Higher Albumin Levels Research Articles

Preoperative undernutrition predicts postoperative complications of acute empyema.

IntroductionSurgery for acute empyema is associated with postoperative complications and relapse. Establishing a predictor for postoperative complications may improve prognosis.ObjectivesTo demonstrate undernutrition as a predictor of complications after surgery for acute empyema.MethodsWe retrospectively analyzed 52 consecutive patients who underwent surgery for acute empyema from 2004 to 2019 and validated the correlation of undernutrition with serum albumin level, patient characteristics, hospital stay, and postoperative complications.ResultsThe median preoperative serum albumin level was 2.4 g/dL (range: 1.1‐3.4). The levels in all patients were lower than the standard value (3.5 g/dL). Patients were divided into two groups based on the median serum albumin levels: the low serum albumin level group (group L, n = 28) and the high serum albumin level group (group H, n = 24). Group L patients were significantly older (64.5 vs 52.9 years, P = .002), had lower median body mass index (21.0 vs 24.2, P = .008), and significantly had Streptococcus anginosus group as the causative bacteria (50% vs 21%, P = .044). Their hospitalization duration was significantly longer (28.1 vs 14.8 days, P < .001), and postoperative complications were significant or tended to be more frequent (all incidence; 11 (39%) vs 2 (8%), P = .012, respiratory‐related; 7 (25%) vs 1 (4%), P = .056) in group L. Further analyses revealed that other undernutrition indicators also correlated with postoperative complications.ConclusionsPreoperative serum albumin level is a valid predictor of complications after surgery for acute empyema. Preoperative nutrition management for empyema patients may reduce the occurrence of postoperative complications.

Renoprotective effect of GLP-1 receptor agonist, liraglutide, in early-phase diabetic kidney disease in spontaneously diabetic Torii fatty rats.

The aim of this study is to investigate the renoprotective effect of the GLP-1 receptor agonist, liraglutide, in early-phase diabetic kidney disease (DKD) using an animal model of type 2 diabetes with several metabolic disorders. Male 8-week-old spontaneously diabetic Torii (SDT) fatty rats (n = 19) were randomly assigned to three groups. The liraglutide group (n = 6) was injected subcutaneously with liraglutide. Another treatment group (n = 6) received subcutaneous insulin against hyperglycemia and hydralazine against hypertension for matching blood glucose levels and blood pressure with the liraglutide group. The control groups of SDT fatty (n = 7) and non-diabetic Sprague-Dawley rats (n = 7) were injected only with a vehicle. The control group of SDT fatty rats exhibited hyperglycemia, obesity, hypertension, hyperlipidemia, glomerular sclerosis, and tubulointerstitial injury with high urinary albumin and L-FABP levels. Liraglutide treatment reduced body weight, food intake, blood glucose and blood pressure levels, as well as ameliorated renal pathologic findings with lower urinary albumin and L-FABP levels. Liraglutide increased expressions of phosphorylated (p)-eNOS and p-AMPK in glomeruli, downregulated renal expression of p-mTOR, and increased renal expressions of LC3B-II, suggesting activation of autophagy. However, these effects were not caused by the treatments with insulin and hydralazine, despite comparable levels of hyperglycemia and hypertension to those achieved with liraglutide treatment. Liraglutide may exert a renoprotective effect via prevention of glomerular endothelial abnormality and preservation of autophagy in early-phase DKD, independent of blood glucose, and blood pressure levels.

Risk factors associated with adverse pregnancy outcomes in patients with new-onset systemic lupus erythematosus during pregnancy.

To investigate the risk factors for Adverse pregnancy outcome (APOs) in patients with new-onset SLE during pregnancy. Eighty-five patients with new-onset SLE during pregnancy were analyzed retrospectively. Univariate and multivariate logistic regression were used to identify risk factors for different APOs (pregnancy loss, preterm birth, fetal growth restriction, and eclampsia/preeclampsia). A two-sided p-value below 0.05 was considered significant, and two-sided 95% confidence intervals (CIs) are reported. Multivariate analysis indicated that renal involvement (aOR: 7.356; 95%CI:1.516,35.692) and greater SLE disease activity index (SLEDAI) grade (aOR:5.947;95%CI: 1.586,22.294) increased the risk for composite APO, and that use of heparin therapy (aOR: 0.081; 95%CI: 0.012, 0.532) was a protective factor. Advanced gestational age at disease onset (aOR: 0.879; 95%CI: 0.819,0.943) and high serum albumin level (aOR: 0.908,95%CI: 0.831,0.992) protected against pregnancy loss. Renal involvement increased the risk for preterm birth (aOR: 2.272; 95%CI: 1.030,7.222) and fetal growth restriction (aOR: 9.070; 95%CI: 1.131,72.743). Hypertension (aOR: 19.185; 95%CI: 3.921,93.868), renal involvement (aOR: 8.380, 95%CI: 1.944,74.376) increased the risk for eclampsia/preeclampsia. New onset SLE during pregnancy increased the risk for multiple APOs. Timely management of the risk factors identified here may help to improve pregnancy outcomes in these patients.

The Duration of Hemodialysis and its Implication to Barthel Score and Laboratory Parameters among End Stage Renal Disease Patients

Background: While it was proven that hemodialysis for treating patients with end stage renal disease (ESRD) provided the reduced mortality rate, the reports on its adequacy in the context of laboratory parameters and psychological function were limited. Aim: To assess the implication of hemodialysis duration on Barthel score and laboratory parameters among ESRD patients. Â Methods: During the period, a cross-sectional study was conducted at Dr. Soetomo General Hospital. Information related to age, gender, history of hypertension, history of diabetes mellitus, and the levels of hemoglobin, albumin, calcium, and phosphor were retrieved from medical records. While, we performed the interview to each participant using Barthel index questionnaire to assess the function independence. We used multiple logistic regression analysis to determine the correlation and estimate of effect. Results: We totally include we included 65 patients with the hemodialysis duration of more than one year and 16 patients with the hemodialysis duration of less than one year. Our results found that the higher levels of albumin and hemoglobin were observed in patients with hemodialysis duration of more than one year. While, the duration of hemodialysis did not affect the Barthel score and serum mineral parameters. Conclusion: Â The duration of hemodialysis of more than one year is associated with the improvement of albumin and hemoglobin levels

Blood Loss and Related Laboratory Changes after Single-Event Multilevel Surgery and Hip Reconstructive Surgery in Patients with Cerebral Palsy.

BackgroudSingle-event multilevel surgery (SEMLS) and hip reconstructive surgery (HRS) often cause intraoperative bleeding, consequently increasing the probability of transfusion and postoperative laboratory changes. Therefore, it is important to assess risk factors to predict the amount of blood loss. This study aimed to evaluate blood loss, its influencing factors, and the related laboratory changes during SEMLS and HRS in patients with cerebral palsy (CP).MethodsWe retrospectively examined consecutive CP patients who underwent SEMLS and HRS. Surrogate markers of blood loss, including preoperative and postoperative hemoglobin (Hb), hematocrit, and changes in Hb concentration, were assessed. Albumin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and creatine levels were also analyzed for related laboratory changes. Risk factors were analyzed using multiple regression and logistic regression models.ResultsThe overall cohort comprised 1,188 patients. Of them, 1,007 and 181 underwent SEMLS and HRS, respectively. Furthermore, 72 of 181 patients underwent a concomitant Dega osteotomy. The regression model showed that low preoperative Hb concentration (p < 0.001), high albumin level (p = 0.007), low body mass index (BMI) (p = 0.002), and bilateral HRS (p < 0.001) were significant risk factors of postoperative anemia. Valproate medication was associated with Hb drop, and the risk factors for Hb level < 8 g/dL on postoperative day 2 were bilateral HRS and Dega osteotomy in the HRS subgroup. In total, 21.6% had elevated AST levels on postoperative day 2, and bilateral HRS (p < 0.001), Gross Motor Function Classification System (GMFCS) level V (p = 0.041), Dega osteotomy (p < 0.001), and high preoperative AST level (p < 0.001) increased the risk of AST elevation.ConclusionsWe have summarized the estimated blood loss and related laboratory changes after SEMLS and HRS in patients with CP and identified the risk factors. Clinical guidelines should be accordingly developed to include assessment of these risk factors and their impact in the outcomes of CP patients undergoing SEMLS and HRS.

Polymorphisms in the GCK gene increase the risk of clopidogrel resistance in stable coronary artery disease (SCAD) patients

ABSTRACT Background Diabetes mellitus is a major factor in clopidogrel resistance (CR), and the glucokinase (GCK) gene plays a pivotal role in glucose homeostasis. This study investigated the contribution of GCK polymorphisms to CR risk. Methods Two hundred SCAD patients were recruited, and their platelet functions were detected by the Verify-Now P2Y12 assay. The polymorphisms of GCK were tested based on the methods of polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP). We investigated the associations of GCK polymorphisms and CR. Multivariate logistic regression was performed to analyse the correlations between GCK polymorphisms and clinical values. Results Our study found that the SNPs rs4607517 and rs6975024 were associated with CR. Additionally, patients with the G allele of rs4607517had a greater CR risk, but the C allele of rs6975024 might be a protective factor. Finally, logistic regression revealed that CC + TC (rs6975024) as well as the values of albumin were correlated with a decreased risk of CR, and higher levels of uric acid (UA) may be positively associated with CR. Conclusion The GCK gene polymorphisms might increase the CR risk in SCAD patients. Meanwhile, higher albumin levels and lower UA values might decrease the risk.

Oxidative stress markers in initial therapy and remission of nephrotic syndrome and serum malondialdehyde level predictor from routine laboratory test.

Aim To compare oxidative stress state of children with nephrotic syndrome at the first week of treatment and in remission, and to predict malondialdehyde (MDA) level from routine laboratory tests. Methods This cross-sectional study involved 80 1-18 years old children with nephrotic syndrome, who were divided into two groups: initial group (40 children in the first week of therapy) and remission group (40 children in remission). Demographic characteristics of the patients were taken by a questionnaire. Laboratory tests were measured in the initial group; in the remission group negative or trace proteinuria was measured for three consecutive days. Serum urea, creatinine, albumin, total cholesterol, MDA, superoxide dismutase, glutathione peroxidase, and urine albuminto-creatinine ratio (UACR) were measured and compared between the groups. Albumin, total cholesterol, and UACR were subjected to predict high serum MDA using a mean of all patients' MDA level as a cutoff. Results There were higher albumin levels and lower UACR, total cholesterol, and MDA in the remission group compared to the initial group. Albumin and UACR showed good accuracy, and total cholesterol showed very good accuracy to predict serum MDA level more than 1.35 µmol/L. Conclusion Children with nephrotic syndrome in the first week of therapy showed a higher oxidative stress state than the children in remission. Serum albumin, serum total cholesterol, and UACR can predict serum MDA level with good accuracy.

Characterization and long-term outcomes of patients with myocarditis: a retrospective observational study.

IntroductionThere is limited data on the long-term follow-up of patients with myocarditis.AimTo investigate the long-term follow-up of patients with myocarditis.Material and methodsWe performed a retrospective observational analysis on the clinical long-term outcomes of patients with myocarditis over a 10-year period. The primary outcome was mortality. We identified risk factors for mortality and adverse clinical outcomes. We also compared the characteristics and outcomes of patients presenting with fulminant myocarditis to those presenting with non-fulminant myocarditis.ResultsBetween May 2004 and December 2014, 203 patients with myocarditis or perimyocarditis were admitted to our center. Most patients were male (87.7%) with a median age at presentation of 33 years (interquartile range: 25.4–38.9). The median follow-up period was 56.9 months (interquartile range 25.3–87.3 months), during which the overall mortality was 4.4% (9 patients). Fifteen patients presented with fulminant myocarditis. After multivariable analysis, older age (HR = 1.11, 95% CI: 1.05–1.16, p < 0.001) and a poorer New York Heart Association (NYHA) function class (HR = 4.6, 95% CI: 1.18–18, p = 0.028) were found to be independently associated with a higher risk of mortality, whereas higher albumin levels at presentation (HR = 0.2, 95% CI: 0.07–0.56, p = 0.002) were associated with decreased mortality. The group presenting with fulminant myocarditis had a more severe course of disease and a higher in-hospital mortality (13.3% vs. 0%, p = 0.005).ConclusionsThe overall prognosis of patients with myocarditis is good – in terms of both survival and recovery without residual left ventricular dysfunction.

Phase angle values, a good indicator of nutritional status, are associated with median value of hemoglobin rather than hemoglobin variability in hemodialysis patients

Background Our aim was to elucidate whether Hb variability affects nutritional status in HD patients. Methods This study included chronic HD patients (n = 76) with available monthly Hb levels up to 24 months prior to the body composition monitoring (BCM) measurement. The parameters obtained in the BCM included body mass index (BMI), lean tissue index (LTI), fat tissue index (FTI), body cell mass index (BCMI), overhydration/extracellular water ratio (OH), and phase angle (PhA). The coefficient of variation (Hb-CV), standard deviation (Hb-SD), and range of Hb (Hb-RAN) were used as indexes of Hb variability. In addition, minimum (Hb-Min), maximum (Hb-Max), average (Hb-Avg), and median (Hb-Med) Hb levels (g/dL) were analyzed. Results There were no significant differences in clinical, biochemical, and nutritional indexes based on the Hb-CV level. Compared to patients with an Hb-Med ≤ 10.77, those with an Hb-Med >10.77 had higher albumin levels, total iron-binding capacity (TIBC), and PhA and lower average weekly prescribed darbepoetin. Age, female sex, OH, and darbepoetin dosage were negatively correlated with PhA. Serum albumin, phosphorus, TIBC, Hb-Med, and Hb-Avg were positively correlated with PhA. In multiple linear regression analysis, PhA was positively associated with Hb-Med and serum albumin level, whereas PhA was negatively associated with age and female sex. The area under the curve (AUC) of Hb-Med was 0.665 (p = 0.040) in predicting PhA >5.00° Conclusions PhA was not affected by indexes of Hb variability, whereas PhA was associated with Hb-Med in chronic HD patients.

Development of Nomogram Predicting 10-Year Survivors after Curative Hepatectomy for Hepatocellular Carcinoma

Background: Although hepatectomy is a curative treatment modality for hepatocellular carcinoma (HCC), clinical outcome and predictive factors of 10-year long-term survivors are rarely reported in the literature. Aim of study: To analyze the clinico-pathological factors of 10-year long-term survivors following curative hepatectomy for HCC and to develop a predictive nomogram for 10-year survivors. Methods: From 2004 to 2009, 325 patients with HCC underwent curative hepatectomy. There were 95 patients (29.2%) surviving 10 years or more (group 1), whereas 230 patients (70.8%) surviving < 10 years (group 2). Comparison of clinic-pathological data was made between two groups. Good prognostic factors identified by multivariate analysis were used to construct a nomogram predicting 10-year survivors. Internal validation using bootstrap sampling was also performed. Results: Group 1 was younger, had more asymptomatic tumor, had more hepatitis B carriers, better functional status, better preoperative liver function, and higher albumin level, compared with group 2. Group 1 had smaller tumor, more solitary tumor, more tumor with microvascular invasion and rupture than Group 2. Independent good prognostic factors predicting 10-year survivor were young age, ASA status (≤ 2), high albumin, solitary tumor and no microvascular tumor invasion. A nomogram is constructed (Figure 1) with C-index of 0.801. Internal validation using bootstrap sampling reveals C-index of 0.792. Conclusion: There are 29.2% patients with curative hepatectomy for HCC can survive up to or more than 10 years. Nomogram using age, ASA status, preoperative albumin, solitary tumor and microvascular tumor invasion can accurately predict 10-year survivor.

Vascular mortality rates and effects of hematological inflammatory markers on in-hospital mortality in patients with acute ischemic stroke

Aim: Inflammatory markers that may be associated with on the prognosis of acute ischemic stroke (IS) such as C-reactive protein/albumin ratio, neutrophil/lymphocyte ratio, albumin, red blood cell distribution width (RDW) have been investigated in the recent years. In this study, it was aimed to investigate the effects of all these inflammatory markers on in-hospital mortality and to determine the mortality rates due to cerebral artery occlusion in patients with acute IS. Materials and Methods: Patients hospitalized in our hospital with a diagnosis of acute IS between April 2014 and August 2018 were retrospectively analyzed. Logistic regression analysis was used to investigate the prognostic factors in IS. Receiver operating characteristic (ROC) curve analysis was performed to calculate the cut-off values and evaluate the predictive values of variables. Results: 344 patients, including 267 patients who were alive and 77 patients who died at the hospital, were included in the study. The infarcts that had the highest mortality rate were massive infarcts in the internal carotid artery area (75%), middle cerebral artery-M1 segment infarctions (62.5%) and total basilar artery infarcts (40%). According to the multivariate logistic regression model, only RDW-SD and albumin were found to be poor prognostic factors of IS (p=0.005 and p=0.021). Area under the ROC curve was as follows: RDW-SD 0.613 (95% CI, 0.53-0.69).Conclusions: High RDW-SD and low albumin levels at admission are independent poor prognostic factors of acute IS. Multicenter studies conducted with large patient populations are necessary to determine vascular mortality rates in patients with IS.

Study on Risk Factors of Ventilator-Associated Pneumonia in Elderly Patients with Acute Cerebral Infarction Treated with Endotracheal Intubation and Mechanical Ventilation

To investigate the risk factors of ventilator-associated pneumonia in elderly patients with acute cerebral infarction and to provide guidance for clinical prevention and treatment is the main objective. Gramnegative bacteria 38 strains (67.86 %), Gram-positive bacteria 15 strains (26.79 %) and fungi 3 strains (5.36 %) were detected by pathogenic bacteria culture. There was no significant difference in age, gender, body mass index, smoking, drinking, hypertension, diabetes and coronary heart disease between ventilator-associated pneumonia group and non-ventilator-associated pneumonia group (p>0.05); there were significant differences between ventilator-associated pneumonia group and non-ventilator-associated pneumonia group in antibiotic prophylactic use, time of ventilator use, acute physiology and chronic health evaluation II score and serum albumin level (p<0.05). The receiver operating characteristic curve was drawn and the results showed that the sensitivity of acute physiology and chronic health evaluation II score in predicting ventilator-associated pneumonia in patients with acute cerebral infarction was 93.71 %, the specificity was 77.61 % and the area under the curve value was 0.894. The sensitivity and specificity of albumin in predicting ventilator-associated pneumonia in elderly patients with acute cerebral infarction were 78.51 %, 76.92 % and 0.857 respectively. Multivariate logistic analysis showed that prophylactic use of antibiotics and high serum albumin level could effectively reduce the risk of ventilator-associated pneumonia in elderly patients with acute cerebral infarction undergoing endotracheal intubation and mechanical ventilation (p<0.05), while prolonged time of ventilator use and increased acute physiology and chronic health evaluation II score would increase the risk of ventilator-associated pneumonia in elderly patients with undergoing endotracheal intubation and mechanical ventilation (p<0.05). There are many factors influencing the occurrence of ventilator-associated pneumonia in the elderly patients with acute cerebral infarction undergoing endotracheal intubation and mechanical ventilation, and the intervention according to the risk factors has a positive preventive effect.

The Relationship Between Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios With Hospital Stays and Mortality in the Emergency Department.

BackgroundMost acute pancreatitis scoring is made in the first 48-72 hours or later. Like many inflammatory processes, Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) can be useful in showing the severity and extent of inflammation in acute pancreatitis. Our study aimed to evaluate whether these rates affect mortality according to the NLR and PLR values ​​of patients diagnosed with acute pancreatitis by examining the blood samples taken within the first hour after admission to the emergency department rates are useful in predicting the length of stay.MethodsIn our retrospective study, 557 patients applied to our clinic for 4.5 years, whose amylase and lipase values ​​were higher than two times the cut-off value in blood tests and whose CT imaging was compatible with acute pancreatitis were included in the study.ResultsThe median length of hospitalization of the patients was 4.0 (3.0-6.0) days. Gallstones were detected in 320 (57.5%) patients. Mortality of less than a year was observed in 45 (8.1%) of the study population. Eighteen of the patients (3.2%) showed the need for follow-up in the intensive care unit. A statistically significant relationship was found between mortality and variables hematocrit (HCT), red cell distribution width (RDW),c-reactive protein CRP), glucose, urea, potassium, albumin, PLR, and NLR (p <0.05). A statistically significant correlation was observed between RDW, NLR, glucose, and CRP levels in the two groups divided according to the median value of 4 days we found on hospitalization (p <0.05). According to the graphics and test results obtained by ROC analysis, the mortality status can be predicted at a statistically significant level with PLR and NLR diagnostic tests (p <0.05).ConclusionHigh levels of NLR, PLR, RDW, glucose, CRP, urea, potassium, low albumin and hematocrit values ​​at the first admission in the Emergency Service seem to be associated with increased 1-year mortality in acute pancreatitis.

Prediction of Mortality Incidence in Patients with Chronic Kidney Disease Based on Influential Prognostic Factors with Competing Risks Approach

Background: Chronic Kidney Disease (CKD) is a disease in which the kidney’s functionality declines gradually. The aim of this study was to identify significant laboratory prognostic factors on death due to CKD in a clinical complex. Materials and Methods: A retrospective study including 109 patients with the end-stage renal disease treated at Iran Helal pharmaceutical and the clinical complex was conducted between 2014-2018. The survival time was set as the time interval between starting dialysis until death due to CKD. Also, the transplantation was considered as competing risk, which was occurred for a few patients. A three-parameter Gompertz model was used that considers both the event of interest and the competing event simultaneously. Results: Death due to CKD occurred in 29 (26.6%) of the patients and 19(17.4%) with transplantation. Serum uric acid was a significant prognostic factor that decreased the hazard of mortality by 21%. Serum phosphorus and age by increasing the risk of death, were poor prognoses for the event of interest. Serum uric acid and phosphorus 6.9-9.9 (mg/dl) were associated with 72% and 4.05-fold increased hazard of transplant, respectively. The 4-year cumulative incidence of death and transplant was 48.4% and 29.2%, respectively. Conclusion: We have deduced that high serum phosphorus levels and increased levels of age were associated with worse outcomes. High serum uric acid level was related to better survival, which could be explained by having a better protein-rich diet alongside the high albumin level. [GMJ.2020;9:e1798]

Prediction of Mortality Incidence in Patients with Chronic Kidney Disease Based on Influential Prognostic Factors with Competing Risks Approach.

Background: Chronic Kidney Disease (CKD) is a disease in which the kidney’s functionality declines gradually. The aim of this study was to identify significant laboratory prognostic factors on death due to CKD in a clinical complex. Materials and Methods: A retrospective study including 109 patients with the end-stage renal disease treated at Iran Helal pharmaceutical and the clinical complex was conducted between 2014-2018. The survival time was set as the time interval between starting dialysis until death due to CKD. Also, the transplantation was considered as competing risk, which was occurred for a few patients. A three-parameter Gompertz model was used that considers both the event of interest and the competing event simultaneously. Results: Death due to CKD occurred in 29 (26.6%) of the patients and 19(17.4%) with transplantation. Serum uric acid was a significant prognostic factor that decreased the hazard of mortality by 21%. Serum phosphorus and age by increasing the risk of death, were poor prognoses for the event of interest. Serum uric acid and phosphorus 6.9-9.9 (mg/dl) were associated with 72% and 4.05- fold increased hazard of transplant, respectively. The 4-year cumulative incidence of death and transplant was 48.4% and 29.2%, respectively. Conclusion: We have deduced that high serum phosphorus levels and increased levels of age were associated with worse outcomes. High serum uric acid level was related to better survival, which could be explained by having a better protein-rich diet alongside the high albumin level.

Hepatic cell-sheet fabrication of differentiated mesenchymal stem cells using decellularized extracellular matrix and thermoresponsive polymer

PurposeLiver tissue engineering via cell sheet technology would open new doors for treatment of patients with liver failure. Decellularized tissues could provide sufficient extracellular matrix (ECM) to support development of hepatocytes in in vivo niches. Besides, with the potential of temperature responsive polymer (pNIPAAm) as an intelligent surface for controlling the attachment/detachment of cell, we set out to generate three in vitro microenvironments models including I: pNIPAAm hydrogel (pN hydrogel), II: decellularized ECM incorporated into pNIPAAm hydrogel (dECM + pN hydrogel) and III: decellularized ECM scaffold (dECM scaffold) to investigate the structural and function cues of hepatocyte-like cells after differentiation of adipose tissue-derived mesenchymal stem cells (AT-MSCs) on the surface of these models. MethoddECM scaffold was obtained after decellularization of rat liver, and its efficiency was analyzed. pN hydrogel and dECM + pN hydrogel (1:3 and 2:3 ratios) of were fabricated, and scaffold architecture was characterized. Each well of culturing plates was coated separately with these three constructs and AT-MSCs were instructed to differentiate into hepatocyte-like cells (HLCs). After recellularization, patterns of differentiation, and expression of hepatogenic markers were investigated via biochemical assays and qRT-PCR at different time points. ResultsMultipotency of AT-MSCs, after their ability for osteogenesis and adipogenesis was documented. Production of dense and intact cell sheets was reported in dECM + pN hydrogel, as opposed to pN hydrogel and dECM scaffold. Also, statistically significant difference of HLCs functionality in dECM + pN hydrogel was confirmed after evaluation of the expression of hepatocyte markers including, alpha-fetoprotein, cytokeratin 18, cytochrome P450-2E1 and phosphoenolpyruvate carboxykinase. ConclusionOur results proved dECM + pN hydrogel were able to preserve hepatocyte function in cell sheets owing to the high level of albumin, urea, hepatogenic markers, and glycogenesis potential of HLCs. Accordingly, dECM incorporated in pN hydrogel could remodel microenvironments to guide the AT-MSCs into conducive differentiation and proliferation to give rise to multilayer sheets of cells in their own ECM.

Associations of serum uric acid and urinary albumin with the severity of diabetic retinopathy in individuals with type 2 diabetes

BackgroundDiabetic retinopathy (DR) is a serious microvascular complication of type 2 diabetes mellitus (T2DM). The aim of this retrospective study was to reveal the risk factors for the severity of DR in individuals with T2DM. Demographic data and biochemical parameters were collected and analyzed.MethodsA total of 518 individuals with type 2 diabetes were included. These individuals were classified into three groups according to the severity of diabetic retinopathy: non-diabetic retinopathy (NDR) group (N = 172), non proliferative diabetic retinopathy (NPDR) group (N = 184), and proliferative diabetic retinopathy (PDR) group (N = 162). Demographic and clinical measurement data of the individuals were collected by reviewing medical records and direct interview. The demographic data and biochemical parameters between groups were compared using Student’s t-test. Moreover, the factors related to severity of diabetic retinopathy were identified by using the multivariate logistic regression analysis.ResultsNo significant difference in age, gender, body mass index (BMI), and diabetes duration was found among these three groups. The serum uric acid (SUA), total cholesterol (TC), low density lipoprotein cholesterol (LDL-c), homocysteine, and urinary albumin levels were significantly higher in the NPDR and PDR group than those in the NDR group (P < 0.05). The individuals in the PDR group had obviously higher levels of SUA, homocysteine, and urinary albumin than individuals in the NPDR group (P < 0.05). The multivariate logistic regression analysis revealed that high SUA, homocysteine, TC, LDL-c, and urinary albumin levels were associated with more serious diabetic retinopathy (OR > 1; P < 0.05).ConclusionThe concentrations of SUA and urinary albumin are associated with the severity of DR in individuals with T2DM.

Single-center experience on actual mid-term (≥5 years) and long-term (≥10 years) survival outcome in patients with hepatocellular carcinoma after curative hepatectomy: A bimodal distribution.

Analysis for actual mid-term (≥5 years) and long-term (≥10 years) survivors with hepatocellular carcinoma (HCC) following curative hepatectomy are rarely reported in the literature.This retrospective study aims to study the mid- and long-term survival outcome and associated prognostic factors following curative hepatectomy for HCC in a tertiary referral center.The clinical data of 325 patients who underwent curative hepatectomy for HCC were reviewed. They were stratified into 3 groups for comparison (Group 1, overall survival <5 years; Group 2, overall survival ≥5, and <10 years; Group 3, overall survival ≥10 years). Favorable independent prognostic factors for mid- and long-term survival were analyzed.A bimodal distribution of actual survival outcome was observed, with short-term (<5 years) survival of 52.7% (n = 171), mid-term survival of 18.1% (n = 59), and long-term survival of 29.2% (n = 95). Absence of microvascular invasion (OR 3.690, 95% CI: 1.562–8.695) was independent good prognostic factor for mid-term survival. Regarding long-term overall survival, young age (OR 1.050, 95% CI: 0.920–0.986), ASA grade ≤2 (OR 3.746, 95% CI: 1.325–10.587), high albumin level (OR 1.008, 95% CI: 0.920–0.986), solitary tumor (OR 3.289, 95% CI: 1.149–7.625) and absence of microvascular invasion (OR 4.926, 95% CI: 2.192–11.111) were independent good prognostic factors.Curative hepatectomy results in bimodal actual survival outcome with favorable long-term survival rate of 29.2%. Favorable independent prognostic factors (age, ASA grade, albumin level, tumor number, and microvascular invasion) are identified for overall survival.

What is the normal composition of pericardial fluid?

ObjectiveBiochemical and cytological pericardial fluid (PF) analysis is essentially based on the knowledge of pleural fluid composition. The aim of the present study is to identify reference intervals (RIs) for...

Diverting colostomy is an effective procedure for ulcerative chronic radiation proctitis patients after pelvic malignancy radiation

BackgroundChronic radiation proctitis (CRP) with rectal ulcer is a common complication after pelvic malignancy radiation, and gradually deteriorating ulcers will result in severe complications such as fistula. The aim of this study was to evaluate effect of colostomy on ulcerative CRP and to identify associated influence factors with effectiveness of colostomy.MethodsBetween November 2011 to February 2019, 811 hospitalized patients were diagnosed with radiation-induced enteritis (RE) in Sun Yat-sen University Sixth Affiliated Hospital, among which 284 patients presented with rectal ulcer, and 61 ulcerative CRP patients were retrospectively collected and analyzed.ResultsThe overall effective rate of colostomy on ulcerative CRP was 49.2%, with a highest effective rate of 88.2% within 12 to 24 months after colostomy. 9 (31.1%) CRP patients with ulcers were cured after colostomy and 12 (19.67%) patients restored intestinal continuity, among which including 2 (3.3%) patients ever with rectovaginal fistula. 100% (55/55) patients with rectal bleeding and 91.4% (32/35) patients with anal pain were remarkably alleviated. Additionally, multivariable analysis showed the duration of stoma [OR 1.211, 95% CI (1.060–1.382), P = 0.005] and albumin (ALB) level post-colostomy [OR 1.437, 95% CI (1.102–1.875), P = 0.007] were two independent influence factors for the effectiveness of colostomy on the rectal ulcer of CRP patients.ConclusionsColostomy was an effective and safe procedure for treating rectal ulcer of CRP patients, and also a potential strategy for preventing and treating fistula. Duration of stoma for 12–24 months and higher ALB level could significantly improve the effectiveness of colostomy on ulcerative CRP patients.