Long-term survival in stroke patients: insights into triglyceride-glucose body mass index from ICU data.

BACKGROUND: The Triglyceride Glucose-Body Mass Index (TyG-BMI) has been established as a robust indicator of insulin resistance (IR), reflecting metabolic health across various populations. In general, lower TyG-BMI values are often associated with better metabolic health outcomes and a reduced risk of adverse health events in non-critically ill populations. Previous studies have highlighted a significant negative association between TyG-BMI and all-cause mortality (ACM) among critically ill atrial fibrillation patients. Given the high prevalence and severe outcomes associated with stroke, understanding how TyG-BMI at the time of ICU admission correlates with ACM in critically ill stroke patients becomes imperative. This study aims to assess the correlation between TyG-BMI and ACM in this specific patient cohort, exploring how traditional associations between TyG-BMI and metabolic health may differ in the context of acute, life-threatening illness. METHODS: Patient data were retrieved by accessing the Medical Information Mart for Intensive Care IV (MIMIC-IV 2.2) database, categorizing patients into three groups on the basis of TyG-BMI tertiles. The study evaluated both primary and secondary outcomes: the primary outcomes included the 90-day, 180-day, and 1-year ACM, while secondary outcomes encompassed ICU, in-hospital, and 30-day ACM. Our study employed the Kaplan-Meier (K-M) curve method for outcome comparison across the groups while utilizing multivariate Cox proportional-hazards regression models and restricted cubic splines (RCS) to explore TyG-BMI association with these outcomes. Additionally, interaction and subgroup analyses were performed, focusing on different mortality time points. RESULTS: Among a cohort of 1707 individuals diagnosed with stroke, the average age was 68 years (interquartile range [IQR]: 58-78 years), with 946 (55.42%) of the participants being male. The analysis of K-M curves suggested that patients having a lower TyG-BMI level faced a heightened risk of long-term ACM, whereas the short-term ACM exhibited no statistically significant differences across the three TyG-BMI groups. Furthermore, Cox proportional-hazards regression analysis validated a statistically significant increased risk of long-term ACM among patients belonging to the lowest TyG-BMI tertile. Additionally, RCS analysis results demonstrated L-shaped correlations between the TyG-BMI index and both short- and long-term ACM. These findings underscore the TyG-BMI predictive value for long-term mortality in stroke patients, highlighting a nuanced relationship that varies over different time frames. The results revealed no interactions between TyG-BMI and the stratified variables, with the exception of age. CONCLUSION: In our study, lower TyG-BMI levels in critically ill stroke patients are significantly related to a higher risk of long-term ACM within the context of the United States. This finding suggests the potential of TyG-BMI as a marker for stratifying long-term risk in this patient population. However, it's crucial to note that this association was not observed for short-term ACM, indicating that the utility of TyG-BMI may be more pronounced in long-term outcome prediction. Additionally, our conclusion that TyG-BMI could serve as a reliable indicator for managing and stratifying stroke patients over the long term is preliminary. To confirm our findings and assess the universal applicability of TyG-BMI as a prognostic tool, it is crucial to conduct rigorously designed research across various populations.

Triglyceride-glucose index: a novel evaluation tool for all-cause mortality in critically ill hemorrhagic stroke patients-a retrospective analysis of the MIMIC-IV database.

BACKGROUND: Hemorrhagic stroke (HS), including non-traumatic intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH), constitutes a substantial proportion of cerebrovascular incidents, accounting for around 30% of stroke cases. The triglyceride-glucose index (TyG-i) represents a precise insulin resistance (IR) indicator, a crucial metabolic disturbance. Existing literature has demonstrated an association between TyG-i and all-cause mortality (ACM) among individuals suffering from ischemic stroke (IS). Yet, the TyG-i prognostic implications for severe HS patients necessitating intensive care unit (ICU) admission are not clearly understood. Considering the notably elevated mortality and morbidity associated with HS relative to IS, investigating this association is warranted. Our primary aim was to investigate TyG-i and ACM association among critically ill HS patients within an ICU context. METHODS: Herein, patients with severe HS were identified by accessing the Medical Information Mart for Intensive Care-IV (MIMIC-IV, version 2.2) database, using the International Classification of Diseases (ICD)-9/10 as diagnostic guidelines. Subsequently, we stratified the subjects into quartiles, relying on their TyG-i scores. Moreover, we measured mortality at ICU, in-hospital, 30 days, 90 days, and 1 year as the outcomes. Cox proportional hazards regression analysis and restricted cubic splines (RCS) were deployed for elucidating the relation between the TyG-i and ACM while utilizing the Kaplan-Meier (K-M) method to estimate survival curves. The findings' robustness was assessed by conducting subgroup analysis and interaction tests employing likelihood ratio tests. RESULTS: The analysis included 1475 patients, with a male predominance of 54.4%. Observed mortality rates in the ICU, hospital, 30 days, 90 days, and 1 year were 7.3%, 10.9%, 13.8%, 19.7%, and 27.3%, respectively. Multivariate Cox regression analysis results manifested that heightened TyG-i was significantly related to ACM at 30 days (adjusted hazard ratio [aHR]: 1.32; 95% confidence interval [CI]: 1.05-1.67; P = 0.020), 90 days (aHR: 1.27; 95% CI: 1.04-1.55; P = 0.019), and 1 year (aHR: 1.22; 95% CI: 1.03-1.44; P = 0.023). The results of RCS analysis demonstrated a progressive elevation in ACM risk with rising TyG-i levels. Interaction tests found no significant effect modification in this relationship. CONCLUSION: In summary, TyG-i exhibits a significant correlation with ACM among patients enduring critical illness due to HS. This correlation underscores the probable utility of TyG-i as a prognostic tool for stratifying HS patients according to their risk of mortality. Applying TyG-i in clinical settings could enhance therapeutic decision-making and the management of disease trajectories. Additionally, this investigation augments existing research on the linkage between the TyG-i and IS, elucidating the TyG-i's role in predicting mortality across diverse stroke categories.

Self-powered biosensing platform for Highly sensitive detection of soluble CD44 protein.

In this study, a self-powered biosensor based on an enzymatic biofuel cell was proposed for the first time for the ultrasensitive detection of soluble CD44 protein. The as-prepared biosensor was composed of the co-exist aptamer and glucose oxidase bioanode and bilirubin oxidase modified biocathode. Initially, the electron transfer from bioanode to biocathode was hindered due to the presence of the aptamer with high insulation, generating a low open-circuit voltage (EOCV). Once the target CD44 protein was present, it was recognized and captured by the aptamer at the bioanode, thus the interaction between the target CD44 protein and the immobilized aptamer caused the structural change at the surface of the electrode, which facilitated the transfer of electrons. The EOCV showed a good linear relationship with the logarithm of the CD44 protein concentrations in the range of 0.5-1000 ng mL-1 and the detection limit was 0.052 ng mL-1 (S/N = 3). The sensing platform showed excellent anti-interference performance and outstanding stability that maintained over 97% of original EOCV after 15 days. In addition, the relative standard deviation (1.40-1.96%) and recovery (100.23-101.31%) obtained from detecting CD44 protein in real-life blood samples without special pre-treatment indicated that the constructed biosensor had great potential for early cancer diagnosis.

Research on the inhibitory properties and mechanism of carboxymethyl cellulose-modified sulfur quantum dots towards calcium sulfate and calcium carbonate.

An eco-friendly antimicrobial sulfur quantum dot scale inhibitor (CMC-SQDs) synthesized using carboxymethyl cellulose (CMC) showed strong inhibition of calcium sulfate (CaSO4) at a concentration just below 1 mg/L, with an inhibition efficiency exceeding 99 %. However, the precise interaction process between CMC-SQDs and CaSO4 remains unclear. This article investigates the effectiveness of SQDs in inhibiting the formation of CaSO4 and calcium carbonate (CaCO3) scales. Through static scale inhibition tests, molecular dynamics simulations, and quantum chemical calculations, the study aims to elucidate the different impacts of CMC-SQDs on CaSO4 and CaCO3 scale formation. The research focuses on understanding the relationship between the structural activity of CMC-SQDs and their scale-inhibiting performance and delving into the underlying mechanisms of scale inhibition. The findings describe the role of SQDs in a water-based solution, acting as persistent "nanodusts" that interact with calcium (Ca2+) ions and sulfate ions. CMC forms complexes with Ca2+ ions, and the presence of SQDs enhances the van der Waals force, indirectly increasing the resistance of associated ions and the binding energy on the surface of precipitated gypsum. Conversely, SQDs exhibit weak surface stability and have minimal binding energy when interacting with calcite, leading to limited occupation of available adsorption sites.

Stress hyperglycemia and risk of adverse outcomes in patients with acute ischemic stroke: a systematic review and dose-response meta-analysis of cohort studies.

Background: Stroke represents a prominent global health issue, exhibiting the third highest incidence of disability and a significant burden on both healthcare and the economy. Stress hyperglycemia, an acute reaction of the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system, leading to adverse outcomes and mortality. Several previous studies have indicated that stress hyperglycemia, as evaluated by the stress hyperglycemia ratio (SHR), significantly increases the risk of adverse outcomes and mortality in stroke patients. However, there is a lack of further investigation into the influence of dynamic changes in stress hyperglycemia on the clinical outcomes of acute ischemic stroke (AIS) patients. Consequently, we performed a meticulous analysis, considering dose-response relationships from existing studies, to ascertain the correlation between dynamic changes in stress hyperglycemia and the susceptibility to adverse outcomes in patients with AIS. Methods: This investigation was prospectively registered in PROSPERO and adhered to the PRISMA guidelines. A comprehensive search was performed across English and Chinese databases. A two-sided random-effects model was employed to consolidate the odds ratios (ORs) of the highest vs. lowest categories of SHR. Restricted cubic spline (RCS) models were employed to estimate potential non-linear trends between SHR and the risk of adverse outcomes in AIS patients. Egger's test was utilized to assess publication bias. Heterogeneity was evaluated using Cochran's Q-test. The Newcastle-Ottawa Scale (NOS) tool was employed to evaluate the risk of bias of the included studies. Results: The final analysis incorporated a total of thirteen studies, which were published between 2019 and 2023, encompassing a participant cohort of 184,179 individuals. The SHR exhibited a significant association with the risk of various adverse outcomes. Specifically, a higher SHR was correlated with a 2.64-fold increased risk of 3-month poor functional outcomes (OR: 2.64, 95% CI 2.05-3.41, I2 = 52.3%, P < 0.001), a 3.11-fold increased risk of 3-month mortality (OR: 3.11, 95% CI 2.10-4.59, I2 = 38.6%, P < 0.001), a 2.80-fold increased risk of 1-year mortality (OR: 2.80, 95% CI 1.81-4.31, I2 = 88%, P < 0.001), a 3.90-fold increased risk of intracerebral hemorrhage (ICH) and 4.57-fold increased risk of symptomatic ICH (sICH) (ICH-OR: 3.90, 95% CI 1.52-10.02, I2 = 84.3%, P = 0.005; sICH-OR: 4.57, 95% CI 2.05-10.10, I2 = 47.3%, P < 0.001), a 1.73-fold increased risk of neurological deficits (OR: 1.73, 95 CI 1.44-2.08, I2 = 0%, P < 0.001), and a 2.84-fold increased risk of stroke recurrence (OR: 2.84, 95 CI 1.48-5.45, I2 = 50.3%, P = 0.002). It is noteworthy that, except for hemorrhagic transformation (HT) and stroke recurrence, the remaining adverse outcomes exhibited a "J-shaped" non-linear dose-response relationship. Conclusion: In summary, our findings collectively suggest that increased exposure to elevated SHR is robustly linked to a heightened risk of adverse outcomes and mortality in individuals with AIS, exhibiting a non-linear dose-response relationship. These results underscore the significance of SHR as a predictive factor for stroke prognosis. Therefore, further investigations are warranted to explore the role of SHR in relation to adverse outcomes in stroke patients from diverse ethnic populations. Furthermore, there is a need to explore the potential benefits of stress hyperglycemia control in alleviating the physical health burdens associated with AIS. Maintaining a lower SHR level may potentially reduce the risk of adverse stroke outcomes. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42023424852.

Systemic inflammation response index as a clinical outcome evaluating tool and prognostic indicator for hospitalized stroke patients: a systematic review and meta-analysis.

BACKGROUND: Stroke, which is the main element of cerebrovascular disease (CVD), has become the foremost reason for death and disability on a global scale. The systemic inflammation response index (SIRI), a newly developed and comprehensive indicator, has demonstrated promise in forecasting clinical results for diverse ailments. Nevertheless, the uncertainty surrounding the assessment and prediction of clinical outcomes for stroke patients by SIRI persists, and the conflicting findings from the limited studies conducted on this matter further complicate the situation. Consequently, we performed a thorough systematic review and meta-analysis to explore the correlation between SIRI and the clinical results in individuals suffering from stroke. METHODS: This research was registered in PROSPERO and carried out following the PRISMA guidelines. A thorough investigation was carried out on PubMed, Embase, the Cochrane Library, Web of Science, and Scopus databases. Furthermore, we conducted a manual search in Chinese databases, such as China national Knowledge Infrastructure (CNKI), WanFang, VIP, and China Biology Medicine (CBM). We assessed the potential for bias in the studies included by utilizing the Newcastle-Ottawa Scale (NOS) tool. Adverse clinical outcomes were the main focus of the study, with secondary endpoints including mortality, the predictive value of SIRI, SIRI values across various endpoints, and clinical parameters associated with subarachnoid hemorrhage (SAH) in relation to low and high SIRI group. RESULTS: Following rigorous evaluation, a grand total of 22 investigations, encompassing a populace of 12,737 individuals, were considered suitable for incorporation in the final analysis. The findings from our meta-analysis indicate a strong and consistent correlation between elevated SIRI levels and adverse functional outcomes, irrespective of the method used to evaluate unfavorable outcomes. Furthermore, increased SIRI values have a strong correlation with mortality rates in both the short and long term. Besides, SIRI is a useful indicator of the severity of SAH. SIRI demonstrates strong predictive ability in identifying unfavorable outcomes and stroke-related pneumonia (SAP), as higher SIRI values are typically linked to negative endpoints. Nevertheless, the meta-analysis indicated that there was no significant increase in the risk of early neurological deterioration (END) and acute hydrocephalus (AHC) in high SIRI group when comparing to low SIRI. CONCLUSION: This study could potentially pave the way for groundbreaking insights into the relationship between SIRI and stroke patient outcomes, as it appears to be the first meta-analysis to explore this association. Given the critical role of the inflammatory response in stroke recovery, closely monitoring patients with high SIRI levels could represent a promising strategy for mitigating brain damage post-stroke. Thus, further investigation into SIRI and its impact on clinical outcomes is essential. While our initial findings offer valuable insights into this area, continued research is necessary to fully elucidate the potential of SIRI, ideally through dynamic monitoring and large-scale, multi-center studies. Ultimately, this research has the potential to inform clinical decision-making and improve patient outcomes following stroke. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/ ; Identifier CRD42023405221.

Association between a four-parameter inflammatory index and all-cause mortality in critical ill patients with non-traumatic subarachnoid hemorrhage: a retrospective analysis of the MIMIC-IV database (2012-2019).

Background: Non-traumatic subarachnoid hemorrhage (SAH), primarily due to the rupture of intracranial aneurysms, contributes significantly to the global stroke population. A novel biomarker, pan-immune-inflammation value (PIV) or called the aggregate index of systemic inflammation (AISI), linked to progression-free survival and overall survival in non-small-cell lung cancer and mortality in Coronavirus Disease 2019 (COVID-19) patients, has surfaced recently. Its role in non-traumatic SAH patients, however, remains under-researched. This study aims to determine the relationship between PIV and all-cause mortality in non-traumatic SAH patients. Methods: A retrospective analysis was conducted using data from the Medical Information Mart for Intensive Care (MIMIC-IV) database to examine the association between PIV and all-cause mortality in critically ill patients with non-traumatic SAH. PIV measurements were collected at Intensive Care Unit (ICU) admission, and several mortality measures were examined. To control for potential confounding effects, a 1:1 propensity score matching (PSM) method was applied. The optimal PIV cutoff value was identified as 1362.45 using X-tile software that is often used to calculate the optimal cut-off values in survival analysis and continuous data of medical or epidemiological research. The relationship between PIV and short- and long-term all-cause mortality was analyzed using a multivariate Cox proportional hazard regression model and Kaplan-Meier (K-M) survival curve analysis. Interaction and subgroup analyses were also carried out. Results: The study included 774 non-traumatic SAH patients. After PSM, 241 pairs of score-matched patients were generated. The Cox proportional hazard model, adjusted for potential confounders, found a high PIV (≥ 1362.45) independently associated with 90-day all-cause mortality both pre- (hazard ratio [HR]: 1.67; 95% confidence intervals (CI): 1.05-2.65; P = 0.030) and post-PSM (HR: 1.58; 95% CI: 1.14-2.67; P = 0.042). K-M survival curves revealed lower 90-day survival rates in patients with PIV ≥ 1362.45 before (31.1% vs. 16.1%%, P < 0.001) and after PSM (68.9% vs. 80.9%, P < 0.001). Similarly, elevated PIV were associated with increased risk of ICU (pre-PSM: HR: 2.10; 95% CI: 1.12-3.95; P = 0.02; post-PSM: HR: 2.33; 95% CI: 1.11-4.91; P = 0.016), in-hospital (pre-PSM: HR: 1.91; 95% CI: 1.12-3.26; P = 0.018; post-PSM: 2.06; 95% CI: 1.10-3.84; P = 0.034), 30-day (pre-PSM: HR: 1.69; 95% CI: 1.01-2.82; P = 0.045; post-PSM: 1.66; 95% CI: 1.11-2.97; P = 0.047), and 1-year (pre-PSM: HR: 1.58; 95% CI: 1.04-2.40; P = 0.032; post-PSM: 1.56; 95% CI: 1.10-2.53; P = 0.044) all-cause mortality. The K-M survival curves confirmed lower survival rates in patients with higher PIV both pre- and post PSM for ICU (pre-PSM: 18.3% vs. 8.4%, P < 0.001; post-PSM:81.7 vs. 91.3%, P < 0.001), in-hospital (pre-PSM: 25.3% vs. 12.8%, P < 0.001; post-PSM: 75.1 vs. 88.0%, P < 0.001), 30-day (pre-PSM: 24.9% vs. 11.4%, P < 0.001; post-PSM:74.7 vs. 86.3%, P < 0.001), and 1-year (pre-PSM: 36.9% vs. 20.8%, P < 0.001; P = 0.02; post-PSM: 63.1 vs. 75.1%, P < 0.001) all-cause mortality. Stratified analyses indicated that the relationship between PIV and all-cause mortality varied across different subgroups. Conclusion: In critically ill patients suffering from non-traumatic SAH, an elevated PIV upon admission correlated with a rise in all-cause mortality at various stages, including ICU, in-hospital, the 30-day, 90-day, and 1-year mortality, solidifying its position as an independent mortality risk determinant. This study represents an attempt to bridge the current knowledge gap and to provide a more nuanced understanding of the role of inflammation-based biomarkers in non-traumatic SAH. Nevertheless, to endorse the predictive value of PIV for prognosticating outcomes in non-traumatic SAH patients, additional prospective case-control studies are deemed necessary.

Intraoperative irrigation of artificial cerebrospinal fluid and temperature of irrigation fluid for chronic subdural hematoma: a systematic review and meta-analysis.

Purpose: To systematically review the different types of irrigation fluid and the different temperatures of irrigation fluid on postoperative recurrence rates in the evacuation of chronic subdural hematoma (CSDH). Methods: We conducted a comprehensive search of electronic databases, including PubMed, Embase, the Cochrane Library, the China National Knowledge Infrastructure (CNKI), WanFang, the Chinese VIP Information (VIP), and China Biology Medicine (CBM), and reference lists of relevant studies to identify all eligible studies. Two reviewers independently screened the titles and abstracts for inclusion, and the full-text articles were assessed for eligibility based on predetermined inclusion and exclusion criteria. Data were extracted using a standardized form, and the quality of the studies was assessed using a risk of bias tool. Meta-analyses were performed using a fixed-or random-effects model, and heterogeneity was assessed using the I2 statistic. The primary endpoint was the postoperative recurrence rate. Results: After stringent screening, a total of 11 studies were identified, including six English publications, four Chinese publications, and one Japanese publication, involving a population of 29,846 patients. Our meta-analysis provides evidence that artificial cerebrospinal fluid (ACF) could decrease the post-operative recurrence rate by 47% after the evacuation of CSDH when compared to normal saline (NS) [(odds ratio) OR 0.53, 95% confidence intervals (CI): 0.31-0.90, p = 0.02, I2 = 67%]. Besides, the irrigation fluid at body temperature could decrease the postoperative recurrence rate of CSDH by 64% when compared to room temperature (OR = 0.36, 95% CI = 0.22-0.59, p < 0.0001, I2 = 0%). Conclusion: Our analysis revealed significant difference in the choice of irrigation fluid for CSDH surgery. Notably, we found that irrigation with fluid at body temperature demonstrated superiority over irrigation with fluid at room temperature, resulting in fewer instances of recurrence. This straightforward technique is both safe and widely available, providing an opportunity to optimize outcomes for patients with CSDH. Our findings suggest that the use of body-temperature NS or ACF of room temperature during operation should be considered a standard of procedure in CSDH surgery. Nevertheless, whether the different temperature of ACF could be considered a standard of procedure in CSDH surgery still need high-quality RCTs to further identify. Systematic review registration: https://www.crd.york.ac.uk/prospero/; Identifier CRD42023424344.

The rupture risk factors of mirror intracranial aneurysms: A systematic review and meta-analysis based on morphological and hemodynamic parameters.

OBJECTIVE: Intracranial aneurysms (IAs) are a prevalent form of vascular disease that can lead to fatal outcomes upon rupture. Mirror intracranial aneurysms (MIAs) are a specific type of multiple aneurysms situated symmetrically on both sides of the parent arteries. The factors contributing to the risk of MIA rupture, based on morphological and hemodynamic parameters, are currently controversial. Thus, we conducted a systematic review and meta-analysis to investigate the risk factors for MIA rupture. METHODS: The study performed an electronic search of Chinese and English databases, including China national Knowledge Infrastructure (CNKI), WanFang, VIP, PubMed, Embase, Web of Science, Scopus, and the Cochrane Library databases, and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The morphological parameters (IA size, aspect ratio [AR], size ratio [SR], bottleneck factor [BNF], height-width ratio [HWR], irregular shape) and hemodynamic parameters (wall shear stress [WSS], low WSS area [LSA], oscillatory shear index [OSI]) were analyzed for their significance in determining the risk of MIA rupture. RESULTS: The analysis comprised 18 retrospective studies involving 647 patients, with a total of 1294 IAs detected, including 605 ruptured and 689 unruptured. The meta-analysis revealed that IA size, AR, SR, and irregular shape exhibited significant differences between the ruptured and unruptured groups, but HWR did not. In terms of hemodynamic parameters, WSS, OSI, and LSA were found to have significant differences between the two groups. CONCLUSIONS: Our results demonstrate that larger IAs, higher AR, SR, and BNF are associated with a higher risk of rupture in patients with MIAs, regardless of their location. there is no significant difference in HWR between the ruptured and unruptured groups. These preliminary findings offer valuable insights for clinical decision-making and a more comprehensive comprehension of the current MIA status. Nevertheless, larger and multi-center studies are indispensable for corroborating these findings. Systematic review registration: https://www.crd.york.ac.uk/prospero/ identifier: CRD42022345587.

Research advances in imaging markers for predicting hematoma expansion in intracerebral hemorrhage: a narrative review.

Introduction: Stroke is a major global health concern and is ranked as the second leading cause of death worldwide, with the third highest incidence of disability. Intracerebral hemorrhage (ICH) is a devastating form of stroke that is responsible for a significant proportion of stroke-related morbidity and mortality worldwide. Hematoma expansion (HE), which occurs in up to one-third of ICH patients, is a strong predictor of poor prognosis and can be potentially preventable if high-risk patients are identified early. In this review, we provide a comprehensive summary of previous research in this area and highlight the potential use of imaging markers for future research studies. Recent advances: Imaging markers have been developed in recent years to aid in the early detection of HE and guide clinical decision-making. These markers have been found to be effective in predicting HE in ICH patients and include specific manifestations on Computed Tomography (CT) and CT Angiography (CTA), such as the spot sign, leakage sign, spot-tail sign, island sign, satellite sign, iodine sign, blend sign, swirl sign, black hole sign, and hypodensities. The use of imaging markers holds great promise for improving the management and outcomes of ICH patients. Conclusion: The management of ICH presents a significant challenge, and identifying high-risk patients for HE is crucial to improving outcomes. The use of imaging markers for HE prediction can aid in the rapid identification of such patients and may serve as potential targets for anti-HE therapies in the acute phase of ICH. Therefore, further research is needed to establish the reliability and validity of these markers in identifying high-risk patients and guiding appropriate treatment decisions.

Association of the stress hyperglycemia ratio and clinical outcomes in patients with stroke: A systematic review and meta-analysis.

Objective: Stress hyperglycemia (SH) is common in patients with acute diseases, such as stroke and myocardial infarction. Stress hyperglycemia ratio (SHR) is calculated by glucose/glycated hemoglobin and has been widely used for evaluating SH. But whether SHR is associated with clinical outcomes in stroke patients remains unclear so far. Although many studies have shown that higher SHR means poor outcomes, there is still no absolute evidence that SHR plays a critical role in stroke patients. Hence, we performed a systematic review and meta-analysis aiming to investigate the association between SHR and clinical outcomes in stroke patients. Methods: We performed a comprehensive literature search of the PubMed, Embase, Cochrane Library databases, Clinicaltrials.gov, and WHO-ICTRP. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we performed our study. The Newcastle-Ottawa Scale (NOS) tool was used to examine the potential bias of included studies. The endpoints including poor outcome, mortality, neurological deficit, hemorrhagic transformation (HT), and infectious complications were statistically analyzed. Results: Sixteen retrospective studies met the eligibility criteria, and a number of 183,588 patients were included. Our meta-analysis demonstrated a significant increase in the incidence of poor outcome, according to assessment by the modified Rankin Scale (mRS) ≥ 3 points [odds ratio (OR) 2.53, 95% confidence interval (CI) 1.99-3.22, P < 0.00001, I 2 = 68%], mortality (OR 1.96, 95% CI 1.58-2.44, P < 0.00001, I 2 = 61%), neurological deficit (OR 1.99, 95% CI 1.47-2.70, P < 0.00001, I 2 = 75%), hemorrhagic transformation (HT) (OR 3.70, 95% CI 2.69-5.08, P < 0.00001, I 2 = 0%), and infectious complications [(Pneumonia) OR 2.06, 95% CI 1.57-2.72, P < 0.00001, I 2 = 24%; (Urinary tract infection) OR 2.53, 95% CI 1.45-4.42, P = 0.001, I 2 = 57%] in stroke patients with higher SHR. However, no significant influence was observed for recanalization rate (OR 0.86, 95% CI 0.54-1.38, P = 0.53, I 2 = 0%). Conclusion: With or without diabetes, no matter whether undergoing intravenous thrombolysis or mechanical thrombectomy, higher SHR significantly increased the occurrence of poor outcomes, mortality, neurological deficit, HT, and infectious complications. The recanalization rate was not statistically significant between the two groups. More attention must be paid in clinical practice to SH. Future investigation should focus on the diagnostic value of SHR and the early control of hyperglycemia. Meanwhile, whether SHR could become a novel and promising target for early intervention is worthy of attention in further research. Besides, the influence of the dynamic change of glucose-to-HbA1c ratio, namely SHR, on intracerebral hemorrhage outcomes requires further investigation in future research. Although no randomized double-blind studies have been conducted, the available massive sample studies reflect the actual situation in the clinic and assist clinical decision makers. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42022345587.

Association of the systemic immune-inflammation index (SII) and clinical outcomes in patients with stroke: A systematic review and meta-analysis.

Introduction: A novel systemic immune-inflammation index (SII) has been proven to be associated with outcomes in patients with cancer. Although some studies have shown that the SII is a potential and valuable tool to diagnose and predict the advise outcomes in stroke patients. Nevertheless, the findings are controversial, and their association with clinical outcomes is unclear. Consequently, we conducted a comprehensive review and meta-analysis to explore the relationship between SII and clinical outcomes in stroke patients. Methods: A search of five English databases (PubMed, Embase, Cochrane Library, Scopus, and Web of Science) and four Chinese databases (CNKI, VIP, WanFang, and CBM) was conducted. Our study strictly complied with the PRISMA (the Preferred Reporting Items for Systematic Reviews and Meta-Analyses). We used the NOS (Newcastle-Ottawa Scale) tool to assess the possible bias of included studies. The endpoints included poor outcome (the modified Rankin Scale [mRS] ≥ 3 points or > 3 points), mortality, the severity of stroke (according to assessment by the National Institute of Health stroke scale [NIHSS] ≥ 5 points), hemorrhagic transformation (HT) were statistically analyzed. Results: Nineteen retrospective studies met the eligibility criteria, and a total of 18609 stroke patients were included. Our study showed that high SII is significantly associated with poor outcomes (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.02-1.09, P = 0.001, I2 = 93%), high mortality (OR 2.16, 95% CI 1.75-2.67, P < 0.00001, I2 = 49%), and the incidence of HT (OR 2.09, 95% CI 1.61-2.71, P < 0.00001, I2 = 42%). We also investigated the difference in SII levels in poor/good outcomes, death/survival, and minor/moderate-severe stroke groups. Our analysis demonstrated that the SII level of the poor outcome, death, and moderate-severe stroke group was much higher than that of the good outcome, survival, and minor stroke group, respectively (standard mean difference [SMD] 1.11, 95% CI 0.61-1.61, P < 0.00001 [poor/good outcome]; MD 498.22, 95% CI 333.18-663.25, P < 0.00001 [death/survival]; SMD 1.35, 95% CI 0.48-2.23, P = 0.002 [severity of stroke]). SII, on the other hand, had no significant impact on recanalization (OR 1.50, 95% CI 0.86-2.62, P = 0.16). Discussion: To the best of our knowledge, this may be the first meta-analysis to look at the link between SII and clinical outcomes in stroke patients. The inflammatory response after a stroke is useful for immunoregulatory treatment. Stroke patients with high SII should be closely monitored, since this might be a viable treatment strategy for limiting brain damage after a stroke. As a result, research into SII and the clinical outcomes of stroke patients is crucial. Our preliminary findings may represent the clinical condition and aid clinical decision-makers. Nonetheless, further research is needed to better understand the utility of SII through dynamic monitoring. To generate more robust results, large-sample and multi-center research are required. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022371996.

Effect of the passive films on CaCO3 scale depositing on Q235 steel: Electrochemical and surface investigation.

The deposition of the CaCO3 scale in circulating cooling water is a common and serious concern in the industry, which hinders the heat transfer, reduces water flow and blocks membrane filters. This paper aims at studying the effect of the γ-Fe2O3, Fe2(MoO4)3·Î³-Fe2O3 and FePO4·Î³-Fe2O3 passive films on CaCO3 scale deposition on Q235 steel by electrochemical methods, including linear sweep voltammetry (LSV), chronoamperometry and electrochemical impedance spectroscopy (EIS) tests. The scale and corrosion inhibition performance of the passive films was evaluated by the residual current density (ir) and charge transfer resistance (Rct) values. Electrochemical results suggested that the passive films could inhibit corrosion and reduce the CaCO3 scale deposition on Q235 steel and the FePO4·Î³-Fe2O3 complex passive film showed the best anti-scaling effect. Scanning electron microscope (SEM) and X-ray diffractometer (XRD) tests showed that the passive films could lead to a decrease in the proportion of aragonite to calcite under cathodic water reduction conditions and the composition of the FePO4·Î³-Fe2O3 complex passive film could deform the CaCO3 crystal.

A ternary hybrid of Zn-doped MoS2-RGO for highly effective electrocatalytic hydrogen evolution.

Modification of MoS2-based catalysts is effective in solving the overdependence of hydrogen evolution reactions (HERs) on noble metal catalysts. In this work, a Zn-doped molybdenum disulfide-reduced graphene oxide (Zn-MoS2-RGO) hybrid was synthesized in one step employing a hydrothermal method. By substituting the position of Mo, uniform doping with Zn improved the catalytic activity of MoS2 for HER. The interlayer spacing of MoS2 increased from 0.65 to 0.75 nm, demonstrating RGO effectively interpolate into MoS2 nanosheets. This prevented aggregation and exposed more edge active sites of MoS2. According to density functional theory (DFT) calculations, the layered structure of the MoS2 nanosheets doped with Zn and intercalated with RGO promoted charge transfer and resulted in outstanding hydrogen evolution activity. Compared with MoS2 (6.86 eV), the Zn-MoS2-RGO hybrid (5.47 eV) with a considerably lower energy level value exhibited excellent electrocatalytic performance. Under optimal conditions, at a potential of -0.3 V vs. RHE, the current density reached -169 mA cm-2 in a 0.5 M H2SO4 solution, 4.78 µmol of H2 was produced in 6 h, and the Faraday efficiency reached 92%. The results obtained herein indicated that Zn-MoS2-RGO was a promising candidate for application in electrocatalytic HER.

Smart coatings embedded with polydopamine-decorated layer-by-layer assembled SnO2 nanocontainers for the corrosion protection of 304 stainless steels.

Polydopamine (PDA), which is a mussel-inspired synthetic polymer, is widely used in surface modification field because of the high potential of the dopamine functional groups. Herein, we develop an SnO2 nanocontainer and deposit polypyrrole (PPy), molybdate corrosion inhibitors and PDA layers using the layer-by-layer self-assembly technology. Then, the SnO2 nanocontainer were incorporated into the epoxy coating to improve their corrosion resistance and self-healing ability and realize the active corrosion protection of stainless steels. The XRD, FTIR, TGA and Zeta potential results confirm the deposition of each layer on the surface of the SnO2 nanocontainer. The FESEM and HRTEM images confirm the formation of the core-shell structures on the SnO2 nanocontainers. The ICP-MS test indicates the slow-release tendency of the encapsulated molybdate corrosion inhibitors the in neutral environments. Further, the corrosion behaviors of the epoxy-based coatings with/without 10 wt% SnO2 nanocontainers are evaluated using electrochemical tests in 3.5 wt% NaCl solution. Results suggest that epoxy coatings with PDA-decorated SnO2 nanocontainers exhibit a high corrosion resistance and an excellent self-healing performance. The enhanced anti-corrosion and self-healing properties of the epoxy coatings can be attributed to the deposited PDA layer on the SnO2 nanocontainer, which serves as a pH-sensitive gatekeeper that can control the on-demand release of the molybdate corrosion inhibitor and promote the reformation of the cracked polymer networks using the dopamine functional groups and iron oxide. Furthermore, various OH groups provided by PDA facilitates the dispersion of the SnO2 nanocontainers in epoxy coatings. The application of multi-functional dopamine-based gatekeepers will allow more applications with respect to multi-functional intelligent anti-corrosive coating formulations.

Experimental and theoretical studies of sodium acetyldithiocarbamate for the removal of Cu2+ and Ni2+ from aqueous solution.

With the continuous worsening of water pollution, the use of various collectors to remove heavy metal ions from aqueous solutions has attracted widespread attention. In this work, an acid-resistant collector, sodium acetyldithiocarbamate (ADTC) that combines acetamide with carbon disulfide was proposed for heavy metal removal. The structure of ADTC was characterized by Fourier transform infrared spectroscopy (FT-IR) and nuclear magnetic resonance spectrometer (NMR). Flame atomic absorption spectrophotometry (FAAS) was used to detect the concentration of metal ions in the solution before and after the treatment of the chelating agents. The chelation removal efficiency are compared for different chelating agents for Cu2+ and Ni2+ in acidic aqueous solution with pH = 1-7, and compared to the chelation removal efficiency of sodium diethyldithiocarbamate (DDTC) and sodium ethyl xanthate (SEX) chelating agents. The experimental results suggest the order of the chelating ability is ADTC > DDTC > SEX for Cu2+ and Ni2+. The chelating ability of ADTC to Ni2+ is stronger than that of Cu2+. The chelating ability of the collector is greatly affected by the pH value. The ADTC has a good chelating ability in the pH range of 3-7. The molecular orbital distribution, charge and electrostatic potential surfaces in quantum chemistry are used to explore the main active sites of the chelating agent are the S atom. The results of high resolution mass spectrometry showed that the ADTC is coordinated with the positive divalent metal ion in the ratio of 2:1. According to the results, the dithioamino (-NHCSS-) groups are coordinated with the positive divalent metal ion in a 2:1 ratio. Molecular dynamics simulation is used to explore the adsorption energy and binding strength of the chelating agent on the metal surface.

A new pressurization-insulation and pre-sealing system to improve pressure in cubic press from 6 GPa to 12 GPa.

In this paper, a pressurization-insulation and pre-sealing (PIPS) system is designed to increase the cell pressure of the widely used large volume cubic press without sacrificing cell volume. The sample chamber was sandwiched between a pair of tungsten carbide anvils used as the pressurization system. Ultra-high pressure in the cavity was up to about 12 GPa, and the pressure limit had increased by 100% in contrast with that of an anvil-gasket (AG) system. Furthermore, the confining pressure around the sample chamber was supported by grade 304 stainless steel and a zirconia-calcium oxide solid solution before a press load of 2.8 MN was applied as well as by four surrounding anvils. The relationship between the sample chamber pressure and the press load for this system was calibrated at room temperature using transitions in zinc telluride. With samples of similar volumes, the proposed system retained not only stability but also uniform pressure and temperature fields, in contrast with the AG system and the anvil-preformed gasket cubic press pressurization system. The results of more than 20 experiments show that the proposed PIPS system can operate stably under a press load of 4.2 MN, corresponding cell pressure of 10 GPa, and temperature in the cell exceeding 1800 °C by using graphite as a heater.

A self-curing konjac glucomannan/CaCO3 coating for corrosion protection of AA5052 aluminum alloy in NaCl solution.

A composite coating containing konjac glucomannan (KGM) and CaCO3 was fabricated on AA5052 alloy through a self-curing process, and its surface morphology and component were characterized by scanning electron microscope (SEM), Fourier transform infrared spectroscopy (FT-IR), X-ray diffraction (XRD) and thermogravimetric analysis (TGA). The effect of Ca(OH)2 content on the protective property of the composite coating for aluminum alloy in 3.5 wt% NaCl solution was evaluated by electrochemical impedance spectroscopy measurements. Moreover, the inhibitory performance of the coating on the pitting corrosion of metal was examined by potentiodynamic polarization curves and atomic force microscopy (AFM). The images of scanning electron microscope show the composite coating with a thickness of 50 µm has well-defined branch-shaped structure. The FT-IR spectra confirm the successful fabrication of the polymer coating through the formation of CaCO3. The results of electrochemical impedance spectroscopy suggest that the resistance of the aluminum alloy sample coated with such protective layer is improved by six orders of magnitude, compared with the bare metal. After 60 d of immersion, the polarization curve data and AFM analysis show the pitting corrosion occurring on AA5052 surface is prevented due to the barrier property of coating.

Fabrication of an antimony doped tin oxide-graphene nanocomposite for highly effective capacitive deionization of saline water.

In this study, antimony doped tin oxide loaded reduced graphene oxide (ATO-RGO) nanocomposites were synthesized via a facile hydrothermal approach. As a typical N-type semiconductor, the ATO in the composite can enhance the conductivity between graphene sheets, thus improving the specific capacitance and electrosorption performance. Under the optimal conditions, the largest surface area was 445.2 m2 g-1 when the mass content of ATO in the nanocomposite was 20 wt%. The synthesized optimal ATO-RGO electrode displayed excellent specific capacity (158.2 F g-1) and outstanding electrosorptive capacity (8.63 mg g-1) in sodium chloride solution, which were much higher than the corresponding results of pristine graphene (74.3 F g-1 and 3.98 mg g-1). At the same applied voltage, electrosorption capacity and charge efficiency of the ATO-RGO (20 wt%) material were better than those of reported carbon materials in recent years.

Effect of scale inhibitors on the structure and morphology of CaCO3 crystal electrochemically deposited on TA1 alloy.

The deposition of CaCO3 scale in circulating cooling water on metal surface is a major concern in industry. This paper focuses on the feasibility of electrochemical methods to study the scale inhibition performance of 1-hydroxyethylidene-1,1-diphosphonic acid (HEDP) and 2-phosphonobutane-1,2,4-tricarboxylic acid (PBTCA), Polyacrylic Acid (PAA), including linear sweep voltammetry, chronoamperometry, and electrochemical impedance spectroscopy (EIS). In addition, the coverage, morphology and structure of deposited CaCO3 crystal on titanium alloy surface in the absence and presence of inhibitors were investigated by X-ray diffraction (XRD) and scanning electron microscopy (SEM). A new method for calculating the efficiency of scale inhibitors was proposed so that it can be calculated by using the change in residual current density (ir). In order to prove the feasibility and accuracy of such method, the efficiencies of inhibitors were evaluated using ir and charge transfer resistance (Rct), respectively. In addition, molecular dynamics (MD) simulations were performed to evaluate the interaction between the scale inhibitor molecule and the CaCO3 crystal. The experimental results show that both the residual current density obtained by chronoamperometry and the charge transfer resistance obtained by electrochemical impedance spectroscopy can be used to evaluate the efficiency of scale inhibitors, and there is high consistency from the calculation results. It is also confirmed by X-ray diffraction and scanning electron microscopy studies that the presence of inhibitor reduces the surface coverage of CaCO3 at metal electrode and that the crystal structure of CaCO3 is transformed from the original aragonite into the most unstable vaterite. The best inhibition efficiency of PBTCA for CaCO3 deposit is confirmed by the results of MD simulations.