catalase content changes can obviously be explained by the fact that its activity can be partially compensatory maintained. Conclusions. In patients with hepatopulmonary syndrome, the peroxidation activity enhances with an increase in the liver cirrhosis severity, resulting in the redox homeostasis imbalance, leading to the ventilation-perfusion disorders and partially compensated metabolic acidosis.

Relationship between Compound α-Ketoacid and Microinflammation in Patients with Chronic Kidney Disease.

Chronic kidney disease (CKD) refers to the presence of structural or functional abnormalities in the kidneys that affect health, lasting for more than 3 months. CKD is not only the direct cause of global incidence rate and mortality, but also an important risk factor for cardiovascular disease. Persistent microinflammatory state has been recognized as an important component of CKD, which can lead to renal fibrosis and loss of renal function, and plays a crucial role in the pathophysiology and progression of the disease. Simultaneously, compound &#945;-Ketoacid can bind nitrogen-containing metabolites in the blood and accelerate their excretion from the body, thereby reducing the level of metabolic waste, alleviating gastrointestinal reactions in patients, and reducing the inflammatory response and oxidative stress state of the body. Compound &#945;-Ketoacid contains amino acids required by CKD patients. In this review, we explore the relationship between compound &#945;-Ketoacid and microinflammation in patients with CKD. The review indicated that compound &#945;-Ketoacid can improve the microinflammatory state in CKD patients by improving the nutritional status of CKD patients, improving patient's acid-base balance disorder, regulating oxidative stress, improving gut microbiota, and regulating abnormal lipid metabolism.

Acute kidney injury comorbidity analysis based on international classification of diseases-10 codes.

Acute kidney injury (AKI) is a clinical syndrome that occurs as a result of a dramatic decline in kidney function caused by a variety of etiological factors. Its main biomarkers, serum creatinine and urine output, are not effective in diagnosing early AKI. For this reason, this study provides insight into this syndrome by exploring the comorbidities of AKI, which may facilitate the early diagnosis of AKI. In addition, organ crosstalk in AKI was systematically explored based on comorbidities to obtain clinically reliable results. We collected data from the Medical Information Mart for Intensive Care-IV database on patients aged [Formula: see text] 18 years in intensive care units (ICU) who were diagnosed with AKI using the criteria proposed by Kidney Disease: Improving Global Outcomes. The Apriori algorithm was used to mine association rules on the diagnoses of 55,486 AKI and non-AKI patients in the ICU. The comorbidities of AKI mined were validated through the Electronic Intensive Care Unit database, the Colombian Open Health Database, and medical literature, after which comorbidity results were visualized using a disease network. Finally, organ diseases were identified and classified from comorbidities to investigate renal crosstalk with other distant organs in AKI. We found 579 AKI comorbidities, and the main ones were disorders of lipoprotein metabolism, essential hypertension, and disorders of fluid, electrolyte, and acid-base balance. Of the 579 comorbidities, 554 were verifiable and 25 were new and not previously reported. In addition, crosstalk between the kidneys and distant non-renal organs including the liver, heart, brain, lungs, and gut was observed in AKI with the strongest heart-kidney crosstalk, followed by lung-kidney crosstalk. The comorbidities mined in this study using association rules are scientific and may be used for the early diagnosis of AKI and the construction of AKI predictive models. Furthermore, the organ crosstalk results obtained through comorbidities may provide supporting information for the management of short- and long-term treatment practices for organ dysfunction.

Phenotyping Down syndrome: discovery and predictive modelling with electronic medical records.

Individuals with Down syndrome (DS) have a heightened risk for various co-occurring health conditions, including congenital heart disease (CHD). In this two-part study, electronic medical records (EMRs) were leveraged to examine co-occurring health conditions among individuals with DS (Study 1) and to investigate health conditions linked to surgical intervention among DS cases with CHD (Study 2). De-identified EMRs were acquired from Vanderbilt University Medical Center and facilitated creating a cohort of N=2282 DS cases (55% females), along with comparison groups for each study. In Study 1, DS cases were one-by-two sex and age matched with samples of case-controls and of individuals with other intellectual and developmental difficulties (IDDs). The phenome-disease association study (PheDAS) strategy was employed to reveal co-occurring health conditions in DS versus comparison groups, which were then ranked for how often they are discussed in relation to DS using the PubMed database and Novelty Finding Index. In Study 2, a subset of DS individuals with CHD [N=1098 (48%)] were identified to create longitudinal data for N=204 cases with surgical intervention (19%) versus 204 case-controls. Data were included in predictive models and assessed which model-based health conditions, when more prevalent, would increase the likelihood of surgical intervention. In Study 1, relative to case-controls and those with other IDDs, co-occurring health conditions among individuals with DS were confirmed to include heart failure, pulmonary heart disease, atrioventricular block, heart transplant/surgery and primary pulmonary hypertension (circulatory); hypothyroidism (endocrine/metabolic); and speech and language disorder and Alzheimer's disease (neurological/mental). Findings also revealed more versus less prevalent co-occurring health conditions in individuals with DS when comparing with those with other IDDs. Findings with high Novelty Finding Index were abnormal electrocardiogram, non-rheumatic aortic valve disorders and heart failure (circulatory); acid-base balance disorder (endocrine/metabolism); and abnormal blood chemistry (symptoms). In Study 2, the predictive models revealed that among individuals with DS and CHD, presence of health conditions such as congestive heart failure (circulatory), valvular heart disease and cardiac shunt (congenital), and pleural effusion and pulmonary collapse (respiratory) were associated with increased likelihood of surgical intervention. Research efforts using EMRs and rigorous statistical methods could shed light on the complexity in health profile among individuals with DS and other IDDs and motivate precision-care development.

Comorbidity Patterns and Management in Inpatients with Endocrine Diseases by Age Groups in South Korea: Nationwide Data.

This study aimed to examine comorbidity associations across age groups of inpatients with endocrine diseases as the primary diagnosis throughout the life cycle to develop an effective management strategy. Data were obtained from the Korean National Hospital Discharge In-depth Injury Survey (KNHDS) from 2006 to 2021, involving 68,515 discharged patients aged ≥ 19 years with a principal diagnosis of endocrine disease. A database was constructed for analysis, extracting general characteristics and comorbidities. Employing R version 4.2.3, the Chi-squared test and the Apriori algorithm of ARM (association rule mining) were used for analyzing general characteristics and comorbidity associations. There were more women (53.1%) than men (46.9%) (p < 0.001, with women (61.2 ± 17.2) having a higher average age than men (58.6 ± 58.6) (p < 0.001). Common comorbidities include unspecified diabetes mellitus; essential (primary) hypertension; unspecified diabetes mellitus; and other disorders of fluid, electrolyte, and acid-base balance. Notably, type 2 diabetes mellitus, disorders of lipoprotein metabolism and other lipidemia, polyneuropathy in diseases classified elsewhere, retinal disorders in diseases classified elsewhere, and essential (primary) hypertension prevail across all age groups. Association rules further highlight specific comorbidities appearing selectively in certain age groups. In conclusion, establishing a management strategy for comorbidities in patients with a primary diagnosis of an endocrine disorder is necessary.

Multifactorial Colonization of the Pregnant Woman's Reproductive Tract: Implications for Early Postnatal Adaptation in Full-Term Newborns.

This retrospective study aimed to investigate the impact of microorganisms identified in the reproductive tract on disorders during the early adaptation period in newborns. A cohort of 823 patients and cervical canal cultures were analyzed to identify the presence of microorganisms. Newborns included in the study were divided into two groups due to the number of pathogens identified in the swab from the cervical canal of the mother. The first group consisted of newborns whose mothers had one pathogen identified (N = 637), while the second group consisted of newborns whose mothers had two or more pathogens identified (N = 186). The analysis of disorders of the early adaptation period included the incidence of respiratory distress syndrome, the number of procedures performed with the use of CPAP, oxygen therapy, antibiotic therapy and parenteral nutrition. Respiratory distress syndrome was more common in group II than in group I (85 vs. 31, p = 0.001). In group II, CPAP (63 vs. 21, p = 0.001), oxygen therapy (15 vs. 8, p = 0.02) and antibiotics were used more frequently (13 vs. 8, p = 0.01). The findings of this study revealed that the number of pathogens colonizing the reproductive tract had a significant influence on the early adaptation period in newborns. Multifactorial colonization of the reproductive tract was associated with an increased incidence of infections in newborns and a higher prevalence of acid-base balance disorders. This study highlights the importance of monitoring and addressing the microbial composition of the reproductive tract during pregnancy.

Гостро кровоточивий рак шлунка, ускладнений перфорацією

покращення та оптимізація діагностики та лікування ускладнень раку шлунка.Було проліковано 56 пацієнтів із ускладненим раком шлунка. Середній вік хворих становив56 років. З них жінок було 13 (або 23,21%), а чоловіків – 43 (або 76,79%). Під час всебічногодіагностично-лікувального моніторингу було виявлено, що 15 пацієнтів (або 26,79%) страждаливід шлунково-кишкової кровотечі, 12 пацієнтів (або 21,43%) мали стеноз шлунка різного ступеняважкості, а у решти 29 пацієнтів (або 51,79%) рак шлунка ускладнився перфорацією шлунка,при цьому у 21 пацієнта перфорація виливалася в кровотечу. Досліджували також вік, стать,передопераційну діагностику, місцезнаходження перфорації, глибину інвазії стінки шлунка,наявність метастазів у лімфатичних вузлах, вид операції, рівень лімфатичної диссекції, стадіюта інші ускладнення. Відсоток ускладнення у вигляді перфорації серед раку шлунка становив51,79%. Захворювання частіше зустрічалося на III/IV стадії (70%). Проведені операції:гастректомія у 16 хворих та атипова резекція зони ураження шлунка з відновленням дефектуу 10 пацієнтів. Смерть, пов’язана з хірургічним втручанням, спостерігалася у 4 пацієнтів.Було виконано 10 субтотальних гастректомій і 6 тотальних гастректомій. У 15 пацієнтівспостерігалася клінічно виражена шлунково-кишкова кровотеча, яка проявлялася у виглядімелени, гематемезису або у вигляді мелени та гематемезису одночасно (2,5%). Середнійвік становив 68 ± 12 (діапазон 47–87). Ускладнення у вигляді стенозу шлунка було виявлено у12 пацієнтів (21,43%). Під час дослідження у 5 пацієнтів було виявлено субкомпенсованийстеноз пілоричного відділу шлунка, у решти пацієнтів – декомпенсований стеноз. Вибір методуоперативного втручання проводився індивідуально, залежно від стану хворого, ступеня стенозуі характеру патоморфологічних змін, стану секреторної та моторної функції шлунка, наявностісупупровідньої патології та стадії раку шлунка. Перевагу надавали субтотальній резекціїшлунка. У цій групі пацієнтів наявний 1 випадок летальності, який був обумовлений ІV стадієюраку шлунка та декомпенсованим стенозом з вираженими розладами водно-електролітногобалансу і кислотно-лужної рівноваги.

Research progress of metabolomics in acute kidney injury

Acute kidney injury (AKI) is caused by a variety of diseases, which leads to acute renal function decline, azotemia, water and electrolyte disorders and acid-base balance disorders. Metabolomics is a research method that can quantitatively analyze all metabolites in an organism and find the relative relationship between metabolites and physiological and pathological changes. In recent years, several metabolites screened based on metabolomics have been proposed as potential biomarkers to assess the early development and prognosis of AKI and for the discovery of unknown potential therapeutic targets. Based on metabolomics, this paper reviews the risk prediction, early diagnosis, disease monitoring, prognosis assessment and the application of corresponding drugs for AKI, so as to provide reference for precision medicine.

Comorbidity network analysis using graphical models for electronic health records.

The comorbidity network represents multiple diseases and their relationships in a graph. Understanding comorbidity networks among critical care unit (CCU) patients can help doctors diagnose patients faster, minimize missed diagnoses, and potentially decrease morbidity and mortality. The main objective of this study was to identify the comorbidity network among CCU patients using a novel application of a machine learning method (graphical modeling method). The second objective was to compare the machine learning method with a traditional pairwise method in simulation. This cross-sectional study used CCU patients' data from Medical Information Mart for the Intensive Care-3 (MIMIC-3) dataset, an electronic health record (EHR) of patients with CCU hospitalizations within Beth Israel Deaconess Hospital from 2001 to 2012. A machine learning method (graphical modeling method) was applied to identify the comorbidity network of 654 diagnosis categories among 46,511 patients. Out of the 654 diagnosis categories, the graphical modeling method identified a comorbidity network of 2,806 associations in 510 diagnosis categories. Two medical professionals reviewed the comorbidity network and confirmed that the associations were consistent with current medical understanding. Moreover, the strongest association in our network was between "poisoning by psychotropic agents" and "accidental poisoning by tranquilizers" (logOR 8.16), and the most connected diagnosis was "disorders of fluid, electrolyte, and acid-base balance" (63 associated diagnosis categories). Our method outperformed traditional pairwise comorbidity network methods in simulation studies. Some strongest associations between diagnosis categories were also identified, for example, "diagnoses of mitral and aortic valve" and "other rheumatic heart disease" (logOR: 5.15). Furthermore, our method identified diagnosis categories that were connected with most other diagnosis categories, for example, "disorders of fluid, electrolyte, and acid-base balance" was associated with 63 other diagnosis categories. Additionally, using a data-driven approach, our method partitioned the diagnosis categories into 14 modularity classes. Our graphical modeling method inferred a logical comorbidity network whose associations were consistent with current medical understanding and outperformed traditional network methods in simulation. Our comorbidity network method can potentially assist CCU doctors in diagnosing patients faster and minimizing missed diagnoses.

Assessing the Risk of Developing Delirium on Admission to Inpatient Rehabilitation: A Clinical Prediction Model

ObjectivesTo develop a clinical model to predict the risk of an individual patient developing delirium during inpatient rehabilitation, based on patient characteristics and clinical data available on admission. DesignRetrospective observational study based on electronic health record data. Setting and ParticipantsWe studied a previously validated data set of inpatients including incident delirium episodes during rehabilitation. These patients were admitted to ZURZACH Care, Rehaklinik Bad Zurzach, a Swiss inpatient rehabilitation clinic, between January 1, 2015, and December 31, 2018. MethodsWe performed logistic regression analysis using backward and forward selection with alpha = 0.01 to remove any noninformative potential predictor. We subsequentially used the Akaike information criterion (AIC) to select the final model among the resulting “intermediate” models. Discrimination of the final prediction model was evaluated using the C-statistic. ResultsOf the 20 candidate predictor variables, 6 were included in the final prediction model: a linear spline of age with 1 knot at 60 years and a linear spline of the functional independence measure (FIM), a measure of the functional degree of patients independency, with 1 knot at 64 points, diagnosis of disorders of fluid, electrolyte, and acid-base balance (E87), use of other analgesic and antipyretics (N02B), use of anti-parkinson drugs (N04B), and an anticholinergic burden score (ACB) of ≥3 points. Conclusions and ImplicationsOur clinical prediction model could, upon validation, identify patients at risk of incident delirium at admission to inpatient rehabilitation, and thus enable targeted prevention strategies.

Hematomyelia associated with coronavirus disease 2019: A rare case report.

Coronavirus disease 2019 (COVID-19) can damage the central nervous system. Although there have been reports of cerebral hemorrhage and infarction caused by COVID-19, hematomyelia due to COVID-19 has never been reported. A 40-year-old male was admitted to the hospital with positive nucleic acid detection for COVID-19 after experiencing fever for 2 weeks, urinary retention, fecal retention, and pain in both lower extremities for a week. The patient diagnosis was established using thoracic and lumbar magnetic resonance imaging (MRI). Contrast-enhanced thoracic and lumbar MRI revealed subdural (dorsal predominant) short T1 and slightly long T2 bands in the T12-S2 infundibular canal in the scan field, and the subdural hematoma was yet to be distinguished from other diseases. Spinal cord edema was observed in the left vertebral plate and facet joint of the T11 vertebral body, indicative of inflammation. The cerebrospinal fluid (CSF) was positive for COVID-19 nucleic acid. Antiinfection, immunomodulation, correction of acid-base balance and electrolyte disorders, improvement of circulation, nerve nutrition, and other symptomatic supportive treatments were administered to the patient. The patient symptoms significantly improved after 4 weeks of anti-infection and immunomodulatory therapy. Repeat thoracolumbar MRI revealed absorption of the spinal cord hematoma, and the patient was discharged from the hospital. To date, COVID-19-related hematomyelia has not been reported and anti-infective and immunomodulatory therapies may be effective. COVID-19 not only easily leads to brain injury but can also cause spinal cord injury and even spinal cord hemorrhage. When patients with COVID-19 experience symptoms and signs of spinal cord injury, spinal cord injury and bleeding caused by COVID-19 should be considered, and MRI and lumbar puncture should be performed as soon as possible to make a clear diagnosis.

Low sodium intake ameliorates hypertension and left ventricular hypertrophy in mice with primary aldosteronism.

The goal of this paper is to elucidate the effects of sodium restriction on hypertension and left ventricular (LV) hypertrophy in a mouse model with primary aldosteronism (PA). Mice with genetic deletion of TWIK-related acid-sensitive K (TASK)-1 and TASK-3 channels (TASK-/-) were used as the animal model of PA. Parameters of the LV were assessed using echocardiography and histomorphology analysis. Untargeted metabolomics analysis was conducted to reveal the mechanisms underlying the hypertrophic changes in the TASK-/- mice. The TASK-/- adult male mice exhibited the hallmarks of PA, including hypertension, hyperaldosteronism, hypernatremia, hypokalemia, and mild acid-base balance disorders. Two weeks of low sodium intake significantly reduced the 24-h average systolic and diastolic BP in TASK-/- but not TASK+/+ mice. In addition, TASK-/- mice showed increasing LV hypertrophy with age, and 2weeks of the low-sodium diet significantly reversed the increased BP and LV wall thickness in adult TASK-/- mice. Furthermore, a low-sodium diet beginning at 4weeks of age protected TASK-/- mice from LV hypertrophy at 8-12weeks of age. Untargeted metabolomics demonstrated that the disturbances in heart metabolism in the TASK-/- mice (e.g., Glutathione metabolism; biosynthesis of unsaturated fatty acids; amino sugar and nucleotide sugar metabolism; pantothenate and CoA biosynthesis; D-glutamine and D-glutamate metabolism), some of which were reversed after sodium restriction, might be involved in the development of LV hypertrophy. In conclusion, adult male TASK-/- mice exhibit spontaneous hypertension and LV hypertrophy, which are ameliorated by a low-sodium intake.

Protective effect of salidroside on lung tissue in rats exposed rapidly to high altitude.

To study the protective effect and mechanism of salidroside on lung tissue of rats exposed rapidly to high altitude. Thirty-six Wistar male rats were randomly divided into blank control group, model control group, Rhodiola rosea capsule (137 mg/kg) group, salidroside low-dose (14 mg/kg), medium-dose (28 mg/kg) and high-dose (56 mg/kg) groups, with 6 rats in each group. After 5 continuous days of drug administration in the plain lab, rats were rapidly moved to 4010 m plateau field lab. After exposure to hypoxia condition for 3 days the blood gas indexes were detected; the serum levels of inflammatory factors were measured by enzyme linked immunosorbent assay (ELISA); the oxidative stress index of lung tissue was measured; the pathological changes of lung tissue were observed by microscopy with hematoxylin and eosin (HE) staining; and the expression of occludin in lung tissues was determined by western blotting. Compared with blank control group, arterial oxygen saturation (SaO 2), arterial oxygen partial pressure (PaO 2), blood pH, standard bicarbonate (SBC) and actual bicarbonate levels in model control group were significantly decreased, and hemoglobin level was significantly increased (all P<0.05). In the model control group, the contents of mast cell protease (MCP) 1, interleukin (IL)-6 and IL-1β were significantly increased, while the contents of interferon-γ were significantly decreased (all P<0.01). The contents of glutathione and total superoxide dismutase in the lung tissues of model control group were significantly decreased, while the content of malondialdehyde was significantly increased (all P<0.01). After Rhodiola rosea and salidroside were given, SaO 2, pH, hemoglobin, SBC and actual bicarbonate were improved compared with the model control group. Compared with the model control group, the Rhodiola rosea group and salidroside groups had different degrees of improvement in the contents of the above inflammatory factors and oxidative stress indexes, and the salidroside groups had better improvement in MCP-1 and IL-6 than the Rhodiola rosea group. HE staining showed that, after the administration of Rhodiola rosea capsules and salidroside at low, medium and high doses, the hypoxic injury was significantly improved, the cell wall gradually became thinner, and the alveolar wall gradually became complete. The expression of occludin in the model control group was lower than that in the blank control group ( P<0.05), while the expression of occludin in the salidroside high-dose group was significantly higher than that in the model control group ( P<0.01). Salidroside can improve the abnormality of blood gas index, hypoxia symptoms and acid-base balance disorder, dysregulation of inflammatory factors caused by hypoxia in rats, and improve lung tissue injury and oxidative stress injury, which has a protective effect on lung tissue injury of rats exposed rapidly to the high-altitude plateau, and the effect is better than Rhodiola rosea capsule on the whole.

Sequential treatment of severe pneumonia with respiratory failure and its influence on respiratory mechanical parameters and hemodynamics.

BACKGROUNDThe pathophysiological characteristics of severe pneumonia complicated by respiratory failure comprise pulmonary parenchymal changes leading to ventilation imbalance, alveolar capillary injury, pulmonary edema, refractory hypoxemia, and reduced lung compliance. Prolonged hypoxia can cause acid-base balance disorder, peripheral circulatory failure, blood-pressure reduction, arrhythmia, and other adverse consequences.AIMTo investigate sequential mechanical ventilation’s effect on severe pneumonia complicated by respiratory failure. METHODSWe selected 108 patients with severe pneumonia complicated by respiratory failure who underwent mechanical ventilation between January 2018 and September 2020 at the Luhe Hospital’s Intensive Care Unit and divided them into sequential and regular groups according to a randomized trial, with each group comprising 54 patients. The sequential group received invasive and non-invasive sequential mechanical ventilation, whereas the regular group received invasive mechanical ventilation. Blood-gas parameters, hemodynamic parameters, respiratory mechanical parameters, inflammatory factors, and treatment outcomes were compared between the two groups before and after mechanical-ventilation treatment. RESULTSThe arterial oxygen partial pressure and stroke volume variation values of the sequential group at 24, 48, and 72 h of treatment were higher than those of the conventional group (P < 0.05). The carbon dioxide partial pressure value of the sequential group at 72 h of treatment and the Raw value of the treatment group at 24 and 48 h were lower than those of the conventional group (P < 0.05). The pH value of the sequential group at 24 and 72 h of treatment, the central venous pressure value of the treatment at 24 h, and the Cst value of the treatment at 24 and 48 h were higher than those of the conventional group (P < 0.05). The tidal volume in the sequential group at 24 h of treatment was higher than that in the conventional group (P < 0.05), the measured values of interleukin-6 and tumor necrosis factor-α in the sequential group at 72 h of treatment were lower than those in the conventional group (P < 0.05), and the total time of mechanical ventilation in the sequential group was shorter than that in the conventional group, with a statistically significant difference (P < 0.05).CONCLUSIONTreating severe pneumonia complicated by respiratory failure with sequential mechanical ventilation is more effective in improving respiratory system compliance, reducing inflammatory response, maintaining hemodynamic stability, and improving patient blood-gas levels; however, from this study’s perspective, it cannot reduce patient mortality.

ACID-BASE STATE OF BLOOD AND MIXED SALIVA IN THE ORAL CAVITY IN PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA AND THEIR SIGNIFICANCE IN DIAGNOSIS AND PREDICTION OF THE DISEASE

Acid-base imbalance is an indicator of many pathological changes, including community-acquired pneumonia. The aim of this work is to study the acid-base state of blood and mixed saliva in patients with community-acquired pneumonia during test loads and to determine the effectiveness of the load in diagnosis of the disease. Materials and methods. The study included 34 adult patients with community-acquired pneumonia, who took the treatment at the therapeutic department of the Municipal Clinical Hospital No. 25, Kharkiv. The diagnosis of community-acquired pneumonia was established based on epidemiological, clinical, laboratory, and radiological findings. All indicators obtained were compared with the findings taken from healthy individuals. A comparative study of the blood and saliva pH dynamics in patients with community-acquired pneumonia, as well as the concentration of calcium and inorganic phosphate in mixed saliva under test loads was carried out. A close interconnection in the dynamics between the studied parameters was revealed both under sugar and urea loading. Conclusion. The main diagnostic indicator of the acid-base balance disorders in the blood and saliva of patients with community-acquired pneumonia is pH and excess or deficiency of alkaline. Under a sugar load, patients with community-acquired pneumonia demonstrate an accumulation of acid equivalents, a decrease in the mixed saliva pH, the inorganic phosphate concentration and an increase in the calcium concentration. Under carbamide loading, the phosphate buffer system of saliva gets activated mainly to correct acid-basic status at pH values below 6.0. The results obtained will help to improve the diagnosis of community-acquired pneumonia.

Acid-Base Balance, Blood Gases Saturation, and Technical Tactical Skills in Kickboxing Bouts According to K1 Rules.

Simple SummaryThe aim of our study was to analyze the changes in ABB after a three-round kickboxing fight and the level of technical and tactical skills presented during the fight. Fighting in kickboxing under K1 rules takes place with a high presence of anaerobic metabolism. Kickboxing athletes must have a good tolerance for metabolic acidosis and the ability to conduct an effective duel despite ABB disorders. Properly developed post-workout regeneration also plays an extremely important role. Background: Acid–base balance (ABB) is a major component of homeostasis, which is determined by the efficient functioning of many organs, including the lungs, kidneys, and liver, and the proper water and electrolyte exchange between these components. The efforts made during competitions by combat sports athletes such as kickboxers require a very good anaerobic capacity, which, as research has shown, can be improved by administering sodium bicarbonate. Combat sports are also characterized by an open task structure, which means that cognitive and executive functions must be maintained at an appropriate level during a fight. The aim of our study was to analyze the changes in ABB in capillary blood, measuring levels of H+, pCO2, pO2, HCO3−, BE and total molar CO2 concentration (TCO2), which were recorded 3 and 20 min after a three-round kickboxing bout, and the level of technical and tactical skills presented during the fight. Methods: The study involved 14 kickboxers with the highest skill level (champion level). Statistical comparison of mentioned variables recorded prior to and after a bout was done with the use of Friedman’s ANOVA. Results: 3 min after a bout, H+ and pO2 were higher by 41% and 11.9%, respectively, while pCO2, HCO3−, BE and TO2 were lower by 14.5%, 39.4%, 45.4% and 34.4%, respectively. Furthermore, 20 min after the bout all variables tended to normalization and they did not differ significantly compared to the baseline values. Scores in activeness of the attack significantly correlated (r = 0.64) with pre–post changes in TCO2. Conclusions: The disturbances in ABB and changes in blood oxygen and carbon dioxide saturation observed immediately after a bout indicate that anaerobic metabolism plays a large part in kickboxing fights. Anaerobic training should be included in strength and conditioning programs for kickboxers to prepare the athletes for the physiological requirements of sports combat.