A comparison of three approaches to measuring frailty to determine adverse health outcomes in critically ill patients.

BACKGROUND: studies comparing different frailty measures in intensive care unit settings are lacking. We aimed to compare the frailty index based on physiological and laboratory tests (FI-Lab), modified frailty index (MFI) and hospital frailty risk score (HFRS) to predict short-term outcomes for critically ill patients. METHODS: we conducted a secondary analysis of data from the Medical Information Mart for Intensive Care IV database. Outcomes of interest included in-hospital mortality and discharge with need for nursing care. RESULTS: the primary analysis was conducted with 21,421 eligible critically ill patients. After adjusting for confounding variables, frailty as diagnosed by all three frailty measures was found to be significantly associated with increased in-hospital mortality. In addition, frail patients were more likely to receive further nursing care after being discharged. All three frailty scores could improve the discrimination ability of the initial model generated by baseline characteristics for adverse outcomes. The FI-Lab had the best predictive ability for in-hospital mortality, whereas the HFRS had the best predictive performance for discharge with need for nursing care amongst the three frailty measures. A combination of the FI-Lab with either the HFRS or MFI improved the identification of critically ill patients at increased risk of in-hospital mortality. CONCLUSIONS: frailty, as assessed by the HFRS, MFI and FI-Lab, was associated with short-term survival and discharge with need for nursing care amongst critically ill patients. The FI-Lab was a better predictor of in-hospital mortality than the HFRS and MFI. Future studies focusing on FI-Lab are warranted.

Multi-Object Positioning and Imaging Based on Single-Pixel Imaging Using Binary Patterns.

Single-pixel imaging (SPI) is a new type of imaging technology that uses a non-scanning single-pixel detector to image objects and has important application prospects and value in many fields. Most of the modulators currently used in SPI systems are digital micromirror device (DMD) modulators, which use a higher frequency for binary modulation than other alternatives. When modulating grayscale information, the modulation frequency is significantly reduced. This paper conducts research on multiple discrete objects in a scene and proposes using binary patterns to locate and image these objects. Compared with the existing methods of using gray patterns to locate and image multiple objects, the method proposed in this paper is more suitable for DMD-type SPI systems and has wider applicability and greater prospects. The principle of the proposed method is introduced, and the effectiveness of the method is experimentally verified. The experimental results show that, compared to traditional SPI methods, the number of patterns required by the proposed method is reduced by more than 85%.

Complementary moment detection for tracking a fast-moving object using dual single-pixel detectors.

Target tracking has found important applications in particle tracking, vehicle navigation, aircraft monitoring, etc. However, employing single-pixel imaging techniques to track a fast-moving object with a high frame rate is still a challenge, due to the limitation of the modulation frequency of the spatial light modulator and the number of required patterns. Here we report a complementary single-pixel object tracking approach which requires only two geometric moment patterns to modulate the reflected light from a moving object in one frame. Using the complementary nature of a digital micromirror device (DMD), two identical single-pixel detectors are used to measure four intensities which can be used to acquire the values of zero-order and first-order geometric moments to track the centroid of a fast-moving object. We experimentally demonstrate that the proposed method successfully tracks a fast-moving object with a frame rate of up to 11.1 kHz in the first two experiments. In the third experiment, we compare previous works and find that the method can also accurately track a fast-moving object with a changing size and moving speed of 41.8 kilopixel/s on the image plane. The root mean squared errors in the transverse and axial directions are 0.3636 and 0.3640 pixels, respectively. The proposed method could be suitable for ultrafast target tracking.

Study on mechanism of action of total flavonoids from Cortex Juglandis Mandshuricae against alcoholic liver disease based on "gut-liver axis".

The objective of this study was to investigate the effects and molecular mechanisms of total flavonoids from Cortex Juglandis Mandshuricae (TFC) on preventing alcohol-induced chronic liver injury and regulating gut microbiota in mice. The results showed that oral administration of TFC significantly attenuated alcoholic liver injury in mice. TFC improved lipid accumulation in mice with chronic alcoholic liver injury through activation of the AMPK/PPARα pathway. In addition, TFC maintained the integrity of the intestinal barrier in alcoholic mice, reducing endotoxin leakage from the intestine and further inhibiting the TLR4/NF-κB inflammatory pathway. More importantly, TFC regulated the intestinal microbiota composition and certain bacteria, including Akkermansia muciniphila, Lactobacillus and others. At the same time, reduced levels of short-chain fatty acids due to alcohol consumption were restored. In summary, TFC upregulated AMPK/PPARα signaling pathway to improve hepatic fat accumulation and oxidative stress; TFC positively regulated intestinal flora composition to reduce intestinal disorders caused by alcohol consumption, and further inhibited alcohol-induced inflammatory responses through the intestinal-liver axis. The above findings may be the mechanism of TFC's pharmacological effects against alcoholic liver injury.

Association between frailty and short- and long-term mortality in patients with critical acute myocardial infarction: Results from MIMIC-IV.

Background: Frailty has been recognized as an important prognostic indicator in patients with acute myocardial infarction (AMI). However, no study has focused on critical AMI patients. We aimed to determine the impact of frailty on short- and long-term mortality risk in critical AMI patients. Methods: Data from the Medical Information Mart for Intensive Care (MIMIC)-IV database was used. Frailty was assessed using the Hospital Frailty Risk Score (HFRS). Outcomes were in-hospital mortality and 1-year mortality. Logistic regression and Cox proportional-hazards models were used to investigate the association between frailty and outcomes. Results: Among 5,003 critical AMI patients, 2,176 were non-frail (43.5%), 2,355 were pre-frail (47.1%), and 472 were frail (9.4%). The in-hospital mortality rate was 13.8%, and the 1-year mortality rate was 29.5%. In our multivariable model, frailty was significantly associated with in-hospital mortality [odds ratio (OR) = 1.30, 95% confidence interval (CI): 1.20-1.41] and 1-year mortality [hazard ratio (HR) = 1.29, 95% CI: 1.24-1.35] as a continuous variable (per five-score increase). When assessed as categorical variables, pre-frailty and frailty were both associated with in-hospital mortality (OR = 2.80, 95% CI: 2.19-3.59 and OR = 2.69, 95% CI: 1.93-3.73, respectively) and 1-year mortality (HR = 2.32, 95% CI: 2.00-2.69 and HR = 2.81, 95% CI: 2.33-3.39, respectively) after adjustment for confounders. Subgroup analysis showed that frailty was only associated with in-hospital mortality in critically ill patients with non-ST-segment elevation myocardial infarction (STEMI) but not STEMI (p for interaction = 0.012). In addition, frailty was associated with 1-year mortality in both STEMI and non-STEMI patients (p for interaction = 0.447). The addition of frailty produced the incremental value over the initial model generated by baseline characteristics for both in-hospital and 1-year mortality. Conclusion: Frailty, as assessed by the HFRS, was associated with both in-hospital and 1-year mortality in critical AMI patients. Frailty improves the prediction of short- and long-term mortality in critical AMI patients and may have potential clinical applications.

Recycling Lithium from Waste Lithium Bromide to Produce Lithium Hydroxide.

Lithium resources face risks of shortages owing to the rapid development of the lithium industry. This makes the efficient production and recycling of lithium an issue that should be addressed immediately. Lithium bromide is widely used as a water-absorbent material, a humidity regulator, and an absorption refrigerant in the industry. However, there are few studies on the recovery of lithium from lithium bromide after disposal. In this paper, a bipolar membrane electrodialysis (BMED) process is proposed to convert waste lithium bromide into lithium hydroxide, with the generation of valuable hydrobromic acid as a by-product. The effects of the current density, the feed salt concentration, and the initial salt chamber volume on the performance of the BMED process were studied. When the reaction conditions were optimized, it was concluded that an initial salt chamber volume of 200 mL and a salt concentration of 0.3 mol/L provided the maximum benefit. A high current density leads to high energy consumption but with high current efficiency; therefore, the optimum current density was identified as 30 mA/cm2. Under the optimized conditions, the total economic cost of the BMED process was calculated as 2.243 USD·kg-1LiOH. As well as solving the problem of recycling waste lithium bromide, the process also represents a novel production methodology for lithium hydroxide. Given the prices of lithium hydroxide and hydrobromic acid, the process is both environmentally friendly and economical.

Biochemical and cytotoxic evaluation of latroeggtoxin-VI against PC12 cells.

Latroeggtoxin-VI (LETX-VI) is a peptide neurotoxin discovered from Latrodectus tredecimguttatus eggs. In the current study, the action features of the neurotoxin on PC12 cells were systematically investigated. LETX-VI could promote dopamine release from PC12 cells in the absence and presence of Ca2+, involving an even more complex action mechanism in the presence of Ca2+ and when the treatment time was longer. Although LETX-VI enchanced the autophagy and secretion activity in PC 12 cells, it showed no remarkable influence on the proliferation, cell cycle, apoptosis and ultrastructure of the cells. Pulldown combined with CapLC-MS/MS analysis suggested that LETX-VI affected PC12 cells by interacting with multiple proteins involved in the metabolism, transport, and release of neurotransmitters, particularly dopamine. The low cytotoxicity and effective regulatory action of LETX-VI on PC12 cells suggest the potential of the active peptide in the development of drugs for the treatment of some dopamine-related psychotic diseases and cancers.

Adriamycin coated silica microspheres as labels for cancer biomarker alpha-fetoprotein detection.

Adriamycin (ADM)-coated silica microspheres as a label for the sensitive detection of a cancer biomarker alpha-fetoprotein (AFP) was reported. Silica microspheres (SiO2 MSs) were employed as the carrier for the immobilization of gold nanoparticles (Au NPs), secondary antibody (Ab2) and ADM (denote: ADM@Au NPs@SiO2 MS/Ab2) as labels. In the presence of AFP, the labels were captured on the surface of the Au NP-reduced graphene oxide (rGO) (Au NP-rGO) nanocomposites to form a sandwich structure vs. the specific recognition of antibody-antigen. In a pH 7.4 phosphate buffer solution, a well-defined peak of ADM at about -0.70 V (vs. SCE) was recorded via differential pulse voltammetry, the peak intensity of which was related to the concentration of AFP. Under optimal experimental conditions, the immunoassay exhibited a wide linear range (0.5 pg mL-1 to 75 ng mL-1) and low limit of detection (0.17 pg mL-1). Further, the immunoassay was evaluated for serum samples, which gave satisfactory results.

[Gene cloning, heterologous expression and activity identification of latroeggtoxin-â ¥].

One of the distinct characters of Latrodectus tredecimguttatus is that its toxic components exist not only in the venomous glands, but also in the tissues outside the venomous glands and even in the eggs. Investigation on the toxins outside the venomous glands can deepen our understanding of spider toxins and discover new lead molecules with important application prospects. In order to explore the low-abundance proteinaceous toxins in the L. tredecimguttatus eggs, we used bioinformatic strategies to mine a gene sequence encoding a peptide toxin from the transcriptome of L. tredecimguttatus eggs, and then heterologously expressed the gene successfully with a 3'-RACE combined with nest PCR strategy. Biological activity analyses indicated that the expressed peptide toxin, named latroeggtoxin-Ⅵ (LETX-Ⅵ), could inhibit Na⁺ channel currents in ND7/23 cells and promote dopamine release from PC12 cells, without obvious toxicity against Periplaneta americana and bacteria as well as fungi including Staphylococcus aureus and Candida albicans, demonstrating that LETX-Ⅵ is a mammal-specific neurotoxin with a potential application prospect in development of the tool reagents for neurobiological study and the drugs for treating related diseases.

Pull-Down Assay-Guided Insights into the Effects of Latroeggtoxin-VI on Nerve Cells.

Latroeggtoxin-VI (LETX-VI) is a peptide neurotoxin newly found from the eggs of spider L. tredecimguttatus. To explore the mechanism of action of the LETX-VI on nerve cells, the effects of LETX-VI on PC12 cells, a commonly used neuron model, were analyzed using a pull-down assay-guided strategy. LETX-VI was shown to interact with 164 PC12 cell proteins that have diverse molecular functions such as binding, catalysis, regulation, structural activity, etc., thereby extensively affecting the biological processes in the PC12 cells, particularly protein metabolism, response to stimulus, substance transport, and nucleic acid metabolism, with 56.71%, 42.07%, 29.88% and 28.66% of the identified proteins being involved in these biological processes, respectively. By interacting with the relevant proteins, LETX-VI enhanced the synthesis of dopamine; positively regulated cell division and proliferation; and negatively regulated cell cycle arrest, cell death, and apoptotic processes, and therefore has limited cytotoxicity against the PC12 cells, which were further experimentally confirmed. In general, the effects of LETX-VI on PC12 cells are more regulatory than cytotoxic. These findings have deepened our understanding of the action mechanism of LETX-VI on nerve cells and provided valuable clues for further related researches including those on Parkinson's disease.

DNA-templated copper nanoparticles as signalling probe for electrochemical determination of microRNA-222.

An ultrasensitive electrochemical biosensor is described for the determination of microRNAs. It is based on the use of DNA-templated copper nanoparticles (Cu NPs) as signalling probe. MicroRNA-222 was selected as the model analyte. The probe was obtained from two different oligonucleotides (containing complementary bases) via hybridization chain reaction to form long DNA concatemers as template. The Cu NPs were formed by reaction of ascorbate with copper sulfate. The biosensor was fabricated as follows: (a) Capture probe (cDNA) with a thiolated group was immobilized on reduced graphene oxide modified with gold nanoparticles (rGO/Au NPs), (b) materials was placed on a glassy carbon electrode (GCE); (c) the modified electrode (cDNA/rGO/Au NPs/GCE) was sequentially hybridized with microRNA-222 and signal probe; this results in the formation of a sandwich structure of cDNA-microRNA-signal probe on surface of the modified electrode. Differential pulse voltammetry was employed to record the electrochemical response of biosensor in pH 6.0 solution. As a result, a sensitive oxidation current with a peak potential at 0.10 V (vs. SCE) was obtained corresponding to Cu NPs. The experimental conditions were optimized. Under optimal conditions, the biosensor exhibited wide linear response range (0.5 fM to 70 nM) and low limit of detection (0.03 fM; at S/N = 3). The assay possesses high selectivity and can discriminate analyte microRNA from single-base mismatched microRNA. Graphical abstractA sensitive electrochemical biosensor is described for the determination of microRNA-222 by using a dsDNA-templated Cu NPs as signalling probe. (A) represents the preparation of signal probe, and (B) represents the fabrication of electrochemical microRNA sensor.

Risk factors of ventilator-associated pneumonia in elderly patients receiving mechanical ventilation.

Purpose: The aim of this study was to verify the potential risk factors of ventilator-associated pneumonia (VAP) in elderly Chinese patients receiving mechanical ventilation (MV). The secondary aim of this study was to present logistical regression prediction models of VAP occurrence in elderly Chinese patients receiving MV. Methods: Patients (aged 80 years or above) receiving MV for ≥48 h were enrolled from the Chinese People's Liberation Army (PLA) General Hospital from January 2011 to December 2015. A chi-squared test and Mann-Whitney U-test were used to compare the data between participants with VAP and without VAP. Univariate logistic regression models were performed to explore the relationship between risk factors and VAP. Results: A total of 901 patients were included in the study, of which 156 were diagnosed as VAP (17.3%). The incidence density of VAP was 4.25/1,000 ventilator days. Logistic regression analysis showed that the independent risk factors for elderly patients with VAP were COPD (OR =1.526, P < 0.05), intensive care unit (ICU) admission (OR=1.947, P < 0.01), the MV methods (P < 0.023), the number of antibiotics administered (OR=4.947, P < 0.01), the number of central venous catheters (OR=1.809, P < 0.05), the duration of indwelling urinary catheter (OR=1.805, P < 0.01) and the use of corticosteroids prior to MV (OR=1.618, P < 0.05). Logistic regression prediction model of VAP occurrence in the Chinese elderly patients with mechanical ventilation: L o g i t   P = - 6 . 468 + 0 . 423 X 1 + 0 . 666 X 2 + 0 . 871 X 3 + - 0 . 501 X 5 + 0 . 122 X 6 + 0 . 593 X 7 + 0 . 590 X 8 + 1 . 599 X 9 . Conclusion: VAP occurrence is associated with a variety of controllable factors including the MV methods and the number of antibiotics administered. A model was established to predict VAP occurrence so that high-risk patients could be identified as early as possible.