Impact of Charlson Comorbidity Index on in-hospital mortality of patients with hyperglycemic crises: A propensity score matching analysis.

AIM: This study was designed to investigate the association between Charlson Comorbidity Index (CCI) and in-hospital mortality and other clinical outcomes among patients with hyperglycemic crises. METHOD: This retrospective cohort study was conducted using data from electric medical records. A total of 1668 diabetic patients with hyperglycemic crises from six tertiary hospitals met the inclusion criteria. CCI < 4 was defined as low CCI and CCI ≥ 4 was defined as high CCI. Propensity score matching (PSM) with the 1:1 nearest neighbour matching method and the caliper value of 0.02 was used to match the baseline characteristics of patients with high CCI and low CCI to reduce the confounding bias. In-hospital mortality, ICU admission, hypoglycemia, hypokalemia, acute kidney injury, length of stay (LOS), and hospitalisation expense between low CCI and high CCI were compared and assessed. Univariate and multivariate regression were applied to estimate the impact of CCI on in-hospital and other clinical outcomes. OUTCOME: One hundred twenty-one hyperglycemic crisis (HC) patients died with a mortality rate of 7.3%. After PSM, compared with low CCI, patients with high CCI suffered higher in-hospital mortality, ICU admission, LOS, and hospitalisation expenses. After multivariate regression, age (aOR: 1.12, 95% confidence interval [CI]: 1.06-1.18, p < 0.001), CCI(aOR: 4.42, 95% CI: 1.56-12.53, p = 0.005), uninsured (aOR: 22.32, 95% CI: 4.26-116.94, p < 0.001), shock (aOR: 10.57, 95% CI: 1.41-79.09, p = 0.022), mechanical ventilation (aOR: 75.29, 95% CI: 12.37-458.28, p < 0.001), and hypertension (aOR: 4.34, 95% CI: 1.37-13.82, p = 0.013) were independent risk factors of in-hospital mortality of HC patients. Besides, high CCI was an independent risk factor for higher ICU Admission (aOR: 5.91, 95% CI: 2.31-15.08, p < 0.001), hypoglycemia (aOR: 2.19, 95% CI:1.01-4.08, p = 0.049), longer LOS (aOR: 1.23, 95% CI: 1.19-2.27, p = 0.021), and higher hospitalisation expense (aOR: 2089.97, 95% CI: 193.33-3988.61, p = 0.031) of HC patients. CONCLUSION: CCI is associated with in-hospital mortality, ICU admission, hypoglycemia, LOS, and hospitalisation expense of HC patients. CCI could be an ideal indicator to identify, monitor, and manage chronic comorbidities among HC patients.

The impact of insurance status on in-hospital mortality in patients with hyperglycaemic crisis: A propensity score matching analysis.

AIM: This study was designed to determine the associations between insurance status and clinical outcomes among patients with hyperglycaemic crisis. METHODS: Overall, 1668 patients with hyperglycaemic crisis were recruited from the Chongqing Medical University Medical Data Science Academy's big data platform. In-hospital mortality, length of stay and complications (i.e., hypoglycaemia, hypokalemia, pulmonary infection, multiple systemic organ failure, acute kidney injury and deep venous thrombosis) were assessed. Propensity score matching analysis was used to reduce the confounding bias, and univariate and multivariate logistic regression were used to estimate the effect of insurance status on mortality in patients with hyperglycaemic crisis. RESULTS: After matching one uninsured patient to two insured patients with a calliper of 0.02, the uninsured group suffered a higher burden of in-hospital mortality than the insured group (16.9% vs. 9.8%); the insured status (odds ratio = 0.216, 95% confidence interval = 0.079-0.587) was a potential protect factor for in-hospital mortality of patients with hyperglycaemic crisis in the multivariate logistic regression analysis. CONCLUSIONS: Insurance status is associated with the outcomes of hospitalisation for hyperglycaemic crisis; uninsured patients with hyperglycaemic crisis face a higher risk of mortality in China.

The Impact of COVID-19 on the Acute Stroke Care Pathway: Looking Beyond the Short Term.

Background: Early in the pandemic, coronavirus disease 2019 (COVID-19) had been reported with significant impact on the stroke care pathway. Meanwhile, the mid/long-term consequence of treatment efficiency and effectiveness of the acute stroke pathway still remains unknown. Methods: A comprehensive retrospective analysis was conducted on the acute stroke care pathway parameters in a stroke unit in Chongqing, Southwest China. A total of 1492 patients were involved in this study, of whom 634 patients (42.5%) were included during the COVID-19 pandemic, 858 patients (57.5%) included during the similar period of 2019. We collected demographic and clinical characteristics, clinical outcome as the treatment efficiency and effectiveness indicators of the acute stroke pathway. Results: Compared to the same period in 2019, there were 2.8% fewer transient ischemic attack (TIA) patients, while 9.9% more acute ischemic stroke patients in 2020. In addition, patients had significantly higher National Institutes of Health Stroke Scale (NIHSS) scores (P = 0.002) and hospital mortality (P = 0.004) during the pandemic. The median door-CT time (P < 0.001) and emergency stay (P < 0.001) of acute stroke were also remarkably increased during the pandemic. The proportion of patients with intravenous thrombolysis (IVT) was significantly lower (P < 0.001), while the mechanical thrombectomy (MET) was remarkably higher (P = 0.042) in the pandemic group. Moreover, the IVT was significantly delayed during the pandemic (door-needle time: P = 0.001). Conclusion: The COVID-19 outbreak did not reduce the willingness of the acute stroke patient to seek medical help. Benefited from adjustments of stroke procedure in response to the COVID-19 pandemic, no significant reduction was observed in the reperfusion success of the acute stroke care pathway. However, more medical resources need to be invested into the acute stroke care pathway to prevent serious consequences of undiagnosed and untreated strokes.

Synergistic photodynamic and photothermal therapy of BODIPY-conjugated hyaluronic acid nanoparticles.

The combination of photodynamic therapy (PDT) and photothermal therapy (PTT) has emerged as a promising strategy for complete tumor ablation therapy. Herein, a boron dipyrromethene (BODIPY)-conjugated hyaluronic acid polymer that can self-assemble to form the nanoparticles (BODIPY-HA NPs) was prepared for combined cancer PDT and PTT. The fluorescence emission and reactive oxygen species (ROS) generation of BODIPY-HA NPs were inhibited because of the π-π stacking behavior of BODIPY, resulting in photothermal effect under 808 nm light irradiation. Upon the internalization by cancer cells, the BODIPY-HA NPs could disassemble into BODIPY-HA molecules, with the recovery of the fluorescence and ROS generation for PDT. Importantly, in vitro results confirmed that combined PTT and PDT have exhibited better anticancer effect than PTT alone upon 808 nm laser irradiation. These results showed that the self-assembled BODIPY-HA NPs may be a promising nanomedicine for synergistic cancer PDT and PTT.

Hierarchical nano-to-molecular disassembly of boron dipyrromethene nanoparticles for enhanced tumor penetration and activatable photodynamic therapy.

The development of activatable photosensitizers (PSs) is of particular interest for achieving tumor photodynamic therapy (PDT) with minimal side effects. However, the in vivo applications of PSs are limited by complex physiological and biological delivery barriers. Herein, boron dipyrromethene (BDP)-based nanoparticles are developed through the self-assembly of a multifunctional "one-for-all" building block for enhanced tumor penetration and activatable PDT. The nanoparticles show excellent colloidal stability and long circulation lifetime in blood. Once they reach the tumor site, the first-stage size reduction occurs due to the hydrolysis of the Schiff base bond between polyethylene glycol and the cyclic Arg-Gly-Asp peptide in the acidic tumor microenvironment (pH~6.5), facilitating tumor penetration and specific recognition by cancer cells overexpressing integrin ανß3 receptors. Upon the endocytosis by cancer cells, the second-stage size reduction is triggered by more acidic pH in lysosomes (pH~4.5). Importantly, the protonated diethylamino groups can block photoinduced electron transfer from the amine donor to the excited PSs and accelerate complete disassembly of the nanoparticles into single PS molecule, with the recovery of the fluorescence and photoactivity for efficient PDT. This study presents a smart PS delivery strategy involving acidity-triggered hierarchical disassembly from the nano to molecular scale for precise tumor PDT.

Gram-scale synthesis of splat-shaped Ag-TiO2 nanocomposites for enhanced antimicrobial properties.

The control over contagious diseases caused by pathogenic organisms has become a serious health issue. The extensive usage of antibiotics has led to the development of multidrug-resistant bacterial strains. In this regard, metal-oxide-based antibacterial nanomaterials have received potential research interest due to the efficient prevention of microorganism growth. In this study, splat-shaped Ag-TiO2 nanocomposites (NCs) were synthesized on the gram scale and the enhanced antibacterial properties of TiO2 in the presence of silver were examined. The formation of Ag-TiO2 NCs was analyzed through various characterization techniques. The cell viability experimental results demonstrated that the Ag-TiO2 NCs have good biocompatibility. The antibacterial activity of the prepared Ag-TiO2 NCs was tested against the Gram-positive Staphylococcus aureus (S. aureus) and Gram-negative Escherichia coli (E. coli) bacterial strains. The Ag-TiO2 NCs exhibited promising and superior antibacterial properties compared to TiO2 nanospheres as confirmed by the bacterial growth and inhibition zone. The improvement in the antibacterial activity was attributed to the synergistic effect of the hybrid nature of TiO2 nanoparticles in the presence of Ag.

Poly(amidoamine)-modified mesoporous silica nanoparticles as a mucoadhesive drug delivery system for potential bladder cancer therapy.

Bladder cancer, with the highest recurrence rate in all malignancy, is a common urologic cancer that arises on the bladder mucosa. Currently, tumor resection followed by intravesical chemotherapy is the primary treatment of bladder cancer, which has limited effectiveness ascribe to short dwell-time of intravesical drugs in bladder. Therefore, there is a need to develop mucoadhesive and sustained drug delivery systems to increase drug residence time for intravesical chemotherapy. In this study, poly(amidoamine) (PAMAM) dendrimers were modified onto the surface of mesoporous silica nanoparticles (MSNPs) through a layer-by-layer grafting method. A series of PAMAM-modified MSNPs were prepared and compared for their mucoadhesive capabilities on pig bladder wall and controlled drug release properties. Results demonstrated an increase in the mucoadhesive capacity of PAMAM-modified MSNPs upon an increase in the number of PAMAM amino groups, and the maximum nanoparticle mucoadhesivity was observed after two-generation PAMAM were grafted on the surface of MSNPs. An antineoplastic, doxorubicin, was encapsulated in the mesopores of PAMAM-modified MSNPs, and the drug-loaded nanoparticles can provide a sustained drug release triggered by acidic pH. The present study demonstrates that the mucoadhesive and drug release properties of MSNPs can be controlled by the layer number of PAMAM dendrimers on the nanoparticle surface, holding significant potential for the development of mucoadhesive drug delivery systems for bladder cancer therapy.

Comparative efficacy and safety of analgesics for acute renal colic: A network meta-analysis protocol.

INTRODUCTION: Acute renal colic is one of the most common urological emergencies. While previous randomized controlled trials (RCTs) and pairwise meta-analyses only looked at the efficacy of 1 or 2 analgesics. It is not fully understood that the comprehensive ranking of the effectiveness and safeness of analgesics from these published articles. Therefore, this network meta-analysis (NMA) aims to compare and rank the different analgesics for treatment of acute renal colic. METHODS AND ANALYSIS: We will perform a systematic literature search in PubMed, EMBASE, CINAHL, Web of Science, and Cochrane Library to identify RCTs of different analgesics for acute renal colic. RCTs assessing active analgesics intervention against active comparator or placebo controls for acute renal colic will be included. We will also screen the reference lists of included studies, previous reviews and meta-analyses to identify other relevant trials. The primary outcomes will be pain variance at 30 minutes, need rescue medicine, complete pain relief or at least 50% pain relief at 30 minutes, and pain relapse within 24 hours. We will also assess secondary outcomes for safeness (side effects: dizziness, vomit, allergic, hypotension, cardiac toxicity, and drug dependence). The risk of bias of included RCTs will be assessed by using the Cochrane Collaboration's tool, and the quality of evidence will be assessed by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument. We will perform pairwise meta-analysis and Bayesian NMA to compare the effectiveness and safeness of different analgesic interventions. RESULTS: This NMA will compare and rank the different analgesics for treatment of acute renal colic. CONCLUSION: This is the first systematic review to use the NMA to comprehensively compare and rank analgesics for relieving pain of acute renal colic in adults based on most important factors deciding the choice of initial analgesia, and the results can provide implications for clinical practice and further research.