Dynamic changes in heparin-binding protein as a prognostic biomarker for 30-day mortality in sepsis patients in the intensive care unit

Heparin-binding protein (HBP) has been shown to be a robust predictor of the progression to organ dysfunction from sepsis, and we hypothesized that dynamic changes in HBP may reflect the severity of sepsis. We therefore aim to investigate the predictive value of baseline HBP, 24-h, and 48-h HBP change for prediction of 30-day mortality in adult patients with sepsis. This is a prospective observational study in an intensive care unit of a tertiary center. Patients aged 20 years or older who met SEPSIS-3 criteria were prospectively enrolled from August 2019 to January 2020. Plasma levels of HBP were measured at admission, 24 h, and 48 h and dynamic changes in HBP were calculated. The Primary endpoint was 30-day mortality. We tested whether the biomarkers could enhance the predictive accuracy of a multivariable predictive model. A total of 206 patients were included in the final analysis. 48-h HBP change (HBPc-48 h) had greater predictive accuracy of area under the curve (AUC: 0.82), followed by baseline HBP (0.79), PCT (0.72), lactate (0.71), and CRP (0.65), and HBPc-24 h (0.62). Incorporation of HBPc-48 h into a clinical prediction model significantly improved the AUC from 0.85 to 0.93. HBPc-48 h may assist clinicians with clinical outcome prediction in critically ill patients with sepsis and can improve the performance of a prediction model including age, SOFA score and Charlson comorbidity index.

Chest CT Images for COVID-19: Radiologists and Computer-Based Detection

Background

Characteristic chest computed tomography (CT) manifestation of 2019 novel coronavirus (COVID-19) was added as a diagnostic criterion in the Chinese National COVID-19 management guideline. Whether the characteristic findings of Chest CT could differentiate confirmed COVID-19 cases from other positive nucleic acid test (NAT)-negative patients has not been rigorously evaluated.

Purpose

We aim to test whether chest CT manifestation of 2019 novel coronavirus (COVID-19) can be differentiated by a radiologist or a computer-based CT image analysis system.

Methods

We conducted a retrospective case-control study that included 52 laboratory-confirmed COVID-19 patients and 80 non-COVID-19 viral pneumonia patients between 20 December, 2019 and 10 February, 2020. The chest CT images were evaluated by radiologists in a double blind fashion. A computer-based image analysis system (uAI System, Lianying Inc., Shanghai, China) detected the lesions in 18 lung segments defined by Boyden classification system and calculated the infected volume in each segment. The number and volume of lesions detected by radiologist and computer system was compared with Chi-square test or Mann-Whitney U test as appropriate.

Results

The main CT manifestations of COVID-19 were multi-lobar/segmental peripheral ground-glass opacities and patchy air space infiltrates. The case and control groups were similar in demographics, comorbidity, and clinical manifestations. There was no significant difference in eight radiologist identified CT image features between the two groups of patients. There was also no difference in the absolute and relative volume of infected regions in each lung segment.

Conclusion

We documented the non-differentiating nature of initial chest CT image between COVID-19 and other viral pneumonia with suspected symptoms. Our results do not support CT findings replacing microbiological diagnosis as a critical criterion for COVID-19 diagnosis. Our findings may prompt re-evaluation of isolated patients without laboratory confirmation.

Comparing mortality between positive and negative blood culture results: an inverse probability of treatment weighting analysis of a multicenter cohort

Background

The association between blood culture status and mortality among sepsis patients remains controversial hence we conducted a tri-center retrospective cohort study to compare the early and late mortality of culture-negative versus culture-positive sepsis using the inverse probability of treatment weighting (IPTW) method.

Methods

Adult patients with suspected sepsis who completed the blood culture and procalcitonin tests in the emergency department or hospital floor were eligible for inclusion. Early mortality was defined as 30-day mortality, and late mortality was defined as 30- to 90-day mortality. IPTW was calculated from propensity score and was employed to create two equal-sized hypothetical cohorts with similar covariates for outcome comparison.

Results

A total of 1405 patients met the inclusion criteria, of which 216 (15.4%) yielded positive culture results and 46 (21.3%) died before hospital discharge. The propensity score model showed that diabetes mellitus, urinary tract infection, and hepatobiliary infection were independently associated with positive blood culture results. There was no significant difference in early mortality between patients with positive or negative blood culture results. However, culture-positive patients had increased late mortality as compared with culture-negative patients in the full cohort (IPTW-OR, 1.95, 95%CI: 1.14–3.32) and in patients with severe sepsis or septic shock (IPTW-OR, 1.92, 95%CI: 1.10–3.33). After excluding Staphylococcal bacteremia patients, late mortality difference became nonsignificant (IPTW-OR, 1.78, 95%CI: 0.87–3.62).

Conclusions

Culture-positive sepsis patients had comparable early mortality but worse late mortality than culture-negative sepsis patients in this cohort. Persistent Staphylococcal bacteremia may have contributed to the increased late mortality.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-021-05862-w.

Heat stress induces apoptosis through transcription-independent p53-mediated mitochondrial pathways in human umbilical vein endothelial cell

Cells apoptosis induced by intense heat stress is the prominent feature of heat-related illness. However, little is known about the biological effects of heat stress on cells apoptosis. Herein, we presented evidence that intense heat stress could induce early apoptosis of HUVEC cells through activating mitochondrial pathway with changes in mitochondrial membrane potential(ΔΨm), release of cytochrome c, and activation of caspase-9 and -3. We further revealed that p53 played a crucial role in heat stress-induced early apoptosis, with p53 protein rapidly translocated into mitochondria. Using pifithrin-α(PFT), a p53's mitochondrial translocation inhibitor, we found that pretreated with PFT, heat stress induced mitochondrial p53 translocation was significantly suppressed, accompanied by a significant alleviation in the loss of ΔΨm, cytochrome c release and caspase-9 activation. Furthermore, we also found that generation of reactive oxygen species (ROS) was a critical mediator in heat stress-induced apoptosis. In addition, the antioxidant MnTMPyP significantly decreased the heat stress-induced p53's mitochondrial translocation, followed by the loss of ΔΨm, cytochrome c release, caspase-9 activation and heat stress-mediated apoptosis. Conclusively, these findings indicate the contribution of the transcription-independent mitochondrial p53 pathway to early apoptosis in HUVEC cells induced by oxidative stress in response to intense heat stress.

Osteoclast molecular phenotyping by random cDNA sequencing

The osteoclast is a cell type that is highly specialized for its bone resorption function. In order to decipher the numerous biochemical functions of osteoclasts, a description of the gene expression profile of osteoclasts would be beneficial. We have sought to identify genes that are highly expressed in osteoclasts by partially sequencing 194 randomly chosen cDNA clones from a representative rabbit osteoclast cDNA library. Comparison to nucleic acid and protein sequence databases indicates that 135 of these cDNAs are identical to or homologous to known mammalian genes. Reverse transcription-polymerase chain reaction (RT-PCR) assays with microisolated osteoclasts were used to verify the osteoclast expression of some of these genes. Fifty-nine cDNAs, including two abundantly expressed species, have no significant similarity to the sequence databases and likely represent novel genes. The most abundant of the osteoclast expressed genes encode cofilin and the vacuolar H(+)-ATPase 16 kd subunit. Each were represented at a frequency of 4.1% of the clones in the library (95% confidence interval = 2.4-6.6%). The high expression of these gene products is consistent with the high motility of osteoclasts and their very active hydrogen ion secretion. Other abundantly expressed sequences include beta-actin (95% C.I. = 2.0-6.0%), creatine kinase B (95% C.I. = 1.2-4.9%), c-fms and ribosomal protein L18 (95% C.I. = 0.8-4.3%), and cathepsin-OC2, cyclophilin, delta-aminolevulinate synthetase, 16S mitochondrial rRNA, and two novel gene sequences (95% C.I. = 0.5-3.6%).

Murine osteoclasts and spleen cell polykaryons are distinguished by mRNA phenotyping

To probe osteoclast gene expression, we combined the techniques of cell microisolation and RT-PCR to develop a novel and sensitive method for the isolation and mRNA phenotyping of small numbers of authentic osteoclasts and spleen cell polykaryons. Using this method we report (1) direct evidence for the presence of calcitonin receptor mRNA in osteoclasts, (2) confirmation of the recent finding of osteopontin mRNA in osteoclasts, and (3) demonstration that the specific expression of mRNA for tartrate-resistant acid phosphatase, carbonic anhydrase II, calcitonin receptor, and osteopontin enable one to distinguish the osteoclast from the morphologically similar and developmentally related spleen cell polykaryon. We also show that mRNA associated with the osteoblast phenotype, such as alkaline phosphatase, osteocalcin, and type I collagen, are absent in osteoclasts. This is the first report in which such an approach has been used successfully to distinguish the mRNA expression pattern of an authentic osteoclast from a macrophage polykaryon, and as such it should provide an important new tool for evaluating the results of various cell culture model systems designed to examine the origin and ontogeny of osteoclasts. Our results also indicate that these procedures can be used as an alternative to in situ hybridization methods for the cell-specific localization of specific mRNA in a mixed cell preparation and for colocalization of multiple mRNA species to a single cell type.

Chromosome abnormalities in early pregnancy analyzed by direct chromosome preparation of chorionic villi

Chorionic villi chromosome analysis was performed on 1,186 cases of induced abortion between the 5th and 11th week of gestation. The total incidence of major chromosome abnormalities, including numerical and structural chromosomal changes as well as mosaics and polyploids, was 4.5% (53 cases). The most common abnormalities were trisomy 21 (5 cases), trisomy 16 (4 cases), and monosomy X (4 cases). The incidence of chromosome abnormalities increased with the advancing age of the mother.