U-shaped association between serum triglyceride levels and mortality among septic patients: An analysis based on the MIMIC-IV database.

BACKGROUND: Sepsis is characterized by upregulated lipolysis in adipose tissue and a high blood triglyceride (TG) level. It is still debated whether serum TG level is related to mortality in septic patients. The aim of this study is to investigate the association between serum TG level and mortality in septic patients admitted to the intensive care unit (ICU). METHODS: Data from adult septic patients (≥18 years) admitted to the ICU for the first time were obtained from the Multiparameter Intelligent Monitoring in Intensive Care IV (MIMIC-IV) database. The patients' serum TG levels that were measured within the first week after ICU admission were extracted for statistical analysis. The endpoints were 28-day, ICU and in-hospital mortality. RESULTS: A total of 2,782 septic patients were included. Univariate analysis indicated that the relationship between serum TG levels and the risk of mortality was significantly nonlinear. Both the Lowess smoothing technique and restricted cubic spline analyses revealed a U-shaped association between serum TG levels and mortality among septic patients. The lowest mortality rate was associated with a serum TG level of 300-500 mg/dL. Using 300∼500 mg/dL as the reference range, we found that both hypo-TG (<300 mg/dL) and hyper-TG (≥500 mg/dL) were associated with increased mortality. The result was further adjusted by Cox regression with and without the inclusion of some differential covariates. CONCLUSIONS: There was a U-shaped association between serum TG and mortality in septic ICU patients. The optimal concentration of serum TG levels in septic ICU patients is 300-500 mg/dL.

Association between circadian body temperature rhythm during the first 24 hours of ICU stay and 28-day mortality in elderly critically ill patients: A retrospective cohort study.

Disrupted circadian temperature rhythm is commonly observed in elderly patients in the intensive care unit (ICU), but the association between circadian temperature rhythm and mortality in elderly patients is unclear. Adult patients with a relatively complete record of body temperature (BT) during the first 24 hours of ICU stay in the Multi-parameter Intelligent Monitoring in Intensive Care IV (MIMIC-IV) database were included in this retrospective cohort study. The circadian rhythm of body temperature was blunted as a ratio of the maximum BT between 12:00 and 24:00 divided by the minimum BT between 0:00 and 12:00, and we defined it as BT fluctuation ratio. The associations of BT fluctuation ratio with 28-day mortality were assessed separately using Cox proportional hazards model in elderly patients and non-elderly patients. The overall cohort comprised 12 767 patients. After adjusting for covariates, the analysis showed that the BT fluctuation ratio (%) was significantly associated with mortality at 28 days in total patients (hazard ratio: 1.044; 95% CI 1.001-1.088; P = 0.042), and still significantly in elderly patients (hazard ratio 1.055, 95% CI as 1.004-1.109, p = 0.035), but not significantly in non-elderly patients. The implementation of restricted cubic splines demonstrated a nonlinear correlation between the ratio of BT fluctuation and the hazard ratio of 28-day mortality, indicating that increased diurnal temperature fluctuations are linked to elevated risk of mortality. This study revealed that the augmented amplitude of the circadian rhythm of body temperature in the elderly patients constitutes a risk factor for the rise of 28-day mortality. Additionally, the circadian body temperature rhythm may facilitate the early detection of critically ill elderly patients.

Psychophysical Risk Perceptions and Sleep Quality of Medical Assistance Team Members in Square Cabin Hospitals: A Repeated Cross-Sectional Study.

Objective: This study aimed to evaluate the association between the perceptions of psychophysical risks and sleep quality of Medical Assistance Team Members (MATMs) in Square Cabin Hospitals. Methods: Repeated cross-sectional data collection was conducted in Square Cabin Hospitals during two large-scale lockdowns. The first wave was sampled from MATMs dispatched to Wuhan and the second was from MATMs dispatched to Shanghai. Participants completed online questionnaires comprised of the Risk Perception Questionnaire (RPQ), Positive and negative emotions scale (PANAS), and Sleep Quality Scale (SQS), measuring the psychophysical risk perceptions about the MATMs' current work, emotional states, and sleep quality. Changes across two waves of data collection were statistically parsed using the exploratory factor analysis and regression models. Results: Data of 220 participants from first-wave samples [S1] and 300 from second-wave samples [S2] were analyzed. Participants reported more worries about physical risks, such as inadequate protection methods and being infected, and S1 rated higher on all risks compared with S2 (as the biggest p-value was 0.021). Across the different situations, the dominant emotional states of MATMs were positive; a higher level of psychophysical risk perceptions, negative emotional states, and poor sleep quality were consistently interrelated. The psychophysical risk perceptions predicted sleep quality. Negative emotions as a state variable intensified the relationship between physical risk perceptions and sleep quality (bindirect effect = 1.084, bootstrapped CI = [0.705, 1.487]). Conclusions: The results provide important evidence that MATMs' higher level of psychophysical risk perceptions associated with negative emotions could indicate worse sleep quality.

Safety and efficacy of different therapeutic strategies in the endovascular treatment of anterior cerebral artery aneurysms with different features: A single centre experience.

BACKGROUND: Outcomes of endovascular treatment of anterior cerebral artery (ACA) aneurysms are still not well-characterized. OBJECTIVE: The study aimed to review the clinical effect, procedure-related complications and follow-up outcomes and to evaluate the safety and efficacy of endovascular treatment of ACA aneurysms in our center experience. METHODS: From August 2014 to August 2018, a total of 75 consecutive patients with 77 ACA aneurysms were treated via the endovascular approach after providing informed consent. A retrospective review of the clinical, radiological, and endovascular details of these patients was conducted. RESULTS: The mortality and the morbidity in this study were 4% and 9.3%, respectively. Compared with A1 and A2 aneurysms, intraoperative rupture was more common in A3 aneurysms (P = 0.029). Difference between the ruptured and unruptured aneurysms in the distribution of therapeutic strategy (P = 0.003) and immediate embolization degree (P = 0.004) was also significant. Statistical analysis demonstrated that the larger aneurysm (P = 0.031) was, the greater the ratio of aneurysm size to parent artery diameter (P = 0.029) was, the more likely the unruptured aneurysms were to occur ischemic events. Higher Hunt-Hess grade (P = 0.0066) was an independent risk factor for poor clinical outcome. CONCLUSION: Endovascular treatment is feasible and effective for ACA aneurysms.

Inhibition of AIM2 inflammasome activation alleviates GSDMD-induced pyroptosis in early brain injury after subarachnoid haemorrhage.

Only a few types of inflammasomes have been described in central nervous system cells. Among these, the absent in melanoma 2 (AIM2) inflammasome is primarily found in neurons, is highly specific and can be activated only by double-stranded DNA. Although it has been demonstrated that the AIM2 inflammasome is activated by poly(deoxyadenylic-deoxythymidylic) acid sodium salt and leads to pyroptotic neuronal cell death, the role of AIM2 inflammasome-mediated pyroptosis in early brain injury (EBI) after subarachnoid haemorrhage (SAH) has rarely been studied. Thus, we designed this study to explore the mechanism of gasdermin D(GSDMD)-induced pyroptosis mediated by the AIM2 inflammasome in EBI after SAH. The level of AIM2 from the cerebrospinal fluid (CSF) of patients with SAH was detected. The pathway of AIM2 inflammasome-mediated pyroptosis, the AIM2/Caspase-1/GSDMD pathway, was explored after experimental SAH in vivo and in primary cortical neurons stimulated by oxyhaemoglobin (oxyHb) in vitro. Then, we evaluated GSDMD-induced pyroptosis mediated by the AIM2 inflammasome in AIM2 and caspase-1- deficient mice and primary cortical neurons generated through lentivirus (LV) knockdown. Compared with that of the control samples, the AIM2 level in the CSF of the patients with SAH was significantly increased. Pyroptosis-associated proteins mediated by the AIM2 inflammasome were significantly increased in vivo and in vitro following experimentally induced SAH. After AIM2 and caspase-1 were knocked down by an LV, GSDMD-induced pyroptosis mediated by the AIM2 inflammasome was alleviated in EBI after SAH. Intriguingly, when caspase-1 was knocked down, apoptosis was significantly suppressed via impeding the activation of caspase-3. GSDMD-induced pyroptosis mediated by the AIM2 inflammasome may be involved in EBI following SAH. The inhibition of AIM2 inflammasome activation caused by knocking down AIM2 and caspase-1 alleviates GSDMD-induced pyroptosis in EBI after SAH.

The rise of soluble platelet-derived growth factor receptor ß in CSF early after subarachnoid hemorrhage correlates with cerebral vasospasm.

Platelet-derived growth factor ß (PDGFß) has been proposed to contribute to the development of cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH), and soluble PDGFRß (sPDGFRß) is considered to be an inhibitor of PDGF signaling. We aimed at determining the sPDGFRß concentrations in the cerebrospinal fluid (CSF) of patients with aneurysmal SAH (aSAH) and analyzing the relationship between sPDGFRß level and CVS. CSF was sampled from 32 patients who suffered aSAH and five normal controls. Enzyme-linked immunosorbent assay was performed to determine the sPDGFRß concentrations in the CSF. Functional outcome was assessed using modified Rankin scale (mRS) at 6 months after aSAH. CVS was identified using transcranial Doppler or angio-CT or DSA. The cutoff of sPDGFRß for CVS was defined on the ROC curve. The concentrations of sPDGFRß following aSAH were both higher than those of normal controls on days 1-3 and 4-6, and peaked on days 7-9 post-SAH. The cutoff value of sPDGFRß level on days 1-3 for CVS was defined as 975.38 pg/ml according to the ROC curve (AUC = 0.680, p = 0.082). In addition, CSF sPDGFRß concentrations correlated with CVS (r = 0.416, p = 0.018), and multivariate analysis indicated that sPDGFRß level higher than 975.38 pg/ml on days 1-3 was an independent predictor of CVS (p = 0.001, OR = 19.22, 95% CI: 3.27-113.03), but not for unfavorable outcome after aSAH in the current study. CSF sPDGFRß level increases after aSAH and is higher in patients who developed CVS, and sPDGFRß level higher than 975.38 pg/ml on days 1-3 is a potential predictor for CVS after SAH.

The effect of subarachnoid erythrocyte lysate on brain injury: a preliminary study.

Abundant erythrocytes remain and lyse partially in the subarachnoid space after severe subarachnoid haemorrhage (SAH). But the effect of subarachnoid erythrocyte lysate on brain injury is still not completely clear. In this study, autologous erythrocytes (the non-lysate group) and their lysate (the lysate group) were injected separately into the cistern magna of rabbits to induce a model of experimental SAH, although the control group received isotonic sodium chloride solution instead of erythrocyte solution. Results showed that vasospasm of the basilar artery was observed at 72 h after experimental SAH, but there was no significant difference between the non-lysate group and the lysate group. Brain injury was more severe in the lysate group than in the non-lysate group. Meanwhile, the levels of peroxiredoxin 2 (Prx2), IL-6 and TNF-α in brain cortex and in CSF were significantly higher in the lysate group than those in the non-lysate group. These results demonstrated that brain injury was more likely to be caused by erythrocyte lysate than by intact erythrocytes in subarachnoid space, and inflammation response positively correlated with Prx2 expression might be involved in mechanism of brain injury after SAH.

Efficacy and safety of endovascular treatment versus intravenous thrombolysis for acute ischemic stroke: a meta-analysis of randomized controlled trials.

BACKGROUND AND PURPOSE: Although endovascular therapy (ET) is increasingly used in patients with moderate to severe acute ischemic stroke, its efficacy and safety remains controversial. We performed a meta-analysis aiming to compare the benefits and safety of endovascular treatment and intravenous thrombolysis in the treatment of acute ischemic stroke. METHODS: We systematically searched PubMed, Embase, Science direct and Springer unitil July, 2013. The primary outcomes included good outcome (mRS ≤ 2) and excellent outcome (mRS ≤ 1) at 90 days or at trial end point. Secondary outcomes were occurrence of symptomatic hemorrhage and all-cause mortality. RESULTS: Using a prespecified search strategy, 5 RCTs with 1106 patients comparing ET and intravenous thrombolysis (IVT) were included in the meta-analysis. ET and IVT were associated with similar good (43.06% vs 41.78%; OR=1.14; 95% CI, 0.77 to 1.69; P=0.52;) and excellent (30.43% vs 30.42%; OR=1.05; 95% CI, 0.80 to 1.38; P=0.72;) outcome. For additional end points, ET was not associated with increased occurrence of symptomatic hemorrhage (6.25% vs. 6.22%; OR=1.03; 95% CI, 0.62 to 1.69; P=0.91;), or all-cause mortality (18.45% vs. 17.35%; OR=1.00; 95% CI, 0.73 to 1.39; P=0.99;). CONCLUSIONS: Formal meta-analysis indicates that there are similar safety outcomes and functional independence with endovascular therapy and intravenous thrombolysis for acute ischemic stroke.