Prognostic value of C-reactive protein/albumin ratio in neurocritically ill patients

BACKGROUND

The C-reactive protein (CRP)/albumin ratio has been regarded as an outcome predictor in patients with cancer and sepsis. In this study, we evaluated the prognostic value of the CRP/albumin ratio in neurocritically ill patients.

METHODS

We retrospectively reviewed consecutive patients admitted to the neurocritical care unit (NCU) of a university-affiliated hospital, between January 2013 and January 2017. The CRP/albumin ratio was calculated by dividing the CRP level by the albumin concentration that was obtained at NCU admission. Univariable and multivariable logistic regression were used to identify risk factors for 30-day unfavorable outcome (modified Rankin Scale of 4 to 6). The performance of the CRP/albumin ratio was further assessed by receiver operating characteristic (ROC) curve analysis.

RESULTS

Of the 701 patients included, 398 (56.8%) had unfavorable outcome at 30 days. The median (interquartile range) value of the CRP/albumin ratio was noticeably higher in the unfavorable outcome group (0.9 [0.2-2.5]) than that in the favorable group (0.3 [0.1-1.2]). After adjustment for established prognostic markers of outcome, the CRP/albumin ratio (OR 1.205; 95% CI: 1.082-1.344) remained significant in predicting 30-day unfavorable outcome, with an area under the ROC curve of 0.644 and a cutoff value of 0.58. Further exploration showed that the prognostic value of the CRP/albumin ratio existed mainly in patients suffering septic shock (OR 1.616; 95% CI: 1.167-2.236), with an area under the ROC curve of 0.672 and a cutoff value of 1.75.

CONCLUSIONS

A high CRP/albumin ratio at NCU admission was an independent predictor of 30-day unfavorable outcome in neurocritically ill patients, especially in those suffering septic shock.

Exploratory analysis of oral glibenclamide in acute ischemic stroke

OBJECTIVES

Intravenous glibenclamide (GBC) exerts neuroprotection in both preclinical and preliminary clinical studies. This study explored the safety and potential efficacy of oral GBC in patients with acute hemispheric infarction.

MATERIALS & METHODS

During January 2017 and August 2017, adult volunteers were recruited to receive oral GBC treatment, if they presented with an acute anterior ischemic stroke and a National Institute of Health Stroke Score of ≥8. Controls were those who met the above inclusion criteria and had not been on GBC or other sulfonylureas prior to stroke or after hospitalization. Propensity score matching (PSM) was performed to balance baseline characteristics. The primary endpoint was the score on the modified Rankin Scale (mRS) at 6 months.

RESULTS

We included 213 patients in the unmatched cohort (20 in the GBC group and 193 in the control group) and 40 patients (20 in each group) in the matched cohort. In both cohorts, GBC treatment did not increase the risks of early death, hypoglycemia, and early neurological deterioration. Although GBC did not substantially improve 6-month functional outcome that measured in shift analysis of mRS, a slight trend toward less severe disability and death (mRS 5-6) was observed. In the matched cohort, GBC treatment was associated with lighter brain edema, when CED score was used for evaluation.

CONCLUSIONS

In this study, oral GBC is safe in treating acute hemispheric infarction and might have potential in preventing brain edema and consequential severe disability and death. An adequately powered and randomized trial is warranted.

[Efficacy and safety of active transfer of plaque versus provisional stenting with drug-eluting stents for the treatment of coronary bifurcation lesions]

Objective: To compare the efficacy and safety of active transfer of plaque (ATP) versus provisional stenting (PS) with drug-eluting stents (DES) for the treatment of coronary bifurcation lesions. Methods: A total of 1 136 patients with bifurcation lesions hospitalized in 6 selected hospitals between January 2010 and January 2014 were included in this prospective observational trial, patients were divided into either ATP (n=560) or PS group (n=576) accordingly. The primary endpoint was target lesion revascularization within 1 year, and the second endpoints were all-cause death, cardiogenic death, myocardial infarction, stent thrombosis, stroke, recurrent angina within 1 year. Results: There were no significant differences in age, sex, hypertension, diabetes, hyperlipidemia and smoking history between the two groups (P>0.05). The incidence of TIMI blood flow <3 grade in the side branch (1.6%(9/560) vs. 7.5% (43/576), P<0.01), acute occlusion of the side branch (1.3%(7/560) vs. 7.1%(41/576), P<0.01) and implanted stents of side branch (1.8%(10/560) vs. 7.8% (45/576), P<0.01) were significantly lower in the ATP group than those in the PS group. During the one year follow up, the rate of target lesion revascularization was similar between ATP group and PS group (4.6%(26/560) vs. 4.0%(23/576), P=0.66). Conclusions: The effectiveness and safetyof ATP techniquein the patients with coronary bifurcation lesions is comparable to the PS technique. However, ATP technique is superior to PS technique on effectively reducing the incidence of implanted stents in the side branch.

Beam Energy and Centrality Dependence of Direct-Photon Emission from Ultrarelativistic Heavy-Ion Collisions

The PHENIX collaboration presents first measurements of low-momentum (0.4<p_{T}<3  GeV/c) direct-photon yields from Au+Au collisions at sqrt[s_{NN}]=39 and 62.4 GeV. For both beam energies the direct-photon yields are substantially enhanced with respect to expectations from prompt processes, similar to the yields observed in Au+Au collisions at sqrt[s_{NN}]=200. Analyzing the photon yield as a function of the experimental observable dN_{ch}/dη reveals that the low-momentum (>1  GeV/c) direct-photon yield dN_{γ}^{dir}/dη is a smooth function of dN_{ch}/dη and can be well described as proportional to (dN_{ch}/dη)^{α} with α≈1.25. This scaling behavior holds for a wide range of beam energies at the Relativistic Heavy Ion Collider and the Large Hadron Collider, for centrality selected samples, as well as for different A+A collision systems. At a given beam energy, the scaling also holds for high p_{T} (>5  GeV/c), but when results from different collision energies are compared, an additional sqrt[s_{NN}]-dependent multiplicative factor is needed to describe the integrated-direct-photon yield.

Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS))-Part A

Abstract

In 2014, the International Endohernia Society (IEHS) published the first international “Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias.” Guidelines reflect the currently best available evidence in diagnostics and therapy and give recommendations to help surgeons to standardize their techniques and to improve their results. However, science is a dynamic field which is continuously developing. Therefore, guidelines require regular updates to keep pace with the evolving literature.

Methods

For the development of the original guidelines, all relevant literature published up to year 2012 was analyzed using the ranking of the Oxford Centre for Evidence-Based Medicine. For the present update, all of the previous authors were asked to evaluate the literature published during the recent years from 2012 to 2017 and revise their statements and recommendations given in the initial guidelines accordingly. In two Consensus Conferences (October 2017 Beijing, March 2018 Cologne), the updates were presented, discussed, and confirmed. To avoid redundancy, only new statements or recommendations are included in this paper. Therefore, for full understanding both of the guidelines, the original and the current, must be read. In addition, the new developments in repair of abdominal wall hernias like surgical techniques within the abdominal wall, release operations (transversus muscle release, component separation), Botox application, and robot-assisted repair methods were included.

Results

Due to an increase of the number of patients and further development of surgical techniques, repair of primary and secondary abdominal wall hernias attracts increasing interests of many surgeons. Whereas up to three decades ago hernia-related publications did not exceed 20 per year, currently this number is about 10-fold higher. Recent years are characterized by the advent of new techniques—minimal invasive techniques using robotics and laparoscopy, totally extraperitoneal repairs, novel myofascial release techniques for optimal closure of large defects, and Botox for relaxing the abdominal wall. Furthermore, a concomitant rectus diastasis was recognized as a significant risk factor for recurrence. Despite insufficient evidence with respect to these new techniques, it seemed to us necessary to include them in the update to stimulate surgeons to do research in these fields.

Conclusion

Guidelines are recommendations based on best available evidence intended to help the surgeon to improve the quality of his daily work. However, science is a continuously evolving process, and as such guidelines should be updated about every 3 years. For a comprehensive reference, however, it is suggested to read both the initial guidelines published in 2014 together with the update. Moreover, the presented update includes also techniques which were not known 3 years before.

[An analysis of assessment results of prevention and control of occupational hazards in a city]

Objective: To investigate the current status of prevention and control of occupational hazards in a city in 2017, to understand the capability to prevent and control occupational hazards and the level of occupational health supervision and management, and to propose measures to urge employers to assume the main responsibility for the prevention and control of occupational diseases. Methods: An analysis of the main factors influencing the prevention and control of occupational hazards in the city was performed to screen out six semi-quantitative assessment indicators (including the training of the main responsible persons and occupational health management personnel in companies) and four qualitative assessment indicators (including the coverage of supervision and inspection of occupational hazards performed by the district safety supervision department) , which could be used to measure the prevention and control effects of regional occupational hazards. Each indicator was scored. The typical investigation method was used to do data review and on-site inspection of 170 companies, 17 district-level occupational health supervision departments, and 16 sub-district (township) occupational health supervision departments in the city from October to December, 2017. The prevention and control of occupational diseases in each district was scored, and the completion rate and completion situation of each indicator in the city were analyzed. Results: The mean score of prevention and control of occupational hazards in the city was 84.9. The scores of two districts were relatively high, being 88.9 and 88.7, respectively; the scores of 9 (52.9%) districts were higher than 85. The pass rate of training for the main responsible persons and occupational health management personnel in companies in the city was 95.9%, the pass rate of occupational health training for workers was 84.7%, the pass rate of occupational health examination for workers was 96.5%, the pass rate for the inspection of occupational hazardous factors in workplaces was 95.3%, the pass rate for notifying occupational hazards in workplaces is 95.9%, and the pass rate for applying the warning signs of occupational hazards in workplaces was 76.5%. Conclusion: The awareness of the importance of prevention and control of occupational hazards in all districts of the city has been increased, but the effectiveness of occupational health training for workers needs to be strengthened. The supply and demand of occupational health technical services are still not matched, and the ways and methods of occupational health supervision and inspection need to be improved.

A Non-Invasive Continuous Blood Pressure Estimation Approach Based on Machine Learning

Considering the existing issues of traditional blood pressure (BP) measurement methods and non-invasive continuous BP measurement techniques, this study aims to establish the systolic BP and diastolic BP estimation models based on machine learning using pulse transit time and characteristics of pulse waveform. In the process of model construction, the mean impact value method was introduced to investigate the impact of each feature on the models and the genetic algorithm was introduced to implement parameter optimization. The experimental results showed that the proposed models could effectively describe the nonlinear relationship between the features and BP and had higher accuracy than the traditional methods with the error of 3.27 ± 5.52 mmHg for systolic BP and 1.16 ± 1.97 mmHg for diastolic BP. Moreover, the estimation errors met the requirements of the Advancement of Medical Instrumentation and British Hypertension Society criteria. In conclusion, this study was helpful in promoting the practical application of methods for non-invasive continuous BP estimation models.

[Comparison of preoperative planning of radioactive seed implantation for pelvic wall recurrent gynecological malignant tumors between 3D-printing non-coplanar template and 3D-printing coplanar template]

Objective: To compare the difference of preoperative planning parameters between 3D-printing non-coplanar template (3D-PNCT) and 3D-printing coplanar template (3D-PCT) in the treatment of pelvic wall recurrent gynecological malignant tumor with radioactive seeds implantation, and to guide the clinical application. Methods: From January 2016 to March 2018, 33 patients with pelvic wall recurrent gynecological malignant tumor were treated with radioactive seeds implantation assisted by 3D-printing template and in Peking University Third Hospital. All patients underwent 3D-PNCT and 3D-PCT preoperative planning. The D(90) of target remained similar for the same patient. The parameters were compared with Wilcoxon test or Kruskal-Wallis test. Results: D(90) was similar between the two groups (P>0.05). The number of inserting needles through intestine and bone in 3D-PNCT group was less than that in 3D-PCT group (0 (0-13), 0 (0-25), Z=-2.941, P<0.05;0 (0-3), 0 (0-25), Z=-2.232, P<0.05). Conclusion: For patients with gynecological malignancies with pelvic recurrence, both of the two peroperative plans could achieve prescription dose, but 3D-PNCT is more safer.

Pulsed Microwave-Pumped Drug-Free Thermoacoustic Therapy by Highly Biocompatible and Safe Metabolic Polyarginine Probes

Serious side effects are plaguing traditional chemotherapy, and the development of drug-free treatment is expected to ease the dilemma. Herein, drug-free polyarginine probes are fabricated from the co-polymerization of arginine monomer and slight amount of rhodamine B monomer, which are efficient for thermoacoustic imaging and therapy with high biocompatibility and safe metabolism. Polyarginine can be strongly pumped upon pulsed microwave irradiation, generating significant thermoacoustic shockwaves, namely thermocavitation, which can in situ destroy mitochondria to initiate programmed cancer cell apoptosis. In vivo explorations demonstrate the high theranostic efficiency for cancer thermoacoustic imaging and cancer inhibition, exhibiting low systemic cytotoxicity and good biocompatibility after systemic administration. Herein, pulsed microwave-pumped biocompatible polyarginine is promising for drug-free precision theranostics without any detectable side effects, and the deep penetration potency of microwave makes it potentially able to treat deep-seated diseases in future biomedicine.

[Processing of impedance cardiogram differential for non-invasive cardiac function detection]

The precise recognition of feature points of impedance cardiogram (ICG) is the precondition of calculating hemodynamic parameters based on thoracic bioimpedance. To improve the accuracy of detecting feature points of ICG signals, a new method was proposed to de-noise ICG signal based on the adaptive ensemble empirical mode decomposition and wavelet threshold firstly, and then on the basis of adaptive ensemble empirical mode decomposition, we combined difference and adaptive segmentation to detect the feature points, A, B, C and X, in ICG signal. We selected randomly 30 ICG signals in different forms from diverse cardiac patients to examine the accuracy of the proposed approach and the accuracy rate of the proposed algorithm is 99.72%. The improved accuracy rate of feature detection can help to get more accurate cardiac hemodynamic parameters on the basis of thoracic bioimpedance.

Explosible nanocapsules excited by pulsed microwaves for efficient thermoacoustic-chemo combination therapy

Microwave irradiation is a powerful non-invasive approach for treating deep-seated diseases in a clinical setting. Pulsed microwave-induced thermoacoustic cavitation allows precise cancer treatment with microwave-absorbing materials. This differs from the traditional continuous microwave-induced thermotherapy which may be harmful to off-target tissues. Here we first report the integration of thermocavitation and cytoplasmic drug release into highly explosible cell-penetrating nanocapsules for effective tumor inhibition under pulsed microwave irradiation. The nanocapsules were formulated from arginine-tethered reduction-responsive copolymers, P(ArgMA-co-DMA)-b-PPOPMA, microwave-absorbing AB and chemotherapeutic DOX using a double-emulsion method. The nanocapsules were internalized by cancer cells rapidly via major energy-independent pathways. Upon pulsed microwave irradiation, AB absorbed energy to generate a giant thermoacoustic shockwave, simultaneously decomposing into carbon dioxide and ammonia which enforced the cavitation damage effect. The thermoacoustic shockwave and gas burst also mechanically disrupted the intracellular organelles resulting in high-ratio cell necrosis and promoted the cytosolic release of DOX into the nucleus to initiate cell death. Importantly, in vivo results demonstrated significantly suppressed tumor growth by the pulsed microwave-triggered thermocavitation and drug release, and minimal systemic toxicity from the microwave treatment. Therefore, our study provides a new strategy for effectively engineering pulsed microwave-responsive nanomaterials for smart cancer therapy.

Outcome Prediction by 40-Hz Steady-State Response After Large Hemispheric Infarction

Background and Purpose: The 40-Hz steady state response (SSR) reflects early sensory processing and has the potential to differentiate disease severity. This study aims to evaluate the predictive value of 40-Hz SSRs on the prognosis of patients with large hemispheric infarction (LHI).

Methods: We conducted a retrospective study in patients with LHI admitted to the neurological intensive care unit (NICU) of Nanfang Hospital, Southern Medical University, Guangzhou, China, between June 2008 and December 2014. Forty-hertz SSRs were recorded within 72 h of onset and categorized into 3 grades. The correlation between 40-Hz SSR grading and clinical outcome was examined.

Results: Of the 97 eligible participants, 41 (42.3%) died within 30 days and 68 (70.1%) exhibited a poor outcome (modified Rankin Scale of 5 and 6) at 90 days after the onset of LHI. We found that 40-Hz SSRs correlated significantly with NIHSS scores at admission and patient outcome. Moreover, Grade III 40-Hz SSR (bilateral sine waves that either disappeared or were not clearly identifiable) had a specificity of 97% and a positive predictive value of 94% in predicting 90-days poor outcome; Grade III 40-Hz SSR also had a specificity of 91% and a positive predictive value of 74% in predicting 30-days mortality.

Conclusions: 40-Hz SSR could be used as a simple and specific method in predicting poor prognosis after LHI.

Nonlinear Thermoacoustic Imaging Based on Temperature-Dependent Thermoelastic Response

In this paper, a novel nonlinear thermoacoustic imaging (NTAI) system is developed based on the temperature-dependent thermoelastic response under microwave irradiation. Specifically, we consider the high-pulse repetition frequency (HPRF) microwave regime, where the tissue temperature increases after microwave irradiation. In this circumstance, the temperature-dependent thermodynamic parameters of the tissue change; thus, the influence of absorbed microwave energy on the thermoacoustic (TA) amplitude is reflected in the change of thermodynamic parameters. Hence, this temperature dependence yields a nonlinear relationship between the TA amplitude and the absorbed microwave energy in the HPRF regime. In this paper, we obtain the nonlinear coefficient as a new parameter to distinguish biological tissues by performing differential measurements in the NTAI system. We further experimentally extract the nonlinear coefficient in phantom and ex vivo mouse, revealing the feasibility of applications in biological tissues identification with high contrast.

[CT-guidance interstitial Iodine-125 seed brachytherapy as a salvage therapy for recurrent head and neck carcinoma]

Objective: To investigate the efficacy of CT-guidance interstitial Iodine-125 seed brachytherapy as a salvage therapy for recurrent head and neck carcinoma. Methods: A total of 122 patients who had been treated for recurrent head and neck carcinoma with CT-guided Iodine-125 seed permanent implantation were conducted a retrospective analysis at Peking University Third Hospital from February 2003 to December 2015. The study included 78 male and 44 female patients. Of the 122 patients, 76 had undergone radical surgery, 106 had received EBRT. Among the patients who underwent EBRT, the total dose delivered to PTV ranged from 30 to 140 Gy (median, 68.4 Gy). The actuarial median number of the implanted Iodine-125 seeds was 38 (range, 5-158). The specific activity of Iodine-125 seeds ranged from 14.8 to 28.9 MBq/seed (median, 22.2 MBq). The evaluation of post plan showed the actuarial D90 ranged from 46 to 282 Gy (median, 121 Gy). The overall local control and survival times were determined by using the Kaplan-Meier method from SPSS 13.0.Univariate analysis was performed on the local control rate and overall survival rate. Results: Tumor responses rate was 75.4%. The median local control time was 10.0 months (95% CI 9.8-24.2 months), and the 1-, 2-, 3-, and 5-year local control were 41.9%, 21.2%, 3.7%, and 3.7%, respectively. Univariate analysis showed that the local control in D90≥120 Gy group had an increasing tendency, but no statistical difference were found. The effect of local control in the squamous cell carcinoma group was slightly worse than that in the non-squamous cell carcinoma group (P=0.032). Multi-factor analysis showed that the effect of local control in the squamous cell carcinoma group was slightly poor (P=0.03). The median survival time was 14 months (95% CI 14.4-35.8 months), and the 1-, 2-, 3- and 5-year survival rate were 51.5%, 34.2%, 19.4%, and 19.4%, respectively. The three factors, such as the tumor responses, KPS status before the seed implantation, and the D90 after the seed implantation, had a tendency to improve the total survival, but there was still no statistical differences. Multivariate analysis showed no clear influence factors. Conclusions: Interstitial permanent Iodine-125 seed implantation is an effective salvage re-irradiation modality for recurrent head and neck carcinoma after previous surgery and/or EBRT. CT image-guided method could yield the reliable seeds configuration and accurate dose distribution.

Pseudorapidity Dependence of Particle Production and Elliptic Flow in Asymmetric Nuclear Collisions of p+Al, p+Au, d+Au, and ^{3}He+Au at sqrt[s_{NN}]=200 GeV

Asymmetric nuclear collisions of p+Al, p+Au, d+Au, and ^{3}He+Au at sqrt[s_{NN}]=200  GeV provide an excellent laboratory for understanding particle production, as well as exploring interactions among these particles after their initial creation in the collision. We present measurements of charged hadron production dN_{ch}/dη in all such collision systems over a broad pseudorapidity range and as a function of collision multiplicity. A simple wounded quark model is remarkably successful at describing the full data set. We also measure the elliptic flow v_{2} over a similarly broad pseudorapidity range. These measurements provide key constraints on models of particle emission and their translation into flow.

In vivo noninvasive blood glucose detection using near-infrared spectrum based on the PSO-2ANN model

BACKGROUND:

To improving the nursing level of diabetics, it is necessary to develop noninvasive blood glucose method.

OBJECTIVE:

In order to reduce the number of the near-infrared signal, consider the nonlinear relationship between the blood glucose concentration and near-infrared signal, and correct the individual difference and physiological glucose dynamic, 2 artificial neural networks (2ANN) combined with particle swarm optimization (PSO), named as PSO-2ANN, is proposed.

METHOD:

Two artificial neural networks (ANNs) are employed as the basic structure of the PSO-ANN model, and the weight coefficients of the two ANNs which represent the difference of individual and daily physiological rule are optimized by particle swarm optimization (PSO).

RESULTS:

Clarke error grid shows the blood glucose predictions are distributed in regions A and B, Bland-Altman analysis show that the predictions and measurements are in good agreement.

CONCLUSIONS:

The PSO-2ANN model is a nonlinear calibration strategy with accuracy and robustness using 1550-nm spectroscopy, which can correct the individual difference and physiological glucose dynamics.