Development and validation of a questionnaire to measure the congenital heart disease of children's family stressor.

Background: Families of children with congenital heart disease (CHD) face tremendous stressors in the process of coping with the disease, which threatens the health of families of children with CHD. Studies have shown that nursing interventions focusing on family stress management can improve parents' ability to cope with illness and promote family health. At present, there is no measuring tool for family stressors of CHD. Methods: The items of the scale were generated through qualitative interviews and a literature review. Initial items were evaluated by seven experts to determine content validity. Factor analysis and reliability testing were conducted with a convenience sample of 670 family members. The criterion-related validity of the scale was calculated using scores on the Self-Rating Anxiety Scale (SAS). Results: The CHD Children's Family Stressor Scale consisted of six dimensions and 41 items. In the exploratory factor analysis, the cumulative explained variance of the six factors was 61.085%. In the confirmatory factor analysis, the six factors in the EFA were well validated, indicating that the model fits well. The correlation coefficient between CHD Children's Family Stressor Scale and SAS was r = 0.504 (p < 0.001), which indicated that the criterion-related validity of the scale was good. In the reliability test, Cronbach's α coefficients of six sub-scales were 0.774-0.940, and the scale-level Cronbach's α coefficient value was 0.945. Conclusion: The study indicates that the CHD Children's Family Stressor Scale is valid and reliable, and it is recommended for use in clinical practice to assess CHD children's family stressors.

Survival analysis and prognostic model establishment of secondary osteosarcoma: a SEER-based study.

Background: Surgical excision is considered one of the most effective treatments for secondary osteosarcoma (SO). It remains unclear whether the survival of patients with secondary osteosarcoma (SO) could be associated with their surgical willingness. Materials and methods: The statistics of the patients diagnosed with SO between 1975 and 2008 were gathered from the surveillance epidemiology and end results (SEER) database. The patients were divided into three subgroups according to their surgical compliance. The authors used the multivariable Logistic regression analysis and cox regression method to reveal the influence of surgical compliance on prognosis and the risk factors of surgical compliance. Additionally, the authors formulated a nomogram model to predict the overall survival (OS) of patients. The concordance index (C-index) was used to evaluate the accuracy and practicability of the above prediction model. Results: Sixty-three (9.2%) of the 688 patients with SO who were recommended for surgical treatment refused to undergo surgery. Lower surgical compliance can be ascribed to an earlier time of diagnosis and refusal of chemotherapy. The lower overall survival (OS) {[hazard ratio (HR)] 1.733, [CI] 1.205-2.494, P value [P]=0.003} of not surgical compliant patients was verified by the multivariate cox regression method, compared with surgical compliant patients. In addition, the discernibility of the nomogram model was proven to be relatively high (C-index=0.748), by which we can calibrate 3-year- and 5-year OS prediction plots to obtain good concordance to the actual situation. Conclusions: Surgical compliance was proved to be an independent prognostic factor in the survival of patients with SO.

Microplastics shaped performance, microbial ecology and community assembly in simultaneous nitrification, denitrification and phosphorus removal process.

The widespread use of microplastics (MPs) has led to an increase in their discharge to wastewater treatment plants. However, the knowledge of impact of MPs on macro-performance and micro-ecology in simultaneous nitrification, denitrification, and phosphorus removal (SNDPR) systems is limited, hampering the understanding of potential risks posed by MPs. This study firstly comprehensively investigated the performance, species interactions, and community assembly under polystyrene (PS) and polyvinyl chloride (PVC) exposure in SNDPR systems. The results showed under PS (1, 10 mg/L) and PVC (1, 10 mg/L) exposure, total nitrogen removal was reduced by 3.38-10.15 %. PS and PVC restrained the specific rates of nitrite and nitrate reduction (SNIRR, SNRR), as well as the activities of nitrite and nitrate reductase enzymes (NIR, NR). The specific ammonia oxidation rate (SAOR) and activity of ammonia oxidase enzyme (AMO) were reduced only at 10 mg/L PVC. PS and PVC enhanced the size of co-occurrence networks, niche breadth, and number of key species while decreasing microbial cooperation by 5.85-13.48 %. Heterogeneous selection dominated microbial community assembly, and PS and PVC strengthened the contribution of stochastic processes. PICRUSt prediction further revealed some important pathways were blocked by PS and PVC. Together, the reduced TN removal under PS and PVC exposure can be attributed to the inhibition of SAOR, SNRR, and SNIRR, the restrained activities of NIR, NR, and AMO, the changes in species interactions and community assembly mechanisms, and the suppression of some essential metabolic pathways. This paper offers a new perspective on comprehending the effects of MPs on SNDPR systems.

Two new N-containing heterocyclic compounds from the roots of Platycodon grandiflorus.

Two unusual N-containing heterocyclic compounds, Plagranlines B-C, were isolated from the roots of Platycodon grandiflorus. Plagranline B (1) was consisted of neolignane and monomeric quinoline constituent units and plagranline C (2) possessed pyridinone ring that was not commonly discovered in natural product. Their planar structures were elucidated based on analysis of NMR and HRESIMS spectroscopy data, and their absolute configurations were determined by quantum chemical calculations, including GIAO 13C NMR (DP4+) calculation and ECD calculation. In addition, extensive activity screening including glycosidases, oestrogen-like, and NO inhibitory assays were performed, compounds 1 and 2 possessed the weak activities.

Atrial Cardiomyopathy Predicts the Functional Outcome and Mortality in Stroke Patients.

AIM: Atrial cardiomyopathy (ACM) is characterized by atrial dysfunction. This study aims to assess the prognostic significance of ACM in patients with noncardioembolic stroke (NCS). METHODS: Patients with NCS within seven days of onset were prospectively enrolled between January 2019 and December 2020. ACM was defined as either an N-terminal pro-brain natriuretic peptide (NT-pro BNP) ＞250 pg/ml or a P-terminal force in precordial lead V1 (PTFV1) ≥ 5000µV·ms. A poor functional outcome was determined as a score of 3-6 on the modified Rankin Scale (mRS) within a 2-year follow-up period. Logistic regression and Cox regression analyses were employed to examine the relationship between ACM and the long-term prognosis of patients with NCS. RESULTS: A total of 1,346 patients were enrolled, of whom 299 (22.2%) patients were diagnosed with ACM. A total of 207(15.4%) patients experienced a poor functional outcome, and 58 (4.3%) patients died. A multivariate logistic regression analysis indicated that ACM was significantly associated with a poor functional outcome in NCS patients [adjusted odds ratio (aOR): 2.01; 95% confidence interval (CI): 1.42-2.87; p＜0.001]. Additionally, a multivariate Cox regression analysis showed that an NT-pro BNP ＞250 pg/ml was significantly associated with an increased risk of all-cause mortality [adjusted hazard ratio (aHR), 2.51; 95% CI: 1.42-4.43; p=0.001]. CONCLUSIONS: ACM may serve as a novel predictor of a poor long-term functional outcome in patients with NCS. Elevated NT-pro BNP levels (＞250 pg/ml) were found to be associated with a higher risk of all-cause mortality. These findings warrant further validation in multicenter studies.

Using altered auditory feedback to study pitch compensation and adaptation in tonal language speakers.

Human speech production is strongly influenced by the auditory feedback it generates. Auditory feedback-what we hear when we speak-enables us to learn and maintain speaking skills and to rapidly correct errors in our speech. Over the last three decades, the real-time altered auditory feedback (AAF) paradigm has gained popularity as a tool to study auditory feedback control during speech production. This method involves changing a speaker's speech and feeding it back to them in near real time. More than 50% of the world's population speak tonal languages, in which the pitch or tone used to pronounce a word can change its meaning. This review article aims to offer an overview of the progression of AAF paradigm as a method to study pitch motor control among speakers of tonal languages. Eighteen studies were included in the current mini review and were compared based on their methodologies and results. Overall, findings from these studies provide evidence that tonal language speakers can compensate and adapt when receiving inconsistent and consistent pitch perturbations. Response magnitude and latency are influenced by a range of factors. Moreover, by combining AAF with brain stimulation and neuroimaging techniques, the neural basis of pitch motor control in tonal language speakers has been investigated. To sum up, AAF has been demonstrated to be an emerging tool for studying pitch motor control in speakers of tonal languages.

Measurement of the distance between corneal apex and pupil center in patients following small-incision lenticule extraction or implantable collamer lens implantation and its correlation with the surgical-induced astigmatism.

BACKGROUND: To investigate the change in the distance between corneal apex and pupil center after small-incision lenticule extraction (SMILE) or implantable collamer lens (ICL) implantation and its correlation with surgical-induced astigmatism (SIA). METHODS: This study included patients who had undergone SMILE (n = 112) or ICL implantation (n = 110) to correct myopia and myopic astigmatism. The angle kappa was measured using a Scheimpflug imaging device (Pentacam) and represented as Cartesian values between the pupil center and the corneal vertex (X, Y) and chord u ([Formula: see text]orientation), and was compared pre- and post-operative. RESULTS: Following SMILE, the magnitude of chord u[Formula: see text]) significantly increased in both eyes (Wilcoxon signed-rank test, OD: P<0.001; OS: P=0.007), while no significant change was observed in the orientation. A significant correlation was found between the J0 component of SIA and the change in the magnitude of chord u for both eyes (OD: R2=0.128, P<0.001; OS: R2=0.033, P=0.004). After ICL implantation, the orientation of the chord u was significantly different in the right eye (Wilcoxon signed-rank test, P = 0.008), and the Y-intercept significantly decreased in both eyes (Wilcoxon signed-rank test, P<0.001). A significant correlation was found between J0 of SIA and the change in the magnitude of chord u for the right eyes (R2=0.066, P=0.002). A significant correlation was found between J45 of SIA and the change in the magnitude of chord u for the left eyes (R2=0.037, P=0.044). CONCLUSIONS: The magnitude of the chord u increased following the SMILE procedure, whereas the Y-intercept significantly decreased after ICL implantation. SIA was related to the change in the magnitude of chord u.

The value of sequential application of hydrogen peroxide, povidone-iodine and physiological saline in reducing postoperative infections after total knee arthroplasty: A prospective, randomized, controlled study.

BACKGROUND: Currently, in the field of total joint arthroplasty (TJA), there are no studies that have demonstrated the value of the sequential application of hydrogen peroxide, povidone-iodine, and physiological saline during the surgical procedure in decreasing postoperative infections in total knee arthroplasty (TKA), and in decreasing the incidence of periprosthetic joint infections (PJI) in particular. This study aimed to assess the efficacy of the sequential application of hydrogen peroxide, povidone-iodine, and physiological saline in reducing postoperative infections in TKA. METHODS: The study prospectively included 4743 patients, with Group A (2371, 49.9%) receiving sequential intraoperative application of hydrogen peroxide, povidone-iodine, and physiological saline irrigation of the incision, and Group B (2372, 50.1%) receiving intraoperative application of physiological saline irrigation of the incision only, to collect the patients' baseline data and clinical characteristics, and to statistically assess the incidence of superficial infections and the PJI during the follow up period to evaluate the clinical value of the study. RESULTS: The baseline levels of patients in Groups A and B were comparable. There were 132 (2.8%) lost visits during the study period. The incidence of superficial infections within 30 days after surgery was 0.22% in Group A and 1.17% in Group B, the difference between the two groups was statistically significant (P = 0.007). The incidence of PJI was 0.17% in Group A and 1.26% in Group B, the difference between the two groups was statistically significant (P = 0.0121). CONCLUSION: Sequential application of hydrogen peroxide, povidone-iodine, and physiological saline to irrigate incision in TKA can significantly reduce the incidence of postoperative superficial infections and PJI. The scientific and rational application of this therapy intraoperatively greatly reduces the incidence of PJI and postoperative superficial infections, which is of great benefit to the patient's prognosis.

Temperature-dependent charge carrier behavior in phosphorene quantum dots probed by terahertz time-domain spectroscopy.

Although phosphorene quantum dots (PQDs) have gained significant attention in optoelectronics and physics due to their unique optical responses, the low-frequency electromagnetic properties of PQDs and the effects of temperature still remain largely unexplored. Herein, we investigate the temperature-dependent terahertz (THz) response of PQDs by using THz time-domain spectroscopy. Effective THz conductivity of the PQD sample is extracted based on THz measurements to analyze the charge carrier behavior. It is shown that the carriers in the PQDs can be approximated as a weakly confined Drude gas of classical and noninteracting charge particles, which are described by the modified Drude-Smith formula. Then, we also obtain the temperature dependences of the effective characteristic parameters for the charge carriers. As the temperature increases, the plasma frequency linearly enhances whereas both of the carrier diffusion time and the momentum scattering time decrease, which are akin to conventional semiconductors to a large extent. In addition, the confinement factor is closed to 1 and nearly insensitive to temperature. These results are helpful to gain an in-depth understanding of the low-frequency electromagnetic response of charge carriers in PQDs and to explore new applications in photonics and optoelectronics.

Discovery of ent-labdane derivatives from Andrographis paniculata and their anti-inflammatory activity.

The plant Andrographis paniculata has a long history of cultivation in Southeast Asia, especially its extensive anti-inflammatory activity, and the famous natural antibiotic andrographolide comes from this plant. In China, A. paniculata, as the main crop, has become a major source of traditional Chinese medicine (TCM) for the clinical treatment of inflammation. To further explore the diverse diterpene lactones with better anti-inflammatory activity from A. paniculata, twenty-one ent-labdanes, including six undescribed compounds (andropanilides D-I), were isolated. Their structures with absolute configurations were thoroughly determined by comprehensive NMR spectroscopic data, HRESIMS analysis and quantum chemical calculations. All isolated compounds were evaluated for anti-inflammatory activities based on the Griess method. Meanwhile, after structure-activity relationships analysis, the anti-inflammatory activity of andropanilide D (1) (IC50 = 2.31 µM) was found to be better than that of the positive control drug (dexamethasone, IC50 = 6.52 µM) and andrographolide (IC50 = 5.89 µM). Further mechanisms of activity indicated that andropanilide D significantly reduced the secretion of TNF-α, IL-6 and IL-1ß and downregulated the protein expression of COX-2 and iNOS in LPS-induced RAW264.7 macrophages in a concentration-dependent manner based on Western blot and ELISA experiments. In conclusion, andropanilide D possesses potential medicinal value for the treatment of inflammation and further expands the material basis of the anti-inflammatory effect of A. paniculata.

Influence of corneal diameter on the accuracy of corneal tomography in patients with forme fruste keratoconus or thin corneas.

CLINICAL RELEVANCE: The detection of subclinical ectasia is important in preoperative screening for laser-refractive surgery. Previous studies have confirmed the impact of corneal diameter on the diagnostic accuracy of several ectasia indices in tomographically normal eyes. BACKGROUND: This study aimed to investigate the influence of corneal diameter on the diagnostic accuracy of Pentacam tomographic indices in eyes with forme fruste keratoconus (FFKC) and thin corneas. METHODS: One hundred and one eyes of 101 patients with FFKC (FFKC group), 104 eyes of 104 patients with a corneal thickness <490 µm (thin cornea group), and 200 eyes of 200 normal subjects (normal group) were analysed in the study. Pentacam ectasia indices were compared between the groups. RESULTS: The results of multiple linear regression analysis showed that the standardised coefficients for corneal diameter and overall deviation of normality (BAD-D) were -0.386, -0.552, and -0.552 for the FFKC, thin cornea, and normal groups, respectively (p < 0.001). Comparing for the classifications (normal versus abnormal) of the individual indices demonstrated that for corneal diameters ≤11.9 mm, the rates of abnormal cases were significantly higher in the FFKC group than in the normal group for seven indices and in the thin cornea group than normal group for nine indices. For corneal diameters >11.9 mm, the rates of abnormal cases were higher in the FFKC than normal group for three indices and higher in the thin cornea group than normal group for seven indices. CONCLUSION: Belin/Ambrosio Enhanced Ectasia display indices may underestimate the risk of ectasia in patients with large corneas, especially those with FFKC.

Application of aptamer-conjugated graphene oxide for specific enrichment of microcystin-LR in Achatina fulica prior to matrix-assisted laser desorption ionization mass spectrometry.

Microcystin-LR (MC-LR), as a hepatotoxin, can cause liver swelling, hepatitis, and even liver cancer. In this study, MC-LR aptamer (Apt-3) modified graphene oxide (GO) was designed to enrich MC-LR in white jade snail (Achatina fulica) and pond water, followed by matrix-assisted laser desorption ionization mass spectrometry (MALDI-MS) analysis. Results indicated that the Apt-3/PEG/GO nanocomposites were highly specific to MC-LR, and the detection limit of MALDI-MS was 0.50 ng/mL. Moreover, the MC-LR can be released from nanocomposites at 75°C, thus, the reuse of Apt-3/PEG/GO is realized. Real sample analysis indicated that the Apt-3/PEG/GO nanocomposites coupled with MALDI-MS were efficient in detecting trace amounts of MC-LR in real samples. With the merits of being low cost, reusable, and easy to besynthesized, this Apt-3/PEG/GO MALDI-MS is expected to be comprehensively applied by anchoring suitable aptamers for different targets.

A novel machine learning model to predict high on-treatment platelet reactivity on clopidogrel in Asian patients after percutaneous coronary intervention.

BACKGROUND: Various genetic and nongenetic variables influence the high on-treatment platelet reactivity (HTPR) in patients taking clopidogrel. AIM: This study aimed to develop a novel machine learning (ML) model to predict HTPR in Chinese patients after percutaneous coronary intervention (PCI). METHOD: This cohort study collected information on 507 patients taking clopidogrel. Data were randomly divided into a training set (90%) and a testing set (10%). Nine candidate Machine learning (ML) models and multiple logistic regression (LR) analysis were developed on the training set. Their performance was assessed according to the area under the receiver operating characteristic curve, precision, recall, F1 score, and accuracy on the test set. Model interpretations were generated using importance scores by transforming model variables into scaled features and representing in radar plots. Finally, we established a prediction platform for the prediction of HTPR. RESULTS: A total of 461 patients (HTPR rate: 19.52%) were enrolled in building the prediction model for HTPR. The XGBoost model had an optimized performance, with an AUC of 0.82, a precision of 0.80, a recall of 0.44, an F1 score of 0.57, and an accuracy of 0.87, which was superior to those of LR. Furthermore, the XGBoost method identified 7 main predictive variables. To facilitate the application of the model, we established an XGBoost prediction platform consisting of 7 variables and all variables for the HTPR prediction. CONCLUSION: A ML-based approach, such as XGBoost, showed optimum performance and might help predict HTPR on clopidogrel after PCI and guide clinical decision-making. Further validated studies will strengthen this finding.

The construction of highly selective surface molecularly imprinted polymers based on Cu(II) coordination for the detection of bisphenol A.

Herein, we designed and constructed a highly selective MIPs for bisphenol A (BPA) named Cu-MIPs@CS based on Cu(II) coordination. The synthesis of Cu-MIPs@CS employed a dummy template strategy and surface imprinting technology, with chitosan (CS) as the substrate linked to imprinted layers via Cu2+ bridging. 4-vinylpyridine acted as the functional monomer, capable of forming a complex with the template ketoprofen, while ethylene glycol dimethacrylate served as the cross linker. Cu-MIPs@CS exhibited a significantly enhanced imprinting factor of 14.78 for BPA, which was approximately 6.6 times higher than that of imprinted materials without Cu2+ (MIPs@CS). Cu-MIPs@CS exhibited a selective factor of 12.74 towards resorcinol, which possessed identical functional groups but a smaller size than BPA, representing an enhancement of selectivity by 12.25-fold compared to MIPs@CS. More importantly, Cu-MIPs@CS exhibited a superior discrimination ability between BPA and its structural analogue, diphenolic acid, with an excellent selective factor of 2.93, highlighting its significance in distinguish the structural analogue of BPA. In contrast, MIPs@CS lack sufficient selectivity to differentiate between them. Through exploration of adsorption mechanism of Cu-MIPs@CS, it was demonstrated that the incorporation of Cu2+ significantly reduced nonspecific adsorption, but also facilitated the creation of more selective imprinted cavities by introducing metal coordination, thereby notably enhancing the selectivity of Cu-MIPs@CS. Finally, the developed Cu-MIPs@CS were applied as the solid phase extraction adsorbent and combined with HPLC-DAD detection to establish an analytical method towards BPA in drinking water samples. The limit of detection of the method was 0.14 µg L-1 and recoveries ranged from 95.6 % to 101 %. This work provided broad prospects for construction of highly selective MIPs and accurate quantification of trace amounts of BPA.

Highly sensitive fluoroprobe for detecting Sudan dyes in paprika utilizing carbon dot-embedded zeolitic imidazolate framework-8.

In this manuscript, we synthesized CDs@ZIF-8 through a one-step, in-situ method by integrating green-emitting carbon dots (CDs) with zeolitic imidazolate framework-8 (ZIF-8). The resulting CDs@ZIF-8 was utilized as an ultrasensitive probe for detection, leveraging the inner filter effect. The analysis demonstrated the capability to detect Sudan dyes. Sudan I, for example, could be detected within a concentration range spanning from 0.25 to 70 µM, achieving a remarkable detection limit of 76.56 nM. This established method was effectively employed for detecting Sudan I in paprika. Compared with CDs, CDs@ZIF-8 exhibited a 3.32-fold increase in sensitivity and a wider detection range. This enhanced performance was attributed to the porous ZIF-8, which allowed for the enrichment of targets around CDs and avoided the aggregation of CDs. Additionally, embedding the CDs in ZIF-8 improved their pH stability. Our study provides a new approach for using CDs under limited conditions by leveraging metal-organic frameworks.

Neuroprotective effect of plasmalogens on AlCl3-induced Alzheimer's disease zebrafish via acting on the regulatory network of ferroptosis, apoptosis and synaptic neurotransmission release with oxidative stress as the center.

Plasmalogens (Pls) are considered to play a potential role in the treatment of neurodegenerative diseases. In the present study, an Alzheimer's disease (AD) model of zebrafish induced by AlCl3 was established to investigate whether the marine-derived Pls could alleviate cognitive impairments of AD zebrafish. Behavioral tests were carried out to assess the athletic ability. The transcriptional profiles of zebrafish in the control, AD model and AD_PLS group were compared and analyzed to determine the potential mechanisms of dietary Pls on AD. The study found that Pls could reverse athletic impairment in the AD zebrafish model, and the expression levels of genes related to ferroptosis, synaptic dysfunction and apoptosis were significantly altered between experimental groups. Further analysis showed that all of these genes were associated with oxidative stress (OS). These data suggest that healthy protective role of marine-derived Pls on AD zebrafish may result from inhibition of ferroptosis and neuronal apoptosis, restoring synaptic neurotransmission release, and reducing neuroinflammation. Among them, Oxidative stress is acted as the center to connect different regulation pathways. This study provides evidence to support the essential roles of OS in pathogenesis of AD, and the application of Pls in relieving AD.

Online teaching emotion analysis based on GRU and nonlinear transformer algorithm.

Nonlinear models of neural networks demonstrate the ability to autonomously extract significant attributes from a given target, thus facilitating automatic analysis of classroom emotions. This article introduces an online auxiliary tool for analyzing emotional states in virtual classrooms using the nonlinear vision algorithm Transformer. This research uses multimodal fusion, students' auditory input, facial expression and text data as the foundational elements of sentiment analysis. In addition, a modal feature extractor has been developed to extract multimodal emotions using convolutional and gated cycle unit (GRU) architectures. In addition, inspired by the Transformer algorithm, a cross-modal Transformer algorithm is proposed to enhance the processing of multimodal information. The experiments demonstrate that the training performance of the proposed model surpasses that of similar methods, with its recall, precision, accuracy, and F1 values achieving 0.8587, 0.8365, 0.8890, and 0.8754, respectively, which is superior accuracy in capturing students' emotional states, thus having important implications in assessing students' engagement in educational courses.

Bionic Surfaces for Fog Collection: A Comprehensive Review of Natural Organisms and Bioinspired Strategies.

Water scarcity has become a critical global threat, particularly in arid and underdeveloped regions. However, certain insects and plants have evolved the capability to obtain water from fog under these arid conditions. Bionic fog collection, characterized by passive harvesting, minimal energy requirements, and low maintenance costs, has proven to be an efficient method for water harvesting, offering a sustainable water source. This review introduces two superwettable surfaces, namely, superhydrophilic and superhydrophobic surfaces, detailing their preparation methods and applications in fog collection. The fog collection mechanisms of three typical natural organisms, Namib Desert beetles, spider silk, and cactus, along with their bionic surfaces for fog collection devices, are discussed. Additionally, other biological surfaces exhibiting fog transport properties are presented. The main challenges regarding the fabrication and application of bionic fog collection are summarized. Furthermore, we firmly believe that environmentally friendly, low-cost, and stable fog collection materials or devices hold promising prospects for future applications.

Relationship between blood urea nitrogen to serum albumin ratio and short-term mortality among patients from the surgical intensive care unit: a population-based real-world study.

BACKGROUND: Patients admitted to the surgical intensive care unit (SICU) often suffer from multi-organ dysfunction and have a high mortality rate. Therefore, finding a simple but effective clinical indicator to predict the prognosis of patients is essential to improve their survival. The aim of this study was to investigate the relationship between blood urea nitrogen to serum albumin ratio (B/A) and short-term mortality among patients from the SICU. METHODS: All eligible adult patients admitted to the SICU from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database were recruited for this study. Participants were divided into a death group (n = 638) and a survival group (n = 2,048) based on the 90-day prognosis, and then grouped by B/A quartiles. We used restricted cubic splines (RCS) to visually analyze the correlation of B/A with 30- and 90-day risk of death. Cumulative survival rates were estimated using Kaplan-Meier survival curves according to B/A quartiles and evaluated using the log-rank test. Cox proportional risk models were developed and sensitivity analyses were performed to explore whether B/A was independently associated with short-term outcomes in SICU patients. Receiver operating characteristic (ROC) curves were analyzed to ascertain the value of B/A for prognosticating 90-day outcome. RESULTS: A total of 2686 participants were included in the final study, and their 30-day and 90-day all-cause mortality rates were 17.61% and 23.75%, respectively. The differences in 30-day and 90-day mortality rates were statistically significant among the four groups of patients (all p < 0.001). RCS curves showed that B/A was linearly associated with the risk of 30-day and 90-day all-cause mortality in SICU patients (χ2 = 0.960, p = 0.811; χ2 = 1.940, p = 0.584). Kaplan-Meier analysis showed that the 90-day cumulative survival rate gradually decreased as B/A increased, with patients in the highest quartile of B/A having the lowest survival rate (p < 0.001). Cox regression indicated that elevated B/A (> 9.69) was an independent risk factor for 30-day and 90-day all-cause mortality in SICU patients. The analysis of ROC curves demonstrated that B/A exhibited a significant predictive ability for 90-day mortality, with an optimal threshold of 6.587, a sensitivity of 56.9%, and a specificity of 64.8%. CONCLUSIONS: Elevated B/A (> 9.69) on admission was an independent risk factor for short-term mortality in SICU patients, and clinicians should pay more attention to this group of patients and intervene clinically at an early stage to reduce mortality.

Assessment of Keratoconus Risk in Very Asymmetric Ectasia Using Corneal Tomographic and Biomechanical Parameters.

Purpose: To investigate the relationship between corneal tomographic or biomechanical parameters and risk of keratoconus in very asymmetric ectasia (VAE). Methods: This retrospective case-control single-centre study included patients with VAE and normal controls. The VAE group had clinical ectasia in one eye and normal topography (VAE-NT) in the fellow eye; VAE-NT eyes were selected for analysis. The control group was selected from corneal refractive surgery candidates; the right eye was enrolled. Scheimpflug-based corneal tomography (Pentacam) and corneal biomechanical assessment (Corvis ST) were performed. Univariate and multivariable logistic regression were performed using Cox proportional hazards models to evaluate keratoconus-associated risk factors. A two-piecewise linear regression model was applied to examine the threshold effect of selected vital paragmeters on the risk of keratoconus according to a smoothing plot. Results: Threshold effect between tomographic integration and risk of keratoconus was observed. Discrepancy between the central corneal thickness and thinnest corneal thickness (discrepancy CCT vs TCT) greater than 5 µm, discrepancy between the apex corneal thickness and thinnest corneal thickness (discrepancy ACT vs TCT) greater than 3 µm, vector distance between CCT and TCT (distance CCT vs TCT) greater than 0.65 mm indicated a significant increased risk of keratoconus. Risk of keratoconus decreased when distance CCT vs TCT was less than 0.65 mm. Conclusion: Discrepancy CCT vs TCT, discrepancy ACT vs TCT, and distance CCT vs TCT can be used as indicators for risk assessment of early keratoconus.