Risk factor analysis and prediction model construction for severe adenovirus pneumonia in children.

BACKGROUND: Severe adenovirus pneumonia in children has a high mortality rate, but research on risk prediction models is lacking. Such models are essential as they allow individualized predictions and assess whether children will likely progress to severe disease. METHODS: A retrospective analysis was performed on children with adenovirus pneumonia who were hospitalized at the Children's Hospital of Nanjing Medical University from January 2017 to March 2024. The patients were grouped according to clinical factors, and the groups were compared using Ridge regression and multiple logistic regression to identify risk factors associated with severe adenovirus pneumonia. A prediction model was constructed, and its value in clinical application was evaluated. RESULTS: 699 patients were included in the study, with 284 in the severe group and 415 in the general group. Through the screening of 44 variables, the final risk factors for severe adenovirus pneumonia in children as the levels of neutrophils (OR = 1.086, 95% CI: 1.054‒1.119, P < 0.001), D-dimer (OR = 1.005, 95% CI: 1.003‒1.007, P < 0.001), fibrinogen degradation products (OR = 1.341, 95% CI: 1.034‒1.738, P = 0.027), B cells (OR = 1.076, 95%CI: 1.046‒1.107, P < 0.001), and lactate dehydrogenase (OR = 1.008, 95% CI: 1.005‒1.011, P < 0.001). The value of the area under the receiver operating characteristic curve was 0.974, the 95% CI was 0.963-0.985, and the P-value of the Hosmer-Lemeshow test was 0.547 (P > 0.05), indicating that the model had strong predictive power. CONCLUSION: In this study, the clinical variables of children with adenovirus pneumonia were retrospectively analyzed to identify risk factors for severe disease. A prediction model for severe disease was constructed and evaluated, showing good application value.

Zeolite/ZnAl-layer double hydroxides with different Zn/Al ratios and intercalated anions as the substrate of constructed wetlands: synthesis, characterization and purification effect of Hexavalent chromium.

The study aimed to synthesize novel zeolite substrates modified with four types of ZnAl-LDHs including Cl-LDHs(1:1), Cl-LDHs(3:1), CO3-LDHs(1:1), and CO3-LDHs(3:1); investigate Cr(VI) removal efficiencies in lab-scale constructed wetlands (CWs); and explore the effect of different Zn/Al ratios and intercalated anions on the removal efficiencies of Cr(VI) by modified zeolite. Different ZnAl-LDHs were prepared by co-precipitation method and coated onto the surface of original zeolite. Field emission scanning electron microscope and energy dispersive spectrometer were used to analyze physicochemical properties of zeolite/ZnAl-LDHs. Obtained results confirmed the successful LDHs-coating modification. The results of both X-ray diffraction and Fourier transform infrared suggested that the typical diffraction peak and functional groups of ZnAl-LDHs were detected in modified zeolites, and the peak of CO32- in CO3-LDHs at 1362 cm-1 was stronger and sharper than Cl-LDHs. It could be demonstrated by above results that the synthesis crystallinity and coating effect of CO3-LDHs was better than Cl-LDHs. Furthermore, it could be found that under the condition of same intercalated anion, LDHs with metal molar ratio of 1:1 had better crystallinity than LDHs with metal molar ratio of 3: 1. Subsequent determination of the removal performance of Cr(VI) by purification experiments revealed that zeolite/Cl-LDHs(3:1) showed the best Cr(VI) removal performance, and the removal rate of Cr(VI) was improved by 32.81% compared with the original zeolite, which suggested that could be an efficient substrate of CWs for Cr(VI) removal. The high crystallinity indicated that the structure of LDHs was stable and it was difficult to remove Cr(VI) by ion exchange. The above explained why the Cr(VI) removal efficiency by zeolite/Cl-LDHs is superior to that by zeolite/CO3-LDHs under the condition of same metal molar ratio. With the increase of metal molar ratio, the charge density of LDHs layers and intercalated anion increased, thus enhancing the electrostatic attraction of LDHs layers to Cr(VI) and the interlayer anion exchange capacity. However, the effect of charge density on Cr(VI) removal efficiency may be greater than crystallinity on removal efficiency, which could be responsible for the fact that zeolite/ZnAl-LDHs(3:1) had better Cr(VI) removal efficiency than zeolite/ZnAl-LDHs(1:1) under the condition of same intercalated anion.

Effectiveness and Safety of Ultrasound-Guided Local Paricalcitol Injection in Treating Secondary Hyperparathyroidism in ESRD: A Retrospective Study.

PURPOSE: To compare the safety and efficacy of percutaneous paricalcitol injection with intravenously administered paricalcitol in treating parathyroid hyperplasia in patients with secondary hyperparathyroidism (SHPT). METHODS: This study was approved by the Ethics Committee of our institution. We retrospectively collected data on patients who received percutaneous paricalcitol injection (24 patients) and intravenously administered paricalcitol (22 patients) based on their intact parathyroid hormone (iPTH) level. Serum iPTH, calcium, phosphorus, and the volume of the parathyroid gland were measured at several indicated time points after treatment, and adverse events associated with the two treatments were evaluated. RESULTS: After 6 months of follow-up, we found that patients from the percutaneous injection group had significantly decreased levels of iPTH (from 1887.81 ± 726.81 pg/mL to 631.06 ± 393.06 pg/mL), phosphate (from 1.94 ± 0.36 mmol/L to 1.71 ± 0.34 mmol/L), and volume of the parathyroid gland (from 0.87 ± 0.50 cm3 to 0.60 ± 0.36 cm3), with relief from ostealgia within 48-72 h. In the intravenously administered group, the levels of iPTH decreased from 686.87 ± 260.44 pg/mL to 388.47 ± 167.36 pg/mL; while there was no significant change in phosphate levels, the volume of the parathyroid gland and ostealgia relief were observed at the end of follow-up. The serum calcium level did not significantly change, and no severe complications were observed in both groups. In vitro fluorescence-activated single cell sorting (FACS) analysis indicated that paricalcitol induced parathyroid cell apoptosis in a dose-dependent manner. CONCLUSIONS: Percutaneous paricalcitol injection is a selective treatment for SHPT in ESRD.

HFOV vs CMV for neonates with moderate-to-severe perinatal onset acute respiratory distress syndrome (NARDS): a propensity score analysis.

This study aimed to evaluate whether high-frequency oscillatory ventilation (HFOV) could reduce mortality and the incidence of bronchopulmonary dysplasia (BPD) of perinatal-onset neonatal acute respiratory distress syndrome (NARDS) compared with conventional mechanical ventilation (CMV). Medical records were collected and retrospectively analyzed. Among the 700 neonates with NARDS who needed invasive ventilation, 501 (71.6%) received CMV, while 199 (28.4%) received HFOV. One-to-one propensity score matching (127:127) was used to match the baseline characteristics of patients who received CMV and HFOV. The results showed that birth weight and oxygenation index (OI) were independently associated with mortality in the multivariate logistic regression. No significant differences were observed in mortality or the incidence of BPD between the two groups. The incidence of intraventricular hemorrhage (IVH) and ventilation-free days were significantly lower in the HFOV group than in the CMV group (3.9 vs 11.80%, p=0.02; 15.226 vs 20.967 days, p=0.01). There were no significant differences between the two groups regarding other secondary outcomes.Conclusion: HFOV was associated with a decreased incidence of IVH in infants with NARDS compared with CMV. However, there were significantly more VFDs in the CMV group than in the HFOV group, and HFOV did not appear to be superior to CMV in decreasing the mortality and incidence of BPD in infants with NARDS. What is Known: • The diagnostic criteria of neonatal acute respiratory distress syndrome (Montreux criteria) were established in 2017. • To date, studies comparing high-frequency oscillatory ventilation and conventional mechanical ventilation in the treatment of neonatal acute respiratory distress syndrome are insufficient. What is New: • High-frequency oscillatory ventilation did not appear to be superior to conventional mechanical ventilation in decreasing the mortality and incidence of bronchopulmonary dysplasia in infants with moderate-to-severe perinatal-onset neonatal acute respiratory distress syndrome. • High-frequency oscillatory ventilation was associated with a decreased incidence of intraventricular hemorrhage in infants with moderate-to-severe perinatal-onset acute respiratory distress syndrome compared with conventional mechanical ventilation.

Visualized podocyte-targeting and focused ultrasound responsive glucocorticoid nano-delivery system against immune-associated nephropathy without glucocorticoid side effect.

Glucocorticoids are widely used in the treatment of nephritis, however, its dose-dependent side effects, such as the increased risk of infection and metabolic disturbances, hamper its clinical use. This study reports a visualized podocyte-targeting and focused ultrasound responsive glucocorticoid nano-delivery system (named as Dex/PFP@LIPs-BMS-α), which specific delivers dexamethasone (Dex) to podocyte targets and reduces systemic side effects. Methods: The glucocorticoid nano-delivery system was synthesized by a lipid thin film and a simple facile acoustic-emulsification method. This glucocorticoid nano-delivery system used BMS-470539 (BMS-α), a synthetic compound, as a "navigator" to specifically identify and target the melanocortin-1 receptor (MC-1R) on podocytes. The loaded perfluoropentane (PFP) realizes the directed "explosion effect" through ultrasound-targeted microbubble destruction (UTMD) technology under the coordination of low intensity focused ultrasound (LIFU) to completely release Dex. Results: Both in vitro and in vivo experiments have demonstrated that Dex/PFP@LIPs-BMs-α accurately gathered to podocyte targets and improved podocyte morphology. Moreover, in vivo, proteinuria and serum creatinine levels were significantly reduced in the group treated with Dex/PFP@LIPs-BMS-α, and no severe side effects were detected. Furthermore, Dex/PFP@LIPs-BMS-α, with capabilities of ultrasound, photoacoustic and fluorescence imaging, provided individualized visual guidance and the monitoring of treatment. Conclusion: This study provides a promising strategy of Dex/PFP@LIPs-BMS-α as effective and safe against immune-associated nephropathy.

Efficacy and safety of hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI) on anemia in non-dialysis-dependent chronic kidney disease (NDD-CKD): a systematic review and meta-analysis.

PURPOSE: HIF-PHI (hypoxia-inducible factor prolyl hydroxylase inhibitor) was developed to improve renal anemia. This study was to evaluate the efficiency and safety of HIF-PHI in patients with non-dialysis-dependent chronic kidney disease (NDD-CKD). METHODS: The literature was extracted from PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, and the Wanfang database. Statistical tests and forest plots were depicted by Review Manager Version 5.3. The primary outcome was a change in hemoglobin level from baseline (ΔHb). Secondary outcomes were changes in ferritin (ΔFerritin), hepcidin (ΔHepcidin), and transferrin saturation from baseline (ΔTSAT), and adverse events (AEs). This study is registered with PROSPERO (registration number CRD42020199656). RESULTS: Ten trials were included. The results showed that HIF-PHI improved the ΔHb [SMD 3.03 (95% CI 2.10, 3.96), P < 0.00001] in NDD patients. HIF-PHI reduced hepcidin levels in the NDD patients [SMD - 1.44 (95% CI - 2.19-0.70), P = 0.0002]. ΔFerritin values were reduced significantly in the HIF-PHI group [SMD - 1.08 (95% CI - 1.63-0.53), P = 0.0001]. However, ΔTSAT values showed no significant difference in the HIF-PHI group compared to the placebo group [SMD - 0.23 (95% CI - 0.66-0.21), P = 0.31]. In the safety assessment, HIF-PHI did not increase adverse events significantly [RR 0.98 (95% CI 0.88-1.10), P = 0.74]. CONCLUSION: HIF-PHI improves renal anemia and iron utilization disorder in NDD-CKD patients, without significantly more adverse events.

Correlation between body composition measurement by bioelectrical impedance analysis and intradialytic hypotension.

OBJECTIVE: To explore the correlation between body composition measurement by bioelectrical impedance analysis (BIA) and intradialytic hypotension (IDH). METHODS: The clinical data of 127 patients with end-stage renal disease (ESRD) who underwent regular dialysis in the Blood Purification Center of the Second Affiliated Hospital of Chongqing Medical University were retrospectively analyzed. According to the occurrence of IDH, the patients were divided into IDH group and intradialytic normotension group. The difference in body composition measured by BIA and its relationship with IDH were compared between the two groups. RESULTS: Compared with intradialytic normotension group, the intracellular water (ICW) ratio (P = 0.009), extracellular water (ECW) ratio (P = 0.029), total body water (TBW) ratio (P = 0.012), protein ratio (P = 0.010), soft lean mass (SLM) ratio (P = 0.011), fat-free mass (FFM) ratio (P = 0.012) and skeletal muscle mass (SMM) ratio (P = 0.009) in IDH group were significantly decreased. However, the fat mass (FM) ratio (P = 0.016), percentage body fat (PBF) ratio (P = 0.001), extracellular water/total body water (ECW/TBW) ratio (P = 0.036), extracellular water/total body water in trunk (ECW/TBWT) ratio (P = 0.045) and visceral fat area (VFA) (P = 0.003) in IDH group were significantly increased when compared with intradialytic normotension group. In addition, there was a positive correlation between systolic blood pressure (SBP) during IDH and ECW ratio, ECW/TBW ratio, and ECW/TBWTR ratio before dialysis. CONCLUSIONS: The body composition of dialysis patients is closely related to the occurrence of IDH. Strengthening the body composition management of dialysis patients outside the hospital may reduce the occurrence of IDH and improve the long-term prognosis of dialysis patients.

Differences in Serum Amino Acid Phenotypes Among Patients with Diabetic Nephropathy, Hypertensive Nephropathy, and Chronic Nephritis.

BACKGROUND We assessed levels of circulating amino acids in different etiologies of chronic kidney disease (CKD) and the association of amino acids with risk factors of CKD progression. MATERIAL AND METHODS High-performance liquid chromatography-based analysis was used to determine amino acid profiles in patients with diabetic nephropathy (DN, n=20), hypertensive nephropathy (HN, n=26), and chronic nephritis (CN, n=33), and in healthy controls (HC, n=25). RESULTS All 3 types of CKD patients displayed decreased serum levels of serine, glycine, GABA, and tryptophan compared with healthy controls. Moreover, serine and tryptophan were positively correlated with glucose in DN cohorts. Total cholesterol was positively correlated with tryptophan levels in the DN cohort and negatively correlated with serine levels in the CN cohort. In the HN cohort, glycine was negatively correlated with triglyceride levels, and systolic blood pressure (SBP) was negatively correlated with GABA levels. CONCLUSIONS Patients with different etiologies of CKD have significantly different amino acids profiles, and this indicates specific supplementary nutritional needs in CKD patients.

Targeted metabolomics study of serum bile acid profile in patients with end-stage renal disease undergoing hemodialysis.

BACKGROUND: Bile acids are important metabolites of intestinal microbiota, which have profound effects on host health. However, whether metabolism of bile acids is involved in the metabolic complications of end-stage renal disease (ESRD), and the effects of bile acids on the prognosis of ESRD remain obscure. Therefore, this study investigated the relationship between altered bile acid profile and the prognosis of ESRD patients. METHODS: A targeted metabolomics approach based on ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) was used to determine the changes in serum bile acids between ESRD patients (n = 77) and healthy controls (n = 30). Univariate and multivariate statistical analyses were performed to screen the differential proportions of bile acids between the two groups. RESULTS: Six differentially expressed bile acids were identified as potential biomarkers for differentiating ESRD patients from healthy subjects. The decreased concentrations of chenodeoxycholic acid, deoxycholic acid and cholic acid were significantly associated with dyslipidemia in ESRD patients. Subgroup analyses revealed that the significantly increased concentrations of taurocholic acid, taurochenodeoxycholic acid, taurohyocholic acid and tauro α-muricholic acid were correlated to the poor prognosis of ESRD patients. CONCLUSIONS: The serum bile acid profile of ESRD patients differed significantly from that of healthy controls. In addition, the altered serum bile acid profile might contribute to the poor prognosis and metabolic complications of ESRD patients.

Agomelatine versus paroxetine in treating depressive and anxiety symptoms in patients with chronic kidney disease.

OBJECTIVE: Depressive and anxiety symptoms could affect the quality of life and prognostic outcomes in chronic kidney disease (CKD) patients, but only a few studies focus on the interventions to manage or prevent these symptoms in CKD patients. Therefore, this study was conducted to compare the efficacy and acceptability of agomelatine versus paroxetine in treating depressive and anxiety symptoms in CKD patients. METHODS: CKD stage 2-4 patients with depressive and anxiety symptoms were included. The first patient was randomized in April 2013 and the last clinic visit occurred in March 2017. The included patients were randomly assigned to receive paroxetine 20-40 mg/day or agomelatine 25-50 mg/day. The treatment was continued for 12 weeks. The Hamilton Depression Rating Scale (HDRS) (17-item) and Hamilton Anxiety Rating Scale (HARS) were the primary outcome measures, and the response rate, remission rate, and Activities of Daily Living (ADL) scale were the secondary outcome measures. Meanwhile, the adverse events were recorded during the whole treatment period. RESULTS: At baseline and week 4, both groups had similar average HDRS and HARS scores. But at week 8 and 12, compared to the patients receiving paroxetine, the patients receiving agomelatine had significantly lower average HDRS scores (p=0.002, p=0.001, respectively) and HARS scores (p<0.00001, p<0.00001, respectively). At week 12, the patients receiving agomelatine had a non-significantly lower average ADL score, and non-significantly higher response and remission rates. The adverse events in both groups were mild and transient. CONCLUSION: These results demonstrated that the agomelatine had some advantages over par-oxetine in treating CKD stage 2-4 patients with depressive and anxiety symptoms, and future studies are needed to further explore its efficacy and acceptability.

Experience of 1166 thyroidectomy without use of prophylactic antibiotic.

BACKGROUND: Although the procedure requires a small surgical incision and a short duration, incision infection rate is very low in thyroidectomy; however, doctors still have misgivings about infection events. AIM: We retrospectively analyzed the prevention of incision infection without perioperative use of antibacterial medications following thyroidectomy. MATERIALS AND METHODS: 1166 patients of thyroidectomy were not administered perioperative antibiotics. Unilateral total lobectomy or partial thyroidectomy was performed in 68.0% patients with single-side nodular goiter or thyroid adenoma. Bilateral partial thyroidectomy was performed in 25.5% patients with nodular goiter or Graves' disease. The mean time of operation was 80.6 ± 4.87 (range: 25-390) min. RESULTS: Resuturing was performed in two patients of secondary hemorrhage from residual thyroid following bilateral partial thyroidectomy. Temporally recurrent nerve paralysis was reported following right-side total lobectomy and left-side subtotal lobectomy in a nodular goiter patient. One case had suppurative infection in neck incision 5 days after bilateral partial thyroidectomy. CONCLUSIONS: Thyroidectomy, which is a clean incision, involves a small incision, short duration, and minor hemorrhage. If the operation is performed under strict conditions of sterility and hemostasis, antibacterial medications may not be required to prevent incision infection, which reduces cost and discourages the excessive use of antibiotics.

Netrin-1 pretreatment protects rat kidney against ischemia/reperfusion injury via suppression of oxidative stress and neuropeptide Y expression.

Netrin-1 has been found to protect kidneys from ischemia/reperfusion injury. In this study, we aimed to address whether the protective effects were mediated through suppression of oxidative stress and neuropeptide Y. Compared to sham-operated animals, animals after ischemia/reperfusion showed marked kidney damage and significantly increased levels of serum creatinine, blood urea nitrogen, malondialdehyde, and neuropeptide Y. Renal myeloperoxidase activity was elevated in animals with ischemia/reperfusion relative to sham-operated animals, whereas renal superoxide dismutase activity was reduced. Netrin-1 pretreatment attenuated ischemia/reperfusion-induced functional and pathological changes in the kidney. Moreover, the ischemia/reperfusion-induced changes in the oxidative stress biomarkers and neuropeptide Y were significantly counteracted by prior administration of netrin-1. Taken together, our data showed that netrin-1 pretreatment prevented renal ischemia/reperfusion injury, at least partially through reduction of oxidative stress and neuropeptide Y expression.

[Protective effect of lipoxin A4 against rhabdomyolysis-induced acute kidney injury in rats].

AIM: To investigate the protective effect of lipoxin A4 (LXA(4);) against rhabdomyolysis-induced acute kidney injury (AKI) and the possible mechanism. METHODS: The animal model of AKI was produced by intramuscular injection with glycerol. SD rats were randomly divided into 3 groups: the normal, AKI and LXA(4); groups. Blood urea nitrogen and serum creatinine levels were evaluated using a HITACHI 747 automatic analyzer. For histological examination, sections were stained with HE. The activity of myeloperoxidase (MPO) was detected by spectrophotometer. Expressions of TNF-α, IL-6 were determined by ELISA, and NF-κB in renal tissues was detected by Western blot analysis. RESULTS: The levels of blood urea nitrogen and serum creatinine decreased, and the injury of kidney was improved significantly in rats treated with LXA(4); as compared with AKI rats (P<0.05). The levels of TNF-α and IL-6, the activity of MPO and the expression of NF-κB were significantly lower in LXA(4); group than in AKI group (P<0.05). CONCLUSION: LXA(4); can significantly protect rats against AKI partly by blocking NF-κB activation and reducing inflammatory cytokine expression and inflammatory cells infiltration in the kidney.

Diagnostic value of HE4 for ovarian cancer: a meta-analysis.

BACKGROUND: Ovarian cancer (OC) is the second most common gynecological cancer and the first cause of death from gynecological malignancy in Western Europe and the USA. While human epididymis-specific protein 4 (HE4) has been reported as a predictive diagnostic index, it has not been widely accepted because of inconsistent conclusions. The aim of this study was to evaluate the diagnostic value of HE4 systematically for ovarian cancer. METHODS: All relevant original studies about HE4 in the diagnosis of ovarian cancer published from January 1974 to May 2011 were retrieved. By measuring methodological qualities, 12 papers were selected for this study, while 531 articles were searched. The overall diagnostic sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-), and area under the receiver operating characteristic curve (AUC-ROC) were used to evaluate the diagnostic value of HE4 for ovarian cancer using the Meta-DiSc statistical software. RESULTS: There were 2607 subjects included in this meta-analysis. The sensitivity, specificity, LR+ and LR- (95% confidence interval) of HE4 was 0.800 (0.770-0.827), 0.916 (0.902-0.929), 10.271 (6.982-15.109) and 0.228 (0.181-0.287), respectively. The area under the summary receiver operating characteristic (sROC) curve of HE4 was 0.946. The index of Q* was 0.885. CONCLUSIONS: HE4 was found to be better than CA125 as an auxiliary indicator for the diagnosis of ovarian cancer in terms of better sensitivity, specificity, LR+ and LR-.

Efficacy and safety of right hemihepatectomy through the right retrohepatic tunnel.

We wished to study the efficacy and safety of the retrograde ligation of short hepatic veins (SHVs) and the right hepatic vein (HV) through the retrohepatic tunnel in patients who underwent hemihepatectomy due to large hepatic carcinoma in the right lobe of the liver. Right hemihepatectomy was performed in 23 patients with tumors larger than 8 cm in diameter. The liver was separated at the secondary porta, and the interspace between right HVs and middle HVs was expanded. The right hepatic portal vein and hepatic artery were freed and ligated, followed by the retrograde dissection of SHVs and the right HV along the right retrohepatic space anterior to the inferior vena cava. A blocking belt was set at the left side of the midline, after which the right liver was cut off. The procedure was successfully completed in all patients. The average amount of intraoperative blood loss was 640 ml. The change in hepatic function was observed on the third postoperative day. Twenty-two patients exhibited satisfactory results; one patient died from postoperative hepatic failure. In conclusion, this procedure can be safely performed in most hemihepatectomy patients with liver tumors.