The optimal blood glucose is significantly associated with lower mortality in critically ill patients with cardiogenic shock: an analysis revealed with time series blood glucose records.

BACKGROUND: The optimal blood glucose (BG) level for patients with cardiogenic shock in the intensive care unit (ICU) remains unclear. Studies have found that both excessively high and low BG levels contribute to adverse cardiovascular events. Our study aims to investigate the optimal BG level for critically ill patients with cardiogenic shock and evaluate the effects of optimal BG on the prognosis of patients. METHODS: A total of 2013 patients with cardiogenic shock obtained from the Medical Information Mart for Intensive Care (MIMIC) IV database were included in the final cohort for our retrospective observational study for data analysis. The exposure was time-weighted average BG (TWA-BG), which was calculated by the time-series BG records and corresponding time stamps of patients with cardiogenic shock during their stay in the ICU. The cut-off value of TWA-BG was identified by the restricted cubic spline curve and included patients were categorized into three groups: low TWA-BG group (TWA-BG ≤ 104 mg/dl), optimal TWA-BG group (104 < TWA-BG ≤ 138 mg/dl), and high TWA-BG group (TWA-BG > 138 mg/dl). The primary outcome was 28-day mortality, and the secondary outcomes were ICU and in-hospital mortality. We performed the log-rank test to detect whether there is a difference in mortality among different groups in the original cohort. Multiple distinct models were employed to validate the robustness of the results. RESULTS: Our study revealed that the optimal BG level for critically ill patients with cardiogenic shock is 104-138 mg/dl. Compared to the optimal TWA-BG group, the low TWA-BG group (hazard ratio (HR): 1.67, 95% confidence interval (CI): 1.19-2.33, p = 0.002) and high TWA-BG group (HR: 1.72, 95% CI: 1.46-2.03, p < 0.001) exhibited higher 28-day mortality. Similarly, the low TWA-BG group and high TWA-BG group demonstrated higher risks in terms of ICU mortality (low TWA-BG group: HR: 2.30, 95% CI: 1.40-3.79, p < 0.001; high TWA-BG group: HR: 1.77, 95% CI: 1.45-2.17, p < 0.001) and in-hospital mortality (low TWA-BG group: HR: 1.73, 95% CI: 1.19-2.51, p = 0.001; high TWA-BG group: HR: 1.64, 95% CI: 1.38-1.95, p < 0.001). Sensitivity analysis conducted through propensity score matching and the subgroup analysis further substantiated the robustness of the results. CONCLUSION: The optimal BG level for patients with cardiogenic shock is 104-138 mg/dl. BG levels below 104 mg/dl and above 138 mg/dl were associated with a less favorable prognosis.

Tendency of dynamic vasoactive and inotropic medications data as a robust predictor of mortality in patients with septic shock: An analysis of the MIMIC-IV database.

Background: Septic shock patients fundamentally require delicate vasoactive and inotropic agent administration, which could be quantitatively and objectively evaluated by the vasoactive-inotropic score (VIS); however, whether the dynamic trends of high-time-resolution VIS alter the clinical outcomes remains unclear. Thus, this study proposes the term VIS Reduction Rate (VRR) to generalise the tendency of dynamic VIS, to explore the association of VRR and mortality for patients with septic shock. Methods: We applied dynamic and static VIS data to predict ICU mortality by two models: the long short-term memory (LSTM) deep learning model, and the extreme gradient boosting (XGBoost), respectively. The specific target cohort was extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database by the sophisticated structured query language (SQL). Enrolled patients were divided into four groups by VRR value: ≥50%, 0 ~ 50%, -50% ~ 0, and < -50%. Statistical approaches included pairwise propensity score matching (PSM), Cox proportional hazards regression, and two doubly robust estimation models to ensure the robustness of the results. The primary and secondary outcomes were ICU mortality and in-hospital mortality, respectively. Results: VRR simplifies the dosing trends of vasoactive and inotropic agents represented by dynamic VIS data while requiring fewer data. In total, 8,887 septic shock patients were included. Compared with the VRR ≥50% group, the 0 ~ 50%, -50% ~ 0, and < -50% groups had significantly higher ICU mortality [hazard ratio (HR) 1.32, 95% confidence interval (CI) 1.17-1.50, p < 0.001; HR 1.79, 95% CI 1.44-2.22, p < 0.001; HR 2.07, 95% CI 1.61-2.66, p < 0.001, respectively] and in-hospital mortality [HR 1.43, 95% CI 1.28-1.60, p < 0.001; HR 1.75, 95% CI 1.45-2.11, p < 0.001; HR 2.00, 95% CI 1.61-2.49, p < 0.001, respectively]. Similar findings were observed in two doubly robust estimation models. Conclusion: The trends of dynamic VIS in ICU might help intensivists to stratify the prognosis of adult patients with septic shock. A lower decline of VIS was remarkably associated with higher ICU and in-hospital mortality among septic shock patients receiving vasoactive-inotropic therapy for more than 24 h.

Corneal curvature, asphericity, and aberrations after transepithelial photorefractive keratectomy and femtosecond laser-assisted in situ keratomileusis for myopia: A prospective comparative study.

PURPOSE: We aimed to compare transepithelial photorefractive keratectomy (TPRK) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for myopia treatment by analyzing corneal curvature, asphericity (Q-value), and corneal aberration. METHODS: Corneal topography was measured before and 6 months after the TPRK or FS-LASIK surgery. We measured and compared corneal curvature (sagittal curvature in the 1- to 7-mm zones), change in keratometric measurements (Kmpost - Kmpre, ΔK), Q-values (from the vertex of the 6-, 7-, 8-, and 9-mm zones), higher-order aberration (HOA), vertical and horizontal trefoil (Z3-3 and Z33), vertical and horizontal coma (Z3-1 and Z31), and spherical aberration (Z40) between the two surgery groups. RESULTS: The sagittal curvature Δ K in the 1-mm zone after TPRK was significantly higher than after FS-LASIK. The Δ K/ΔSE (ΔSE [spherical equivalent] = SEpre - SEpost) ratio in the 1- to 4-mm diameter zones was significantly higher after TPRK than after FS-LASIK. The preoperative Q-values of the 6- and 7-mm zones did not differ between the treatment groups, but postoperative values were significantly higher following FS-LASIK than following TPRK. HOA, Z40, and Z3-1 were all significantly higher after surgery in both groups. Postoperative Z3-3 was significantly higher following TPRK but not following FS-LASIK. There were no postoperative differences in aberrations in either group; however, the change in HOA and Z3-1 was significantly greater following FS-LASIK. CONCLUSION: TPRK changes the corneal curvature to a greater extent and the visual quality (Q-value, aberrations) to a lesser extent than FS-LASIK.

Dowregulation of OTX1 attenuates gastric cancer cell proliferation, migration and invasion.

Orthodenticle homolog 1 (OTX1) has previously been revealed to be tightly associated with the development and progression of several human tumors. However, the functional roles and underlying molecular mechanisms of OTX1 in gastric cancer (GC) remain poorly understood. In the present study, we observed that OTX1 was highly expressed in GC tissues compared with adjacent non­tumor tissues based on a large cohort of samples from The Cancer Genome Atlas (TCGA) database. An immunohistochemical analysis indicated that OTX1 levels were increased in tumors that became metastatic compared with those in tumors that did not. This finding was significantly associated with patients who had shorter overall survival times. The knockdown of OTX1 significantly inhibited the proliferation, migration and invasion of SGC­7901 and MGC­803 cells. Furthermore, the knockdown of OTX1 induced cell cycle arrest in the G0/G1 phase and reduced the expression of cyclin D1. In addition, the inhibition of OTX1 led to increased GC cell apoptosis by upregulating cleaved PARP, cleaved caspase­3 and Bax. In conclusion, our data indicated that OTX1 functions as a key regulator in tumor growth and metastasis of GC cells. Thus, OTX1 may be a promising novel target for molecular therapy directed toward GC.

[Effect of fructose-1,6-diphosphete on myocardial preservation during pulmonary operations].

OBJECTIVE: To investigate the effect of fructose-1,6-diphosphete(FDP) on myocardial preservation in pulmonary operations. METHODS: One hundred and six patients undergoing selective pulmonary lobectomy or segmentectomy were randomly divided into 2 groups with 53 patients each. FDP 200 mg/kg was infused intravenously before anesthesia in the FDP group, while 5% glucose with the same volume was given instead of FDP in the control group. ECGs were monitored from before the anesthesia to 72 h after the operation;the time and type of arrhythmia were recorded. Blood samples were taken before the operation (T0), immediately after the operation(T1), at 24 h(T2),48 h(T3)and 72 h(T(4)) after the operation to determine plasma creatine kinase isoenzyme MB(CK-MB) and cardiac troponin I(cTnI) concentrations. RESULTS: The incidence of arrhythmia in FDP group (35 times) was significantly lower than that in the control group(67 times). The incidence of all types of arrhythmia in the FDP group was also significantly lower than that in the control group. The concentrations of CK-MB and cTnI in the FDP group were significantly lower than those in the control group at T1, T2, T3, and T4. CONCLUSION: FDP is effective for myocardial preservation in pulmonary operations.

[Activation related genes of memory CD(4)(+) T cells in asthma patients].

OBJECTIVE: To screen and identify the genes of activated memory CD(4)(+) T cells in asthma. METHODS: Differential display polymerase chain reaction (DDPCR) was utilized to identify genes of memory CD(4)(+) T cells after activation from asthmatic patients and normal individuals, and the mRNA levels of the differentially expressed genes were analyzed by reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: Nineteen differentially expressed cDNA fragments were isolated. The homology analysis indicated that two fragments possessed a high degree of homology with interleukin-7 (IL-7) mRNA and MM-1 mRNA. RT-PCR confirmed that IL-7 mRNA and MM-1 mRNA levels were increased in memory CD(4)(+) T cells after activation in asthmatic patients (0.390 +/- 0.029, 0.629 +/- 0.047, F = 983, 1264 respectively, all P < 0.05). CONCLUSION: The up-regulated expression of IL-7 and MM-1 genes in memory CD(4)(+) T cells after activation may be a molecular mechanism that differentiates the response to allergens of asthma patients from normal individuals.