Enhancing Localized Electron Density over Pd1.4Cu Decorated Oxygen Defective TiO2-x Nanoarray for Electrocatalytic Nitrite Reduction to Ammonia.

Electrocatalytic nitrite (NO2 -) reduction to ammonia (NH3) is a promising method for reducing pollution and aiding industrial production. However, progress is limited by the lack of efficient selective catalysts and ambiguous catalytic mechanisms. This study explores the loading of PdCu alloy onto oxygen defective TiO2-x, resulting in a significant increase in NH3 yield (from 70.6 to 366.4 µmol cm-2 h-1 at -0.6 V vs reversible hydrogen electrode) by modulating localized electron density. In situ and operando studies illustrate that the reduction of NO2 - to NH3 involves gradual deoxygenation and hydrogenation. The process also demonstrated excellent selectivity and stability, with long-term durability in cycling and 50 h stability tests. Density functional theory (DFT) calculations elucidate that the introduction of PdCu alloys further amplified electron density at oxygen vacancies (Ovs). Additionally, the Ti─O bond is strengthened as the d-band center of the Ti 3d rising after PdCu loading, facilitating the adsorption and activation of *NO2. Moreover, the presence of Ovs and PdCu alloy lowers the energy barriers for deoxygenation and hydrogenation, leading to high yield and selectivity of NH3. This insight of controlling localized electron density offers valuable insights for advancing sustainable NH3 synthesis methods.

Integrative transcriptomic and metabolomic analysis to elucidate the effect of gossypol on Enterobacter sp. GD5.

Gossypol, a yellow polyphenolic compound found in the Gossypium genus, is toxic to animals that ingest cotton-derived feed materials. However, ruminants display a notable tolerance to gossypol, attributed to the pivotal role of ruminal microorganisms in its degradation. The mechanisms of how rumen microorganisms degrade and tolerate gossypol remain unclear. Therefore, in this study, Enterobacter sp. GD5 was isolated from rumen fluid, and the effects of gossypol on its metabolism and gene expression were investigated using liquid chromatography-mass spectrometry (LC-MS) and RNA analyses. The LC-MS results revealed that gossypol significantly altered the metabolic profiles of 15 metabolites (eight upregulated and seven downregulated). The Kyoto Encyclopedia of Genes and Genomes analysis results showed that significantly different metabolites were associated with glutathione metabolism in both positive and negative ion modes, where gossypol significantly affected the biosynthesis of amino acids in the negative ion mode. Transcriptomic analysis indicated that gossypol significantly affected 132 genes (104 upregulated and 28 downregulated), with significant changes observed in the expression of catalase peroxidase, glutaredoxin-1, glutathione reductase, thioredoxin 2, thioredoxin reductase, and alkyl hydroperoxide reductase subunit F, which are related to antioxidative stress. Furthermore, Gene Ontology analysis revealed significant changes in homeostatic processes following gossypol supplementation. Overall, these results indicate that gossypol induces oxidative stress, resulting in the increased expression of antioxidative stress-related genes in Enterobacter sp. GD5, which may partially explain its tolerance to gossypol.

Predictive model for postpartum hemorrhage requiring hysterectomy in a minority ethnic region.

BACKGROUND: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality, and hysterectomy is an important intervention for managing intractable PPH. Accurately predicting the need for hysterectomy and taking proactive emergency measures is crucial for reducing mortality rates. AIM: To develop a risk prediction model for PPH requiring hysterectomy in the ethnic minority regions of Qiandongnan, China, to help guide clinical decision-making. METHODS: The study included 23490 patients, with 1050 having experienced PPH and 74 who underwent hysterectomies. The independent risk factors closely associated with the necessity for hysterectomy were analyzed to construct a risk prediction model, and its predictive efficacy was subsequently evaluated. RESULTS: The proportion of hysterectomies among the included patients was 0.32% (74/23490), representing 7.05% (74/1050) of PPH cases. The number of deliveries, history of cesarean section, placenta previa, uterine atony, and placenta accreta were identified in this population as independent risk factors for requiring a hysterectomy. Receiver operating characteristic curve analysis of the prediction model showed an area under the curve of 0.953 (95% confidence interval: 0.928-0.978) with a sensitivity of 90.50% and a specificity of 90.70%. CONCLUSION: The model demonstrates excellent predictive power and is effective in guiding clinical decisions regarding PPH in the ethnic minority regions of Qiandongnan, China.

Blue Perovskite Lasing Derived from Bound Excitons through Defect Engineering.

All-inorganic perovskite films have emerged as promising candidates for laser gain materials owing to their outstanding optoelectronic properties and straightforward solution processing. However, the performance of blue perovskite lasing still lags far behind due to the inevitable high density of defects. Herein, we demonstrate that defects can be utilized instead of passivated/removed to form bound excitons to achieve excellent blue stimulated emission in perovskite films. Such a strategy emphasizes defect engineering by introducing a deep-level defect in mixed-Rb/Cs perovskite films through octylammonium bromide (OABr) additives. Consequently, the OA-Rb/Cs perovskite films exhibit blue amplified spontaneous emission (ASE) from defect-related bound excitons with a low threshold (13.5 µJ/cm2) and a high optical gain (744.7 cm-1), which contribute to a vertical-cavity surface-emitting laser with single-mode blue emission at 482 nm. This work not only presents a facile method for creating blue laser gain materials but also provides valuable insights for further exploration of high-performance blue lasing in perovskite films.

Pan-cancer analysis of immune checkpoint receptors and ligands in various cells in the tumor immune microenvironment.

Drugs that target immune checkpoint have become the most popular weapon in cancer immunotherapy, yet only have practical benefits for a small percentage of patients. Tumor cells constantly interact with their microenvironment, which is made up of a variety of immune cells as well as endothelial cells and fibroblasts. Immune checkpoint expression and blocked signaling of immune cells in the tumor microenvironment (TME) are key to tumor progression. In this study, we perform deliberation convolution on the TCGA database for human lung, breast, and colorectal cancer to infer crosstalk between immune checkpoint receptors (ICRs) and ligands (ICLs) in TME of pan-carcinogenic solid tumor types, validated by flow cytometry. Analysis of immune checkpoints showed that there was little variation between different tumor types. It showed that CD160, LAG3, TIGIT were found to be highly expressed in CD8+ T cells instead of CD4+ T cells, PD-L1, PD-L2, CD86, LGALS9, TNFRSF14, LILRB4 and other ligands were highly expressed on macrophages, FVR, NECTIN2, FGL1 were highly expressed on Epithelial cells, CD200 was highly expressed in Endothelial cells, and CD80 was highly expressed in CD8 High expression on T cells. Overall, our study provides a new resource for the expression of immune checkpoints in TME on various types of cells. Significance: This study provides immune checkpoint expression of immune cells of multiple cancer types to infer immune mechanisms in the tumor microenvironment and provide ideas for the development of new immune checkpoint-blocking drugs.

Constructing Slip Stacking Diversity in Van der Waals Homobilayers.

The van der Waals (vdW) interface provides two important degrees of freedom-twist and slip-to tune interlayer structures and inspire unique physics. However, constructing diversified high-quality slip stackings (i.e., lattice orientations between layers are parallel with only interlayer sliding) is more challenging than twisted stackings due to angstrom-scale structural discrepancies between different slip stackings, sparsity of thermodynamically stable candidates and insufficient mechanism understanding. Here, using transition metal dichalcogenide (TMD) homobilayers as a model system, this work theoretically elucidates that vdW materials with low lattice symmetry and weak interlayer coupling allow the creation of multifarious thermodynamically advantageous slip stackings, and experimentally achieves 13 and 9 slip stackings in 1T″-ReS2 and 1T″-ReSe2 bilayers via direct growth, which are systematically revealed by atomic-resolution scanning transmission electron microscopy (STEM), angle-resolved polarization Raman spectroscopy, and second harmonic generation (SHG) measurements. This work also develops modulation strategies to switch the stacking via grain boundaries (GBs) and to expand the slip stacking library from thermodynamic to kinetically favored structures via in situ thermal treatment. Finally, density functional theory (DFT) calculations suggest a prominent dependence of the pressure-induced electronic band structure transition on stacking configurations. These studies unveil a unique vdW epitaxy and offer a viable means for manipulating interlayer atomic registries.

Synergistic effect of ultrasound and reinforced electrical environment by bioinspired periosteum for enhanced osteogenesis via immunomodulation of macrophage polarization through Piezo1.

The periosteum plays a vital role in repairing bone defects. Researchers have demonstrated the existence of electrical potential in the periosteum and native bone, indicating that electrical signals are essential for functional bone regeneration. However, the clinical use of external electrical treatments has been limited due to their inconvenience and inefficacy. As an alternative, low-intensity pulsed ultrasound (LIPUS) is a noninvasive form of physical therapy that enhances bone regeneration. Furthermore, the wireless activation of piezoelectric biomaterials through ultrasound stimulation would generate electric charges precisely at the defect area, compensating for the insufficiency of external electrical stimulation and potentially promoting bone regeneration through the synergistic effect of mechanical and electrical stimulation. However, the optimal integration of LIPUS with an appropriate piezoelectric periosteum is yet to be explored. Herein, the BaTiO3/multiwalled-carbon nanotubes/collagen (BMC) membranes have been fabricated, possessing physicochemical properties including improved surface hydrophilicity, enhanced mechanical performance, ideal piezoelectricity, and outstanding biocompatibility, all of which are conducive to bone regeneration. When combined with LIPUS, the endogenous electrical microenvironment of native bone was recreated. After that, the wireless-generated electrical signals, along with the mechanical signals induced by LIPUS, were transferred to macrophages and activated Ca2+ influx through Piezo1. Ultimately, the regenerative effect of the BMC membrane with LIPUS stimulation (BMC + L) was confirmed in a mouse cranial defect model. Together, this research presents a co-engineering strategy that involves fabricating a novel biomimetic periosteum and utilizing the synergistic effect of ultrasound to enhance bone regeneration, which is achieved through the reinforcement of the electrical environment and the immunomodulation of macrophage polarization.

Microwave heating-assisted synthesis of ultrathin platinum-based trimetallic nanosheets as highly stable catalysts towards oxygen reduction reaction in acidic medium.

There are currently almost no ternary platinum-based nanosheets used for acidic oxygen reduction reactions (ORR) due to the difficulty in synthesizing ternary nanosheets with high Pt content. In this work, several ultrathin platinum-palladium-copper nanosheets (PtPdCu NSs) with a thickness of around 1.90 nm were prepared via a microwave heating-assisted method. Microwave heating allows a large number of Pt atoms to deposit into PdCu nanosheets, forming Pt-based ternary nanosheets with high Pt content. Among them, Pt38Pd50Cu12 NSs catalyst displays the highest mass activity (MA) measured in 0.1 M HClO4 of 0.932 A/mgPt+Pd which is 8.6 times of that Pt/C. Besides, Pt38Pd50Cu12 NSs catalyst also exhibits excellent stability with an extremely low MA attenuation after 80,000 cycles accelerated durability testing (ADT) tests. In the single cell tests, the Pt38Pd50Cu12 NSs catalyst manifests higher maximum power density of 796 mW cm-2 than Pt/C of 606 mW cm-2. Density functional theory (DFT) calculations indicate the weaker adsorption between Pt and O-species in Pt38Pd50Cu12 NSs leads to a significant enhancement of ORR activity. This study provides a new strategy to design and prepare ultrathin Pt-based trimetallic nanosheets as efficient and durable ORR catalysts.

Monoammonium Modified Dion-Jacobson Quasi-2D Perovskite for High Efficiency Pure-Blue Light Emitting Diodes.

Quasi-2D perovskites exhibit impressive optoelectronic properties and hold significant promise for future light-emitting devices. However, the efficiency of perovskite light-emitting diodes (PeLEDs) is seriously limited by defect-induced nonradiative recombination and imbalanced charge injection. Here, the defect states are passivated and charge injection balance is effectively improved by introducing the additive cyclohexanemethylammonium (CHMA) to bromide-based Dion-Jacobson (D-J) structure quasi-2D perovskite emission layer. CHMA participates in the crystallization of perovskite, leading to high quality film composed of compact and well-contacted grains with enhanced hole transportation and less defects. As a result, the corresponding PeLEDs exhibit stable pure blue emission at 466 nm with a maximum external quantum efficiency (EQE) of 9.22%. According to current knowledge, this represents the highest EQE reported for pure-blue PeLEDs based on quasi-2D bromide perovskite thin films. These findings underscore the potential of quasi-2D perovskites for advanced light-emitting devices and pave the way for further advancements in PeLEDs.

Bead-based spontaneous Raman codes for multiplex immunoassay.

In the immunoassay process, for fulfilling the need to identify multiple analytes in a small amount of complex sample matrix, it is desirable to develop highly efficient and specific multiplex suspension array technology. Raman coding strategy offers an attractive solution to code the suspension arrays by simply combing narrow spectral bands with stable signal intensities through solid-phase synthesis on the resin beads. Based on this strategy, we report the bead-based spontaneous Raman codes for multiplex immunoassay. The study resulted in superior selectivity of the Raman-encoded beads for binding with single and multiple analytes, respectively. With the use of mixed types of Raman-encoded immunoassay beads, multiple targets in small amounts of samples were identified rapidly and accurately. By confirming the feasibility of bead-based spontaneous Raman codes for multiplex immunoassay, we anticipate this novel technology to be widely applied in the near future.

Engineering valence-mismatched Ti4+ into Fe-based metal-organic-frameworks for enhanced photocatalytic CO2 reduction.

A series of low-dose high-valence Ti4+ doped MIL-53-NH2(Fe) photocatalysts were synthesized for visible-light-driven CO2 reduction. The highest CO2-to-CO conversion rate of Ti4+ doped MIL-53-NH2(Fe) was 7.24 mmol g-1 h-1 and the highest CO selectivity was 94% in acetonitrile solvent using [Ru(bpy)3]2+ and triethanolamine.

Residual distribution and risk assessment of neonicotinoids in urban green space soils of the pearl river delta, South China: A socioeconomic analysis.

Urban green spaces are the soil component in cities that interacts most closely with humans. This study investigated the residues of seven neonicotinoids (NEOs) in soils from urban green spaces within the Pearl River Delta (PRD) region and analyzed the correlation between the residue characteristics and the region's economic development. Notably, we introduced the Nemerow Index method, a comprehensive approach, to quantify the overall pollution level of NEOs in the soil of urban park green spaces and utilized this to assess the cumulative exposure probability risks for different populations in this scenario. We found that: (1) The soil of urban park green spaces exhibited varying degrees of NEOs contamination (Σ7NEOs: N.D.-137.31; 6.25 µg/kg), with imidacloprid and clothianidin constituting the highest proportions (89.46 % and 83.60 %); (2) The residual levels of NEOs in Children's Park were significantly higher than those in community parks within Guangzhou, with an average value of 13.30 µg/kg compared to 3.30 µg/kg; (3) The residual characteristics of NEOs exhibited a positive correlation with regional economic development; specifically, the per capita GDP well correlated with IMIRPF, a summation of seven NEOs in imidacloprid equivalents via relative potency factors (R2 =0.86). Regions with higher economic development typically exhibited elevated IMIRPF levels; (4) The fitted cumulative probability distributions for average daily exposure doses revealed that children's exposure was an order of magnitude higher than adults'. Despite this, the exposure risks for both groups remained within acceptable limits.

Liraglutide ameliorates TAC-induced cardiac hypertrophy and heart failure by upregulating expression level of ANP expression.

Recent studies have underscored the cardioprotective properties of liraglutide. This research explores its impact on cardiac hypertrophy and heart failure following transverse aortic constriction (TAC). We found that liraglutide administration markedly ameliorated cardiac hypertrophy, fibrosis, and function. These benefits correlated with increased ANP expression and reduced activity in the calcineurin A/NFATc3 signaling pathway. Moreover, liraglutide mitigated ER stress and cardiomyocyte apoptosis, and enhanced autophagy. Notably, the positive effects of liraglutide diminished when co-administered with A71915, an ANP inhibitor, suggesting that ANP upregulation is critical to its cardioprotective mechanism.

20- Deoxyingenol attenuate morphine-induced hippocampus neurotoxicity and memory impairments in rats.

Objective: The present study aimed to see if 20-Deoxyingenol(20-DOI) could protect hippocampus neurons from the neurotoxic effects of morphine and reduce memory loss in rats. Method: Male Wistar rats were given morphine hydrochloride (45 mg/kg, sc, four weeks) and 20-DOI (10, 20 mg/kg, ip., coadministered with morphine) for the Morris Water Maze (MWM) test to investigate the effects of 20-DOI on spatial learning and memory. Western blotting was used to evaluate the expression of the hippocampal CA1 region of the cleaved caspase-3, Bax, and Bcl2 proteins and so on. Moreover, these assays were used to evaluate the expression of superoxide dismutase (SOD)2, heme oxygenase 1(HO1) protein, and glutathione peroxidase (GPx) activity within the hippocampus CA1 area. Results: The administration of 20-DOI (10 and 20 mg/kg) to morphine-treated mice enhanced spatial learning and reduced memory deficits. Additionally, 20-DOI treatment reduced apoptosis and oxidative stress in the hippocampal CA1 region of morphine-treated rats. Moreover, 20-DOI improved the autophagy level of the hippocampal CA1 area of morphine-treated rats using Transcription factor EB (TFEB), and 20-DOI prevented spatial learning and memory impairment in morphine-treated rats. The current observation could be partially due to the inhibition of neuronal apoptosis and oxidative stress in the hippocampal CA1 region of rats treated with morphine and the improved autophagy in this region. Conclusions: 20-DOI attenuated morphine administration in rats with chronic disease caused spatial learning and memory dysfunction. These mechanistic effects could be partially related to 20-DOI protecting the CA1 region of rat hippocampal neurons from the morphine-induced oxidative stress, apoptosis, and autophagy through TFEB.

Comprehensive pan-cancer analysis reveals VSIR as a candidate immunologic, diagnostic, and prognostic biomarker.

OBJECTIVES: Being a checkpoint, the expression level of V-set immunoregulatory receptor (VSIR) serves as an indicator of the extent of immunosuppression. Our objective was to undertake a pan-cancer analysis to examine the expression, genetic alterations, prognosis, and immunologic features associated with VSIR. METHODS: The Cancer Genome Atlas (TCGA), Genotype-Tissue Expression (GTEx), GEPIA2, UALCAN, OncoDB, Human Protein Atlas (HPA), STRING, DAVID, cell culture, clinical sample collection, and reverse transcription quantitative polymerase chain reaction (RT-qPCR) were used. RESULTS: This study comprehensively assessed VSIR across 33 cancers using TCGA and GTEx databases. Differential expression analysis revealed elevated VSIR in several cancers, notably in cholangiocarcinoma, esophageal carcinoma, kidney renal cell carcinoma, and liver hepatocellular carcinoma, while decreased expression was observed in various others. Prognostic analysis highlighted its significant association with reduced overall survival (OS) in ESCA and LIHC. Investigation into cancer stages demonstrated a correlation between VSIR expression and stage in ESCA and LIHC. Promoter methylation analysis indicated decreased VSIR methylation levels in tumors, implicating a role in oncogenesis. Furthermore, subcellular localization predictions, Tumor Mutational Burden (TMB), and Microsatellite Instability (MSI) correlations revealed intriguing insight into VSIR's function. Notably, a positive correlation was identified between VSIR expression and various immune cells in both cancers. Protein-protein interaction (PPI) network construction and gene enrichment analysis elucidated VSIR-associated dysregulated pathways, emphasizing its possible involvement in diverse pathways. Finally, experimental validation using LIHC clinical samples and cell lines confirmed elevated VSIR expression, supporting its oncogenic role. CONCLUSION: Collectively, these findings present a comprehensive understanding of VSIR's diverse roles and potential clinical implications in ESCA and LIHC.

Multi-Scenario Validation and Assessment of a Particulate Matter Sensor Monitor Optimized by Machine Learning Methods.

OBJECTIVE: The aim was to evaluate and optimize the performance of sensor monitors in measuring PM2.5 and PM10 under typical emission scenarios both indoors and outdoors. METHOD: Parallel measurements and comparisons of PM2.5 and PM10 were carried out between sensor monitors and standard instruments in typical indoor (2 months) and outdoor environments (1 year) in Shanghai, respectively. The optimized validation model was determined by comparing six machining learning models, adjusting for meteorological and related factors. The intra- and inter-device variation, measurement accuracy, and stability of sensor monitors were calculated and compared before and after validation. RESULTS: Indoor particles were measured in a range of 0.8-370.7 µg/m3 and 1.9-465.2 µg/m3 for PM2.5 and PM10, respectively, while the outdoor ones were in the ranges of 1.0-211.0 µg/m3 and 0.0-493.0 µg/m3, correspondingly. Compared to machine learning models including multivariate linear model (ML), K-nearest neighbor model (KNN), support vector machine model (SVM), decision tree model (DT), and neural network model (MLP), the random forest (RF) model showed the best validation after adjusting for temperature, relative humidity (RH), PM2.5/PM10 ratios, and measurement time lengths (months) for both PM2.5 and PM10, in indoor (R2: 0.97 and 0.91, root-mean-square error (RMSE) of 1.91 µg/m3 and 4.56 µg/m3, respectively) and outdoor environments (R2: 0.90 and 0.80, RMSE of 5.61 µg/m3 and 17.54 µg/m3, respectively), respectively. CONCLUSIONS: Sensor monitors could provide reliable measurements of PM2.5 and PM10 with high accuracy and acceptable inter and intra-device consistency under typical indoor and outdoor scenarios after validation by RF model. Adjusting for both climate factors and the ratio of PM2.5/PM10 could improve the validation performance.

A Report of Two Cases of Meningoencephalitis Caused by Streptococcus intermedius.

Objective: In this paper, we analyzed the clinical data of patients with meningoencephalitis caused by Streptococcus intermedius to understand better the clinical characteristics of the disease and recommend auxiliary diagnostic mode as well as treatment experience. Methods: We reviewed the clinical data of two patients admitted to our department in 2019 with meningoencephalitis caused by S. intermedius. Results: Two female patients were examined, one of whom had a history of radiotherapy for nasopharyngeal carcinoma while the other had no underlying disease. These two patients were admitted with symptoms of meningoencephalitis. Cerebrospinal fluid examinations revealed elevated levels of leukocytes and protein. After treatment with meropenem, the condition improved for a brief time, but then worsened with a decline in mental status and limb movement. Blood and cerebrospinal fluid cultures demonstrated the absence of pathogenic bacteria, while genome sequencing of cerebrospinal fluids revealed the presence of S. intermedius. Cranial magnetic resonance imaging revealed multiple cerebral abscesses (CAs). After coadministration of linezolid as an anti-infective, clinical symptoms gradually improved, and the CAs shrank on follow-up imaging. The condition exhibited a pattern of improvement-deterioration-improvement. Conclusion: Meningoencephalitis caused by S. intermedius is complex and prone to fluctuation and formation of multiple CAs. The definitive clinical diagnosis of this disease can be aided by genome sequencing technology, and early clarification of the etiology combined with the use of potent antibiotics is effective.

Protective effect of dexmedetomidine against delayed bone healing caused by morphine via PI3K/Akt mediated Nrf2 antioxidant defense system.

Background: As a class of analgesics, opioids are frequently used to treat both acute and chronic moderate to severe pain. Patients frequently receive opioid painkillers after orthopedic accidents or surgeries. Evidence suggests that opioid drug users have a 55.1% higher risk of fracture and poor bone repair than non-users of opioid drugs. The key pathogenic alterations in the incidence and progression of poor bone repair are over apoptosis and aging of osteoblasts due to the stress caused by oxidation. Dexmedetomidine (Dex) has been proven to protect against a variety of degenerative illnesses by reducing oxidative stress. However, nothing is known about how it affects bone repair. Methods: PI3K/Akt/Nrf2 pathway was detected by immunofluorescence and Western blot. SOD, CAT, JC-1, dihydroethidium and mitosox were used in the Oxidative Stress. Micro-CT, H&E and Masson's staining, immunohistochemically were performed to evaluate the therapeutic effects of DEX on calvarial defects in the morphine-induced rat model. Results: We found that morphine-induced an imbalance in the metabolism and catabolism of primary rat Osteoblasts. However, these conditions could be inhibited by DEX treatment. In the meantime, DEX induced the expression of Nrf2-regulated antioxidant enzymes such as NQO1, HO-1, GCLm, GCLc, and TrxR1. DEX-mediated Nrf2 activation is linked to the PI3K/Akt signaling system. Furthermore, it has been established that intravenous DEX enhanced the growth of bone healing in a model of a surgically produced rat cranial lesion. Conclusion: This is the first description of the unique DEX mechanism acting as a Nrf2 activator against morphine-mediated oxidative harm, raising the possibility that the substance may be used to prevent bone defects.

A nomogram predicting pneumonia after cardiac surgery: a retrospective modeling study.

BACKGROUND: Postoperative pneumonia (POP) is the most prevalent of all nosocomial infections in patients who underwent cardiac surgery. The aim of this study was to identify independent risk factors for pneumonia after cardiac surgery, from which we constructed a nomogram for prediction. METHODS: The clinical data of patients admitted to the Department of Cardiothoracic Surgery of Nanjing Drum Tower Hospital from October 2020 to September 2021 who underwent cardiac surgery were retrospectively analyzed, and the patients were divided into two groups according to whether they had POP: POP group (n=105) and non-POP group (n=1083). Preoperative, intraoperative, and postoperative indicators were collected and analyzed. Logistic regression was used to identify independent risk factors for POP in patients who underwent cardiac surgery. We constructed a nomogram based on these independent risk factors. Model discrimination was assessed via area under the receiver operating characteristic curve (AUC), and calibration was assessed via calibration plot. RESULTS: A total of 105 events occurred in the 1188 cases. Age (>55 years) (OR: 1.83, P=0.0225), preoperative malnutrition (OR: 3.71, P<0.0001), diabetes mellitus(OR: 2.33, P=0.0036), CPB time (Cardiopulmonary Bypass Time) > 135 min (OR: 2.80, P<0.0001), moderate to severe ARDS (Acute Respiratory Distress Syndrome )(OR: 1.79, P=0.0148), use of ECMO or IABP or CRRT (ECMO: Extra Corporeal Membrane Oxygenation; IABP: Intra-Aortic Balloon Pump; CRRT: Continuous Renal Replacement Therapy )(OR: 2.60, P=0.0057) and MV( Mechanical Ventilation )> 20 hours (OR: 3.11, P<0.0001) were independent risk factors for POP. Based on those independent risk factors, we constructed a simple nomogram with an AUC of 0.82. Calibration plots showed good agreement between predicted probabilities and actual probabilities. CONCLUSION: We constructed a facile nomogram for predicting pneumonia after cardiac surgery with good discrimination and calibration. The model has excellent clinical applicability and can be used to identify and adjust modifiable risk factors to reduce the incidence of POP as well as patient mortality.