A Randomized Trial Comparing Standard of Care to Bayesian Warfarin Dose Individualization.

The quality of warfarin treatment may be improved if management is guided by the use of models based upon pharmacokinetic-pharmacodynamic theory. A prospective, two-armed, single-blind, randomized controlled trial compared management aided by a web-based dose calculator (NextDose) with standard clinical care. Participants were 240 adults receiving warfarin therapy following cardiac surgery, followed up until the first outpatient appointment at least 3 months after warfarin initiation. We compared the percentage of time spent in the international normalized ratio acceptable range (%TIR) during the first 28 days following warfarin initiation, and %TIR and count of bleeding events over the entire follow-up period. Two hundred thirty-four participants were followed up to day 28 (NextDose: 116 and standard of care: 118), and 228 participants (114 per arm) were followed up to the final study visit. Median %TIR tended to be higher for participants receiving NextDose guided warfarin management during the first 28 days (63 vs. 56%, P = 0.13) and over the entire follow-up period (74 vs. 71%, P = 0.04). The hazard of clinically relevant minor bleeding events was lower for participants in the NextDose arm (hazard ratio: 0.21, P = 0.041). In NextDose, there were 89.3% of proposed doses accepted by prescribers. NextDose guided dose management in cardiac surgery patients requiring warfarin was associated with an increase in %TIR across the full follow-up period and fewer hemorrhagic events. A theory-based, pharmacologically guided approach facilitates higher quality warfarin anticoagulation. An important practical benefit is a reduced requirement for clinical experience of warfarin management.

Incidence and influencing factors of acute gastrointestinal injury after cardiac surgery.

BACKGROUND: To investigate the incidence and influencing factors of acute gastrointestinal injury (AGI) after cardiac surgery. METHODS: A total of 346 cases receiving treatment in the Intensive Care Unit (ICU) of the Department of Cardiovascular Surgery in our hospital from January 2021 to December 2021 were enrolled and their basic information was collected, including age, gender, height, weight, past medical history, Nutrition Risk Screening 2002, Body Mass Index (BMI), total operation duration, stay in ICU, preoperative blood routine examination results, complete biochemical examination, diamine oxidase (DAO) on Day 1, D-lactic acid index, a postoperative gastrointestinal condition, other postoperative complications and death during hospitalization. Moreover, logistic regression analysis was performed to identify the independent risk factors influencing the incidence of AGI after cardiac surgery. RESULTS: The incidence and mortality of AGI after cardiac surgery were 10.40% (36/346) and 25% (9/36), respectively. A dichotomous logistic regression multivariate analysis revealed that DAO on Day 1 (odd ratio = 1.062, p = 0.006) and stay in ICU (odd ratio = 1.192, p < 0.001) were independent risk factors of AGI after cardiac surgery, and total protein is a protective factor (odd ratio = 0.914, p = 0.012). CONCLUSIONS: Factors influencing AGI after cardiac surgery have been determined in this study. Our data suggest that patients with AGI after cardiac surgery have a decreased preoperative total protein, and elevated DAO on Day 1. Total protein and DAO on Day 1 were found to be correlated with AGI.

Serum cystatin C is a potential predictor of short-term mortality and acute kidney injury in acute aortic dissection patients: a retrospective cohort study.

Background: Serum cystatin C concentration is associated with cardiovascular disease. However, the relationship between cystatin C and acute aortic dissection (AAD) remains unclear. In the current study, we aim to evaluate the predictive value of cystatin C in the occurrence of acute kidney injury (AKI) and the prognosis of AAD patients. Methods: The patients with AAD admitted to our hospital from November 2019 through January 2022 were consecutively included in the retrospective cohort study. A complete blood cell count, serum biochemistry tests, including cystatin C and creatinine, in-hospital mortality and the incidence of AKI were recorded. All the patients were categorized into four groups according to the quartile of their serum cystatin C levels. Multivariate logistic and Cox regression analyses were conducted to determine the independent risk factors for the incidence of AKI and the prognosis of AAD patients, respectively. Kaplan-Meier analyses and log-rank tests were used to evaluate differences in survival. Receiver operating characteristic (ROC) curves were used to assess the predictive value of cystatin C for short-term mortality and the incidence of AKI in AAD patients. Results: A total of 357 patients were included in this study. The results showed that the higher the concentration of cystatin C, the higher the level of serum creatinine and the higher the incidence of AKI. Mortality was significantly higher in the group with serum cystatin C levels >1.18 mg/L. Type A AAD, white blood cell count >10×109/L, platelet count <100×109/L, and serum cystatin C concentration >1.18 mg/L [adjusted hazards ratio (HR) =2.405, 95% confidence interval (CI), 1.029-4.063, P=0.041] were independent risk factors for in-hospital mortality. Cystatin C levels >1.18 mg/L remained an independent predictor of AKI in AAD after adjusting for the confounding [odds ratio (OR) 76.489, 95% CI, 25.586-228.660]. The areas under the ROC curves of cystatin C in predicting the mortality and incidence of AKI in AAD patients were 0.655 (95% CI, 0.551-0.760) and 0.807 (95% CI, 0.758-0.856), respectively. Conclusions: In sum, serum cystatin C concentration is a potential predictor of short-term mortality and the incidence of AKI in AAD patients.

Experience of rehabilitation management in public hospital after it was identified as designated rehabilitation hospital for COVID-19 patients: A qualitative study.

Objective: It is essential to focus on the rehabilitation of COVID-19 patients after discharge to prevent their long-term sequelae, but there is less research on healthcare organizations enhancing rehabilitation services for patients discharged from COVID-19. Therefore, this study aimed to describe how a public hospital provides better rehabilitation services for patients after being identified as a designated rehabilitation hospital for patients with COVID-19 and attempted to combine the theory of organizational change to analyze how the hospital finally successfully transformed. Methods: A tertiary public hospital located in the center of Xi'an was selected for the study. It was identified as a designated hospital for the rehabilitation of patients discharged from the hospital with COVID-19. Nine hospital leaders and group leaders closely related to the rehabilitation management work were invited to participate in interviews to explore the fact about the hospital's rehabilitation work. The semi-structured interview with the hospital director and the focus group interview with group leaders were used for data collection. Two researchers independently conducted a thematic analysis of these responses. Results: One hundred and seventy-eight primary codes, 22 subcategories, six main categories, and one core theme were obtained from data analysis. The main categories include organization and coordination (overall deployment, transfer patient, and external coordination), hospital infection prevention and control (process transformation, ward disinfection, hospital infection training, inspection, and supervision), staff management (staff classification, closed-loop management, and staff health screening), individual services for patients (create an individual scheme, humanistic care, organize special activities, and strengthen communication and guidance), comprehensive supporting (basic medical guarantee, daily necessities guarantee, health and nutrition guarantee, and assistance fund guarantee) and positive transformation (strategic thinking, benchmarking, strengthen cohesion, and expand influence). Conclusion: The hospital had to transform its operations in the face of a complex environment during the pandemic. After deciding to transform, the hospital effectively prevented nosocomial infections and provided rehabilitation services to 583 patients through systematic management measures such as organizational coordination, staff classification, and personalized services. In the end, it has been successfully transformed and has grown rapidly. To ensure that it can continue to grow sustainably, the hospital enhanced the new ways that have emerged from this transformation.

Dexmedetomidine reduces acute kidney injury after endovascular aortic repair of Stanford type B aortic dissection: A randomized, double-blind, placebo-controlled pilot study.

STUDY OBJECTIVE: To determine the effect of dexmedetomidine on acute kidney injury (AKI) following endovascular aortic repair (EVAR) for Stanford type B aortic dissection (TBAD). DESIGN: Randomized, double-blind, placebo-controlled, pilot study. SETTING: University Hospital. PATIENTS: 102 TBAD patients undergoing EVAR procedures were enrolled. Patients with dissection involving aortic arch or renal artery were excluded. INTERVENTIONS: Patients were randomly assigned, in a 1:1 ratio, to a dexmedetomidine group (intravenous dexmedetomidine 0.4 µg/kg/h immediately after anesthesia induction and 0.1 µg/kg/h after extubation, which was maintained until 24 h) or a normal saline control group. MEASUREMENTS: The primary outcome was the incidence of AKI within the first two days after surgery, based on the Acute Kidney Injury Network (AKIN) criteria. The secondary outcomes included serum cystatin C and estimated glomerular filtration rate on postoperative days 1, 2, and 7, and in-hospital need for renal replacement therapy (RRT). Long-term outcomes included RRT and all-cause mortality. MAIN RESULTS: Ninety-eight patients completed the study (dexmedetomidine, n = 48; control, n = 50). AKIN stage 1 AKI occurred in 3/48 (6.3%) patients receiving dexmedetomidine, compared with 11/50 (22%) patients receiving normal saline (odds ratio = 0.24, 95% CI: 0.07 to 0.89, P = 0.041). This difference remained significant after adjusting for baseline covariates (adjusted odds ratio = 0.21, 95% CI: 0.05 to 0.84; P = 0.028). Dexmedetomidine led to a lower serum cystatin C on postoperative day 1 (median [IQR] mg/L: 1.31 [1.02-1.72] vs. 1.58 [1.28-1.96]). There were no between-group differences in other secondary or long-term outcomes. During the follow-up (median = 28.4 months), 1 patient in the dexmedetomidine group and 3 patients in the control group required RRT. CONCLUSIONS: Dexmedetomidine reduced the incidence of AKI in TBAD patients after EVAR procedures. The long-term benefits of dexmedetomidine in this patient population warrant further investigation. TRIAL REGISTRATION: ChiCTR-IPR-15006372.

Symptom clusters and quality of life among patients with chronic heart failure: A cross-sectional study.

AIM: This study aimed to identify symptom clusters among patients with chronic heart failure (HF) and examine their independent relationships with quality of life (QoL). METHODS: A descriptive cross-sectional design was adopted, and 201 Chinese participants were recruited. Their symptom profiles and QoL were assessed using the Memorial Symptom Assessment Scale-Heart Failure and Minnesota Living with Heart Failure Questionnaire. Exploratory factor analysis was used to identify the symptom clusters. Pearson's correlation analysis and multiple regression analysis were conducted to examine their independent relationships with QoL. RESULTS: Six distinct symptom clusters were identified: the fatigue, dyspneic, discomfort, congestive, ischemic, and emotional symptom clusters. These six symptom clusters accounted for 57.508% of the variance in patient symptom experiences and were positively related to their overall QoL. Moreover, the fatigue (ß = .317, p < .001), dyspneic (ß = .228, p < .001), congestive (ß = .363, p < .001), and emotional (ß = .200, p < .001) symptom clusters independently predicted QoL. CONCLUSION: The six symptom clusters that were identified in this study and the relationships that they shared with QoL are expected to inform future approaches to symptom management. Interventions that target these symptom clusters will improve the QoL of patients with HF.

Effect of Tempering Temperature after Thermo-Mechanical Control Process on Microstructure Characteristics and Hydrogen-Induced Ductility Loss in High-Vanadium X80 Pipeline Steel.

In this study, an optimum tempering temperature after a thermo-mechanical control process (TMCP) was proposed to improve the hydrogen-induced ductility loss of high-vanadium X80 pipeline steel. The results showed that with increasing tempering temperature from 450 to 650 °C, the size and quantity of granular bainite decreased but the spacing of deformed lath ferrite and the fraction of massive ferrite increased. The number of fine vanadium carbides increased as well. However, as the tempering temperature increased to 700 °C, the microstructure of T700 steel completely converted to massive ferrite and the grain size became larger. Additionally, the amount of nanoscale precipitates decreased again, and the mean size of precipitates evidently increased in T700 steel. The steel tempering at 650 °C, containing the most vanadium precipitates with a size less than 20 nm, had the lowest hydrogen diffusion coefficient and the best resistance to hydrogen-induced ductility loss.

Genetic influence on bleeding and over-anticoagulation risk in patients undergoing warfarin treatment after heart valve replacements.

Background: Warfarin acts in heart valve replacement patients to minimize thromboembolic complications. We investigated whether patients can be distinguished based on their genotypes to efficiently and safely administer warfarin therapy after heart valve replacements.Research design and methods: A retrospective analysis was conducted in patients with warfarin therapy who underwent elective heart valve replacements between January 2013 and September 2018. The patients were divided into normal, sensitive, and highly sensitive bins based on their CYP2C9 and VKORC1 genotypes. The primary endpoints were over-anticoagulation and overt bleeding.Results: 375 patients were enrolled, with 65 classified as normal, 281 as sensitive, and 29 as highly sensitive responders. Compared with normal responders, sensitive and highly sensitive responders spent more time on over-anticoagulation in the first 28 (P < 0.001) and 90 (P = 0.001) days; experienced more frequent bleeding events in the first 28 days (P = 0.029; OR, 2.18; 95% CI, 1.15-4.13); required lower warfarin doses to obtain stable INR (P < 0.001); had higher warfarin sensitivity indices (P < 0.001).Conclusion: Predicting evidence have been obtained with CYP2C9 and VKORC1 genotypes in identifying heart valve replacement patients with higher efficient sensitivity and with a higher risk of bleeding and over-anticoagulation.

Biodegradable Black Phosphorus-based Nanomaterials in Biomedicine: Theranostic Applications.

Ascribe to the unique two-dimensional planar nanostructure with exceptional physical and chemical properties, black phosphorous (BP) as the emerging inorganic twodimensional nanomaterial with high biocompatibility and degradability has been becoming one of the most promising materials of great potentials in biomedicine. The exfoliated BP sheets possess ultra-high surface area available for valid bio-conjugation and molecular loading for chemotherapy. Utilizing the intrinsic near-infrared optical absorbance, BPbased photothermal therapy in vivo, photodynamic therapy and biomedical imaging has been realized, achieving unprecedented anti-tumor therapeutic efficacy in animal experiments. Additionally, the BP nanosheets can strongly react with oxygen and water, and finally degrade to non-toxic phosphate and phosphonate in the aqueous solution. This manuscript aimed to summarize the preliminary progresses on theranostic application of BP and its derivatives black phosphorus quantum dots (BPQDs), and discussed the prospects and the state-of-art unsolved critical issues of using BP-based material for theranostic applications.

[Green synthesis of silver nanoparticles and their application in SERS].

In the present paper, we have successfully synthesized silver nancomparticles by reducing of silver nitrate in alkaline solution via 60 degrees C water bath for 20 minutes with the use of tyrosine, a nontoxic and green macromolecule, as a reducing and stabilizing agent. The formation of silver nanoparticles was observed visually by color change of the solutions (from faint yellow to brown yellow). The morphologies of the Ag NPs were characterized by UV-Vis absorption spectroscopy and transmission electron microscopy (TEM). The UV-Vis absorption peak of silver nanoparticles located at 412 nm. The TEM image of silver nanoparticles indicated that the diameters of nanospheres are mainly in the range 15-25 nm. In order to evaluate the SERS activity of the silver nancomparticles, crystal violet and folic acid were used as the Raman probe molecule. The experimental results indicated that there are two ascendancies, firstly, the approach is convenient and the reaction condition is facile, secondly, tyrosine is a water-soluble, nontoxic and biodegradable macromolecule, which makes this approach provide a green strategy to prepare Ag NPs. Significantly, the synthesized Ag NPs exhibits good surface enhanced Raman scattering (SERS) activity as SERS substrates to detect crystal violet and folic acid in aqueous solution.

Silver nanoaggregates on chitosan functionalized graphene oxide for high-performance surface-enhanced Raman scattering.

Herein we describe a self-assembly synthesis of graphene oxide/Ag nanoparticles nano-composites (GO/CS/AgNPs) by non-covalent attachment of AgNPs to chitosan (CS) functionalized graphene oxide (GO) sheets. The negatively charged AgNPs are prone to form aggregates on GO/CS via electrostatic interaction, which is extremely beneficial to the surface-enhanced Raman scattering (SERS) detection of aromatic molecules. Taking advantage of the enrichment of target molecules on GO, the obtained hybrids exhibit strong SERS activity to aromatic molecules (trypan blue and methylene blue). Furthermore, SERS signals of a negatively charged molecule (trypan blue) are stronger than signals of a positively charged molecule (methylene blue) due to the different adsorption capacity of GO/CS/AgNPs for the two opposite charged molecules through electrostatic interaction. Moreover, GO/CS/AgNPs remarkably enhance the main peaks of l-phenylalanine, in comparison with the silver nanoparticles, showing great potential for biomedical applications.

Graphene oxide based surface-enhanced Raman scattering probes for cancer cell imaging.

The intrinsic Raman signals provide the potential of graphene oxide (GO) for cellular imaging. Herein, novel surface-enhanced Raman scattering (SERS) labels based on GO-Ag nanoparticle (NP) composites are developed for fast cellular probing and imaging. The optimum SERS signals of the hybrids can be well controlled by adjusting the weight ratio between AgNO(3) and GO. Utilizing GO-AgNPs as the highly sensitive optical probes, fast SERS imaging of cancer cells is realized with a very short integration time of about 0.06 s per pixel. Furthermore, folic acid (FA) is covalently conjugated to GO for targeting specific cancer cells with folate receptors (FRs). Targeted SERS images can be acquired after 2 h incubation with FA-GO-AgNPs, which are specifically located on the surface of FR-positive cancer cells. In conclusion, the GO-based Raman probes mentioned here open up exciting opportunities for biomedical imaging.