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(1) Currently, the survival prognosis for patients with relapsed and refractory acute myeloid leukemia (R/R AML) is extremely poor. Therefore, the exploration of novel drugs is imperative to enhance the prognosis of patients with R/R AML. The therapeutic efficacy and mechanism of Chidamide, a novel epigenetic regulatory drug, in the treatment of R/R AML remain unclear. METHODS: The mechanism of action of Chidamide has been explored in various AML cell lines through various methods such as cell apoptosis, cell cycle analysis, high-throughput transcriptome sequencing, gene silencing, and xenograft models. RESULTS: Here, we have discovered that chidamide potently induces apoptosis, G0/G1 phase arrest, and mitochondrial membrane potential depolarization in R/R AML cells, encompassing both primary cells and cell lines. Through RNA-seq analysis, we further revealed that chidamide epigenetically regulates the upregulation of differentiation-related pathways while suppressing those associated with cell replication and cell cycle progression. Notably, our screening identified NR4A3 as a key suppressor gene whose upregulation by chidamide leads to P21-dependent cell cycle arrest in the G0/G1 phase. CONCLUSIONS: We have discovered a novel epigenetic regulatory mechanism of chidamide in the treatment of relapsed and refractory acute myeloid leukemia (R/R AML).
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Enzyme-mediated systems have been widely employed for the biotransformation of environmental contaminants. However, the catalytic performance of free enzymes is restricted by the rapid loss of their catalytic activity, stability, and reusability. In this work, we developed an enzyme immobilization platform by elaborately anchoring fungal laccase onto arginine-functionalized boron nitride nanosheets (BNNS-Arg@Lac). BNNS-Arg@Lac showcased â¼75% immobilization yield and enhanced stability against fluctuating pH values and temperatures, along with remarkable reusability across six consecutive cycles, outperforming free natural laccase (nlaccase). A model pollutant, atrazine, was selected for a proof-of-concept demonstration, given the substantial environmental and public health concerns in agriculture runoff. BNNS-Arg@Lac-catalyzed atrazine degradation rate was nearly twice that of nlaccase. Moreover, BNNS-Arg@Lac consistently demonstrated superior atrazine degradation in synthetic agricultural wastewater and various mediator systems compared to nlaccase. Comprehensive product analysis unraveled distinct degradation pathways for BNNS-Arg@Lac and nlaccase. Overall, this research provides a foundation for the future development of enzyme-nanomaterial hybrids for degrading environmental chemicals and may unlock new potential for green and efficient resource recovery and waste management strategies.
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PURPOSE: Programmed death-1 antibody plus chemotherapy has gained approval for the treatment for (human epidermal growth factor receptor 2 negative locally advanced or metastatic gastric or gastroesophageal junction cancer. This study aims to analyze the efficacy and safety of anti-programmed death-1 antibody combined with chemo- or anti-angiogenesis therapy in Chinese patients with advanced or metastatic gastric or gastroesophageal junction cancer in a real-world setting. METHODS: In total, 122 patients treated with anti-programmed death-1 antibody-based combination therapy between April 2019 and December 2021 were encompassed. Clinical outcomes and safety proï¬le were measured and analyzed. RESULTS: In the whole cohort, median overall survival was 17.2 months, median progression-free survival was 10.9 months, and median duration of response was 9.4 months. Notably, in the first-line patients, the median overall survival was not reached, median progression-free survival was 14.8 months, objective response rate was 68.4%. In the second-line group, median overall survival, median progression-free survival, median duration of response, and objective response rate were 10.9 months, 5.9 months, 4.5 months, and 41.5%, respectively. Treatment-related adverse events of any grade were observed in 28.2% of the overall cohort, primarily affecting the hematological and liver function. Grade 3 or 4 adverse events were mainly characterized by increased levels of aspartate aminotransferase, alanine aminotransferase, along with decreased lymphocyte and white blood cells, as well as anemia. CONCLUSIONS: Patients in our cohort experienced a clinical benefit from anti-programmed death-1 antibody-combined treatment in first-line treatment settings, with acceptable treatment-related adverse events. The benefit of anti-programmed death-1 antibody combined with chemo- or anti-angiogenesis treatment to the second-line patients should be further confirmed by large multi-center randomized, controlled clinical trials.
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Neoplasias Esofágicas , Junção Esofagogástrica , Receptor de Morte Celular Programada 1 , Neoplasias Gástricas , Humanos , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/patologia , Masculino , Feminino , Pessoa de Meia-Idade , Junção Esofagogástrica/patologia , Junção Esofagogástrica/efeitos dos fármacos , Idoso , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/patologia , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Resultado do Tratamento , Inibidores de Checkpoint Imunológico/uso terapêutico , Inibidores de Checkpoint Imunológico/efeitos adversos , Intervalo Livre de Progressão , China , População do Leste AsiáticoRESUMO
Supramolecular coordination self-assembly on solid surfaces provides an effective route to form two-dimensional (2D) metal-organic frameworks (MOFs). In such processes, surface-adsorbate interaction plays a key role in determining the MOFs' structural and chemical properties. Here, we conduct a systematic study of Cu-HAT (HAT = 1,4,5,8,9,12-hexaazatriphenylene) 2D conjugated MOFs (c-MOFs) self-assembled on Cu(111), Au(111), Ag(111), and MoS2 substrates. Using scanning tunneling microscopy and density functional theory calculations, we found that the as-formed Cu3HAT2 c-MOFs on the four substrates exhibit distinctive structural features including lattice constant and molecular conformation. The structural variations can be attributed to the differentiated substrate effects on the 2D c-MOFs, including adsorption energy, lattice commensurability, and surface reactivity. Specifically, the framework grown on MoS2 is nearly identical to its free-standing counterpart. This suggests that the 2D van der Waals (vdW) materials are good candidate substrates for building intrinsic 2D MOFs, which hold promise for next-generation electronic devices.
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Structural color, renowned for its enduring vibrancy, has been extensively developed and applied in the fields of display and anticounterfeiting. However, its limitations in brightness and saturation hinder further application in these areas. Herein, we propose a pendant evaporation self-assembly method to address these challenges simultaneously. By leveraging natural convection and Marangoni flow synchronization, the self-assembly process enhances the dynamics and duration of colloidal nanoparticles, thereby enhancing the orderliness of colloidal photonic crystals. On average, this technique boosts the brightness of structural color by 20% and its saturation by 35%. Moreover, pendant evaporation self-assembly is simple and convenient to operate, making it suitable for industrial production. We anticipate that its adoption will remarkably advance the industrialization of structural color, facilitating its engineering applications across various fields, such as display technology and anticounterfeiting identification.
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Efficient medical image segmentation aims to provide accurate pixel-wise predictions with a lightweight implementation framework. However, existing lightweight networks generally overlook the generalizability of the cross-domain medical segmentation tasks. In this paper, we propose Generalizable Knowledge Distillation (GKD), a novel framework for enhancing the performance of lightweight networks on cross-domain medical segmentation by generalizable knowledge distillation from powerful teacher networks. Considering the domain gaps between different medical datasets, we propose the Model-Specific Alignment Networks (MSAN) to obtain the domain-invariant representations. Meanwhile, a customized Alignment Consistency Training (ACT) strategy is designed to promote the MSAN training. Based on the domain-invariant vectors in MSAN, we propose two generalizable distillation schemes, Dual Contrastive Graph Distillation (DCGD) and Domain-Invariant Cross Distillation (DICD). In DCGD, two implicit contrastive graphs are designed to model the intra-coupling and inter-coupling semantic correlations. Then, in DICD, the domain-invariant semantic vectors are reconstructed from two networks (i.e., teacher and student) with a crossover manner to achieve simultaneous generalization of lightweight networks, hierarchically. Moreover, a metric named Fréchet Semantic Distance (FSD) is tailored to verify the effectiveness of the regularized domain-invariant features. Extensive experiments conducted on the Liver, Retinal Vessel and Colonoscopy segmentation datasets demonstrate the superiority of our method, in terms of performance and generalization ability on lightweight networks.
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Processamento de Imagem Assistida por Computador , Humanos , Processamento de Imagem Assistida por Computador/métodos , Algoritmos , Redes Neurais de Computação , Bases de Dados Factuais , Aprendizado ProfundoRESUMO
The Asian citrus psyllid, Diaphorina citri, is the primary vector of the HLB pathogen, Candidatus Liberibacter asiaticus (CLas). The acquisition of CLas shortens the developmental period of nymphs, accelerating the emergence into adulthood and thereby facilitating the spread of CLas. Cuticular proteins (CPs) are involved in insect emergence. In this study, we investigated the molecular mechanisms underlying CLas-promoted emergence in D. citri via CP mediation. Here, a total of 159 CP genes were first identified in the D. citri genome. Chromosomal location analysis revealed an uneven distribution of these CP genes across the 13 D. citri chromosomes. Proteomic analysis identified 54 differentially expressed CPs during D. citri emergence, with 14 CPs exhibiting significant differential expression after CLas acquisition. Five key genes, Dc18aa-1, Dc18aa-2, DcCPR-24, DcCPR-38 and DcCPR-58, were screened from the proteome and CLas acquisition. The silencing of these 5 genes through a modified feeding method significantly reduced the emergence rate and caused various abnormal phenotypes, indicating the crucial role that these genes play in D. citri emergence. This study provides a comprehensive overview of the role of CPs in D. citri and reveals that CLas can influence the emergence process of D. citri by regulating the expression of CPs. These key CPs may serve as potential targets for future research on controlling huanglongbing (HLB) transmission.
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Hepatitis B virus (HBV) infection remains a major global health concern, necessitating the development of sensitive and reliable diagnostic methods. In this study, we propose a novel approach to enhance the sensitivity of HBV DNA detection by leveraging a concentration imbalance-driven DNA circuit (CIDDC) as an operational amplifier, coupled with a hybridization-responsive DNA-templated silver nanocluster (DNA-AgNCs) nanoprobe named Q·C6-AgNCs. The CIDDC system effectively converts and amplifies the input HBV DNA into an enriched generic single-stranded DNA output, which subsequently triggers the fluorescence of the DNA-AgNCs reporter upon hybridization, generating a measurable signal for detection. By incorporating the DNA circuit, we not only achieved enhanced sensitivity with a lower detection limit of 0.11 nM but also demonstrated high specificity with single-base mismatch discriminability for HBV DNA detection. Additionally, this mix-and-detect assay format is simple, user-friendly, and isothermal. This innovative strategy holds promise for advancing molecular diagnostics and facilitating the effective management of HBV-related diseases.
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BACKGROUND: Carbon-based nanozymes have recently received enormous concern, however, there is still a huge challenge for inexpensive and large-scale synthesis of magnetic carbon-based "Two-in-One" mimics with both peroxidase (POD)-like and laccase-like activities, especially their potential applications in multi-mode sensing of antibiotics and neurotransmitters in biofluids. Although some progresses have been made in this field, the feasibility of biomass-derived carbon materials with both POD-like and laccase-like activities by polyatomic doping strategy is still unclear. In addition, multi-mode sensing platform can provide a more reliable result because of the self-validation, self-correction and mutual agreement. Nevertheless, the use of magnetic carbon-based nanozyme sensors for the multi-mode detection of antibiotics and neurotransmitters have not been investigated. RESULTS: We herein report a shrimp shell-derived N, O-codoped porous carbon confined magnetic CuFe2O4 nanosphere with outstanding laccase-like and POD-like activities for triple-mode sensing of antibiotic d-penicillamine (D-PA) and chloramphenicol (CPL), as well as colorimetric detection of neurotransmitters in biofluids. The magnetic CuFe2O4/N, O-codoped porous carbon (MCNPC) armored mimetics was successfully fabricated using a combined in-situ coordination and high-temperature crystallization method. The synthesized MCNPC composite with superior POD-like activity can be used for colorimetric/temperature/smartphone-based triple-mode detection of D-PA and CPL in goat serum. Importantly, the MCNPC nanozyme can also be used for colorimetric analysis of dopamine and epinephrine in human urine. SIGNIFICANCE: This work not only offered a novel strategy to large-scale, cheap synthesize magnetic carbon-based "Two-in-One" armored mimetics, but also established the highly sensitive and selective platforms for triple-mode monitoring D-PA and CPL, as well as colorimetric analysis of neurotransmitters in biofluids without any tanglesome sample pretreatment.
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Antibacterianos , Carbono , Cobre , Neurotransmissores , Carbono/química , Antibacterianos/análise , Antibacterianos/urina , Antibacterianos/sangue , Neurotransmissores/urina , Neurotransmissores/análise , Neurotransmissores/sangue , Porosidade , Cobre/química , Humanos , Nanosferas/química , Colorimetria/métodos , Compostos Férricos/química , Materiais Biomiméticos/química , Animais , Técnicas Biossensoriais/métodos , Cloranfenicol/análise , Cloranfenicol/urina , Limite de DetecçãoRESUMO
BACKGROUND: Septic shock is a lethal disease, and identifying high-risk patients through noninvasive and widely available biomarkers can help improve global outcomes. While the clinical impact of chloride levels on critically ill patients remains unclear, this study aims to investigate the association between hypochloremia and mortality following ICU admission among septic shock patients. METHODS: This is an analysis of data stored in the databases of Medical Information Mart for Intensive Care IV (MIMIC-IV). The initial chloride levels were classified ashypochloremia, normal chloraemia, and hyperchloraemia. A multivariate logistic regression model was applied, adjusting for age, lactate, pH, PO2, urine volume, RDW, creatinine, and liver disease, to assess the association between the three categories of chloride levels and mortality. RESULTS: Of 3726 patients included in the study, 470 patients (12.6%) had hypochloremia on ICU admission. During the follow-up period, 1120 (33.5%) patients died. Hypochloremia was significantly associated with increased mortality and the incidence of AKI after adjusting for several variables. CONCLUSIONS: Hypochloremia is independently associated with higher hospital mortality, AKI incidence among septic shock patients. However, further high-quality research is necessary to establish the precise relationship between hypochloremia and septic shock prognosis.
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To address the inherent limitations of conventional carbon nanotubes (CNTs), such as their tendency to agglomerate and scarcity of catalytic sites, the development of branched carbon nanotubes (BCNTs) with a unique hierarchical structure has emerged as a promising solution. Herein, gram scale quantities of densely branched and structurally consistent Ni-Fe decorated branched CNTs (Ni-Fe@BCNT) have been prepared. This uniform and densely branched architecture ensures excellent dispersibility and superior electrical conductivity. Additionally, each branched tip is equipped with Ni-Fe particles, thereby providing numerous catalytic sites which endow them with exceptional catalytic activity for the conversion of polysulfides. The polypropylene (PP) separator modified with Ni-Fe@BCNT interlayer is fabricated as a multifunctional barrier for Li-S batteries. The experimental results demonstrate that Ni-Fe@BCNT interlayer can effectively suppress the shuttle effect of polysulfides and enhance their redox kinetics. The outstanding catalytic ability of Ni-Fe@BCNT interlayer enables batteries with high specific capacities, outstanding rate performance, and remarkable cycling stability. This approach proposed in this work paves a new path for synthesizing BCNTs and shows great potential for scaling up the production of BCNTs to address more demanding applications.
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BACKGROUND: This study aimed to identify potential subtypes of hepatocellular carcinoma (HCC) associated with cirrhosis and to investigate key markers using bioinformatic analysis of gene expression datasets-0. METHODS: Three data sets (GSE17548, GSE56140, and GSE87630) were extracted from the Gene Expression Omnibus (GEO) database and normalized using the Limma package in R. Principal component analysis (PCA) and cluster analysis was performed to examine data distribution and identify subtypes. Differential gene expression analysis was performed using the Limma software package. Protein-protein interaction analysis and functional annotation were performed using the STRING database and Cytoscape software. Important signaling pathways and processes were identified using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) Pathway Analysis. RESULTS: The analysis revealed different subtypes of HCC associated with cirrhosis and identified several key genes, including CCNB2, MCM4, and CDC20, with strong binding power and prognostic value. Functional annotation indicated involvement in cell cycle regulation and metabolic pathways. ROC analysis showed high sensitivity and specificity of these genes in predicting HCC prognosis. CONCLUSION: These results suggest that CCNB2, MCM4, and CDC20 may serve as potential biomarkers for predicting HCC prognosis in patients with cirrhosis and provide insights into the molecular mechanisms of HCC progression.
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The industrialization of lithium-sulfur (Li-S) batteries faces challenges due to the shuttling effect of lithium polysulfides (LiPSs) and the growth of lithium dendrites. To address these issues, a simple and scalable method is proposed to synthesize 2D membranes comprising a single layer of cubic graphitic cages encased with few-layer, curved MoS2. The distinctive 2D architecture is achieved by confining the epitaxial growth of MoS2 within the open cages of a 2D-ordered mesoporous graphitic framework (MGF), resulting in MoS2@MGF heterostructures with abundant sulfur vacancies. The experimental and theoretical studies establish that these MoS2@MGF membranes can act as a multifunctional interlayer in Li-S batteries to boost their comprehensive performance. The inclusion of the MoS2@MGF interlayer facilitates the trapping and conversion kinetics of LiPSs, preventing their shuttling effect, while simultaneously promoting uniform lithium deposition to inhibit dendrite growth. As a result, Li-S batteries with the MoS2@MGF interlayer exhibit high electrochemical performance even under high sulfur loading and lean electrolyte conditions. This work highlights the potential of designing advanced MoS2-encased heterostructures as interlayers, offering a viable solution to the current limitations plaguing Li-S batteries.
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Sepsis, a life-threatening medical condition, manifests as new or worsening organ failures due to a dysregulated host response to infection. Many patients with sepsis have manifested a hyperinflammatory phenotype leading to the identification of inflammatory modulation by corticosteroids as a key treatment modality. However, the optimal use of corticosteroids in sepsis treatment remains a contentious subject, necessitating a deeper understanding of their physiological and pharmacological effects. Our study conducts a comprehensive review of randomized controlled trials (RCTs) focusing on traditional corticosteroid treatment in sepsis, alongside an analysis of evolving clinical guidelines. Additionally, we explore the emerging role of artificial intelligence (AI) in medicine, particularly in diagnosing, prognosticating, and treating sepsis. AI's advanced data processing capabilities reveal new avenues for enhancing corticosteroid therapeutic strategies in sepsis. The integration of AI in sepsis treatment has the potential to address existing gaps in knowledge, especially in the application of corticosteroids. Our findings suggest that combining corticosteroid therapy with AI-driven insights could lead to more personalized and effective sepsis treatments. This approach holds promise for improving clinical outcomes and presents a significant advancement in the management of this complex and often fatal condition.
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Robust anti-counterfeiting techniques aim for easy identification while remaining difficult to forge, especially for high-value items such as currency and passports. However, many existing anti-counterfeiting techniques rely on deterministic processes, resulting in loopholes for duplication and counterfeiting. Therefore, achieving high-level encryption and easy authentication through conventional anti-counterfeiting techniques has remained a significant challenge. To address this, this work proposes a solution that combined fluorescence and structural colors, creating a physically unclonable multiplex encryption system (PUMES). In this study, the physicochemical properties of colloidal photonic inks are systematically adjusted to construct a comprehensive printing phase diagram, revealing the printable region. Furthermore, the brightness and color saturation of inkjet-printed colloidal photonic crystal structural colors are optimized by controlling the substrate's hydrophobicity, printed droplet volume, and the addition of noble metals. Finally, fluorescence is incorporated to build PUMES, including macroscopic fluorescence and structural color patterns, as well as microscopic physically unclonable fluorescence patterns. The PUMES with intrinsic randomness and high encoding capacity are authenticated by a deep learning algorithm, which proved to be reliable and efficient under various observation conditions. This approach can provide easy identification and formidable resistance against counterfeiting, making it highly promising for the next-generation anti-counterfeiting of currency and passports.
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Nitrite (NO2-) is categorized as a carcinogenic substance and is subjected to severe limitations in water and food. To safeguard the public's health, developing fast and convenient methods for determination of NO2- is of significance. Point-of-care testing (POCT) affords demotic measurement of NO2- and shows huge potential in future technology beyond those possible with traditional methods. Here, a novel ratiometric fluorescent nanoprobe (Ru@MOF-NH2) is developed by integrating UiO-66-NH2 with tris(2,2'-bipyridyl)ruthenium(II) ([Ru(bpy)3]2+) through a one-pot approach. The special diazo-reaction between the amino group of UiO-66-NH2 and NO2- is responsible for the report signal (blue emission) with high selectivity and the red emission from [Ru(bpy)3]2+ offers the reference signal. The proposed probe shows obviously distinguishable color change from blue to red towards NO2- via naked-eye. Moreover, using a smartphone as the detection device to read color hue, ultra-sensitive quantitative detection of NO2- is achieved with a low limit of detection at 0.6 µΜ. The accuracy and repeatability determined in spiked samples through quantitative visualization is in the range of 105 to 117% with a coefficient of variation below 4.3%. This POCT sensing platform presents a promising strategy for detecting NO2- and expands the potential applications for on-site monitoring in food and environment safety assessment.
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Estruturas Metalorgânicas , Ácidos Ftálicos , Nitritos , Fluorescência , Dióxido de Nitrogênio , Corantes FluorescentesRESUMO
To improve the security of data transmission in the highway freight information system, this study is an application plan for the highway freight information system based on quantum communication. This solution is based on quantum communication technology to encrypt and transmit key sensitive data[1]; it realizes unified management of quantum keys through the quantum key cloud terminal and provides key services for the highway freight information system; it realizes access to the system through the quantum key cloud service platform. The secure use of mobile terminal quantum keys improves the overall security of the road freight information system. This scheme uses the quantum encryption key generated only once, effectively protecting the entire system's security. The quantum key management server and quantum key cloud platform defined in this plan manage terminals and quantum keys respectively, and jointly produce and distribute quantum keys with the help of other hardware facilities and software to provide secure transmission of key information.
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Porcine circovirus type 2 (PCV2) infection cause multi-systemic inflammation in pigs. Platycodon grandiflorus polysaccharide (PGPSt) has been reported to have the effects of immune regulation and disease resistance. Nevertheless, the role and mechanism of PGPSt in the inflammatory response of 3D4/21 cells induced by PCV2 infection remain unclear. The present study aims to investigate effects of PGPSt on inflammatory response and its possible underlying mechanisms in vitro models. Cells were treated with PCV2 for 36 h to construct a cell inflammation model. The 3D4/21 cell lines were pretreated with or without PGPSt, and the changes of inflammation-related markers and the signaling pathway were detected by CCK-8, ELISA, qPCR and Western blot. The results showed that PGPSt was non-toxic to cells and protected PCV2-infected cells from inflammatory damage. PGPSt could significantly inhibit the high acetylation of histone H3 (AcH3) and histone H4 (AcH4), down-regulate HAT and up-regulate HDAC activity, and reduce the expression of pro-inflammatory enzymes iNOS and COX-2 proteins levels. Then the levels of IL-1ß, IL-6 and TNF-α were significantly inhibited, and the level of IL-10 was promoted. We also observed that PGPSt inhibited the phosphorylation of p65, p38 and Erk1/2, which subsequently inhibited nuclear translocation of NF-κB p65 to express pro-inflammatory factors. In conclusion, PGPSt can reduce the inflammatory response by regulating histone acetylation, reducing the release of inflammatory factors, reducing the expression of pro-inflammatory enzymes, and inhibiting the activation of NF-κB and MAPKs signaling pathways. This suggests that PGPSt had an anti-inflammatory effect on the inflammatory response caused by PCV2 infection, which provided theoretical data support for the research.
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Circovirus , Platycodon , Animais , Suínos , NF-kappa B/metabolismo , Platycodon/metabolismo , Circovirus/fisiologia , Inflamação , Histonas/metabolismo , Polissacarídeos/farmacologiaRESUMO
Parkinson's disease (PD) is currently the second most incurable central neurodegenerative disease resulting from various pathogenesis. As the "energy factory" of cells, mitochondria play an extremely important role in supporting neuronal signal transmission and other physiological activities. Mitochondrial dysfunction can cause and accelerate the occurrence and progression of PD. How to effectively prevent and suppress mitochondrial disorders is a key strategy for the treatment of PD from the root. Therefore, the emerging mitochondria-targeted therapy has attracted considerable interest. Herein, the relationship between mitochondrial dysfunction and PD, the causes and results of mitochondrial dysfunction, and major strategies for ameliorating mitochondrial dysfunction to treat PD are systematically reviewed. The study also prospects the main challenges for the treatment of PD.
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Mitocôndrias , Doença de Parkinson , Doença de Parkinson/metabolismo , Doença de Parkinson/patologia , Humanos , Mitocôndrias/metabolismo , Mitocôndrias/efeitos dos fármacos , AnimaisRESUMO
ABSTRACT: Objective: To achieve a better prediction of in-hospital mortality, the Sequential Organ Failure Assessment (SOFA) score needs to be adjusted and combined with comorbidities. This study aims to enhance the prediction of SOFA score for in-hospital mortality in patients with Sepsis-3. Methods: This study adjusted the maximum SOFA score within the first 3 days (Max Day3 SOFA) in relation to in-hospital mortality using logistic regression and incorporated the age-adjusted Charlson Comorbidity Index (aCCI) as a continuous variable to build the age-adjusted Charlson Comorbidity Index-Sequential Organ Failure Assessment (aCCI-SOFA) model. The outcome was in-hospital mortality. We developed, internally validated, and externally validated the aCCI-SOFA model using cohorts of Sepsis-3 patients from the MIMIC-IV, MIMIC-III (CareVue), and the FAHWMU cohort. The predictive performance of the model was assessed through discrimination and calibration, which was assessed using the area under the receiver operating characteristic and calibration curves, respectively. The overall predictive effect was evaluated using the Brier score. Measurements and main results: Compared with the Max Day3 SOFA, the aCCI-SOFA model showed significant improvement in area under the receiver operating characteristic with all cohorts: development cohort (0.81 vs 0.75, P < 0.001), internal validation cohort (0.81 vs 0.76, P < 0.001), MIMIC-III (CareVue) cohort (0.75 vs 0.68, P < 0.001), and FAHWMU cohort (0.72 vs 0.67, P = 0.001). In sensitivity analysis, it was suggested that the application of aCCI-SOFA in early nonseptic shock patients had greater clinical value, with significant differences compared with the original SOFA scores in all cohorts ( P < 0.05). Conclusion: For septic patients in intensive care unit, the aCCI-SOFA model exhibited superior predictive performance. The application of aCCI-SOFA in early nonseptic shock patients had greater clinical value.