Approaches for posaconazole therapeutic drug monitoring and their clinical benefits.

OBJECTIVE: This review examines the progress of research on posaconazole therapeutic drug monitoring (TDM) that has focused on differences in the TDM of posaconazole after clinical application in different formulations and in different populations, the factors that affect posaconazole concentrations, the advantages of posaconazole TDM in terms of clinical efficacy and cost savings, and measurement methods. METHODS: A literature search (2006 to 2024) was performed in PubMed and Embase with the following search terms: noxafil, posaconazole hydrate, posaconazole, drug monitoring, therapeutic drug monitoring, and TDM. Abstracts of review articles, prospective studies, and retrospective studies were reviewed. RESULTS: TDM should be implemented earlier for posaconazole tablets and injections than for oral posaconazole suspensions. Posaconazole TDM is beneficial for improving clinical efficacy, and the incidence of breakthrough invasive fungal infections (IFIs) can be significantly reduced by gradually adjusting the posaconazole dose in response to TDM in patients with inadequate trough concentrations. Early TDM allows more patients to achieve target therapeutic posaconazole concentrations. TDM can also facilitate dose adjustments, which reduce the cost of this expensive drug. Different assay techniques, including chromatography, microbiological detection, chemofluorimetry, paper spray mass spectrometry, and capillary electrophoresis, can be used for posaconazole TDM. CONCLUSIONS: Posaconazole TDM has potential clinical utility and cost-saving benefits and could improve the outcomes of IFI treatment.

How Do In-Car Navigation Aids Impair Expert Navigators' Spatial Learning Ability?

Reliance on digital navigation aids has already shown negative impacts on navigators' innate spatial abilities. How this happens is still an open research question. We report on an empirical study with twenty-four experienced (male) taxi drivers to evaluate the long-term impacts of in-car navigation system use on the spatial learning ability of these navigation experts. Specifically, we measured cognitive load by means of electroencephalography (EEG) coupled with eye tracking to assess their visuospatial attention allocation during a video-based route-following task while driving through an unknown urban environment. We found that long-term reliance on in-car navigation aids did not affect participants' visual attention allocation during spatial learning but rather limited their ability to encode viewed geographic information into memory, which, in turn, led to greater cognitive load, especially along route segments between intersections. Participants with greater dependence on in-car navigation aids performed worse on the spatial knowledge tests. Our combined behavioral and neuropsychological findings provide evidence for the impairment of expert navigators' spatial learning ability when exposed to long-term use of digital in-car navigation aids.

PNSC928, a plant-derived compound, specifically disrupts CtBP2-p300 interaction and reduces inflammation in mice with acute respiratory distress syndrome.

BACKGROUND: Prior research has highlighted the involvement of a transcriptional complex comprising C-terminal binding protein 2 (CtBP2), histone acetyltransferase p300, and nuclear factor kappa B (NF-κB) in the transactivation of proinflammatory cytokine genes, contributing to inflammation in mice with acute respiratory distress syndrome (ARDS). Nonetheless, it remains uncertain whether the therapeutic targeting of the CtBP2-p300-NF-κB complex holds potential for ARDS suppression. METHODS: An ARDS mouse model was established using lipopolysaccharide (LPS) exposure. RNA-Sequencing (RNA-Seq) was performed on ARDS mice and LPS-treated cells with CtBP2, p300, and p65 knockdown. Small molecules inhibiting the CtBP2-p300 interaction were identified through AlphaScreen. Gene and protein expression levels were quantified using RT-qPCR and immunoblots. Tissue damage was assessed via histological staining. KEY FINDINGS: We elucidated the specific role of the CtBP2-p300-NF-κB complex in proinflammatory gene regulation. RNA-seq analysis in LPS-challenged ARDS mice and LPS-treated CtBP2-knockdown (CtBP2KD), p300KD, and p65KD cells revealed its significant impact on proinflammatory genes with minimal effects on other NF-κB targets. Commercial inhibitors for CtBP2, p300, or NF-κB exhibited moderate cytotoxicity in vitro and in vivo, affecting both proinflammatory genes and other targets. We identified a potent inhibitor, PNSC928, for the CtBP2-p300 interaction using AlphaScreen. PNSC928 treatment hindered the assembly of the CtBP2-p300-NF-κB complex, substantially downregulating proinflammatory cytokine gene expression without observable cytotoxicity in normal cells. In vivo administration of PNSC928 significantly reduced CtBP2-driven proinflammatory gene expression in ARDS mice, alleviating inflammation and lung injury, ultimately improving ARDS prognosis. CONCLUSION: Our results position PNSC928 as a promising therapeutic candidate to specifically target the CtBP2-p300 interaction and mitigate inflammation in ARDS management.

Targeting 5-Hydroxytryptamine Receptor 1A in the Portal Vein to Decrease Portal Hypertension.

BACKGROUND & AIMS: Portal hypertension (PH) is one of the most frequent complications of chronic liver disease. The peripheral 5-hydroxytryptamine (5-HT) level was increased in cirrhotic patients. We aimed to elucidate the function and mechanism of 5-HT receptor 1A (HTR1A) in the portal vein (PV) on PH. METHODS: PH models were induced by thioacetamide injection, bile duct ligation, or partial PV ligation. HTR1A expression was detected using real-time polymerase chain reaction, in situ hybridization, and immunofluorescence staining. In situ intraportal infusion was used to assess the effects of 5-HT, the HTR1A agonist 8-OH-DPAT, and the HTR1A antagonist WAY-100635 on portal pressure (PP). Htr1a-knockout (Htr1a-/-) rats and vascular smooth muscle cell (VSMC)-specific Htr1a-knockout (Htr1aΔVSMC) mice were used to confirm the regulatory role of HTR1A on PP. RESULTS: HTR1A expression was significantly increased in the hypertensive PV of PH model rats and cirrhotic patients. Additionally, 8-OH-DPAT increased, but WAY-100635 decreased, the PP in rats without affecting liver fibrosis and systemic hemodynamics. Furthermore, 5-HT or 8-OH-DPAT directly induced the contraction of isolated PVs. Genetic deletion of Htr1a in rats and VSMC-specific Htr1a knockout in mice prevented the development of PH. Moreover, 5-HT triggered adenosine 3',5'-cyclic monophosphate pathway-mediated PV smooth muscle cell contraction via HTR1A in the PV. We also confirmed alverine as an HTR1A antagonist and demonstrated its capacity to decrease PP in rats with thioacetamide-, bile duct ligation-, and partial PV ligation-induced PH. CONCLUSIONS: Our findings reveal that 5-HT promotes PH by inducing the contraction of the PV and identify HTR1A as a promising therapeutic target for attenuating PH. As an HTR1A antagonist, alverine is expected to become a candidate for clinical PH treatment.

Safety and efficacy of magnesium-rich artificial cerebrospinal fluid for subarachnoid hemorrhage.

Objectives: This study aimed to investigate the efficacy of using a newly formulated magnesium-rich artificial cerebrospinal fluid (MACSF) as an alternative to normal saline (NS) for intraoperative irrigation during aneurysm clipping in improving the prognosis of patients with Aneurysmal subarachnoid hemorrhage (aSAH). Methods: Patients with aSAH who underwent intraoperative irrigation with MACSF or NS during the clipping in the First Affiliated Hospital of Xi 'an Jiaotong University from March 2019 to March 2022 were selected as MACSF group and NS group, respectively. The primary prognostic indicators were the incidence of favorable outcomes (mRS 0-2). The secondary outcome measures included cerebral vasospasm (CVS), mortality, total hospital stay, and intensive care unit (ICU) stay. Safety was evaluated based on the occurrence rates of hypermagnesemia, meningitis, and hydrocephalus. Results: Overall, 34 and 37 patients were enrolled in the MACSF and NS groups, respectively. At 90 days after aSAH onset, the proportion of favorable prognosis in the MACSF group was significantly higher than that in the NS group (p = 0.035). The incidence of CVS within 14 days after surgery was significantly lower in the MACSF group than that in the NS group (p = 0.026). The mortality rate in the MACSF group was significantly lower than in the NS group (p = 0.048). The median lengths of hospital stay (p = 0.008) and ICU stay (p = 0.018) were significantly shorter in the MACSF group than in the NS group. No significant differences were observed in safety measures. Conclusion: Using MACSF as an irrigation fluid for aneurysm clipping can significantly improve the 90-day prognosis of patients with aSAH, which may be related to the reduced incidence of CVS. Clinical trial registration: https://www.clinicaltrials.gov, identifier NCT04358445.

Independent effect of the triglyceride-glucose index on all-cause mortality in critically ill patients with chronic obstructive pulmonary disease and asthma: A retrospective cohort study.

BACKGROUND: The triglyceride-glucose (TyG) index serves as a reliable proxy for insulin resistance (IR). IR has been linked to heightened incidence, prevalence, or severity of chronic obstructive pulmonary disease (COPD) and asthma. Prior research indicates that critically ill patients are prone to developing IR. Nevertheless, few studies have delved into the correlation between IR and all-cause mortality in critically ill patients with COPD and asthma. Therefore, the aim of this study is to explore the association between the TyG index and all-cause mortality in patients with COPD and asthma, with the goal of assessing the impact of IR on the prognosis of this patient population. METHODS: This is a retrospective study, and all data are from the Medical Information Mart for Intensive Care IV (MIMIC-IV) critical care database. This study included 684 ICU patients with COPD and asthma and divided them into quartiles based on TyG index levels. The primary outcomes of this study were all-cause mortality during follow-up, encompassing mortality at 30 days, 90 days, and 180 days. The Kaplan-Meier analysis was used to compare all-cause mortality among the above four groups. Cox proportional hazards analyses were performed to examine the association between TyG index and all-cause mortality in critically ill patients with COPD and asthma. Restricted cubic spline analysis was used to assess potential nonlinear association between the TyG index and the primary outcome. RESULTS: A total of 684 patients (53.9% female) were included. The 90-days all-cause mortality rate and 180-days all-cause mortality were 11.7% and 12.3%, respectively. Kaplan-Meier analysis revealed a significant association between the TyG index and both 90-days all-cause mortality (log-rank p = .039) and 180-days all-cause mortality (log-rank p = .017). Cox proportional hazards analysis revealed a significant association between the TyG index and 90-days all-cause mortality in both the unadjusted model (HR, 1.30 [95% CI 1.08-1.57] p = .005) and the model adjusted for age, gender, and diabetes (HR, 1.38 [95% CI 1.15-1.67] p < .001). Similarly, the TyG index was associated with 180-days all-cause mortality in the unadjusted model (HR, 1.30 [95% CI 1.09-1.56] p = .004) and the model adjusted for age, sex, and diabetes (HR, 1.38 [95% CI 1.15-1.66] p < .001). The restricted cubic splines (RCS) regression model indicated a significant nonlinear association between the TyG index and both 90-days and 180-days all-cause mortality. Specifically, TyG index >4.8 was associated with an increased risk of mortality at both 90 days and 180 days. CONCLUSIONS: In summary, our results extend the utility of the TyG index to critically ill patients with COPD and asthma. Our study shows that the TyG index is a potential predictor of all-cause mortality in critically ill patients with COPD and asthma. In addition, in patients with a TyG index exceeding 4.8, there was a heightened risk of mortality. Measuring the TyG index may help with risk stratification and prognosis prediction in critically ill patients with COPD and asthma. Further prospective studies are needed to confirm our findings.

A systematic review of global distribution, sources and exposure risk of phthalate esters (PAEs) in indoor dust.

Phthalate esters (PAEs) are a class of plasticizers that are readily released from plastic products, posing a potential exposure risk to human body. At present, much attention is paid on PAE concentrations in indoor dust with the understanding of PAEs toxicity. This study collected 8187 data on 10 PAEs concentrations in indoor dusts from 26 countries and comprehensively reviewed the worldwide distribution, influencing factors, and health risks of PAEs. Di-(2-ethylhexyl) phthalate (DEHP) is the predominant PAE with a median concentration of 316 µg·g-1 in indoor dust. Polyvinyl chloride wallpaper and flooring and personal care products are the main sources of PAEs indoor dust. The dust concentrations of DEHP show a downward trend over the past two decades, while high dust concentrations of DiNP are found from 2011 to 2016. The median dust contents of 8 PAEs in public places are higher than those in households. Moreover, the concentrations of 9 PAEs in indoor dusts from high-income countries are higher than those from upper-middle-income countries. DEHP in 69.8% and 77.8% of the dust samples may pose a potential carcinogenic risk for adults and children, respectively. Besides, DEHP in 16.9% of the dust samples may pose a non-carcinogenic risk to children. Nevertheless, a negligible risk was found for other PAEs in indoor dust worldwide. This review contributes to an in-depth understanding of the global distribution, sources and health risks of PAEs in indoor dust.

Geographic disparities of dietary inflammatory index and its association with hypertension in middle-aged and elders in China: results from a nationwide cross-sectional study.

Background: Geographic distribution of dietary inflammatory index (DII) in China has not been thoroughly evaluated and evidence on the association between DII and hypertension among Chinese middle-aged and older population was inadequate. Objective: To investigate the geographic disparities of DII and its association with hypertension among Chinese middle-aged and elders. Methods: Data was from the China Adults Chronic Diseases and Nutrition Surveillance (CACDNS 2015) for middle-aged and older participants. The DII for each participant was determined through a combination of 3 days 24 h dietary recall interviews and a food frequency questionnaire. Spatial analysis was employed to investigate the geographic distribution of DII in China. Restricted cubic spline models and binary logistic regression analysis were used to assess the relationship between DII and hypertension. The least absolute shrinkage and selection operator (LASSO) regression was applied for identifying key hypertension-related factors, which was then included in the establishment of a risk prediction nomogram model, with the receiver operating characteristic (ROC) curve and decision curve analysis (DCA) being built to evaluate its discriminatory power for hypertension. Results: A total of 52,087 middle-aged and older participants were included in the study, among whom 36.6% had hypertension. it revealed that a clear spatial correlation in the national distribution of DII scores (Moran I: 0.252, p = 0.001), with higher DII scores concentrated in the northwest region and lower DII scores concentrated in the southeast region. Hypertensive participants had higher DII scores compared to those without hypertension (OR: 1.507 vs. 1.447, p = 0.003). Restricted cubic spline models and binary logistic regression analysis demonstrated a positive association between DII and hypertension after adjusting for potential confounding factors. There was a significant increasing trend in the proportion of hypertensive individuals as DII scores increase (p for trend = 0.004). The nomogram model, constructed using key factors identified through LASSO regression, demonstrated a robust discriminative capacity, with an area under the curve (AUC) of 73.2% (95% CI, 72.4-74.0%). Decision curve analysis confirmed the reliability and effectiveness of the nomogram model. Sensitivity analysis conducted within the subpopulation aged under 45 years yielded results consistent with the primary analysis. Conclusion: In Chinese adults middle-aged and older, geographic disparities in dietary inflammatory potential are notable, with lower levels observed in the southeastern coastal regions of China and higher levels in the northwestern regions. Meanwhile, there is a positive association between the inflammatory potential of the diet and hypertension. Additional research is needed to investigate regional disparities in dietary inflammatory potential and pinpoint specific dietary patterns associated with lower inflammation.

Organophosphate esters (OPEs) and novel brominated flame retardants (NBFRs) in indoor dust: A systematic review on concentration, spatial distribution, sources, and human exposure.

In recent years, the indoor exposure of organophosphate esters (OPEs) and novel brominated flame retardants (NBFRs) has received widespread attention worldwide. Using published data on 6 OPEs in 23 countries (n = 1437) and 2 NBFRs in 18 countries (n = 826) in indoor dust, this study systematically reviewed the concentrations, spatial distribution, sources and exposure risk of 8 flame retardants (FRs) worldwide. Tris(chloroisopropyl)phosphate (TCIPP) is the predominant FR with a median concentration of 1050 ng g-1 ΣCl-OPEs are significantly higher than Σnon-Cl-OPEs (p < 0.05). ΣOPEs in indoor dust from industrially-developed countries are higher than those from the countries lacking industrial development. Household appliances, electronics and plastic products are the main sources of non-Cl-OPEs and NBFRs, while interior decorations and materials contribute abundant Cl-OPEs in indoor dust. The mean hazard index (HI) of TCIPP for children is greater than 1, possibly posing non-cancer risk for children in some countries. The median ILCRs for 3 carcinogenic OPEs are all less than 10-6, suggesting no cancer risk induced by these compounds for both adults and children. This review helps to understand the composition, spatial pattern and human exposure risk of OPEs and NBFRs in indoor dust worldwide.

Atomic-Level Insights into Hollow Silica-Based Materials for Drug Delivery: Effects of Wettability and Porosity.

Experimental evidence has demonstrated that the drug carrier capacity can be significantly enhanced through the use of hollow silica particles. Nevertheless, the effects of varying functional drug carrier surfaces and porous structures remain ambiguous. This study employs molecular dynamics simulations to examine the effects of varying the surface wettability, pore size, and flow velocity on the transfer process. The different levels of wettability of the silica surface with the coarse-grained water model is illustrated by adjusted interaction parameters. The effect of wettability is investigated. With weak interactions, the flow molecules form a nanodroplet to transfer through the porous structure. A strong interaction will lead to molecules flowing as a liquid film to transfer through the structure. Interestingly, the "contradiction effect" is observed when the flow molecules fail to penetrate the porous structure with weak interactions, during which surface tension dominates their flow behavior. Moreover, different porous structures are considered. The flow behaviors are divided into three processes: (1) fast flowing, (2) transient point, and (3) penetration flowing. Furthermore, the concept of surface molecules is defined to quantitatively measure the effect of porosity. A recommended contact angle is proposed. The results will pave the way for more carrier structures in medical engineering.

Prolonged Tracheal Intubation in the ICU as a Possible Risk Factor for Arytenoid Dislocation After Liver Transplant Surgery: A Retrospective Case-Control Study.

BACKGROUND Arytenoid dislocation (AD) is a rare complication of general anesthesia with tracheal intubation, with a published incidence of 0.009-0.097%. This retrospective case-control study aimed to identify risk factors associated with AD in patients who underwent liver transplantation. MATERIAL AND METHODS This study included 476 patients who underwent liver transplantation between January 2013 and December 2022. Patients with AD who underwent surgery were included in the AD group. For each case of AD, 4 patients matched by anesthesia type and anesthetist were randomly selected as the non-AD group. Data on patient characteristics, anesthetic factors, and surgical factors were collected and compared between patients with and without AD. Logistic regression analysis was performed to determine the risk factors for AD after liver transplantation. RESULTS Of the 476 patients who underwent liver transplantation, 17 (3.57%) had AD. AD occurred on the left side in 13 patients and on the right side in 4 patients. The 17 patients who experienced AD and 68 matched non-AD patients were enrolled. Patients in the AD group had a greater intubation depth (24 [23-24] vs 24 [24-24], P=0.043), a higher level of hemoglobin (134.5 [118-147.5] vs 112 [96.25-125], P=0.014), and prolonged tracheal intubation in the ICU (19.75 [15.87-31.87] vs 13 [10.62-15], P<0.001) compared to those in the non-dislocation group. Multivariate logistic regression analysis showed that prolonged tracheal intubation in the ICU was independently associated with the occurrence of AD in patients who underwent liver transplantation (P=0.013). CONCLUSIONS This study showed that the incidence of AD was 3.57% in patients undergoing liver transplant surgery and that prolonged tracheal intubation in the ICU was a possible risk factor for AD.

The relationship between hemoglobin/red blood cell distribution width ratio and mortality in patients with intracranial hemorrhage: a possible protective effect for the elderly?

Intracranial hemorrhage (ICH) is a neurological emergency with a poor prognosis. This study aimed to understand the association between hemoglobin levels, red blood cell distribution width ratio (HRR), and mortality in patients with ICH. Information on patients with ICH was extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Cox proportional risk models were used to assess the relationship between HRR and 28-day and 90-day mortality, and constructed by adjusting for relevant covariates. Segmented regression models and smoothing curves were used to analyze the linear relationship between HRR and mortality. This study recruited 4,716 patients with ICH. The HRR Q4 group was negatively associated with the 28- and 90-day mortality. For patients aged > 65 years, the right-hand threshold inflection points of the HRR were 0.92 and 0.93, respectively, which were negatively associated with 28-day mortality (HR:0.06, 95% CI 0.01, 0.35, p = 0.0016) and with 90-day mortality (p = 0.0006). In the non-linear model, both 28-day mortality (HR, 0.17; 95% CI 0.04-0.75, p = 0.0191; HRR > 0.89) and 90-day mortality (HR, 0.13; 95% CI 0.04-0.49, p = 0.0022; HRR > 0.85) were associated in men. In the subgroup analysis, the negative association between HRR and mortality was more pronounced in patients > 65 years of age, as well as in patients with non-dementia, diabetes, and malignant cancer. We found a non-linear relationship between mortality and the HRR in elderly patients, and a higher HRR was negatively associated with mortality in patients with ICH.

High prevalence of postoperative arytenoid dislocation in patients undergoing liver transplantation: A case-control study.

Arytenoid dislocation (AD) is a rare complication of surgery under general anesthesia. The potential factors for AD remain poorly defined, and the identification of risk factors is beneficial for reducing its incidence. We found that patients undergoing liver transplantation appeared to be more susceptible to postoperative AD at our hospital. The present study was designed to clarify this issue. A retrospective hospital-based case-control study was conducted in patients undergoing surgery under general anesthesia between 2017 and 2021. Recorded data for all patients were age, sex, body weight, height, body mass index, position of patients during surgery, duration of surgery, emergency status of surgery, and liver transplantation. Logistic regression analysis was performed to determine risk factors for AD. Thirty thousand one hundred fifty-four patients who underwent general anesthesia between 2017 and 2021 were included. Sixteen (0.05%) patients were diagnosed with AD, including 10 (3.9%) patients among 259 patients who underwent liver transplantation and 6 patients had complications among the 29,895 patients who underwent other operations (P < .0001). Postoperative AD incidence was significantly elevated in patients undergoing liver transplantation. This finding should be clinically relevant and alarming for anesthesiologists and clinicians to help avoid arytenoid dislocation and improve patient outcomes. Further studies that incorporate detailed data are needed to determine risk factors for AD.

Efficacy and safety evaluations of adalimumab biosimilars in the treatment of psoriasis.

PURPOSE: We aimed to systematically evaluate the efficacy and safety of adalimumab biosimilar agents in the treatment of moderate-to-severe plaque psoriasis, in order to provide evidence-based reference data for clinical medicine. MATERIALS AND METHODS: Five databases were searched by electronic retrieval: PubMed, Embase, Cochrane Library, WanFang and CNKI (China National Knowledge Internet). The retrieval period was from the establishment of each database up to April 2022. Randomized controlled trials (RCTs) on adalimumab biosimilar agents compared with their reference agents in the treatment of moderate-to-serve plague psoriasis were included. A meta-analysis using RevMan software was applied to 8 RCTs involving 2589 patients. RESULTS: After 16 weeks of medication, there was no significant difference in the response rates of adalimumab biosimilar agents and their reference agents defined as a decrease in the Psoriasis Area and Severity Index (PASI) of ≥75% (PASI 75) (p > 0.05), or in the PASI 50, PASI 90 and PASI 100 measures (p > 0.05). After 16 weeks and 24 weeks of medication, there was no significant difference in the incidence rate of serious adverse events (SAEs) between adalimumab biosimilar agents and their reference agents (p > 0.05). After 16 weeks, 24 weeks and 51 weeks of medication, there was no significant difference in withdrawal rate due to SAEs, treatment-emergent adverse events and adverse events of special interest between adalimumab biosimilar agents and their reference agents (p > 0.05). CONCLUSION: These findings suggest that biosimilar agents of adalimumab have an overall efficacy and safety profile for psoriasis comparable to those of their reference agents.

Therapeutic effects of vasopressin on cardiac arrest: a systematic review and meta-analysis.

OBJECTIVE: To demonstrate the therapeutic effect of vasopressin as an alternative treatment for cardiac arrest. DESIGN: Systematic review and meta-analysis. METHODS: PubMed, EMBASE, the Cochrane Library and Web of Science were searched for randomised controlled trials. The intervention included administration of vasopressin alone or vasopressin combined with epinephrine or vasopressin, steroids and epinephrine (VSE) versus epinephrine combined with placebo as control group. The primary outcome was the return of spontaneous circulation (ROSC). The secondary outcomes included mid-term survival and mid-term good neurological outcome. We conducted subgroup analyses of the primary outcome based on different settings, different study drug strategies and different types of initial rhythm. RESULTS: Twelve studies (n=6718) were included, of which eight trials (n=5638) reported the data on patients with out-of-hospital cardiac arrest and four trials (n=1080) on patients with in-hospital cardiac arrest (IHCA). There were no significant differences between intravenous vasopressin and placebo in the outcomes of ROSC (relative risk (RR): 1.11; 95% CI: 0.99 to 1.26), mid-term survival (RR: 1.23; 95% CI: 0.90 to 1.66) and mid-term good neurological outcome (RR: 1.20; 95% CI: 0.77 to 1.87). However, in the subgroup analysis, intravenous vasopressin as part of VSE can significantly improve the rate of ROSC (RR: 1.32; 95% CI: 1.18 to 1.47) but not the rate of mid-term survival (RR: 2.15; 95% CI: 0.75 to 6.16) and mid-term good neurological outcome (RR: 1.80; 95% CI: 0.81 to 4.01) for patients with IHCA. CONCLUSIONS: Our study failed to demonstrate increased benefit from vasopressin with or without epinephrine compared with the standard of care. However, vasopressin as a part of VSE is associated with the improvement of ROSC in patients with IHCA, and the benefit on mid-term survival or mid-term good neurological outcome is uncertain. Larger trials should be conducted in the future to address the effect of vasopressin only, vasopressin plus epinephrine or VSE on cardiac arrest. PROSPERO REGISTRATION NUMBER: CRD42021293347.

A nationwide survey of polycyclic aromatic hydrocarbons (PAHs) in household dust in China: spatial distribution, sources, and health risk assessment.

As a carrier of toxic substances, household dust has a great impact on human health. Here we collected 73 household dust samples from 27 provinces and 1 municipality in China to investigate the levels, spatial distribution, sources, and carcinogenic risk of 16 polycyclic aromatic hydrocarbons (PAHs). The total concentrations of 14 detected PAHs (∑14 PAHs) ranged from 3.72 to 60,885 ng g-1. High ∑14 PAHs were found in Northeast and Southwest China. High molecular weights (HMW) PAHs (4-6 rings) were predominant PAHs in most dust samples, accounting for 93.6% of ∑14 PAHs. Household fuel, cooking frequency, air conditioning, and smoking were the main factors influencing PAH concentrations in household dust. Principal component analysis model indicated that fossil combustion (81.5%) and biomass combustion and vehicle exhaust (8.1%) are the primary sources of PAHs. Positive matrix factorization model suggested that household cooking and heating contributed about 70% of ∑14 PAHs, and smoking contributed another 30%. The values of benzo[a]pyrene equivalent in rural dust were found to be higher than those in urban dust. The sum of toxic equivalents (TEQs) of 14 PAHs were in range of 0.372-7241 ng g-1, in which 7 HMW PAHs accounted for 98.0 ± 1.98% of the total TEQs. Monte Carlo Simulation showed a low to moderate potential carcinogenic risk of PAHs in household dusts. This study documents comprehensive information on human exposure to PAHs in household dust at a national-scale.

Use of the cardiopulmonary coupling index based on refined composite multiscale entropy for prognostication of acute type A aortic dissection.

Objectives: The aim of this study is to assess the influence of cardiopulmonary coupling (CPC) based on RCMSE on the prediction of complications and death in patients with acute type A aortic dissection (ATAAD). Background: The cardiopulmonary system may be nonlinearly regulated, and its coupling relationship with postoperative risk stratification in ATAAD patients has not been studied. Methods: This study was a single-center, prospective cohort study (ChiCTR1800018319). We enrolled 39 patients with ATAAD. The outcomes were in-hospital complications and all-cause readmission or death at 2 years. Results: Of the 39 participants, 16 (41.0%) developed complications in the hospital, and 15 (38.5%) died or were readmitted to the hospital during the two-year follow-up. When CPC-RCMSE was used to predict in-hospital complications in ATAAD patients, the AUC was 0.853 (p < 0.001). When CPC-RCMSE was used to predict all-cause readmission or death at 2 years, the AUC was 0.731 (p < 0.05). After adjusting for age, sex, ventilator support (days), and special care time (days), CPC-RCMSE remained an independent predictor of in-hospital complications in patients with ATAAD [adjusted OR: 0.8 (95% CI, 0.68-0.94)]. Conclusion: CPC-RCMSE was an independent predictor of in-hospital complications and all-cause readmission or death in patients with ATAAD.

[Relationship between dietary fiber intake and glucose metabolism in the elderly of China in 2015].

OBJECTIVE: To investigate the dietary fiber intake status and analyze the relationship between dietary fiber and glucose metabolic disorder of the elderly in China. METHODS: Data were collected from the participants of Chinese adult chronic diseases and nutrition surveillance in 2015. General information were collected by standardized questionnaires, anthropometric index and blood pressure of respondents were measured according to standard method. Food intake was collected by three consecutive day 24 h dietary recalls, dietary fiber was calculated through China food composition. Fasting venous blood were collected to measure glucose, HbA1C, and other related biochemical index. Subjects were divided into three groups: normal glucose(NG, normal glucose), pre-diabetes(Pre-DM, pre-diabetes mellitus) and diabetes(T2DM, type 2 diabetes mellitus). Multiple logistic regression model was used to analyze the relationship between dietary fiber intake and Pre-DM as well as T2DM. RESULTS: A total of 20 996 elderly people aged 60 years and above were included. There 10 773 cases were males(51.3%) and 10 223 cases were females(48.7%), the age of both gender were(68.21±6.26) years and(67.67±6.26) years. A total of 6526 cases of pre-diabetes were detected in 20 996 elderly participants with detection rate of 31.1%. There 3274 cases were male and 3252 cases were female, the detection rates of both genders were 30.4% and 31.8%, respectively. While 1572 participants were detected as T2DM(784 of males and 788 of females), the detection rate of T2DM was 7.5%, 7.3% for males and 7.7% for females. There were significant differences in mean age, BMI, waist circumference, systolic blood pressure, diastolic blood pressure, TC, TG, HDL-C, LDL-C, HbA1c level among different dietary intake groups(P<0.005). With the increase of dietary fiber intake, the proportion of overweight and obesity, central obesity and dyslipidemia showed an increasing trend(P<0.05), and the proportion of hypertension showed a decreasing trend(P<0.000 1). After adjusting for potential confounding factors, compared to participants with lowest fiber intake, participants in subgroups of lower, minor lower, and higher fiber intake were associated with decreased risk of pre-diabetes, the OR and 95%CI were(OR=0.911, 95%CI 0.835-0.993), (OR= 0.861, 95%CI 0.790-0.938) and(OR= 0.913, 95%CI 0.838-0.994), respectively. However, there was only a statistically significant negative association between the higher intake of dietary fiber and T2DM(OR = 0.848, 95%CI 0.726-0.991). CONCLUSION: Dietary fiber intake was negatively related with diabetes and pre-diabetes mellitus. The risk of glucose metabolic disorder was decreased with the increase of dietary fiber intake.