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1.
J Coll Physicians Surg Pak ; 34(5): 617-619, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38720227

RESUMO

This cross-sectional study was aimed to compare insulin resistance, Triglyceride- Glucose (TyG) index, fatty liver index (FLI) and hepatic steatosis index (HSI), glycaemic and lipids among groups/quartiles based upon estimated Glucose Disposal Rate (eGDR) from August 2022 to December 2022 among 249 male participants. The eGDR results in (mg/kg/min) were divided into four quartiles as: Group-I: {<6.88, n = 62}, Group-II: {<6.88-9.45, n = 63}, Group-III: {9.46-10.39, n = 62}, and Group-IV: {>10.39, n = 62}. Fasting plasma glucose (FPG), HbA1c, low density lipoprotein (LDL), homeostasis model assessment for insulin-resistance (HOMAIR), and TyG index demonstrated significant worsening increase from high to low eGDR groups. Receiver operating curve (ROC) analysis to calculate area under curve (AUC) for diagnostic efficiency candidate indices for eGDR demonstrated highest AUC for FLI as AUC: 0.736 (95% CI: 0.669-0.803), p < 0.001, followed by FPG: AUC: 0.682 (95% CI: 0.606-0.757), HOMAIR: AUC: 0.670 (95% CI: 0.602-0.739), HSI: AUC: 0.660 (95% CI: 0.589-0.731), TyG index: 0.658 (95% CI: 0.583-0.732), and HbA1c: 0.639 (95% CI: 0.583-0.732). Glycaemic measures, lipid indices, insulin resistance and TyG index deteriorated with declining eGDR. Diagnostic performance as evaluated by AUC for eGDR was highest for FLI, followed by FPG, HOMAIR, HSI, TyG index, HbA1c, and triglycerides. Key Words: Triglyceride, Insulin, Glucose, Diabetes.


Assuntos
Glicemia , Homeostase , Resistência à Insulina , Triglicerídeos , Humanos , Resistência à Insulina/fisiologia , Masculino , Triglicerídeos/sangue , Estudos Transversais , Glicemia/metabolismo , Homeostase/fisiologia , Adulto , Pessoa de Meia-Idade , Fígado Gorduroso/diagnóstico , Fígado Gorduroso/sangue , Hemoglobinas Glicadas/metabolismo , Hemoglobinas Glicadas/análise
2.
Int J Biol Macromol ; 268(Pt 1): 131493, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38608983

RESUMO

Chitosan (CTS), has emerged as a highly intriguing biopolymer with widespread applications, drawing significant attention in various fields ranging from medicinal to chemosensing. Key characteristics of chitosan include solubility, biocompatibility, biodegradability and reactivity, making it versatile in numerous sectors. Several derivatives have been documented for their diverse therapeutic properties, such as antibacterial, antifungal, anti-diabetic, anti-inflammatory, anticancer and antioxidant activities. Furthermore, these compounds serve as highly sensitive and selective chemosensor for the detection of various analytes such as heavy metal ions, anions and various other species in agricultural, environmental and biological matrixes. CTS derivatives interacting with these species and give analytical signals. In this review, we embark on an exploration of the latest advancements in CTS-based materials, emphasizing their noteworthy contributions to medicinal chemistry spanning the years from 2021 to 2023. The intrinsic biological and physiological properties of CTS make it an ideal platform for designing materials that interact seamlessly with biological systems. The review also explores the utilization of chitosan-based materials for the development of colorimetric and fluorimetric chemosensors capable of detecting metal ions, anions and various other species, contributing to advancements in environmental monitoring, healthcare diagnostics, and industrial processes.


Assuntos
Quitosana , Quitosana/química , Humanos , Materiais Biocompatíveis/química , Animais
3.
Crit Rev Anal Chem ; : 1-20, 2024 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-38655923

RESUMO

In recent decades, heavy metal ions have emerged as a significant global environmental concern, posing threats to the delicate balance of ecosystems worldwide. Their introduction into ecosystems occurs through various activities and poses a serious risk to human health. Among heavy metal ions, Cd2+ is recognized as a highly toxic pollutant. Its widespread use contributes to its accumulation in the environment. Chronic exposure to Cd2+ ions present serious risks to both the environment and human health. Therefore, the detection of these metal ions are very important. Organic fluorometric and colorimetric detection have emerged as promising tools for this purpose, offering advantages such as high sensitivity, selectivity, and sometimes reversibility. This review offers a comprehensive overview of the recent advancements in the fluorometric and colorimetric detection of Cd2+ using organic chemosensors from 2019 to 2024. We delve into key aspects of these studies, including the design strategies employed to design novel chemosensors and the underlying sensing mechanisms. Furthermore, we explore the diverse applications of these organic chemosensors, ranging from environmental monitoring to biomedical diagnostics. By analyzing the latest research findings, this review aims to offer insights into the current state-of-the-art in the field of Cd2+ detection using organic chemosensors. Additionally, it highlights the potential opportunities and challenges that lie ahead, paving the way for future advancements in this important area of research.

5.
Am J Transl Res ; 16(2): 432-445, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38463578

RESUMO

BACKGROUND: Human cell division cycle-associated protein 8 (CDCA8), a critical regulator of mitosis, has been identified as a prospective prognostic biomarker in several cancer types, including breast, colon, and lung cancers. This study analyzed the diagnostic/prognostic potential and clinical implications of CDCA8 across diverse cancers. METHODS: Bioinformatics and molecular experiments. RESULTS: Analyzing TCGA data via TIMER2 and GEPIA2 databases revealed significant up-regulation of CDCA8 in 23 cancer types compared to normal tissues. Prognostically, elevated CDCA8 expression correlated with poorer overall survival in KIRC, LUAD, and SKCM, emphasizing its potential as a prognostic marker. UALCAN analysis demonstrated CDCA8 up-regulation based on clinical variables, such as cancer stage, race, and gender, in these cancers. Epigenetic exploration indicated reduced CDCA8 promoter methylation levels in Kidney Renal Clear Cell Carcinoma (KIRC), Lung Adenocarcinoma (LUAD), and Skin Cutaneous Melanoma (SKCM) tissues compared to normal controls. Promoter methylation and mutational analyses showcased a hypomethylation and low mutation rate for CDCA8 in these cancers. Correlation analysis revealed positive associations between CDCA8 expression and infiltrating immune cells, particularly CD8+ and CD4+ T cells. Protein-protein interaction (PPI) network analysis unveiled key interacting proteins, while gene enrichment analysis highlighted their involvement in crucial cellular processes and pathways. Additionally, exploration of CDCA8-associated drugs through DrugBank presented potential therapeutic options for KIRC, LUAD, and SKCM. In vitro validation using reverse transcription-quantitative polymerase chain reaction (RT-qPCR) confirmed elevated CDCA8 expression in LUAD cell lines (A549 and H1299) compared to control cell lines (Beas-2B and NL-20). CONCLUSION: This study provides concise insights into CDCA8's multifaceted role in KIRC, LUAD, and SKCM, covering expression patterns, diagnostic and prognostic relevance, epigenetic regulation, mutational landscape, immune infiltration, and therapeutic implications.

6.
Anal Biochem ; 688: 115479, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38342200

RESUMO

Fluorescein itself is a synthetic organic compound and a prominent member of the xanthene dye family. It exhibits strong fluorescence under ultraviolet (UV) or blue light excitation, making it widely used in various applications, including fluorescence microscopy, flow cytometry, immunoassays, and molecular biology techniques. One of the reasons fluorescein derivatives are highly valuable is their tunable fluorescence properties. Through chemical modifications of the fluorescein structure, different functional groups or substituents can be introduce, altering the compound's fluorescence characteristics such as emission wavelength, intensity, and photo stability. This flexibility allows for tailoring of fluorescent probes to specific experimental requirements, enhancing their utility in a range of scientific disciplines. Fluorescein derivatives also possess excellent antimicrobial and antioxidant activity. This review sheds light on the significant impact of fluorescein derivatives as biological active compounds, highlighting their potential in designing new therapeutic agents with antimicrobial properties. Additionally, their role as antioxidants is discussed. A major aspect covered in the review is the application of fluorescein derivatives as powerful cell imaging probes. Their unique fluorescent properties make them valuable tools for visualizing cellular structures and processes, opening up new possibilities for studying cellular dynamics and interactions.


Assuntos
Anti-Infecciosos , Antioxidantes , Fluoresceína , Antioxidantes/farmacologia , Corantes Fluorescentes/química , Microscopia de Fluorescência , Anti-Infecciosos/farmacologia
7.
JAMA Netw Open ; 7(1): e2353158, 2024 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-38289602

RESUMO

Importance: Over 50% of Acute Respiratory Failure (ARF) survivors experience cognitive, physical, and psychological impairments that negatively impact their quality of life (QOL). Objective: To evaluate the efficacy of a post-intensive care unit (ICU) program, the Mobile Critical Care Recovery Program (m-CCRP) consisting of a nurse care coordinator supported by an interdisciplinary team, in improving the QOL of ARF survivors. Design, Setting, and Participants: This randomized clinical trial with concealed outcome assessments among ARF survivors was conducted from March 1, 2017, to April 30, 2022, with a 12-month follow-up. Patients were admitted to the ICU services of 4 Indiana hospitals (1 community, 1 county, 2 academic), affiliated with the Indiana University School of Medicine. Intervention: A 12-month nurse-led collaborative care intervention (m-CCRP) supported by an interdisciplinary group of clinicians (2 intensivists, 1 geriatrician, 1 ICU nurse, and 1 neuropsychologist) was compared with a telephone-based control. The intervention comprised longitudinal symptom monitoring coupled with nurse-delivered care protocols targeting cognition, physical function, personal care, mobility, sleep disturbances, pain, depression, anxiety, agitation or aggression, delusions or hallucinations, stress and physical health, legal and financial needs, and medication adherence. Main Outcomes and Measures: The primary outcome was QOL as measured by the 36-item Medical Outcomes Study Short Form Health Survey (SF-36) physical component summary (PCS) and mental component summary (MCS), with scores on each component ranging from 0-100, and higher scores indicating better health status. Results: In an intention-to-treat analysis among 466 ARF survivors (mean [SD] age, 56.1 [14.4] years; 250 [53.6%] female; 233 assigned to each group), the m-CCRP intervention for 12 months did not significantly improve the QOL compared with the control group (estimated difference in change from baseline between m-CCRP and control group: 1.61 [95% CI, -1.06 to 4.29] for SF-36 PCS; -2.50 [95% CI, -5.29 to 0.30] for SF-36 MCS. Compared with the control group, the rates of hospitalization were higher in the m-CCRP group (117 [50.2%] vs 95 [40.8%]; P = .04), whereas the 12-month mortality rates were not statistically significantly lower (24 [10.3%] vs 38 [16.3%]; P = .05). Conclusions and Relevance: Findings from this randomized clinical trial indicated that a nurse-led 12-month comprehensive interdisciplinary care intervention did not significantly improve the QOL of ARF survivors after ICU hospitalization. These results suggest that further research is needed to identify specific patient groups who could benefit from tailored post-ICU interventions. Trial Registration: ClinicalTrials.gov Identifier: NCT03053245.


Assuntos
Qualidade de Vida , Insuficiência Respiratória , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Cuidados Críticos , Unidades de Terapia Intensiva , Agressão
8.
Alzheimers Dement ; 20(1): 278-287, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37589315

RESUMO

INTRODUCTION: As the number of older intensive care unit (ICU) survivors grows, there is an urgent need to identify modifiable risk factors for post-ICU dementia. METHODS: We performed a secondary data analysis of 3144 ICU patients ≥ 50 years of age without a history of dementia or severe mental illness who were screened as part of the Pharmacological Management of Delirium (PMD) study. Delirium was assessed using the Confusion Assessment Method for the ICU. Dementia was identified using International Classification of Diseases Ninth and Tenth revision codes for dementia or prescription of anti-dementia medication. RESULTS: Average age (standard deviation) was 65.2 ± 9.5 years; 50.4% were female; and 37.3% were Black. Analyses identified stroke (adjusted hazard ratio [HR] 2.49; 95% confidence interval [CI: 1.52, 4.07], P < 0.001), and depression (adjusted HR 3.03; 95% CI [1.80, 5.10], P < 0.001) as post-ICU risk factors for dementia. DISCUSSION: Future studies will need to examine whether interventions targeting post-ICU stroke and depression can lower dementia incidence in ICU survivors. HIGHLIGHTS: Risk factors for post-intensive care unit (ICU) dementia were distinct from those of Alzheimer's disease. Cardiovascular risk factors were not associated with dementia in older ICU survivors. Post-ICU stroke was associated with a higher risk of dementia in older ICU survivors. Post-ICU depression was associated with a higher risk of dementia in older ICU survivors.


Assuntos
Delírio , Demência , Acidente Vascular Cerebral , Humanos , Feminino , Idoso , Pessoa de Meia-Idade , Masculino , Delírio/epidemiologia , Delírio/etiologia , Estudos Prospectivos , Unidades de Terapia Intensiva , Fatores de Risco , Acidente Vascular Cerebral/complicações , Demência/epidemiologia , Demência/complicações , Sobreviventes
9.
Heart Lung ; 63: 35-41, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37748302

RESUMO

BACKGROUND: Postoperative delirium occurs in up to 80% of patients undergoing esophagectomy. We performed an exploratory proteomic analysis to identify protein pathways that may be associated with delirium post-esophagectomy. OBJECTIVES: Identify proteins associated with delirium and delirium severity in a younger and higher-risk surgical population. METHODS: We performed a case-control study using blood samples collected from patients enrolled in a negative, randomized, double-blind clinical trial. English speaking adults aged 18 years or older, undergoing esophagectomy, who had blood samples obtained were included. Cases were defined by a positive delirium screen after surgery while controls were patients with negative delirium assessments. Delirium was assessed using Richmond Agitation Sedation Scale and Confusion Assessment Method for the Intensive Care Unit, and delirium severity was assessed by Delirium Rating Scale-Revised-98. Blood samples were collected pre-operatively and on post-operative day 1, and discovery proteomic analysis was performed. Between-group differences in median abundance ratios were reported using Wilcoxon-Mann-Whitney Odds (WMWodds1) test. RESULTS: 52 (26 cases, 26 controls) patients were included in the study with a mean age of 64 (SD 9.6) years, 1.9% were females and 25% were African American. The median duration of delirium was 1 day (IQR: 1-2), and the median delirium/coma duration was 2.5 days (IQR: 2-4). Two proteins with greater relative abundance ratio in patients with delirium were: Coagulation factor IX (WMWodds: 1.89 95%CI: 1.0-4.2) and mannosyl-oligosaccharide 1,2-alpha-mannosidase (WMWodds: 2.4 95%CI: 1.03-9.9). Protein abundance ratios associated with mean delirium severity at postoperative day 1 were Complement C2 (Spearman rs = -0.31, 95%CI [-0.55, -0.02]) and Mannosyl-oligosaccharide 1,2-alpha-mannosidase (rs = 0.61, 95%CI = [0.29, 0.81]). CONCLUSIONS: We identified changes in proteins associated with coagulation, inflammation, and protein handling; larger, follow-up studies are needed to confirm our hypothesis-generating findings.


Assuntos
Delírio , Delírio do Despertar , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Masculino , Estudos de Casos e Controles , Delírio/etiologia , Delírio/epidemiologia , Esofagectomia/efeitos adversos , Proteômica , Unidades de Terapia Intensiva
10.
J Vasc Surg Venous Lymphat Disord ; 12(2): 101687, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37708934

RESUMO

OBJECTIVE: The objective of this study was to help guide inferior vena cava (IVC) filter choices by better understanding the retrieval characteristics, complications, and total costs between two commonly used IVC filters. METHODS: All patients who underwent retrieval or attempted retrieval of Denali (Bard Peripheral Vascular) or Option (Argon Medical Devices) IVC filters were identified between March 2016 and October 2021 at a single tertiary care center. Those with imaging studies that permitted evaluation of filter placement, presence or degree of tilt, and/or hooking of the filter into the IVC wall were included in the present study. Filter retrieval success, number of attempts, use of advanced techniques, and fluoroscopy and procedural times were recorded and compared between the two filters. RESULTS: A total of 87 patients presented for retrieval of 52 Denali and 35 Option Elite filters during the study period. Denali filters were more likely to be successfully retrieved at the first attempt (94% vs 77%; P = .019). The procedural and fluoroscopy times were shorter for Denali filters (29 minutes vs 63 minutes [P < .001] and 7 minutes vs 25 minutes [P < .001], respectively). Denali filters were less likely to be significantly tilted (≥15○) at retrieval (12% vs 29%; P < .001) or to have the filter hook embedded in the IVC wall (6% vs 40%; P < .001). Tilting of the filter of ≥15○ had no significant effects on the retrieval success rate (no tilt or tilt <15○ vs tilt of ≥15○: 98% vs 100%; P = .58). In contrast, filter hook penetration into the IVC wall significantly reduced successful recovery (41% vs 99%; P < .001). CONCLUSIONS: The findings from this study suggest that although the filter designs are similar, a benefit exists in the ease of retrievability of the Denali over the Option filter. We found that tilting and hooking of the filter in the IVC wall occurred significantly more with the Option filter. These factors likely made retrieval more difficult and contributed to the longer procedure and fluoroscopy times.


Assuntos
Filtros de Veia Cava , Humanos , Fatores de Tempo , Remoção de Dispositivo/métodos , Implantação de Prótese , Veia Cava Inferior/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento
11.
Front Oncol ; 13: 1282823, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37954081

RESUMO

Background: Xeroderma pigmentosum (XP), a rare disease with defects in DNA repair genes, has >1,000-fold increased risk of ultraviolet-induced skin cancers. Immune checkpoint inhibitors (ICIs) are used for treating cancers with large numbers of mutations but may also promote adverse events (AEs). Deficient DNA repair in XP patients may lead to increased numbers of mutations, leading to enhanced efficacy of cancer response or, alternatively, to increased AE in response to ICI. We sought to compare the efficacy and AE of ICI in XP patients with metastatic or unresectable cancers to that of ICI-treated patients in the general population. Methods: In this retrospective study, we reviewed medical records of XP patients treated in the United States and in London (UK). We also reviewed published reports of ICI-treated XP patients and patients in the general population. Results: Metastatic or unresectable cancers in all 22 (100%) XP patients showed regression or remission in response to ICI. The types and frequencies of AE in XP patients were similar to those reported among ICI-treated patients in the general population. However, two XP patients had concurrent additional cancers that did not respond to ICI, two XP patients had cancer recurrence or progression after initial response, and eight XP patients developed new skin cancers during or after ICI treatment. Conclusion: In this retrospective study with small sample size, XP patients demonstrated positive responses to ICI and the treatment was well tolerated but some patients developed new skin cancers while being treated. ICIs can be considered in treating metastatic or unresectable cancers in XP patients.

12.
J Coll Physicians Surg Pak ; 33(11): 1327-1329, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37926890

RESUMO

A cross-sectional analysis was conducted to compare conventional and emerging anthropometric measures among male participants with and without fatty liver disease (FLD). The objective was to assess differences and diagnostic efficiency of anthropometric-parameters using receiver operating curve (ROC) analysis at Combined Military Hospital Multan, NUMS from April to October 2022. Comparison for anthropometric measurements between non-FLD (n=164) vs. FLD (n=85) indicated significant differences in weight (74.01 + 11.96 vs. 85.91 + 14.07 kg, p<0.001), waist circumference (9.38 + 9.82 vs. 101.35 + 10.74 cm, p<0.001), BMI (24.81 + 4.0 vs. 29.21 + 4.38 kg/m2, p<0.001), waist-to-hip ratio (WHpR) (0.924 + 0.054 vs. 0.971 + 0.054, p<0.001), waist-to-height ratio (WHtR) (0.508 + 0.054 vs. 0.578 + 0.062, p<0.001), and abdominal volume index (AVI) (16.17 + 3.56 vs. 20.77 + 4.61, p<0.001). Fatty liver index (FLI) also showed significant difference between non-FLD vs. FLD groups (38.35 + 27.12 vs. 72.01 + 21.31, p<0.001). AUCs for various significant anthropometric measurements from highest to lowest as 0.821 (95% CI: 0.767-0.874) for FLI, 0.815 (95% CI: 0.761-0.869) for WHtR, 0.809 (95% CI: 0.754-0.863) for AVI, and 0.808 (95% CI: 0.754-0.863) for waist circumference with lowest recorded AUC for height as 0.422 (95% CI: 0.347-0.497). Key Words: Fatty liver disease (FLD), Body mass index (BMI), A body shape index (ABSI), C-index, Abdominal volume index (AVI), Body roundness index (BRI).


Assuntos
Hepatopatias , Razão Cintura-Estatura , Humanos , Masculino , Estudos Transversais , Antropometria , Índice de Massa Corporal , Circunferência da Cintura , Fatores de Risco , Curva ROC
13.
J Coll Physicians Surg Pak ; 33(10): 1085-1086, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37804010

RESUMO

Null.

14.
Health Sci Rep ; 6(10): e1634, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37867787

RESUMO

Background and Aims: Given the growing utilization of critical care services by an aging population, development of population-level risk models which predict intensive care unit (ICU) survivorship and mortality may offer advantages for researchers and health systems. Our objective was to develop a risk model for ICU survivorship and mortality among community dwelling older adults. Methods: This was a population-based cohort study of 48,127 patients who were 50 years and older with at least one primary care visit between January 1, 2017, and December 31, 2017. We used electronic health record (EHR) data to identify variables predictive of ICU survivorship. Results: ICU admission and mortality within 2 years after index primary care visit date were used to divide patients into three groups of "alive without ICU admission", "ICU survivors," and "death." Multinomial logistic regression was used to identify EHR predictive variables for the three patient outcomes. Cross-validation by randomly splitting the data into derivation and validation data sets (60:40 split) was used to identify predictor variables and validate model performance using area under the receiver operating characteristics (AUC) curve. In our overall sample, 92.2% of patients were alive without ICU admission, 6.2% were admitted to the ICU at least once and survived, and 1.6% died. Greater deciles of age over 50 years, diagnoses of chronic obstructive pulmonary disorder or chronic heart failure, and laboratory abnormalities in alkaline phosphatase, hematocrit, and albumin contributed highest risk score weights for mortality. Risk scores derived from the model discriminated between patients that died versus remained alive without ICU admission (AUC = 0.858), and between ICU survivors versus alive without ICU admission (AUC = 0.765). Conclusion: Our risk scores provide a feasible and scalable tool for researchers and health systems to identify patient cohorts at increased risk for ICU admission and survivorship. Further studies are needed to prospectively validate the risk scores in other patient populations.

15.
PLoS One ; 18(9): e0290298, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37656731

RESUMO

OBJECTIVE: In critically ill adults with delirium, biomarkers of systemic inflammation, astrocyte activation, neuroprotection, and systemic inflammation measured at one week of critical illness may be associated with mortality. DESIGN: Prospective observational study. SETTING: Intensive care unit (ICU). PATIENTS: 178 ICU patients with delirium, alive and remaining in ICU at one week. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Blood samples collected for a pair of previously published, negative, clinical trials were utilized. Samples were collected at study enrollment/ICU admission (Day 1 sample) and one week later (Day 8 sample), and analyzed for interleukins (IL)-6, 8, 10, Insulin-like Growth Factor (IGF), S100 Binding Protein (S100B), Tumor Necrosis Factor Alpha (TNF-A) and C-Reactive Protein (CRP). Delirium, delirium severity, and coma were assessed twice daily using Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), CAM-ICU-7, and Richmond Agitation-Sedation Scale (RASS), respectively. Mortality was assessed until discharge using the electronic medical record. Logistic regression models adjusting for age, sex, severity of illness, comorbidities, sepsis, and randomization status, were used to assess the relationship among biomarkers and mortality. Higher IL-10 quartiles at day 8 were associated with increased odds of hospital mortality (IL-10: OR 2.00 95%CI: 1.1-3.65, p = 0.023). There was a significant interaction between day 1 and day 8 biomarker quartiles only for IL-6. Patients with IL-6 values in the first three quartiles on admission to the ICU that transitioned to higher IL-6 quartiles at day 8 had increased probability of hospital mortality. CONCLUSION: In this hypothesis-generating study, higher IL-6 and IL-10 quartiles at one week, and increase in IL-6 from day 1 to day 8 were associated with increased hospital mortality. Studies with larger sample sizes are needed to confirm the mechanisms for these observations.


Assuntos
Estado Terminal , Delírio , Adulto , Humanos , Mortalidade Hospitalar , Neuroproteção , Astrócitos , Interleucina-10 , Interleucina-6 , Estudos Prospectivos , Biomarcadores , Inflamação
16.
Ann Surg ; 278(6): 850-857, 2023 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-37638414

RESUMO

OBJECTIVE: To assess whether multiplayer immersive Virtual Reality (iVR) training was superior to single-player training for the acquisition of both technical and nontechnical skills in learning complex surgery. BACKGROUND: Superior teamwork in the operating room (OR) is associated with improved technical performance and clinical outcomes. iVR can successfully train OR staff individually; however, iVR team training has yet to be investigated. METHODS: Forty participants were randomized to individual or team iVR training. Individually trained participants practiced alongside virtual avatar counterparts, whereas teams trained live in pairs. Both groups underwent 5 iVR training sessions over 6 weeks. Subsequently, they completed a real-life assessment in which they performed anterior approach total hip arthroplasty surgery on a high-fidelity model with real equipment in a simulated OR. Teams performed together, and individually trained participants were randomly paired up. Videos were marked by 2 blinded assessors recording the 'Non-Operative Technical Skills for Surgeons, Oxford NOn-TECHnical Skills II and Scrub Practitioners' List of Intraoperative Non-Technical Skills' scores. Secondary outcomes were procedure duration and the number of technical errors. RESULTS: Teams outperformed individually trained participants for nontechnical skills in the real-world assessment (Non-Operative Technical Skills for Surgeons: 13.1±1.5 vs 10.6±1.6, P = 0.002, Non-TECHnical Skills II score: 51.7 ± 5.5 vs 42.3 ± 5.6, P = 0.001 and Scrub Practitioners' List of Intraoperative Non-Technical Skills: 10 ± 1.2 vs 7.9 ± 1.6, P = 0.004). They completed the assessment 33% faster (28.2 minutes ± 5.5 vs 41.8 ± 8.9, P < 0.001), and made fewer than half the number of technical errors (10.4 ± 6.1 vs 22.6 ± 5.4, P < 0.001). CONCLUSIONS: Multiplayer training leads to faster surgery with fewer technical errors and the development of superior nontechnical skills.


Assuntos
Internato e Residência , Realidade Virtual , Humanos , Competência Clínica , Currículo , Aprendizagem
17.
Int J Biol Macromol ; 249: 126065, 2023 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-37524273

RESUMO

Herein, we designed an on-site and portable colorimetric assay using cellulose acetate polymeric films incorporated with HKUST-1 metal-organic framework while immersed in a solution of methyl red and brilliant cresyl blue organic dyes as an indicator for monitoring ammonia levels. Ammonia serves as a significant biomarker of food spoilage which falls under the category of volatile organic compounds (VOCs). The designed colorimetric solid-state sensor was comprehensively characterized using FE-SEM, EDS-mapping, XRD, FTIR, and contact angle analyses. The results confirmed the superior stability, water permeability, good crystallinity and desirable morphology of the prepared sensor platform. Additionally, customized smartphone was developed and applied for online signaling and colorimetric analysis. The findings demonstrated two linear ranges: 1-100 ppb and 0.1-1340 ppm with a detection limit of 0.02 ppm. The solid-state sensor exhibited high selectivity in the presence of other VOCs such as methanol, ethanol, acetone, 2-propanol, toluene, humidity, and hexane. It displayed acceptable repeatability in both inter-day (RSD = 3.38 %) and intraday (RSD = 3.86 %), long-term stability over 4 days as well as reusability over 3 cycles. We successfully applied this sensing platform for ammonia monitoring in spoiled meat foods including veal, fish and chicken. The results indicated favorable percentage recovery and repeatability, confirming the feasibility and potential applicability of this intelligent packaging system for monitoring freshness. The platform allows for real-time monitoring and data analysis via smartphone-based online signaling, providing a convenient and effective method for ensuring food quality.


Assuntos
Colorimetria , Produtos da Carne , Animais , Bovinos , Amônia , Produtos da Carne/análise , Carne/análise , Embalagem de Alimentos , Concentração de Íons de Hidrogênio
18.
J Vasc Surg ; 78(2): 490-497, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37150486

RESUMO

OBJECTIVE: Optimizing medical management and risk factor modification are underused strategies in patients with chronic limb-threatening ischemia (CLTI), despite evidence of improved outcomes. The Vascular Quality Initiative (VQI) registry is a tool to improve quality of vascular care. In this study, we used the VQI to evaluate trends in medical management in patients with CLTI undergoing peripheral vascular interventions (PVI), and the impact of changes in management on overall survival (OS), amputation-free survival (AFS), and limb salvage (LS). METHODS: Patients undergoing index PVI for CLTI between 2012 and 2016, with ≥24 months of follow-up were identified from the national VQI registry. Patient details including smoking status and medication use, OS, LS, and AFS were analyzed with linear-by-linear association, t test, and logistic regression. RESULTS: There were 12,370 PVI completed in 11,466 patients. There was a significant increase in infrapopliteal interventions (from 29.8% to 39.0%; P < .001) and PVI performed for tissue loss (from 59.1% to 66.5%; P < .001). The percentage of current smokers at time of PVI decreased (from 36.2% to 30.7%; P = .036). At discharge, statins were initiated in 25%, aspirin in 45%, and P2Y12 therapy in 58% of patients not receiving these medications before PVI. Over the course of follow-up, dual antiplatelet therapy (DAPT) (from 41.1% to 48.0%; P < .001), angiotensin-converting enzyme (ACE) inhibitor (from 46.2% to 51.3%; P < .001), and statin (from 70.4% to 77.5%; P < .001) use increased. Combined DAPT, ACE inhibitor and statin use increased from 33.6% to 39.6% (P ≤ .001). Significant improvement in 24-month OS and AFS was noted (OS, from 90.9% to 93.7% [P = .002]: AFS, from 81.2% to 83.1% [P = .046]), but not LS (from 89.6% to 89.0%; P = .83). Combined therapy with P2Y12 inhibitors, statins and ACE inhibitors was an independent predictor of improved OS (hazard ratio, 0.61; 95% confidence interval, 0.39-0.96; P = .034). DAPT was independent predictor of improved LS (hazard ratio, 0.83; 95% confidence interval, 0.79-0.87; P < .007). CONCLUSIONS: Antiplatelet, ACE inhibitor, and statin use increased over the study period and was associated with improved OS and AFS. LS trends did not change significantly over time, possibly owing to the inclusion of patients with a greater disease burden or inadequate medical management. Medical management, although improved, remained far from optimal and represents an area for continued development.


Assuntos
Procedimentos Endovasculares , Inibidores de Hidroximetilglutaril-CoA Redutases , Doença Arterial Periférica , Humanos , Isquemia Crônica Crítica de Membro , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Medição de Risco , Procedimentos Endovasculares/efeitos adversos , Inibidores da Agregação Plaquetária/efeitos adversos , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/terapia , Isquemia/diagnóstico , Isquemia/terapia , Fatores de Risco , Salvamento de Membro , Inibidores da Enzima Conversora de Angiotensina , Estudos Retrospectivos , Resultado do Tratamento
19.
Environ Monit Assess ; 195(6): 633, 2023 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-37131087

RESUMO

We designed and synthesized a fluorescent "turn-on" and colorimetric chemosensor ((E)-1-((p-tolylimino)methyl)naphthalen-2-ol) SB. The structure of the synthesized chemosensor was investigated by 1H NMR, FT-IR, and fluorescence spectroscopy, and its sensing properties were studied toward Mn2+, Cu2+, Pb2+, Cd2+, Na+, Ni2+, Al3+, K+, Ag+, Zn2+, Co2+, Cr3+, Hg2+, Ca2+, and Mg2+. SB showed an excellent colorimetric (yellow to yellowish brown) in MeOH and fluorescence "turn-on" sensing response to Cu2+ in MeOH/Water (10/90, v/v) media. The sensing mechanism of SB toward Cu2+ was investigated by FT-IR, 1H NMR titration, DFT studies, and Job's plot analysis. The detection limit was calculated to be very low 0.0025 µg mL-1 (0.0025 ppm). Furthermore, the test strip containing SB also showed excellent selectivity and sensitivity toward Cu2+ in a solution medium and when supported on a solid medium.


Assuntos
Colorimetria , Bases de Schiff , Espectroscopia de Infravermelho com Transformada de Fourier , Monitoramento Ambiental , Corantes
20.
Crit Rev Anal Chem ; : 1-25, 2023 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-37029905

RESUMO

Thiazole and its derivatives play an important role in biological and non-biological fields due to several structural and electronic behaviors associated with it. Thiazole derivatives act as chemosensors because they formed metal complexes upon interacting with various heavy metal ions like Cd2+, Co2+, Cr3+, Fe3+, Ag+, Al3+, Cu2+, Pd2+, Hg2+, Ni2+, Ga3+, In3+, Sn4+, Pb2+, Zn2+ as well as other cations. These metal ions are of prime importance from the environmental point of view with high. This review article focuses on the thiazole-based colorimetric as well as fluorometric sensor for the recognition of different heavy metal cations in various specimens like agricultural, biological, and environmental. It also summarizes the binding stoichiometry, detection limit, pH, structure, and practical application of the reported thiazole-based chemosensors. Further, the sensing performances, have been discussed and compared with some reported organic sensors.

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