Laboratory Data Research Articles

Optimizing autologous stem cell collections for patients with multiple myeloma receiving G-CSF and Plerixafor: A single center project.

Increasing indications for cellular therapy collections have stressed our healthcare system, with autologous collections having a longer than desired wait time until apheresis collection. This quality improvement initiative was undertaken to accommodate more patients within existing resources. Patients with multiple myeloma who underwent autologous peripheral blood stem cell collection from October 2022 to April 2023 were included. Demographic, mobilization, laboratory, and apheresis data were retrospectively collected from the medical record. This cohort included 120 patients (49.2% male), with a median age of 60 years. All received G-CSF and 95% received pre-emptive Plerixafor approximately 18 hours pre-collection. Most (79%) had collection goals of at least 8 × 106/kg CD34 cells, with 63% over 70 years old having this high collection goal (despite 20 years of institutional data showing <1% over 70 years old have a second transplant). With collection efficiencies of 55.9%, 44% of patients achieved their collection goal in a single day apheresis collection. A platelet count <150 × 103/μL on the day of collection was a predictor for poor mobilization; among 27 patients with a low baseline platelet count, 17 did not achieve the collection goal and 2 failed to collect a transplantable dose. With minor collection goal adjustments, 15% of all collection appointments could have been avoided over this 6-month period. Other strategies to accommodate more patients include mobilization modifications (Plerixafor timing or substituting a longer acting drug), utilizing platelet counts to predict mobilization, and modifying apheresis collection volumes or schedule templates.

Predictors of acute kidney injury after percutaneous nephrolithotomy in adult patients: prospective observational study.

To assess the frequency and the predictive factors of Acute Kidney injury (AKI) in patients undergoing percutaneous nephrolithotomy (PNL). A prospective observational work. Demographic, preoperative laboratory data, stone characteristics, and intraoperative and postoperative data were gathered. Perioperative AKI had been defined as an elevation in serum creatinine by ≥ 0.3 mg/dl within 48h, or ≥ 1.5 times baseline, or urine volume less than 0.5ml/ kg/hour for 6hours. A multivariate logistic regression analysis was performed to determine the predictive factors of AKI. ROC curves were utilized to determine the cutoff values of the risk variables. P-values were deemed statistically significant when they were less than 0.05. A total of 418 participants had been involved. The frequency of AKI was 13.9, and 17.2% of patients with AKI developed CKD. The risk factors were age > 46.5 years, smoking, BMI > 28.5 kg/m2, hypertension, diabetes, utilization of angiotensin-converting enzyme inhibitors (ACEI), haemoglobin < 10.8 gm/dl, baseline creatinine > 1.41 mg/dl, eGFR < 65.2 ml/min./1.73 m2, serum uric acid > 5.2 mg/dl, stone volume > 1748 mm3, large tract size, long operative time, and intra-operative bleeding. Patients with AKI had a notably extended duration of hospitalization (3.2 days ± 0.45 vs 2.1 ± 0.42, p < 0.001). Perioperative AKI occurred in 13.9% of individuals undergoing PNL. Identification and optimization of the risk factors and meticulous technique during PNL procedures should be attempted to decrease the risk of AKI.

Navigating appendicitis care during the Covid-19 pandemic: a retrospective cohort study in China

BackgroundThe emergence of the COVID-19 pandemic in December 2019 initiated a global transformation in healthcare practices, particularly with respect to hospital management. PCR testing mandates for medical treatment seekers were introduced to mitigate virus transmission.AimsThis study examines the impact of these changes on the management of patients with appendicitis.MethodsWe conducted a retrospective analysis of medical records for 748 patients diagnosed with appendicitis who underwent surgery at a tertiary care hospital during two distinct periods, the pre-pandemic year 2019 and the post-pandemic year 2021. Patient demographics, clinical characteristics, laboratory data, surgical outcomes, and hospital stay duration were assessed.ResultsWhile no significant differences were observed in the general characteristics of patients between the two groups, the time from hospital visit to operation increased significantly during the pandemic. Unexpectedly, delayed surgical intervention was associated with shorter hospital stays but did not directly impact complication rates. There was no discernible variation in the type of surgery or surgical timing based on symptom onset. The pandemic also prompted an increase in appendicitis cases, potentially related to coronavirus protein expression within the appendix.ConclusionsThe COVID-19 pandemic has reshaped the landscape of appendicitis management. This study underscores the complex interplay of factors, including changes in hospital protocols, patient concerns, and surgical timing. Further research is needed to explore the potential link between COVID-19 and appendicitis. These insights are valuable for informing healthcare practices during and beyond the pandemic.

Imaging features, classification and clinical features of intrahepatic congenital portosystemic shunts.

Congenital portosystemic shunts (CPSS) are a rare developmental anomaly diverting blood flow from the portal venous system and the liver to the systemic venous system. This case series examines the sonographic imaging findings, shunt classification, ultrasound shunt ratios, and outcomes in nine children (5 females, 4 males) admitted to our institution between 2015 and 2022 were included in this study. The shunts were initially categorized by the Parks classification and were followed by serial ultrasounds. Clinical presentation, clinical course, laboratory data, shunt ratios, and time to shunt closure were all followed on subsequent ultrasounds. The most common type of CPPS was the Type 3 shunt. In cases where shunt ratios were measured, the shunt ratio gradually decreased in tandem with decreasing ammonia levels until spontaneous closure was achieved. Predictors of lack of shunt closure included high shunt ratios and Type 4 shunts. Patients with CPPS can be followed with the shunt ratio calculation obtained from sonographic imaging, which may correlate to ammonia levels and indicate risk of hepatic encephalopathy as well as predict speed and timing of closure.

Correlation of hematocrit and cardiovascular events in peritoneal dialysis patients

Objective: To investigate the correlation between hematocrit (HCT) and cardiovascular events in peritoneal dialysis (PD) patients. Methods: Patients undergoing maintenance PD in the PD center of Guizhou Provincial People's Hospital from March 19, 2012 to July 9, 2020 were included. Demographic, baseline clinical and laboratory data of the patients were collected and patients were followed up until April 8, 2022. The primary endpoint was the first occurrence of a cardiovascular event. According to the tertiles of baseline HCT, the patients were divided into group Q1 (HCT≤26.6%), group Q2 (HCT>26.6%-32.4%), and group Q3 (HCT>32.4%). Laboratory indexes and cardiovascular events were compared among the three groups. Kaplan-Meier survival curve, Cox regression analysis and sensitivity analysis were used to analyze the effect of HCT on cardiovascular outcomes. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of HCT for cardiovascular events in PD patients. Results: A total of 860 PD patients were included, including 494 males (57.4%) and 366 females (42.6%), with a mean age of (41.5±15.0) years. There were 287 cases in group Q1, 289 cases in group Q2, and 284 cases in group Q3, respectively. A total of 265 (30.8%) patients experienced first cardiovascular events during the follow-up period. The incidence of cardiovascular events in groups Q1, Q2 and Q3 was 36.2% (104/287), 34.3% (99/289), and 21.8% (62/284), respectively, with a statistically significant difference (P<0.001). The incidence of cardiovascular events decreased with the increase of HCT. Multivariate Cox proportional hazards regression model analysis showed that decreased HCT was a risk factor for cardiovascular events. Compared with group Q3, the risk of cardiovascular events in group Q1 increased by 50.7% (group Q2: HR=1.444, 95%CI: 1.029-2.028, P=0.034; group Q1: HR=1.570, 95%CI: 1.096-2.250, P=0.014). In the sensitivity analysis, using kidney transplantation as the competition event, the risk of cardiovascular events was lower in group Q3 than that in group Q1 (subdistributional HR=1.413, 95%CI: 1.006-1.990, P=0.046). Kaplan-Meier survival curve showed that compared with the other two groups, the cardiovascular events-free survival rate of patients in group Q1 was significantly lower (log-rank χ2=9.722, P=0.008). ROC analysis showed that the area under the curve (AUC) of HCT for predicting cardiovascular events in PD patients was 0.583 (95%CI: 0.542-0.623, P<0.001), with the sensitivity of 40.6% and the specificity of 75.1%. Conclusion: Low-level HCT is associated with an increased risk of the first cardiovascular event in PD patients.

Machine learning for prediction of chronic kidney disease progression: Validation of the Klinrisk model in the CANVAS Program and CREDENCE trial.

To validate the Klinrisk machine learning model for prediction of chronic kidney disease (CKD) progression in patients with type 2 diabetes in the pooled CANVAS/CREDENCE trials. We externally validated the Klinrisk model for prediction of CKD progression, defined as 40% or higher decline in estimated glomerular filtration rate (eGFR) or kidney failure. Model performance was assessed for prediction up to 3 years with the area under the receiver operating characteristic curve (AUC), Brier scores and calibration plots of observed and predicted risks. We compared performance of the model with standard of care using eGFR (G1-G4) and urine albumin-creatinine ratio (A1-A3) Kidney Disease Improving Global Outcomes (KDIGO) heatmap categories. The Klinrisk model achieved an AUC of 0.81 (95% confidence interval [CI] 0.78-0.83) at 1 year, and 0.88 (95% CI 0.86-0.89) at 3 years. The Brier scores were 0.020 (0.018-0.022) and 0.056 (0.052-0.059) at 1 and 3 years, respectively. Compared with the KDIGO heatmap, the Klinrisk model had improved performance at every interval (P < .01). The Klinrisk machine learning model, using routinely collected laboratory data, was highly accurate in its prediction of CKD progression in the CANVAS/CREDENCE trials. Integration of the model in electronic medical records or laboratory information systems can facilitate risk-based care.

Malignant tumor increases the risk of all causes in-hospital mortality in critically ill patients with ischemic stroke: analysis of the MIMIC-IV database.

Ischemic stroke (IS) and malignant tumor (MT) have high morbidity and mortality rates worldwide, and several associations exist between them. This study aimed to determine the effect of MT on hospital mortality in patients with IS. Based on their MT status, participants with IS in the Medical Information Mart for Intensive Care IV (MIMIC-IV) were divided into two groups. The primary outcome was in-hospital all causes mortality. Kaplan-Meier survival analysis was performed to evaluate the intergroup in-hospital mortality, and three Cox regression models were used to determine the association between MT and in-hospital mortality. A total of 1605 participants (749 males and 856 females) were included in the study. The mean age was 72.030 ± 15.463 years. Of these, 257 (16%) patients died in the hospital. Kaplan-Meier analysis showed that the MT group had a significantly lower possibility of in-hospital survival than the non-MT group. In the unadjusted model, in-hospital mortality among MT patients had a higher odds ratio (OR) of 1.905 (95% CI, 1.320-2.748; P < 0.001) than the non-MT group. After adjusting for basic information, vital signs, and laboratory data, MT was also associated with increased in-hospital mortality (OR = 1.844, 95% CI: 1.255-2.708; P = 0.002). Among the patients with IS, the risk of all causes in-hospital mortality was higher for MT than for patients non-MT. This finding can assist clinicians in more accurately assessing prognosis and making informed treatment decisions.

A study of morbidity and mortality markers in children diagnosed with severe dengue illness at a quaternary paediatric intensive care unit

Background: To identify the biochemical, haematological, and serological laboratory parameters and establish associations between mortality risk and children with severe dengue fever (DF). Methods: This retro-prospective study included 251 children who were dengue serology positive, aged between 1 month and 18 years, hospitalized in paediatric intensive care unit (PICU) with severe dengue illness from July 2019 to June 2021. Clinical, laboratory, and radiological data were extracted from hospital's electronic database and analyzed. Results: The majority had a mean age of 5.46 years with a significant female predominance (58.2%). Also, 80.1 per cent of children presented in the critical phase with an average PICU stay of 3.59 days. There was a significant mortality risk associated with presenting day of illness (risk 9.5%), ventilation requirements (risk 29.8%), and stay of more than a week in the PICU (risk 36%), with that of the severity of outcomes. The odds of increased mortality risk were associated with prolonged PICU stay exceeding a week and ventilation requirements by 10.03 and 20.19 times respectively. Investigation-wise, abnormal liver enzymes on admission such as SGOT (OR 5.39, p&gt;0.0001); and serum SGPT (OR 5.54, p&lt;0.001) were significantly associated with poorer outcomes. Interestingly, neither thrombocytopenia nor leucopenia was found to be a true marker of mortality and the overall mortality rate was found to be 8.4% (n=21). Conclusions: Any stay of more than a week, abnormal liver enzymes on admission, and ventilation requirements were all associated with higher mortality risk and potential predictors for poor clinical outcomes in the PICU.

The Effect of Apalutamide on Thyroid Function in Prostate Cancer Patients

Abstract Context Apalutamide (APT) is a nonsteroidal anti-androgen medication used to treat metastatic castrate sensitive and non-metastatic castrate-resistant prostate cancer. Early clinical trials of APT identified thyroid dysfunction as a common adverse effect of therapy, but the clinical presentation and management of APT-induced hypothyroidism has not been studied. Methods We report a case series of 16 patients with APT-associated thyroid dysfunction during prostate cancer treatment at two academic medical centers. Patient clinical parameters, thyroid function laboratory data, and thyroid hormone requirements over the course of APT treatment were analyzed. Results Among the 16 patients in our case series with APT-associated hypothyroidism, 3 had no prior thyroid disease and 13 had pre-existing hypothyroidism. The patterns of thyroid dysfunction included overt and subclinical hypothyroidism. The median time from APT initiation to thyroid function test abnormality was 19 weeks, but occurred in some cases as early as 2-4 weeks. Hypothyroidism was effectively managed with thyroid hormone replacement using levothyroxine (LT4), though some patients with pre-existing hypothyroidism required a 2- to 3-fold dose increase while on APT to achieve euthyroid state. In the subset of patients who completed or stopped APT therapy, TSH fell at a median of 11 weeks post-APT therapy and thyroid hormone requirements decreased to near pre-APT levels. Conclusion APT-associated thyroid dysfunction presents as new or worsening hypothyroidism and should prompt initiation or increase in thyroid hormone replacement. Monitoring of thyroid function tests is recommended every 1-2 months for all patients on APT and 2-3 months after completion of APT.

Incidence of Coagulopathy After Resuscitation at a Role 1 Facility: The Prehospital Trauma Registry Experience.

The development of acute traumatic coagulopathy is associated with increased mortality and morbidity in patients with battlefield traumatic injuries. Currently, the incidence of acute traumatic coagulopathy in the Role 1 setting is unclear. We queried the Prehospital Trauma Registry (PHTR) module of the Department of Defense Trauma Registry (DoDTR) for all encounters from inception through May 2019. The PHTR captures data on Role 1 prehospital care. Data from the PHTR was linked to the DoDTR to analyze laboratory data and patient outcomes using descriptive statistics. We defined coagulopathy as an international normalized ratio (INR) of ≥1.5 or platelet count ≤150×109/L. A total of 595 patients met the inclusion criteria; 36% (212) met our definition for coagulopathy, with 31% (185) carrying low platelet numbers, 11% (68) showing an elevated INR, and 7% (41) with both. The baseline (no coagulopathy) cohort had a mean INR of 1.10 (95% CI 1.09-1.12) versus 1.38 (95% CI 1.33-1.43) in the coagulopathic cohort. The mean platelet count was 218 (95% CI 213-223) ×109/L in the baseline cohort versus 117 (95% CI 110-125) ×109/L in the coagulopathic cohort. Our findings indicate a high incidence of coagulopathy in trauma patients. Approximately one-third of wounded patients had laboratory evidence of coagulopathy upon presentation to a forward medical care facility. Advanced diagnostic facilities are therefore needed to facilitate early diagnosis of acute traumatic coagulopathy. Blood products with a long shelf life can aid in early correction.

Recent trends in bone metastasis treatments: A historical comparison using the new Katagiri score system

BACKGROUND Bone metastasis has various negative impacts. Activities of daily living (ADL) and quality of life (QOL) can be significantly decreased, survival may be impacted, and medical expenses may increase. It is estimated that at least 5% cancer patients might be suffering from bone metastases. In 2016, we published the Comprehensive Guidelines for the Diagnosis and Treatment of Bone Metastasis. Since then, the therapeutic outcomes for patients have gradually improved. As life expectancy is a major determinant of surgical intervention, the strategy should be modified if the prolongation of survival is to be achieved. AIM To monitor how bone metastasis treatment has changed before and after launch of our guidelines for bone metastasis. METHODS For advanced cancer patients with bone metastasis who visited the Department of Clinical Oncology at Akita University hospital between 2012 and 2023, parameters including the site and number of bone metastases, laboratory data, and survival time, were extracted from electronic medical records and the Katagiri score was calculated. The association with survival was determined for each factor. RESULTS Data from 136 patients were obtained. The 1-year survival rate for the poor prognosis group with a higher Katagiri score was 20.0% in this study, which was 6% and an apparent improvement from 2014 when the scoring system was developed. Other factors significantly affecting survival included five or more bone metastases than less (P = 0.0080), and treatment with chemotherapy (P &lt; 0.001), bone modifying agents (P = 0.0175) and immune checkpoint inhibitors (P = 0.0128). In recent years, advances in various treatment methods have extended the survival period for patients with advanced cancer. It is necessary not only to simply extend survival time, but also to maintain ADL and improve QOL. CONCLUSION Various therapeutic interventions including surgical approach for bone metastasis, which is a disorder of locomotor organs, are increasingly required. Guidelines and scoring system for prognosis need to be revised promptly.

Geotechnical Properties of Fly Ash Blended Expansive Soil: A Review

Fly ash, an industrial byproduct, is used as both a building material and a soil stabilizer due to its pozzolanic properties. Moreover, it is challenging to extrapolate the results based on an inadequate amount of laboratory data because of the non-homogeneous character of the soil and the diversity in the chemical properties of fly ash. This review article fills in the gaps by providing an overview of the existing data related to the geotechnical characteristics of expansive soil stabilized with fly ash. The chemical composition of fly ash is provided in terms of oxides of various elements to help identify the kinds produced in different nations. Additionally, information about the physical and geotechnical characteristics of fly ash blended expansive soil is provided in order to comprehend the influence of the fly ash's chemical composition and the expansive soil's fines percentage. While the geotechnical property comprises Atterberg's limit, compaction, UCS, shear strength, free swelling index, CBR, and consolidation, the physical property includes specific gravity and durability. Shear modulus, damping ratio, and Poisson's ratio are used to describe the dynamic properties of the modified expansive soil. The published data in this field and the research gap will be identified by the researchers with the aid of this article. Doi: 10.28991/CEJ-SP2024-010-06 Full Text: PDF

Development and validation of a nomogram for oral mucosal membrane pressure injuries in ICU patients: A prospective cohort study.

Establishing a nomogram to estimate the probability of oral mucosal membrane pressure injury of endotracheal tube-intubated hospitalized patients in intensive care unit. Multicentre prospective cohort study. Using Lasso regression and COX regression, variable selection was performed on demographic, clinical and laboratory data of 1037 ICU endotracheal tube-intubated hospitalized patients from West China Hospital, to construct a nomogram. External validation was conducted on 484 ICU endotracheal tube-intubated patients from People's Hospital of Zhongjiang County. Among 38 potential predictors, five variables emerged as independent predictors, integrated into the nomogram: administration of antibiotics, nutritional therapy duration, agitation, hypotension and albumin levels. We established a nomogram based on the hospital characteristics of ICU endotracheal tube-intubated patients, aiding in the prediction of the occurrence of oral mucosal membrane pressure injury. The study followed TRIPOD guidelines. The nomogram we developed can assist clinical worker in better identifying at-risk patients and risk factors. It enables the implementation of evidence-based nursing interventions in care to prevent the development of oral mucosal membrane pressure injury. The study has been registered with the Chinese Clinical Trial Registry (http://www.chictr.org.cn) under registration number ChiCTR2200056615.

Assessment of two recent hot dry rock thermal energy production projects

In this paper, we present analyses of laboratory and field data indicating that the current two-well, injection-production system, connected with multiple hydraulic fractures, is a very promising method for extracting heat from hot dry rock (HDR) systems to generate electricity. The current two-well system could be expanded to a three-well system consisting of one injection well and two symmetric producing wells connected via the central hydraulic fracture emanating from the injection well. To improve a uniform distribution of the injected fluid among all hydraulic fracture stages in the injection well, we advocate for field implementation of a newly designed well stimulation technique, the GeoThermOPTIMAL.We first present an analysis of the post-fracturing flow data obtained from an HDR geothermal injection well at the Utah FORGE Enhanced Geothermal System (EGS) research field site. The site is adjacent to the Roosevelt hydrothermal (HT) field. The objective of the study is to assess the effectiveness of well stimulation in extracting heat from the low-permeability, hot dry granitoid rock in the Utah FORGE research site. The study includes interpreting pressure falloff data obtained during the well stimulation process and employing laboratory-measured core data as a major input in the interpretation of the field falloff data. As a confirmation of the robustness of our analysis in Utah FORGE, we reviewed and analyzed the flow test results published for an injection-production doublet at the Blue Mountain EGS (Project Red) commercial site in Nevada. From the analyses of these two field tests, we have concluded that the interpretation and findings of the Blue Mountain EGS pilot test are consistent with the interpretation and findings from the Utah FORGE field research project test results.In summary, our engineering assessments began with laboratory experiments conducted on various core samples, including those from a granite outcrop and the Utah FORGE geothermal reservoir. These experiments aimed to measure key parameters such as matrix and fracture permeabilities, and porosities (km≈10−18m2, kf,eff≈10−15m2,ϕm≈10−1,andϕf≈10−4). These data served as guides and inputs for analytical and numerical solutions used to match the field pressure response of the geothermal wells. While we did not have core samples from the Blue Mountain EGS wells, we successfully applied the Utah FORGE analysis approach to the Blue Mountain site with cautious optimism.

Safety and myocardio-necrosis laboratory data trend in patients undergoing atrial fibrillation catheter ablation: pulsed field ablation vs. radiofrequency ablation

Abstract Background Pulsed Field Ablation (PFA) is an innovative technology to perform atrial fibrillation (AF) catheter ablation. No form of thermal energy is used, but an irreversible electroporation mechanism that causes selective cardiomyocytes death, sparing the cells of adjacent tissues. There are few data in the literature about peri-procedural trend of myocardium-necrosis laboratory data in patients undergoing PFA versus those with radiofrequency (RF). Purpose Compare the short-term safety and the peri-procedural trend of myocardium-necrosis laboratory data in patients undergoing PFA with those undergoing standard-power (40W) RF catheter ablation. Methods 50 patients undergoing paroxysmal AF catheter ablation with pulmonary veins isolation were retrospectively enrolled, 25 treated with PFA and 25 with RF (matched for age, sex, BMI, left atrium size). The PFA protocol involved four two-second deliveries with the penta-spline catheter in the "basket" and in the "flower" configuration; about RF ablation, circular lesions were carried out at the antrum of each pulmonary vein. All patients underwent serial blood samples including troponin I (TnI, n.v. 0-50 ng/L) and CKMB (n.v 0-5 ng/mL) at time 0 and at 3, 24 and 48 post-procedure hours. Complication were evaluated at pre-discharge visit and at 3-month follow-up. Results The clinical and echocardiographic patient’s characteristics are summarized in Table 1. The TnI and CKMB baseline values were within normal range for all patients, both those treated with PFA and those treated with RF, and there were no statistically significant differences between the two group. Regarding the TnI and CKMB values temporal increase, a statistically significant increase was observed in patients treated with PFA (Table 2). The TnI percentage decrease over the 48 hours in RF-treated patients, although not statistically significant, is slower compared to patients treated with PFA. This data could be explained by considering that PFA causes acute damage (myocardiocytes necrosis by electroporation) with less inflammation and a less progressive nature, while RF causes damage with greater irritation and progression (coagulative necrosis) that may result in myocardial necrosis even in the subsequent hours. Despite evidence of greater myocardial necrosis, there were not procedural complications in those treated with PFA. Therefore, the TnI increase is indicative of selective myocardial damage, likely more antral. Conclusion The increase of myocardio-necrosis laboratory data appears to be higher using PFA compared to RF, and it is not associated with greater adverse events. The trend of the myocardio-necrosis laboratory data shows different reduction curves between PFA and RF, probably related to different ablation power source; these data will need to be re-analysed with a greater number of cases.Table 1Table 2

Genetic, sociodemographic, lifestyle, and clinical risk factors of heart failure aggravation events: data from the UK Biobank

Abstract Background Heart failure (HF) is the leading cause of readmission and hospitalization. Purpose This study examined the associations and clinical utilities of genetic, sociodemographic, lifestyle, laboratory, and clinical risk factors on HF aggravation. Methods Data were from 5,345 UK Biobank middle-aged adults with established HF at enrolment. We performed Cox proportional hazard regression analyses to investigate the associations related to HF admission after enrolment utilizing 24 variables encompassing sociodemographic, clinical, lifestyle, and laboratory data. To assess the impact of genetic factors, we additionally adjusted each polygenic risk score (PRS) for the three medical histories: hypertension, atrial fibrillation (AF), and coronary heart disease (CHD), where the hazard ratios were statistically significant. Results Over a median follow-up of 11.5 [10.9-12.2] years, 247 (4.6%) HF admission events occurred. Among the 24 variables, statistically significant hazard ratios were observed for 10 variables, with hypertension (3.31, 2.19-5.02), AF (2.06, 1.53-2.75), current smoking (1.63, 1.09-2.46), and coronary heart disease (1.58, 1.17-2.13) showing the highest hazard ratios, while female gender (0.65, 0.46-0.91) exhibited the smallest hazard ratio. After adjusting for each PRS individually, HTN PRS (HR 1.06, 0.94-1.21) and AF PRS (HR 1.02, 0.90-1.16) were not statistically significant, whereas CHD PRS (HR 1.15, 1.02-1.31) showed significance in relation to HF admission. In the HF admission prediction model, the C index was 0.859 (0.838-0.880) with clinical variables, and it marginally increased to 0.864 (0.843-0.885) when all factors, including the genetic factor, were applied. Conclusions Sociodemographic, clinical, laboratory, lifestyle, and genetic factors are each associated with HF aggravation with male gender, hypertension, AF, low eGFR, cigarette smoking, and CHD PRS.

Multicenter Analysis of Cardiometabolic-Related Diagnoses in Youth with Congenital Adrenal Hyperplasia: a PEDSnet study.

Small cohorts of youth with congenital adrenal hyperplasia (CAH) demonstrate increased risk of obesity and poor cardiometabolic health. To determine the odds of cardiometabolic-related diagnoses in youth with CAH compared to matched controls in a cross-sectional analysis in a large, multisite database (PEDSnet). Electronic health record data (2009-2019) were used to determine odds of cardiometabolic-related outcomes based on diagnosis, anthropometric and laboratory data using logistic regression among youth with CAH vs. controls. Six PEDSnet sites. Youth with CAH and >1 outpatient visit in PEDSnet (n=1,647) were propensity-score matched on 8 variables to controls (n=6,588). A subset of youth with classic CAH (n=547, with glucocorticoid and mineralocorticoid prescriptions) were matched to controls (n=2,188). N/A. Odds of having cardiometabolic-related diagnoses among youth over 2 years with CAH compared to matched controls. Outcomes were calculated for all individuals with CAH (median age at last visit 12.9 years [7.3, 17.6]) and a subset with classic CAH (median age at last visit 11.6 years [4.7, 17.5]) compared to their matched controls. All patients with CAH had higher odds of overweight/obesity (odds ratio [95% confidence interval] 3.63 [3.24,4.07]), hypertension (3.07 [2.60,3.64]), dysglycemia (1.95 [1.35,2.82], dyslipidemia (2.28 [1.79,2.91]) and liver dysfunction (2.30 [1.91,2.76]) compared to matched controls. Patients with classic CAH had higher odds of overweight/obesity (3.21 [2.61,3.93]), hypertension (8.22 [6.71,10.08]), and liver dysfunction (2.11 [1.55,2.89]) compared to matched controls. Overall, youth with CAH are at increased risk of diagnoses related to worse cardiometabolic health.

Clinical Features and Analysis in Pituitary Stalk Interruption Syndrome

Objective. Pituitary stalk interruption syndrome (PSIS) is characterized by the absence of pituitary stalk, pituitary hypoplasia, and ectopic posterior pituitary. Because the etiology and clinical cognition of PSIS remain elusive, we analyzed the clinical features of PSIS in Chinese patients. Methods. A retrospective analysis was conducted on the clinical presentation, laboratory data, imaging examination, and management of 24 PSIS inpatients from our center over 10 years. Results. Among the 24 PSIS patients, there were 22 males (91.7%) and 2 females (8.3%). Growth hormone deficiency was present in all 24 cases (100%), hypogonadism in 24 cases (100%), secondary adrenal insufficiency in 22 cases (91.2%), and hypothyroidism in 21 cases (87.5%). 20 cases (83.3%) of PSIS patients exhibited deficiencies in four anterior pituitary hormones, 3 cases (12.5%) exhibited deficiencies in three anterior pituitary hormones, and 1 case (4.2%) exhibited deficiencies in two anterior pituitary hormones, with none exhibiting deficiencies in posterior pituitary hormones. Among the 24 PSIS patients, 12 had a history of growth hormone therapy before admission, and 12 had no such history. Additionally, 19 cases (79.2%) with PSIS were complicated by dyslipidemia, 15 cases (62.5%) were complicated by nonalcoholic fatty liver disease, and 9 cases (37.5%) were complicated by hyperuricemia. Conclusions. PSIS often presents with growth retardation and hypogonadotropic hypogonadism, but in some cases, short stature is not exhibited. PSIS is prone to complications such as dyslipidemia, nonalcoholic fatty liver disease, and hyperuricemia, increasing the risk of cardiovascular and cerebrovascular diseases. In clinical practice, the diagnostic ability of PSIS should be improved, and pituitary function and complications should be evaluated in a timely manner to avoid delayed treatment.

Can the pan-immune-inflammation value predict gram negative bloodstream infection-related 30-day mortality in solid organ transplant patients?

BackgroundThe recently used pan-immune-inflammation value (PIV) has not been adequately studied as a predictive marker for mortality in immunosuppressed patients. The aim of this study was to evaluate the usefulness of baseline PIV level as a predictor of 30-day mortality in solid organ transplant (SOT) recipients with gram negative bloodstream infections (GN-BSI).MethodsThis retrospective, cross-sectional study was conducted between January 1, 2019, and December 31, 2022, in 1104 SOT recipients. During the study period, 118 GN-BSI were recorded in 113 patients. Clinical, epidemiological, and laboratory data were collected, and mortality rates (30-day and all-cause) were recorded.ResultsThe 113 recipients had a median age of 50 years [interquartile range (IQR) 37.5–61.5 years] with a male predominance (n = 72, 63.7%). The three most common microorganisms were as follows: 46 isolates (38.9%) of Escherichia coli, 41 (34.7%) of Klebsiella pneumoniae, and 12 (10.2%) of Acinetobacter baumannii. In 44.9% and 35.6% of the isolates, production of extended-spectrum beta-lactamases and carbapenem resistance were detected, respectively. The incidence of carbapenem-resistant GN-BSI was higher in liver recipients than in renal recipients (n = 27, 69.2% vs n = 13, 17.6%, p < 0.001). All-cause and 30-day mortality rates after GN-BSI were 26.5% (n = 30), and 16.8% (n = 19), respectively. In the group with GN-BSI-related 30-day mortality, the median PIV level was significantly lower (327.3, IQR 64.8–795.4 vs. 1049.6, IQR 338.6–2177.1; p = 0.002). The binary logistic regression analysis identified low PIV level [hazard ratio (HR) = 0.93, 95% confidence interval (CI) 0.86–0.99; p = 0.04], and increased age (HR = 1.05, 95% CI 1.01–1.09; p = 0.002) as factors associated with 30-day mortality. The receiver operating characteristic analysis revealed that PIV could determine the GN-BSI-related 30-day mortality with area under curve (AUC): 0.723, 95% CI 0.597–0.848, p = 0.0005.ConclusionsPIV is a simple and inexpensive biomarker that can be used to estimate mortality in immunosuppressed patients, but the results need to be interpreted carefully.

DROPLET MOTION ON HYDROPHOBIC AND HYDROPHILIC SURFACES USING LATTICE BOLTZMANN METHOD WITH BLOOD TEST MICROPAD APPLICATION

Laboratory sciences and disease diagnostics need accelerated medical tests, ease of testing for patients, and lower diagnostic costs. In this respect, one of the most innovative methods is paper-based microfluidic analysis tools, called micro-PAD. Since the chemical-based micro-PADs need sufficient blood to show an accurate blood test, the shape of the micro-PADs, the blood quantity, and the droplet flow to reach the end of the microchannels are important. Therefore, this research showed the liquid droplet motion on a heterogeneous (hydrophobic and hydrophilic) surface using the lattice Boltzmann method, and two star-shaped micro-PADs were modeled to investigate the effect of the droplet size and the droplet deflection from the center of the micro-PAD on liquid flow in microchannels. Based on the obtained results, fluid behavior was similar in two patterns (ten-pointed pattern and four-pointed pattern). This study compared the effects of parallel, convergent, and divergent channels in a four-pointed pattern on fluid velocity. The off-center error of the droplet was considered at the initial moment. The obtained results confirmed the direct relationship between the increased deviation of the center and the lack of uniformity in the fluid penetration. The present simulation results were validated against the laboratory data.