Copper-Catalyzed Tandem Cyclization/Chalcogenation with Elemental S8/Se: Concise Synthesis of 3-(ß-Hydroxychalcogen)benzofurans.

A novel copper-catalyzed cyclization/chalcogenation of o-alkynylphenols with epoxides and elemental S8/Se was developed for the synthesis of a 3-chalcogen-benzofuran architecture in a domino process with no intermediate isolation or purification. Various sensitive functional groups were compatible at room temperature and furnished chalcogenation derivatives in moderate to good yields.

The value of the ACEF II score in Chinese patients with elective and non-elective cardiac surgery.

OBJECTIVE: To evaluate the value of the ACEF II score in predicting postoperative hospital death and acute kidney injury requiring dialysis (AKI-D) in Chinese patients. METHODS: This retrospective study included adult patients who underwent cardiopulmonary bypass open heart surgery between January 2010 and December 2015 at Guangdong Provincial People's Hospital. ACEF II was evaluated to predict in-hospital death and AKI-D using the Hosmer-Lemeshow goodness of fit test for calibration and area under the receiver operating characteristic (ROC) curve for discrimination in non-elective and elective cardiac surgery. RESULTS: A total of 9748 patients were included. Among them, 1080 underwent non-elective surgery, and 8615 underwent elective surgery. Mortality was 1.8% (177/9748). In elective surgery, the area under the ROC (AUC) of the ACEF II score was 0.704 (95% CI: 0.648-0.759), similar to the ACEF score of 0.709 (95% CI: 0.654-0.763). In non-elective surgery, the AUC of the ACEF II score was 0.725 (95% CI: 0.663-0.787), higher than the ACEF score (AUC = 0.625, 95% CI: 0.553-0.697). The incidence of AKI-D was 3.5% (345/9748). The AUC of the ACEF II score was 0.718 (95% CI: 0.687-0.749), higher than the ACEF score (AUC = 0.626, 95% CI: 0.594-0.658). CONCLUSION: ACEF and ACEF II have poor discrimination ability in predicting AKI-D in non-elective surgery. The ACEF II and ACEF scores have the same ability to predict in-hospital death in elective cardiac surgery, and the ACEF II score is better in non-elective surgery. The ACEF II score can be used to assess the risk of AKI-D in elective surgery in Chinese adults.

Roxadustat Improves Erythropoietin Antibody-Mediated Pure Red Cell Aplasia in a Patient with Hemodialysis.

Anemia is a common complication of chronic kidney disease (CKD). Recombinant human erythropoietin (rHu-EPO) is used extensively in patients with CKD. However, anti-erythropoietin (anti-EPO) antibody has been reported during rHu-EPO treatment, which causes pure red cell aplasia (PRCA). We presented a case of 75-year-old man, who underwent hemodialysis for 2 years. He developed PRCA during rHu-EPO treatment. The rHu-EPO was immediately discontinued, and the patient was given roxadustat treatment. After 6 months of roxadustat treatment, the anti-EPO antibody was disappeared, and hemoglobin recovered normal range. The results suggest that roxadustat can be used to treat patients with anti-EPO antibody-mediated PRCA without immunosuppressive therapy.

Prospective model for predicting renal recovery in cardiac surgery patients with acute kidney injury requiring renal replacement therapy.

AIM: To develop a model for predicting renal recovery in cardiac surgery patients with acute kidney injury (AKI) requiring renal replacement therapy (RRT). METHODS: Data from a prospective randomized controlled trial, conducted in a tertiary hospital to compare the survival effect of two dosages of hemofiltration for continuous RRT in cardiac surgery patients between 20 March 2012 and 9 August 2015, were used to develop the model. The outcome was renal recovery defined as alive and dialysis-free 90 days after RRT initiation. Multivariate logistic regression with a stepwise backward selection of variables based on Akaike Information Criterion was applied to develop the model, which was internally validated using bootstrapping. Model discrimination, calibration and clinical value were assessed using the concordance index (C-Index), calibration plots and decision curve analysis, respectively. RESULTS: Totally, 211 patients with AKI requiring RRT (66.8% male) with median age of 57 years were included. The incidence of renal recovery was 33.2% (n = 70). The model included six variables: body mass index stratification, baseline estimated glomerular filtration rate, hypertension, sepsis, mean arterial pressure and mechanical ventilation. The C-Index for this model was 0.807 (95% CI, 0.744-0.870). After correction by the bootstrap, the C-Index was 0.780 (95% CI, 0.720-0.845). The calibration plots indicated good consistency between actual observations and model prediction of renal recovery. Decision curve analysis demonstrated the model was clinical usefulness. CONCLUSION: We developed and validated a model to predict the chance of renal recovery in cardiac surgery patients with AKI requiring RRT.

Development and validation of a model for predicting acute kidney injury after cardiac surgery in patients of advanced age.

OBJECTIVE: To develop a clinical model for predicting postoperative acute kidney injury (AKI) in patients of advanced age undergoing cardiac surgery. METHODS: A total of 848 patients (aged ≥ 60 years) undergoing cardiac surgery were consecutively enrolled. Among them, 597 were randomly selected for the development set and the remaining 251 for the validation set. AKI was the primary outcome. To develop a model for predicting AKI, visualized as a nomogram, we performed logistic regression with variables selected by Lasso regression analysis. The discrimination, calibration, and clinical usefulness of the new model were assessed and compared with those of Cleveland Clinic score and Simplified Renal Index (SRI) score in the validation set. RESULTS: The incidence of AKI was 61.8% in the development set. The new model included seven variables including preoperative serum creatinine, hypertension, preoperative uric acid, New York Heart Association classification ≥ 3, cardiopulmonary bypass time > 120 min, intraoperative red blood cell transfusion, and postoperative prolonged mechanical ventilation. In the validation set, the areas under the receiver operating characteristic curves for assessing discrimination of the new model, Cleveland Clinic score, and SRI score were 0.801, 0.670, and 0.627, respectively. Compared with the other two scores, the new model presented excellent calibration according to the calibration curves. Decision curve analysis presented the new model was more clinically useful than the other two scores. CONCLUSIONS: We developed and validated a new model for predicting AKI after cardiac surgery in patients of advanced age, which may help clinicians assess patients' risk for AKI.

Derivation and validation of a model to predict acute kidney injury following cardiac surgery in patients with normal renal function.

BACKGROUND: The study aimed to construct a clinical model based on preoperative data for predicting acute kidney injury (AKI) following cardiac surgery in patients with normal renal function. METHODS: A total of 22,348 consecutive patients with normal renal function undergoing cardiac surgery were enrolled. Among them, 15,701 were randomly selected for the training group and the remaining for the validation group. To develop a model visualized as a nomogram for predicting AKI, logistic regression was performed with variables selected using least absolute shrinkage and selection operator regression. The discrimination, calibration, and clinical value of the model were evaluated. RESULTS: The incidence of AKI was 25.2% in the training group. The new model consisted of nine preoperative variables, including age, male gender, left ventricular ejection fraction, hypertension, hemoglobin, uric acid, hypomagnesemia, and oral renin-angiotensin system inhibitor and non-steroidal anti-inflammatory drug within 1 week before surgery. The model had a good performance in the validation group. The discrimination was good with an area under the receiver operating characteristic curve of 0.740 (95% confidence interval, 0.726-0.753). The calibration plot indicated excellent agreement between the model prediction and actual observations. Decision curve analysis also showed that the model was clinically useful. CONCLUSIONS: The new model was constructed based on nine easily available preoperative clinical data characteristics for predicting AKI following cardiac surgery in patients with normal kidney function, which may help treatment decision-making, and rational utilization of medical resources.

[Impact of pre-operative uric acid on acute kidney injury after cardiac surgery in elderly patients].

OBJECTIVE: To investigate the impact of pre-operative uric acid on acute kidney injury (AKI) after cardiac surgery in elderly patients. METHODS: Clinical data were collected from 936 elderly patients (age ≥ 60 years) undergoing cardiac surgery with cardiopulmonary bypass in Guangdong General Hospital between January 2005 and May 2011. The baseline serum creatinine was defined as the latest serum creatinine before surgery, and AKI was diagnosed according to RIFLE criteria. Patients were divided into three groups according to the sex-specific cutoff values of serum uric acid tertiles (group A: ≤ 384.65 µmol/L in men, and ≤ 354.00 µmol/L in women; group B:384.66-476.99 µmol/L in men and 354.01-437.96 µmol/L in women; group C: ≥ 477.00 µmol/L in men and ≥ 437.97 µmol/L in women). Multivariate logistic regression analysis was used to analyze the independent risk factors for AKI. RESULTS: Among 936 elderly patients, 576 cases (61.5%) developed AKI. Mean uric acid concentration was higher in AKI patients than in Non-AKI patients ( (436.6 ± 119.1) µmol/L vs. (398.0 ± 107.2) µmol/L, P < 0.001). The incidence of AKI was 56.1% (175/312) in group A, 56.3% (175/311) in group B, 72.2% (226/313) in group C (P < 0.001). Multiple logistic regression analysis showed that, after adjusted for age, gender, co-morbidities(hypertension, diabetes mellitus, cerebrovascular disease, chronic obstructive pulmonary disease), previous cardiac surgery, eGFR<60 ml×min(-1) ×1.73 m(-2), heart function ≥ 3 (NYHA), positive urine protein, combination of coronary artery bypass grafting and valvular surgery, cardiopulmonary bypass operation time, aortic cross-clamping time, pre-operative angiotensin converting enzyme inhibitor or angiotensin II receptor blockers and lipid-lowering drugs use, early postoperative angiotensin converting enzyme inhibitor or angiotensin II receptor blockers, diuretics and digoxin use, post-operation central venous pressure, risk of post operative AKI was significantly higher in group C than in group A (OR:1.897, 95%CI: 1.270-2.833, P = 0.002). CONCLUSION: Pre-operative elevated uric acid is an independent risk factor of AKI after cardiac surgery in elderly patients.

A model for predicting postoperative persistent acute kidney injury (AKI) in AKI after cardiac surgery patients with normal baseline renal function.

BACKGROUND: Persistent acute kidney injury (AKI) after cardiac surgery is not uncommon and linked to poor outcomes. HYPOTHESIS: The purpose was to develop a model for predicting postoperative persistent AKI in patients with normal baseline renal function who experienced AKI after cardiac surgery. METHODS: Data from 5368 patients with normal renal function at baseline who experienced AKI after cardiopulmonary bypass cardiac surgery in our hospital were retrospectively evaluated. Among them, 3768 patients were randomly assigned to develop the model, while the remaining patients were used to validate the model. The new model was developed using logistic regression with variables selected using least absolute shrinkage and selection operator regression. RESULTS: The incidence of persistent AKI was 50.6% in the development group. Nine variables were selected for the model, including age, hypertension, diabetes, coronary heart disease, cardiopulmonary bypass time, AKI stage at initial diagnosis after cardiac surgery, postoperative serum magnesium level of <0.8 mmol/L, postoperative duration of mechanical ventilation, and postoperative intra-aortic balloon pump use. The model's performance was good in the validation group. The area under the receiver operating characteristic curve was 0.761 (95% confidence interval: 0.737-0.784). Observations and predictions from the model agreed well in the calibration plot. The model was also clinically useful based on decision curve analysis. CONCLUSIONS: It is feasible by using the model to identify persistent AKI after cardiac surgery in patients with normal baseline renal function who experienced postoperative AKI, which may aid in patient stratification and individualized precision treatment strategy.

Ketosulfonylmethylenation and sulfonylethyleneation of imidazoheterocycles with dimethylformamide as a methylene source.

A hitherto unreported ketosulfonylmethylenation occurring at the C-3 position of imidazoheterocycles, with dimethylformamide as the methylene source was described. Using CoCl2·6H2O or Fe(acac)3 as efficient and inexpensive catalysts, some important biologically active methylenated compounds were prepared, with high efficacy, favorable functional group compatibilities, and a broad substrate scope.

Advanced oxidation protein products as prognostic biomarkers for recovery from acute kidney injury after coronary artery bypass grafting.

Recovery from acute kidney injury (AKI) is related to long-term prognosis. This study, involving 56 patients with AKI and 56 controls from a prospective cohort undergoing coronary artery bypass grafting (CABG), investigated the prognostic performance of serum levels of advanced oxidation protein products (AOPPs) for predicting non-recovered AKI and non-completely recovered AKI. AOPP levels increased significantly 7 days after surgery in patients with non-recovered or non-completely recovered AKI. Increased AOPP levels were associated with both types of poor recovery from AKI. Results from receiver-operating characteristic (ROC) curves demonstrated that AOPP levels had good prognostic value for predicting non-recovered and non-completely recovered AKI.

Analysis of radon reduction and ventilation systems in uranium mines in China.

Mine ventilation is the most important way of reducing radon in uranium mines. At present, the radon and radon progeny levels in Chinese uranium mines where the cut and fill stoping method is used are 3-5 times higher than those in foreign uranium mines, as there is not much difference in the investments for ventilation protection between Chinese uranium mines and international advanced uranium mines with compaction methodology. In this paper, through the analysis of radon reduction and ventilation systems in Chinese uranium mines and the comparison of advantages and disadvantages between a variety of ventilation systems in terms of radon control, the authors try to illustrate the reasons for the higher radon and radon progeny levels in Chinese uranium mines and put forward some problems in three areas, namely the theory of radon control and ventilation systems, radon reduction ventilation measures and ventilation management. For these problems, this paper puts forward some proposals regarding some aspects, such as strengthening scrutiny, verifying and monitoring the practical situation, making clear ventilation plans, strictly following the mining sequence, promoting training of ventilation staff, enhancing ventilation system management, developing radon reduction ventilation technology, purchasing ventilation equipment as soon as possible in the future, and so on.

Psychological impact and implementation of preventative measures in hemodialysis centers during the COVID-19 pandemic: a provincial questionnaire survey in China.

OBJECTIVES: This study investigated the psychological status of patients and staff, and the implementation of preventative measures in hemodialysis centers in Guangdong province, China, during the 2019 novel coronavirus disease (COVID-19) pandemic. METHODS: An electronic questionnaire survey was carried out anonymously between March 28 and April 3, 2020. All of the 516 hemodialysis centers registered in Guangdong province were invited to participate in the survey. The questionnaires were designed to investigate the psychological status of hemodialysis patients and general staff members (doctors, nurses, technicians, and other staff), and to address the implementation of preventative measures for administrators (directors or head nurses) of the hemodialysis centers. RESULTS: A total of 1782 patients, 3400 staff, and 420 administrators voluntarily participated in this survey. Patients living in rural areas reported a higher incidence of severe anxiety compared to those living in other areas (in rural areas, towns, and cities, the incidence rate was 17.0%, 9.0%, and 8.9%, respectively, P < 0.001). Medical staff were less likely to worry about being infected than non-medical staff (13.1% vs 30.3%, respectively, P < 0.001). With respect to the implementation of preventative measures, hemodialysis centers in general hospitals outperformed stand-alone blood purification centers, while tertiary hospitals outperformed hospitals of other levels. However, restrictions regarding the admission of non-resident patients were lower in tertiary hospitals than in other hospitals. In this situation, only one patient imported from Hubei province was diagnosed with COVID-19. CONCLUSIONS: COVID-19 did not significantly affect the psychological status of most patients and medical staff members. Due to the implementation of comprehensive preventative measures, there were no cluster outbreaks of COVID-19 in hemodialysis centers. This provincial-level survey may provide referential guidance for other countries and regions that are experiencing a similar pandemic.

[The sensitivity and accuracy of RIFLE and AKIN criteria for acute kidney injury diagnosis in intensive care unit patients].

OBJECTIVE: To evaluate the sensitivity/accuracy of 2 different acute kidney injury (AKI) diagnosis/classification criteria, the RIFLE (risk, injury, failure, loss of kidney function, end-stage kidney disease) and the acute kidney injury network (AKIN), for patients in intensive care unit (ICU). METHODS: Clinical data were collected from all adult patients admitted to the Department of Intensive Medicine in Guangdong General Hospital between October 2009 and July 2010, and AKI cases were identified/classified using RIFLE and AKIN criteria separately, for statistical evaluation of their diagnostic sensitivity, and accuracy in hospital mortality prediction. RESULTS: In all 524 patients evaluated, AKI were identified by RIFLE criteria in 95 of them, while by AKIN, 135. The AKI incidence by RIFLE (18.1%), and AKIN (25.8%) were significantly different (P < 0.05). Meanwhile, AKI incidence was found independent from the mortality, either by RIFLE or AKIN (both P < 0.001). In all patients, the area under the receiver operator characteristic curve (ROC curve), the index for hospital mortality prediction, was 0.7293 for RIFLE [with 95% confidence interval (95%CI) ranging from 0.6005 to 0.8581, P < 0.001], and for AKIN, 0.7777 (95%CI: 0.6664 - 0.8890, P < 0.001). No significant difference was found between the total hospital mortality by the two criteria (37.9% vs. 34.1%, P > 0.05). CONCLUSION: Although AKIN criteria has higher sensitivity in AKI diagnosis, it is not different from the RIFLE criteria in predicting hospital mortality in critically ill patients.

Predictive analysis of shaft station radon concentrations in underground uranium mine: A case study.

This paper presented a method for predicting shaft station radon concentrations in a uranium mine of China through theoretical analysis, mathematical derivation and Monte-Carlo simulation. Based upon the queuing model for tramcars, the average waiting time of tramcars and average number of waiting tramcars were determined, which were further used in developing the predictive model for calculating shaft station radon concentrations. The results exhibit that the extent of variation of shaft station radon concentration in the case study mine is not significantly affected by the queuing process of tramcars, and is always within the allowable limit of 200 Bq m(-3). Thus, the empirical limit of 100,000 T annual ore-hoisting yields has no value in ensuring radiation safety for this mine. Moreover, the developed model has been validated and proved useful in assessing shaft station radon levels for any uranium mine with similar situations.

Pulmonary hypertension as an independent predictor of cardiovascular mortality and events in hemodialysis patients.

BACKGROUND: Hemodialysis patients are at an increased risk of cardiovascular (CV) morbidity and mortality. Pulmonary hypertension (PH) has been recently reported as a new entity and unrecognized threat in maintenance hemodialysis (MHD) patients, whether PH predicts CV mortality and events in this population remains unknown. The aim of the present study was to determine the value of PH in predicting CV mortality and events in a prospective cohort of MHD patients. METHODS: We studied 278 MHD patients (98 with and 180 without PH) in Guangdong General Hospital Blood Purification Center, Guangzhou, China. All patients had been followed up for 2 years, and in survival analysis, we considered time to death or first cardiovascular event. The endpoints were all-cause mortality, CV mortality and CV events. PH was defined as systolic pulmonary artery pressure (SPAP) ≥ 35 mmHg as determined by Doppler echocardiographic evaluation. RESULTS: Of the 278 MHD patients, 53 (19.1 %) died as a result of all causes, 28 (10.1 %) died from CV events (52.8 % of causes of death), and 87 (31.3 %) had new-onset CV events. The survival curve showed that all-cause and CV mortality and new-onset CV events were higher in PH group than the non-PH group. In a multivariate Cox proportional hazard model, the adjusted HR for all-cause mortality, CV mortality and CV events was 1.85 [95 % confidence interval (CI) 1.03-3.34], 2.36 (95 % CI 1.05-5.31) and 2.27 (95 % CI 1.44-3.58), respectively. CONCLUSIONS: Our study showed that PH was an independent predictor of all-cause mortality and CV mortality and events in MHD patients. We suggest to evaluate SPAP in MHD patients in order to stratify risk of death and CV events.

[Effect of early postoperative use of ACEI/ARB or diuretics on the incidence of acute kidney injury after cardiac surgery in elderly patients].

OBJECTIVE: To explore the influence of early postoperative use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) or diuretics on acute kidney injury (AKI) after cardiac surgery in elderly patients. METHODS: Data from elderly patients (age≥60 years old) who underwent cardiac surgery with extracorporeal circulation in Guangdong General Hospital between January 2007 and December 2010 were analyzed in this retrospective research. The primary endpoint was AKI as diagnosed according to the serum creatinine criteria of RIFLE (risk, injury, failure, loss, end stage renal disease). The baseline serum creatinine was defined as the latest serum creatinine level before cardiac surgery. Multivariate analysis by logistic regression was used to obtain the independent risk factors for AKI. RESULTS: Among 618 elderly patients, 76 (12.3%) patients received ACEI/ARB during early postoperative period, 491 (79.4%) patients were given diuretics during early postoperative period, and postoperative AKI occurred in 394 (63.8%) patients. The incidence of AKI was 46.1% in patients who received early postoperative ACEI/ARB, and 66.2% in patients who did not (P<0.001). Patients who received diuretics postoperatively were less likely to suffer from AKI compared with patients who did not (57.0% vs. 89.8%, P<0.001). After adjustment of other potential factors of postoperative AKI, logistic regression analysis showed that early postoperative use of ACEI/ARB [odds ratio (OR)=0.131, 95% confidence interval (95%CI) 0.033-0.517, P=0.004], and early postoperative use of diuretics (OR=0.149, 95%CI 0.076-0.291, P<0.001) independently predicted the occurrence of AKI. CONCLUSIONS: Early postoperative use of ACEI/ARB or diuretics is associated with a lower incidence of AKI after cardiac surgery with extracorporeal circulation in elderly patients.