Physiology Evaluation Research Articles

Risk factors for acute kidney injury in patients with severe acute pancreatitis: A systematic review and meta-analysis.

This systematic review and meta-analysis aimed to identify the risk factors for acute kidney injury (AKI) in patients with severe acute pancreatitis (SAP). A comprehensive literature search was conducted using the PubMed, Embase and Cochrane Library databases for case-control studies comparing the clinical characteristics of patients with SAP with and without AKI. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). Pooled odds ratios (ORs) with 95 % confidence intervals (CIs) were calculated using fixed- or random-effects models, based on heterogeneity. Five studies involving 795 patients with SAP were included, of whom 173 (21.8 %) developed AKI. All studies were of high quality according to the NOS. Among the 17 potential risk factors that were analysed, a history of alcohol consumption (OR = 2.36, 95% CI = 0.54-10.43, p < 0.001), elevated serum amylase (OR = 4.50, 95% CI = 1.77-11.43, p = 0.002) and Acute Physiology and Chronic Health Evaluation II (APACHE II) score (OR = 1.57, 95% CI = 0.49-2.64, p = 0.004) were significantly associated with an increased risk of AKI. However, hypertension (OR = 1.14, 95% CI = 0.60-2.16, p = 0.69) and diabetes (OR = 1.88, 95% CI = 0.51-6.95, p = 0.34) were not significantly associated with AKI risk. Based on funnel plots, no obvious publication bias was detected. A history of alcohol consumption, elevated serum amylase and APACHE II score are significant risk factors for AKI in patients with SAP. For early intervention, clinical physicians should be vigilant about the risk of AKI in patients with SAP with these factors. More high-quality studies are needed to validate these findings and explore other potential risk factors.

Root exudation of glyphosate in Eucalyptus urophylla S.T. Blake

Glyphosate stands out in the eucalyptus management, which makes it essential to know its behavior, its effects on the plant, and possible environmental impacts. This study aimed to identify and quantify the root exudation of glyphosate and aminomethylphosphonic acid (AMPA) by Eucalyptus urophylla with chromatographic and biological methods. The five glyphosate doses were tested (0, 360, 720, 1080 and 1440 g a.e ha−1) on E. urophylla plants. The physiological and intoxication evaluations were performed after herbicide application. Water samples remaining from the pots were used for chemical quantification of root exudation of glyphosate and AMPA in high-performance liquid chromatography. Cucurbita pepo plants were used as bioindicators of glyphosate in the water remaining in the pots after applying herbicide. The increase in glyphosate doses promoted linear growth in E. urophylla intoxication and significantly reduced total dry mass and root production. E. urophylla plants had their photosynthetic, transpiratory, and stomatal conductance rates reduced as the herbicide doses increased. The AMPA root exudation was not detected, but it was possible to identify the presence of glyphosate by bioassay and chemical methods. Root exudation of glyphosate by eucalyptus can result in lesser herbicide action in plant control and cause contamination of deeper soil layers.

Probiotic-based therapy as a new useful strategy for the treatment of patients with traumatic brain injury

BackgroundIn the new era, microbial-based medicine is one of the best strategies that try to modify the normal flora with the aim of treating some disorders. This systematic review and meta-analysis was performed to evaluate the use of probiotics in the treatment of the clinical outcomes in cases with traumatic brain injury..MethodsIn this regard, the search strategy was done using databases such as PubMed, Embase, Scopus, CENTRAL, and Google Scholar, from 2006 until April 2024. All studies about the efficacy of probiotic supplementation on the clinical outcomes in traumatic brain injury patients were retrieved. During the assessment process of the eligible studies, we evaluated clinical characteristics such as the Glasgow Coma Scale score, the Sequential Organ Failure Assessment score, the Acute Physiology and Chronic Health Evaluation II score, referral rate and hospitalization period in the intensive care unit, mortality rate, as well as opportunistic infections in both groups of case and control..ResultsIn this study, the authors analyzed data from 6 articles including 391 cases with traumatic brain injury. Our results showed that the probiotic therapy increases the Glasgow Coma Scale score in patients with the average age of more than 50 years. However, there was no a significant difference in the Sequential Organ Failure Assessment and the Acute Physiology and Chronic Health Evaluation scores between the group that had received probiotics and the control group. Although probiotic-based treatment did not significantly affect the intensive care unit admission (or length of stay), but, the risk of infection, and also mortality was significantly lower in the probiotic group (OR: 0.53; 95% CI: 0.3 to 0.8, as well as OR: 0.41; 95% CI: 0.2 to 0.7, respectively)..ConclusionsOverall, due to the modification of microbial flora, probiotic supplements can balance microflora disturbances, which in turn leads to improvement the clinical outcomes in patients with brain injury. Therefore, probiotic-based therapy can be considered as a promising strategy for the treatment of the central nervous system disorders. However, given the limited evidence, more clinical trial studies need to strengthen our results..

Assessment of sestrin 2 as a sepsis marker and predictor of disease severity

Introduction Sestrin 2 is considered a stress-inducible antioxidant protein. This study was aimed to evaluate sestrin 2 in subjects with sepsis, and its correlation with clinical severity and mortality. Methods Sepsis and control group patients were followed from admission to discharge. A blood sample was taken at admission for determination of serum sestrin 2 level. Results Of the total 42 patients with sepsis, there were 25 females and the mean age was 74.9 years. The sestrin 2 levels were significantly higher in the sepsis group. The optimum sestrin 2 cut-off point of ≥3.13 ng/mL had 95.2% sensitivity and 71.4% specificity for sepsis (p < .001). Sestrin 2 levels were higher in patients who needed renal replacement therapy (p = .018), patients who needed vasopressor therapy (p = .001) and patients with organ dysfunction (p = .002). The sestrin 2 level was significantly correlated with Acute Physiology and Chronic Health Evaluation (APACHE) II score, Nutrition Risk in the Critically Ill (NUTRIC) Score, C-reactive protein and albumin. Sestrin 2 levels were not associated with 30 d mortality in sepsis patients. Conclusions Sestrin 2 was significantly higher in the sepsis patients and associated with sepsis related adverse clinical outcomes. These results provided information concerning the clinical utility of sestrin 2.

Application of Sini Decoction at acupoint on gastrointestinal dysfunction in patients with sepsis: A clinical study.

The occurrence of gastrointestinal dysfunction is widely recognized as a prevalent complication in patients with sepsis. To investigate clinical effect of Sini Decoction at acupoint on gastrointestinal dysfunction in sepsis patients. Seventy-five patients with gastrointestinal dysfunction caused by sepsis were randomly divided into 2 groups. Treatment group received routine Western medicine treatment combined with Sini Decoction at acupoint, while control group treated with talcum powder at acupoint. Treatments in both groups lasted 7 days. Changes in the acute physiology and chronic health evaluation II score, sequential organ failure assessment score, mechanical ventilation duration, the length of Intensive Care Unit (ICU) stay, enteral nutrition tolerance scores, abdominal circumference, gastric residual volume, bowel sounds, and serum index were observed. After treatment, the enteral nutrition tolerance score, abdominal circumference, gastric residual volume, and levels of lactate and interleukin-6 were significantly lower in the treatment group compared to the control group. Bowel sounds were more active and motilin levels were higher in the treatment group. Additionally, the length of ICU stay was significantly shorter in the treatment group than in the control group. Our findings demonstrated that the application of Sini Decoction at acupoints in sepsis patients with gastrointestinal dysfunction can effectively enhance gastrointestinal function, leading to a reduction in ICU stay duration and an improvement in patients' prognosis.

Comparative Study Of BISAP Score With APACHE-II Scoring System To Determine The Severity Of Acute Pancreatitis

Introduction: Acute pancreatitis (AP) is a significant abdominal emergency characterized by inflammation of the pancreas, primarily due to autodigestion by pancreatic enzymes. Early severity assessment is crucial for management, as severe cases lead to complications and mortality. While various scoring systems exist, the Bedside Index for Severity in Acute Pancreatitis (BISAP) and APACHE-II (Acute Physiology and Chronic Health Evaluation) scores are commonly used, each with unique advantages and limitations in severity prediction. Objective: This study aims to compare the effectiveness of BISAP and APACHE-II scores in predicting acute pancreatitis severity, helping clinicians optimize treatment decisions. Methods: This observational study was conducted at SMS Hospital, Jaipur, involving 76 patients diagnosed with AP based on clinical, biochemical, and imaging criteria. Participants were assessed using both BISAP and APACHE-II scoring within 24 hours of admission, with a focus on accuracy in predicting severe cases and outcomes. Results: Among participants, the mean age was 43 years, and 84.2% were male. Gallstone disease was the leading cause of AP (55.2%), followed by alcohol (34.2%). BISAP scores ≥3 was associated with significantly higher mortality, highlighting BISAP’s predictive accuracy. The mean BISAP score was 1.86 ± 1.09, while the APACHE-II score was 6.97 ± 5.66, indicating more severe classifications using BISAP. The study found a moderate positive correlation between BISAP and APACHE-II scores, though only BISAP scores significantly predicted patient outcomes. Conclusion: BISAP offers a rapid and accurate assessment tool for AP severity, especially suitable for early intervention in high-risk patients. Compared to APACHE-II, BISAP is simpler, cost-effective, and demonstrates a high negative predictive value, making it more practical for acute settings.

Clinical Course and Outcomes of Brain Tumor Patients Admitted to Medical Intensive Care Unit: A Descriptive Analysis

Background: There is a shortage of data on brain tumor patients admitted in to intensive care unit (ICU) from developing countries. We aimed to assess the clinical course and 30-day mortality with factors affecting the mortality of brain tumor patients who were admitted to medical ICU.Methods: This study was a single-centre retrospective observational cohort study and was conducted in a medical ICU of a tertiary care center in India. We included 42 patients admitted in to the medical oncology ICU over 3 years. Data regarding demographics, baseline characteristics, clinical and laboratory data, need for organ support, and 30-day mortality were collected. Factors associated with increased mortality in these patients were determined.Results: Overall 30-day mortality was 30.95%. The most common indication for ICU admission was altered sensorium (57.1%) followed by sepsis (23.8%). Age [odds ratio, OR: 0.843 (95% confidence interval, CI: 0.721–0.986)], and need for invasive mechanical ventilator (IMV) support [OR: 484.62 (95% CI: 2.707–8676.02)] or vasopressor support [OR: 523.83 (95% CI: 2.12– 3,023.13)] were directly associated with 30-day mortality. Severity indices such as Sequential Organ Failure Assessment (SOFA) score, SAPS II (Simplified Acute Physiology Score II), and Acute physiology and chronic health evaluation II (APACHE II), APACHE III and APACHE IV scores were higher in non-survivors than survivors.Conclusion: Advancing age and need for IMV or vasopressor support may be associated with worse prognosis in brain tumor patients admitted in to ICU. A scoring system could be used along with clinical judgement to triage brain tumor patients for ICU admission.

Association of Serum Blood Urea Nitrogen to Albumin Ratio with in-Hospital Mortality in Patients with Acute Ischemic Stroke: A Retrospective Cohort Study of the eICU Database

Albumin (ALB) and blood urea nitrogen (BUN) are both associated with the prognosis of acute ischemic stroke (AIS). A recent prognostic marker, the BUN/ALB ratio (BAR), has been suggested as a simple and sensitive method to predict certain acute diseases. To determine the predictive value of BAR in relation to the risk of in-hospital mortality among AIS patients. Retrospective cohort study. Cox regression analysis was employed to assess the relationship between in-hospital mortality and BAR, with hazard ratios (HRs) and 95% confidence intervals. Subgroup analysis of acute pulmonary embolism, acute myocardial infarction (AMI), thrombolysis, thrombectomy, and septic shock was performed to further examine this relationship. The predictive value of BAR and BAR multivariate models for in-hospital mortality was evaluated and compared to BUN, ALB, the Acute Physiology and Chronic Health Evaluation IV (APACHE IV) score, and the Sequential Organ Failure Assessment Score (SOFA). Among the 1,635 eligible patients, 226 (13.81%) died during hospitalization. An elevated serum BAR level was associated with an increased in-hospital mortality risk (HR: 1.3) after covariates were adjusted. Additionally, this positive association was observed in patients without AP, AMI, thrombolysis, history of thrombectomy, or septic shock (all; p < 0.05). The efficacy of the BAR multivariate model in predicting in-hospital mortality among AIS patients was superior to that of both APACHE IV and SOFA, with an area under the curve of 0.87. Serum BAR exhibits the potential to identify AIS patients with high mortality risk, which may contribute to enhanced disease surveillance and risk stratification.

Delirium and Weakness Acquired in the Intensive Care Unit: Individual and Combined Effects on 90-Day Mortality in Survivors of Critical Illness.

To compare the individual and combined effects on 90-day mortality among four critically ill survivor groups: normal (without ICU-acquired delirium or ICU-acquired weakness), delirium-only (with ICU-acquired delirium only), weakness-only (with ICU-acquired weakness only) and delirium-weakness (combined ICU-acquired delirium and weakness). A prospective cohort study consecutively recruited delirium-free critically ill patients admitted to six medical ICUs at a university hospital. Delirium was assessed once daily for 14 days (or until death or ICU discharge) using the Confusion Assessment Method for the ICU. Participants who were discharged from the ICUs were assessed for weakness using the Medical Research Council scale. A summed score below 48 defines ICU-acquired weakness. These survivors were evaluated again for 90-day mortality. The study is reported using the STROBE checklist. Delirium developed in 107 (43.2%) participants during their first 14 days of ICU stay; 55 (22.2%) met criteria for weakness by ICU discharge. Participants with delirium were at increased risk for also developing ICU-acquired weakness, and the 90-day mortality was 18.2%. Independent of age and Acute Physiology and Chronic Health Evaluation II score at ICU admission, delirium-only and weakness-only were not associated with higher 90-day mortality, while participants in the delirium-weakness group had a 3.69-fold higher risk of death, compared to those who were normal during the ICU stay. A non-significant interaction was found, suggesting the joint effect of delirium and weakness on mortality is not higher than the sum of both effects individually. Mortality is substantially high among critically ill survivors who experience both delirium and weakness, although no additive effect on mortality was observed when these conditions occur together. Our findings highlight the urgent need to optimise ICU care by prioritising the prevention, early identification and management of these two common ICU-acquired conditions. Study participation and completion of all assessments. ClinicalTrials.gov identifier: NCT04206306.

Segmental post-PCI physiological gradients using ultrasonic or optical flow ratio

Abstract Background Segmental pressure gradients post percutaneous coronary intervention (PCI) may detect residual disease and potential targets for optimization. Ultrasonic flow ratio (UFR) or optical flow ratio (OFR) provide simultaneous physiological and morphological data using a single imaging catheter. Notably, both have been validated against wire based FFR Objectives To evaluate the utility of UFR and OFR to identify residual disease post-PCI. Methods The present study is a sub analysis of the ASET (Acetyl Salicylic Elimination Trial) JAPAN pilot study Phase I which showed the feasibility and safety of low dose prasugrel monotherapy following PCI in Japanese patients presenting with chronic coronary syndrome and an anatomical SYNTAX score &amp;lt;23. Patients with complete intra-vascular imaging pullback data were included with UFR/OFR acquired in all patients post-PCI. Quantitative and qualitative assessment of IVUS or OCT pullbacks was performed by automatically delineating vessel, lumen, and stent contours every 0.5 mm using QCU-CMS (version 4.69, Division of Image Processing, Leiden University Medical Centre). UFR or OFR was calculated using the respective IvusPlus or OctPlus software, Pulse Medical, Shanghai, China.(13)(15) All UFR and OFR tracings, and IVUS and OCT pullbacks were analyzed at the CORRIB Core lab, Galway, Ireland by two analysts blinded to clinical and procedural data. Anatomically focal lesions distal and proximal to the stent were evaluated in segments ≥5mm long. UFR/OFR virtual pullback curves were used to calculate intra-stent pressure gradients and physiologically define lesions as focal or diffuse by segmental pressure drops ≥0.05 over lengths &amp;lt;10mm or ≥10mm, respectively. Results The median post-PCI UFR/OFR was 0.93 (0.88-0.96) with 69/195 vessels (35.4%) having a UFR/OFR≤0.90. There were significantly more focal anatomical and physiological lesions proximal and distal to the stent in vessels with a UFR/OFR≤0.90 versus &amp;gt;0.90. In vessels with a UFR/OFR≤0.90 there was moderate agreement (weighted kappa=0.553, p&amp;lt;0.001) between anatomical and physiological focal lesions proximal to the stent, whilst it was fair (weighted kappa=0.219, p=0.002) distally. In-stent gradient had poor discriminative ability to detect significant stent under-expansion. The performance of a proximal or distal virtual FFR gradient to detect proximal or distal anatomically focal disease was good (AUC–0.835 and 0.877, respectively) Conclusions UFR/OFR enables suboptimal vessel physiology post-PCI to be detected and helps identify the precise anatomical location with corroboration from intra-vascular imaging. Adequately powered physiology optimization trials using UFR/OFR will determine the role of combined morphology and physiological evaluation post PCI in improving clinical outcomes.

Advancing prognostic insights in STEMI patients through microvascular resistance reserve evaluation

Abstract Background Coronary microvascular dysfunction (CMD) after ST-Elevation Myocardial Infarction (STEMI) is associated with persistent symptoms and poor outcomes. Microvascular Resistance Reserve (MRR) is an innovative metric for evaluating coronary microvasculature that is unaffected by epicardial stenoses or the hemodynamic impact of vasodilators. While MRR's prognostic ability is recognized in chronic coronary syndrome, its application in ACS remains unestablished. Purpose We sought to investigate the prognostic value of MRR in STEMI patients. Methods This is a prospective study of 210 STEMI patients with multivessel disease who had undergone successful primary percutaneous coronary intervention (PCI). At 3 months follow-up, they returned for complete revascularization and coronary physiology evaluations, including coronary flow reserve (CFR), fractional flow reserve (FFR), and index of microcirculatory resistance (IMR), using bolus thermodilution. MRR was calculated using the formula: MRR = (CFR/FFR) × (Pa rest/Pa hyper), where Pa rest and Pa hyper represent resting and hyperemic aortic pressure, respectively1. We utilized an MRR cutoff of 3.0 based on Boerhour et al. The association between MRR and major adverse cerebrocardiovascular events (MACCE) at 12-month follow-up, defined as the composite of stroke, revascularization, myocardial infarction (MI), heart failure hospitalization, and death, was investigated. Results The median age was 65 years, and 40.48% were female. At a 3-month follow-up, 27% (56 patients) exhibited MRR &amp;lt;3.0, who were predominantly female (62.50% vs 32.47%, p&amp;lt;0.001) with a higher incidence of diabetes (39.29% vs 18.83%, p = 0.004). No significant differences were observed in age, body mass index, or STEMI location (anterior or inferior) when comparing between MRR groups. The MACCE-free survival at 12 months was significantly lower in patients with an MRR &amp;lt; 3.0 (48.2%) compared to those with an MRR ≥ 3.0 (11.0%; log-rank p &amp;lt; 0.001, Fig1A). The MRR &amp;lt; 3.0 group showed higher rates of ischemic stroke (8.93% vs. 1.30%, p = 0.022) and hospitalization for heart failure (21.43% vs. 2.60%, p &amp;lt; 0.001), while the incidence of nonfatal myocardial infarction (MI) and cardiovascular death were similar between the two MRR groups (Figu1B). In multivariable Cox regression analysis, MRR was an independent predictor for 12-month MACCE (Hazard Ratio 0.45 per unit increase, 95% Confidence Interval 0.31-0.67, p&amp;lt;0.001). The areas under the receiver operating characteristic curves for predicting 12-month MACCE using FFR, CFR, IMR, and MRR yielded values of 0.609, 0.762, 0.781, and 0.743, respectively (Fig2). The prognostic performances of CFR, IMR, and MRR were similar and superior to that of FFR. Conclusion This study establishes the novel parameter MRR as a superior prognostic indicator in STEMI patients compared to FFR, and on par with CFR and IMR. MRR is a reliable predictor of MACCE, and various clinical incidents post-STEMI.

Comparative analysis of compartment-specific immunothrombotic biomarker profiles in bronchoalveolar lavage fluid and serum of patients with pneumonia-related acute respiratory distress syndrome: A preliminary cross-sectional study.

Immunothrombosis has emerged as a potential mechanistic link underlying the development and progression of acute respiratory distress syndrome (ARDS), but understanding its specific profile in patients, both locally and systemically, is limited. The objective of this study was to characterize and compare the immunothrombotic signatures in patients diagnosed with pneumonia-related ARDS (p-ARDS) at both the pulmonary and systemic levels and to evaluate their clinical relevance. The study included 23 consecutive patients diagnosed with p-ARDS admitted to the intensive care unit at a tertiary university hospital from July 2022 to May 2023, alongside 40 concurrently hospitalized patients with common pneumonia as controls. Paired bronchoalveolar lavage fluid (BALF) and serum samples were collected from the participants for the analysis of 15 biomarkers to assess and quantify the pulmonary and systemic immunothrombotic signatures. The study results revealed significant pulmonary inflammation and systemic endothelial injury in p-ARDS patients compared to pneumonia controls. These observations were maintained after adjustment for severity of illness (Acute Physiology and Chronic Health Evaluation II scores). In terms of clinical relevance, inflammatory biomarkers (interleukin [IL]-6, IL-8) in BALF were found to correlate with PaO2/FiO2 ratio, while serum levels of a disintegrin and metalloproteinase with thrombospondin type 1 motif 13 (ADAMTS-13) and thrombomodulin showed associations with Sequential Organ Failure Assessment and Disseminated Intravascular Coagulation scores. In conclusion, this preliminary investigation identified compartment-specific variations in the immunothrombotic signature between patients with p-ARDS and those with pneumonia alone, with inflammatory responses predominantly localized in the alveolar compartments and coagulation/endothelial injury biomarkers more pronounced in peripheral blood.

Impact of nutrition-related laboratory tests on mortality of patients who are critically ill using artificial intelligence: A focus on trace elements, vitamins, and cholesterol.

This study aimed to understand the collective impact of trace elements, vitamins, cholesterol, and prealbumin on patient outcomes in the intensive care unit (ICU) using an advanced artificial intelligence (AI) model for mortality prediction. Data from ICU patients (December 2016 to December 2021), including serum levels of trace elements, vitamins, cholesterol, and prealbumin, were retrospectively analyzed using AI models. Models employed included category boosting (CatBoost), extreme gradient boosting (XGBoost), light gradient boosting machine (LGBM), and multilayer perceptron (MLP). Performance was evaluated using area under the receiver operating characteristic curve (AUROC), accuracy, precision, recall, and F1-score. The performance was evaluated using 10-fold crossvalidation. The SHapley Additive exPlanations (SHAP) method provided interpretability. CatBoost emerged as the top-performing individual AI model with an AUROC of 0.756, closely followed by LGBM, MLP, and XGBoost. Furthermore, the ensemble model combining these four models achieved the highest AUROC of 0.776 and more balanced metrics, outperforming all models. SHAP analysis indicated significant influences of prealbumin, Acute Physiology and Chronic Health Evaluation II score, and age on predictions. Notably, the ratios of selenium to age and low-density lipoprotein to total cholesterol also had a notable impact on the models' output. The study underscores the critical role of nutrition-related parameters in ICU patient outcomes. Advanced AI models, particularly in an ensemble approach, demonstrated improved predictive accuracy. SHAP analysis offered insights into specific factors influencing patient survival, highlighting the need for broader consideration of these biomarkers in critical care management.

Bovine bone meal combined with dephenolized cottonseed protein is an effective fishmeal substitution in Trachinotus ovatus feed: A comprehensive evaluation of growth, muscle quality, and intestinal digestion physiology

To investigate the feasibility of substituting fishmeal (FM) with a combination of bovine bone meal (BBM) and dephenolized cottonseed protein (DCSP), a mixture (consisting of 60 % BBM and 40 % DCSP) was used to replace varying FM levels in Golden pompano (Trachinotus ovatus) feed. Five isoproteic (47 %) and isolipidic (12 %) experimental diets were formulated, with FM levels set at 30 %, 24 %, 18 %, 12 %, and 6 % (namely Control, FM24, FM18, FM12, and FM6). To compensate for the reduced FM content, BBM and DCSP were used as substitutes, and DL-methionine and L-lysine were added to maintain the dietary amino acid balance. Following a 63-day trial, results showed that the growth of FM24, FM18 and FM12 groups did not exhibit significant differences compared to the Control group, while those of FM6 group considerably decreased. The biochemical composition of whole fish did not display significant differences among the five groups, while the muscle protein contents of the FM12 group were higher than the Control group. Most of the muscle texture properties were positively modified in the FM 12 and FM 6 groups. With the substitution ratio increase, the contents of serum total protein, albumin, total amino acids, and cholecystokinin were elevated, while serum peptide YY contents decreased. In addition, intestinal trypsin, NaK-ATPase, and alkaline phosphatase activities in FM18, FM12, and FM6 groups decreased, and lipase activities exhibited the opposite trend. The transcription levels of genes related to amino acid-sensing receptors (asct2 and snat2) were down-regulated with increasing dietary FM substitutions, while the expression levels of appetite regulation factors (pept1, cck, and ghrl) were up-regulated. In conclusion, the FM content in the diet of T. ovatus can be reduced to 12 % through the utilization of a combination of BBM and DCSP, with no adverse effects observed on growth performance, biochemical composition, or muscle texture.

Development and validation of a risk prediction model for feeding intolerance in neurocritical patients with enteral nutrition.

This study collects and analyzes clinical data on enteral nutrition therapy in neurocritical patients, develops and validates a feeding intolerance (FI) risk prediction model, and provides a theoretical basis for screening patients with high risk of feeding intolerance (FI) and delivering personalized care. A convenience sampling method was employed to select 300 patients who were admitted to a tertiary hospital in China for early enteral nutrition therapy in the neurointensive care unit between April 2022 and December 2022. Independent risk factors for FI were identified using univariate and logistic regression analyses. A prediction model was established, and the goodness of fit and discriminant validity of the model were evaluated. The incidence of FI in neurocritical patients receiving enteral nutrition was 71%. Logistic regression analysis identified age, Glasgow Coma Scale (GCS) scores, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, mechanical ventilation, feeding via the nasogastric tube route, hyperglycemia, and low serum albumin as independent risk factors for the development of FI (p < 0.05). The predictive formula for FI risk was established as follows: Logit p = -14.737 + 1.184 × mechanical ventilation +2.309 × feeding route +1.650 × age + 1.336 × GCS tertile (6-8 points) + 1.696 × GCS tertile (3-5 points) + 1.753 × APACHE II score + 1.683 × blood glucose value +1.954 × serum albumin concentration. The Hosmer-Lemeshow test showed χ2 = 9.622, p = 0.293, and the area under the ROC curve was 0.941 (95% confidence interval: 0.912-0.970, p < 0.001). The optimal critical value was 0.767, with a sensitivity of 85.9%, a specificity of 90.8%, and a Youden index of 0.715. The early enteral nutrition FI risk prediction model developed in this study demonstrated good predictive ability. This model can serve as a valuable reference for effectively assessing the risk of FI in neurocritical patients, thereby enhancing clinical outcomes.

The clinical value of serum creatinine to bilirubin ratio in predicting the severity and prognosis of acute pancreatitis.

Bilirubin (BIL) and creatinine (Cr) have been used as potential early predictors of the severity of many diseases. A recent study found that the Cr to BIL ratio (CTR) was more sensitive and specific than either serum Cr or BIL alone. Our research focused on the clinical significance of CTR in evaluating the severity and prognosticating outcomes of acute pancreatitis (AP) in patients. Patients diagnosed with AP at the First Affiliated Hospital of Guangdong Pharmaceutical University between July 1, 2016, and December 31, 2020 were included. The analysis then focused on examining the relationship between CTR levels and the severity of the illness, the occurrence of complications, and the prognosticating outcomes for individuals diagnosed with AP. A total of 286 AP patients were enrolled. Multivariate regression analyses showed that patients with AP with increased CTR levels had a poorer disease (easier to develop severe AP); higher Ranson, and Acute Physiology and Chronic Health Evaluation (APACHE-II) scores; higher incidence of organ failure (acute heart failure, acute kidney injury and acute myocardial infarction ); and leading to a worse prognosis characterized more by frequent use of vasoactive and diuretic agents. When CTR &gt;14.05, AP patients had increased occurrence of AHF and AKI, higher 30-day all-cause mortality rates, more frequently using vasoactive agent and diuretic agent. Besides, the disease severity scores and hospital stays were markedly increased. Patients with AP who exhibit higher CTR levels tend to experience escalating disease severity, more complications, and a poorer outcome compared with those with lower CTR levels.

Rehabilitation for Patients with COVID-19-Associated Acute Respiratory Distress Syndrome During Quarantine: A Single-Center Experience.

Background and Objectives: In this study, we evaluated clinical factors associated with implementing a rehabilitation program for patients with COVID-19-associated acute respiratory distress syndrome (ARDS) requiring mechanical ventilation (MV) during the quarantine period. Materials and Methods: This observational study was conducted in the National Designated Isolated ICU, a dedicated COVID-19 center with 18 beds, from 30 December 2020 to 30 May 2022. One hundred and fifty-four patients (mean age: 67.3 ± 13.4 years; male: 59.7%) were enrolled. The ICU rehabilitation program included early mobilization, chest physiotherapy, and dysphagia treatment. Results: Forty-five patients (29.3%) participated in the rehabilitation program. Multivariate logistic regression identified three significant factors: tracheostomy (odds ratio [OR], 2.796; 95% confidence interval [CI], 1.238-6.316; p = 0.013), body mass index ≥ 25.0 kg/m2 (OR, 2.724; 95% CI, 1.276-5.817; p = 0.010), and extracorporeal membrane oxygenation (OR, 2.931; 95% CI, 1.165-7.377; p = 0.022); patients with all three factors were younger (median 44 vs. 70 years, p < 0.001) and had significantly lower Acute Physiology and Chronic Health Evaluation II scores (median 12 vs. 16, p = 0.002) on the MV day. One-year cumulative mortality rates for patients with 0 to 3 factors were 66.7%, 50.8%, 38.9%, and 15.4%, respectively, with a significant difference among them (log-rank, p < 0.001). Conclusions: Three clinical factors associated with implementing a rehabilitation program during the quarantine period for COVID-19-associated ARDS patients were identified. The program was feasible and beneficial, particularly for younger patients with lower illness severity and fewer comorbidities on the day of MV.

The effectiveness of liver function tests in the prediction of mortality in patients with COVID-19

Objective: To evaluate the impact of liver function test abnormalities on mortality in critically ill coronavirus disease-2019 patients. Method: The single-centre, retrospective study was conducted at the Department of Anaesthesiology and Reanimation, Mersin City Training and Research Hospital, Turkiye, and comprised data from March 2020 to January 2022 of patients with positive real-time reverse transcription polymerase chain reaction test on nasopharyngeal swab sample for coronavirus disease-2019. Comorbidities, demographic data, admission to and discharge from the intensive care unit, Acute Physiology and Chronic Health Evaluation II scores, complete blood count on the first and second day of hospitalisation, coagulation parameters, biochemical analysis, 7-day, 28-day and total mortality of the patients in the intensive care unit were recorded. The patients were then divided into groups, with Group 1 having patients with normal liver enzymes, Group 2 having patients with abnormal liver enzymes, and Group 3 having patients with liver damage. Data was analysed using SPSS 20. Results: Of the 940 subjects, 587(62.4) were males and 353(37.6) were females. The overall mean age of the patients was 67.11±16.65 years. There were 395(42%) patients in Group 1, 534(56.8%) in Group 2 and 11(1.2%) in Group 3. Gamma-glutamyl transferase-1s, aspartate aminotransferase-2nd and albumin-2nd were significant predictors of mortality (p&lt;0.05). Conclusion: High gamma-glutamyl transferase, aspartate aminotransferase and low albumin levels in critically ill coronavirus disease-2019 patients could be considered indicators of high mortality rate. Key Words: Coronavirus, Critical illness, Liver function test, Pandemic.

Prognostic Value of Admission Lactate Levels in Critically Ill Patients: A Comparative Study With Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II Scores

Prognostic Value of Admission Lactate Levels in Critically Ill Patients: A Comparative Study With Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II Scores

Predictive value of the CURB-65, qSOFA, and APACHE II for in-hospital mortality in patients with acute exacerbation chronic obstructive pulmonary disease.

This study aimed to evaluate the efficacy of Quick Sequential Organ Failure Assessment, Confusion, Urea, Respiratory Rate, Blood Pressure, and Age Above or Below 65 Years (CURB-65), and Acute Physiology and Chronic Health Evaluation (APACHE) II in predicting the in-hospital mortality of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This retrospective study was conducted on 1583 hospitalized patients diagnosed with AECOPD from 2017 to 2019. Appropriate clinical data were retrieved from medical records from the time of admission up until the patients were discharged. The patients' most severe physiological condition and laboratory data within the first 24 hours of admission were used to determine CURB-65, Quick Sequential Organ Failure Assessment, and APACHE II scores. The accuracy of these 3 instruments in predicting the in-hospital mortality of patients with AECOPD was compared. It was observed that patients who had died had significantly higher APACHE II and CURB-65 scores (P < .05). Binary logistic regression analysis confirmed their significant association with mortality. The APACHE II score had a sensitivity of 91.6% and a specificity of 89.2%, while CURB-65 had a sensitivity of 94% and a specificity of 67.2%. The receiver operating characteristic curves for APACHE II and CURB-65 showed high predictive accuracy (area under the curve, 0.965 and 0.882, P < .001), respectively. Mortality rates substantially increased with higher scores (P < .001), reaching 38.2% for APACHE II scores ≥16 and 15.8% for CURB-65 scores ≥2. Our findings reveal a clear link between higher mortality rates and higher APACHE II and CURB-65 scores. The receiver operating characteristic curves' strong predictive ability highlights the dependability of these scoring systems in assessing the risk of in-hospital mortality, making them useful tools for predicting the outcomes in critical care.