Glucocorticoid therapy for sepsis in the AI era: a survey on current and future approaches.

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.

Evaluation of factors influencing long-term and textbook outcomes in laparoscopic gastrectomy.

BACKGROUND: Textbook outcome (TO) in gastric cancer surgery is a multidimensional measure of surgical quality. However, its impact on long-term survival after laparoscopic gastrectomy (LG) is unclear. This study aims to evaluate TO in LG, assess its hospital-level relevance, and examine its association with long-term survival. METHODS: In this retrospective cohort study, we analyzed 2278 consecutive gastric cancer patients who underwent laparoscopic gastrectomy (LG) from January 2004 to December 2017. We determined TO achievement rates, compared preoperative and intraoperative variables between TO and non-TO groups, identified independent predictors of TO, and assessed long-term oncologic outcomes using Kaplan-Meier analysis and Cox regression. RESULTS: A total of 1540 LG patients were analyzed, with 994 (64.5%) achieving TO. The least frequently achieved metric was 'hospital stays ≤21 days' (83.4%), followed by 'lymph nodes retrieved ≥15' (84.0%). Factors independently associated with reduced TO likelihood included age ≥65 years, BMI ≥25, ASA III, conversion to open surgery, operation time ≥260 min, and estimated blood loss ≥150 ml. Furthermore, TO was independently linked to improved 5-year overall survival (OS) and disease-free survival (DFS) (HR 0.519 [0.443-0.609] and HR 0.517 [0.443-0.604], respectively). CONCLUSION: Implementing the TO concept in LG provides a benchmark for achieving improved prognoses and empowers surgeons to devise strategies for enhancing surgical care quality.

MRI advances in the imaging diagnosis of tuberculous meningitis: opportunities and innovations.

Tuberculous meningitis (TBM) is not only one of the most fatal forms of tuberculosis, but also a major public health concern worldwide, presenting grave clinical challenges due to its nonspecific symptoms and the urgent need for timely intervention. The severity and the rapid progression of TBM underscore the necessity of early and accurate diagnosis to prevent irreversible neurological deficits and reduce mortality rates. Traditional diagnostic methods, reliant primarily on clinical findings and cerebrospinal fluid analysis, often falter in delivering timely and conclusive results. Moreover, such methods struggle to distinguish TBM from other forms of neuroinfections, making it critical to seek advanced diagnostic solutions. Against this backdrop, magnetic resonance imaging (MRI) has emerged as an indispensable modality in diagnostics, owing to its unique advantages. This review provides an overview of the advancements in MRI technology, specifically emphasizing its crucial applications in the early detection and identification of complex pathological changes in TBM. The integration of artificial intelligence (AI) has further enhanced the transformative impact of MRI on TBM diagnostic imaging. When these cutting-edge technologies synergize with deep learning algorithms, they substantially improve diagnostic precision and efficiency. Currently, the field of TBM imaging diagnosis is undergoing a phase of technological amalgamation. The melding of MRI and AI technologies unquestionably signals new opportunities in this specialized area.

The diagnosis of tuberculous meningitis: advancements in new technologies and machine learning algorithms.

Tuberculous meningitis (TBM) poses a diagnostic challenge, particularly impacting vulnerable populations such as infants and those with untreated HIV. Given the diagnostic intricacies of TBM, there's a pressing need for rapid and reliable diagnostic tools. This review scrutinizes the efficacy of up-and-coming technologies like machine learning in transforming TBM diagnostics and management. Advanced diagnostic technologies like targeted gene sequencing, real-time polymerase chain reaction (RT-PCR), miRNA assays, and metagenomic next-generation sequencing (mNGS) offer promising avenues for early TBM detection. The capabilities of these technologies are further augmented when paired with mass spectrometry, metabolomics, and proteomics, enriching the pool of disease-specific biomarkers. Machine learning algorithms, adept at sifting through voluminous datasets like medical imaging, genomic profiles, and patient histories, are increasingly revealing nuanced disease pathways, thereby elevating diagnostic accuracy and guiding treatment strategies. While these burgeoning technologies offer hope for more precise TBM diagnosis, hurdles remain in terms of their clinical implementation. Future endeavors should zero in on the validation of these tools through prospective studies, critically evaluating their limitations, and outlining protocols for seamless incorporation into established healthcare frameworks. Through this review, we aim to present an exhaustive snapshot of emerging diagnostic modalities in TBM, the current standing of machine learning in meningitis diagnostics, and the challenges and future prospects of converging these domains.

Sensitive Current Sensor Based on a Lanthanide Framework with Lewis Basic Bipyridyl Sites for Cu2+ Detection.

A new Yb-based three-dimensional metal-organic framework with free Lewis basic sites, [Yb2(ddbpdc)3(CH3OH)2] (referred to as ACBP-6), from YbCl3 and (6R,8R)-6,8-dimethyl-7,8-dihydro-6H-[1,5]dioxonino[7,6-b:8,9-b']dipyridine-3,11-dicarboxylic acid (H2ddbpdc) was synthesized by a conventional solvothermal method. Two Yb3+ are connected by three carboxyl groups to form the [Yb2(CO2)5] binuclear unit, which is further bridged by two carboxyl moieties to produce a tetranuclear secondary building unit. With further ligation of the ligand ddbpdc2-, a 3-D MOF with helical channels is constructed. In the MOF, Yb3+ only coordinates with O atoms, leaving the bipyridyl N atoms of ddbpdc2- unoccupied. The unsaturated Lewis basic sites make this framework possible to coordinate with other metal ions. After growing the ACBP-6 in situ into a glass micropipette, a novel current sensor is formed. This sensor shows high selectivity and a high signal-to-noise ratio toward Cu2+ detection with a detection limit of 1 µM, due to the stronger coordination ability between the Cu2+ and the bipyridyl N atoms.

Construction of a MOF-Supported Palladium Catalyst via Metal Metathesis.

A new MOF-supported heterogeneous palladium catalyst Pd/NBB-1 has been synthesized successfully through the effective metal metathesis between Pd(CF3 COO)2 and NBB-1. NBB-1 is a two-dimensional zinc metal-organic framework constructed from 2-aminoterephthalate (NH2 -H2 BDC) and 2,2'-bipyridine-5-carboxylate (HBPC) by solvothermal method. The replacement efficiency of Pd(II) to Zn(II) is up to 72% after only 24 hours, which is beneficial to the catalytic application. Pd/NBB-1 with a low loading of 2 mol% works efficiently in the 1,4-addition reaction of arylboronic acids with α,ß-unsaturated ketones in air, and its catalytic activity keeps unchanged after 3 reaction cycles. This work provides a new strategy to effectively prepare supported noble metal/MOF catalysts, which would further increase the practical applications of metal-organic frameworks.

Assessing the impact of transfusion thresholds in patients with septic acute kidney injury: a retrospective study.

Background: Sepsis is a severe condition that often leads to complications such as acute kidney injury, which significantly increases morbidity and mortality rates. Septic AKI (S-AKI) is common in ICU patients and is associated with poor outcomes. However, there is no consensus on the optimal transfusion threshold for achieving the best clinical results. This retrospective study aims to investigate the relationship between different transfusion thresholds during hospitalization and the prognosis of septic AKI. Methods: Data from patients with S-AKI was extracted from MIMIC-IV. Based on the lowest hemoglobin level 24 h before transfusion, patients were divided into high-threshold (≥7 g/L) and low-threshold (<7 g/L) groups. We compared the outcomes between these two groups, including hospital and ICU mortality rates as primary outcomes, and 30 days, 60 days, and 90 days mortality rates, as well as duration of stay in ICU and hospital as secondary outcomes. Results: A total of 5,654 patients were included in our study. Baseline characteristics differed significantly between the two groups, with patients in the low-threshold group generally being younger and having higher SOFA scores. After performing propensity score matching, no significant differences in survival rates were found between the groups. However, patients in the low-threshold group had a longer overall hospital stay. Conclusion: A lower transfusion threshold does not impact the mortality rate in S-AKI patients, but it may lead to a longer hospital stay.

Design of an antenna effect Eu(III)-based metal-organic framework for highly selective sensing of Fe3.

Highly selective sensing of Fe3+ is very important due to its great effect on biological systems. A novel ligand [1,1':4',1'':4'',1''':4''',1''''-quinquephenyl]-2,2'',2'''',5''-tetracarboxylic acid (H4qptca) was designed and successfully obtained for the first time via three steps in high total yields according to the absorption spectrum of Fe3+. The europium(III)-based metal-organic framework derived from H4qptca, {[Eu(qptca)1/2(H2qptca)1/2(H2O)2]·DMF}n (referred to as SLX-1), was then synthesized and used as a water-stable and highly selective luminescent sensor for Fe3+ in aqueous solution with a comparable detection limit using Ln-MOF probes (6.45 µM) through the antenna effect of SLX-1. Furthermore, the luminescence quenching mechanism was also proposed as a competitive absorption mechanism.

Prognostic Significance of Plasma Hepatocyte Growth Factor in Sepsis.

BACKGROUND: To assess any correlation of plasma hepatocyte growth factor (HGF) levels with relevant endothelial cell injury parameters and determine the prognostic value in septic patients. METHODS: A prospective, observational study was conducted in patients with sepsis admitted to the Department of Critical Care Medicine at the Zhongda Hospital from November 2017 to March 2018. Plasma HGF levels were measured by enzyme-linked immunosorbent assay in the first 24 h after admission (day 1) and on day 3. The primary endpoint was defined as all-cause 28-day mortality. Furthermore, we analyzed the correlation of HGF with relevant endothelial cell injury markers. RESULTS: Eighty-six patients admitted with sepsis were included. HGF levels of nonsurvivors were elevated compared to those of survivors on day 1 (1940.62 ± 74.66 pg/mL vs. 1635.61 ± 47.49 pg/mL; P = 0.002) and day 3 (1824.82 ± 137.52 pg/mL vs. 1309.77 ± 83.49 pg/mL; P = 0.001) and showed a strong correlation with von Willebrand factor (r = 0.45, P < 0.0001), lactate (r = 0.35, P = 0.0011), pulmonary vascular permeability index (r = 0.38, P = 0.0241), first 24 h fluid administration (r = 0.38, P < 0.0001), and sequential organ failure assessment score (r = 0.40, P = 0.0001). Plasma HGF levels were able to prognostically discriminate between survivors and nonsurvivors on day 1 (AUC: 0.72, 95%CI: 0.60-0.84) and day 3 (AUC: 0.77, 95%CI: 0.63-0.91). CONCLUSIONS: HGF levels are associated with sepsis and correlated with established markers of endothelial cell injury. Elevated HGF levels in sepsis patients are an efficient indicator of poor prognosis. TRIAL REGISTRATION: The study was registered in Clinical Trial (Registration Number: NCT02883231).

Metal-organic framework-based micropipette is a metal ion responsive nanochannel after adsorbing H2S.

Glass micropipettes are easy to fabricate, have excellent flexibility and stable properties. HKUST-1 and MIL-68(In) are in situ grown in the tip of a micropipette to construct porous nanochannels. After absorbing H2S, the MIL-68(In)-based nanochannel shows effective metal ion responsiveness for Hg2+-detection.

Accumulation and characteristics of fluorescent dissolved organic matter in loess soil-based subsurface wastewater infiltration system with aeration and biochar addition.

Subsurface wastewater infiltration systems (SWISs) have been widely used to treat rural domestic sewage. However, the low nitrogen removal and severe clogging problem always restrict the sustainability of SWISs for wastewater treatment. This study investigated the effects of aeration and biochar on the accumulation of nutrients and dissolved organic matter (DOM) in the substrate of loess soil-based SWISs for understanding the accumulation characteristics of DOM and the enhanced decontamination mechanism. The results showed that biochar addition could not improve the accumulation of nitrogen and phosphorus in the substrate, but could enhance denitrification (22%) via providing sufficient carbon for microorganisms. Moreover, the accumulation of organic matter in the substrate was also greatly affected. The DOM concentration of System D in the 40-60 cm layer reached 85.76 mg L-1, which indicated that biochar could release abundant DOM. Substrate DOM mainly contained humic acid-like and tryptophan-like substances. Moreover, the refractory macromolecular DOM components with high aromaticity and humification were found in the substrate below 60 cm of systems with biochar addition. This may be related to the DOM released by biochar and the extracellular polymeric substance (EPS) produced by microorganisms. It may affect the sustainability of the substrate to a certain extent, but fortunately that intermittent aeration could reduce this adverse effect. This research could provide new insights for preventing clogging and useful guidance for improving wastewater treatment performance in SWISs.

An innovative biochar-amended substrate vertical flow constructed wetland for low C/N wastewater treatment: Impact of influent strengths.

Application of biochar can be an effective and low cost technique for wastewater treatment while reducing greenhouse gas emissions. In this study, biochar was used as substrates in Vertical flow constructed wetlands (VFCWs) for enhancing the removal of contaminant from low C/N wastewaters with different influent strengths. The removal of organic matter and nitrogen in biochar-added and non-biochar-added VFCWs with different low C/N influent strengths were evaluated systematically. The results demonstrated that combining VFCWs and biochar addition could be an appropriate strategy as compared to conventional VFCWs with average removal of organic pollutants (85%), NH4+-N (39%) and TN (39%) especially at high influent strengths. Meanwhile, N2O emission was also significantly lower in biochar-added VFCWs (138-1008µgm-2h-1) than that in non-biochar-added VFCWs (164-1304µgm-2h-1) under different influent strengths. We believe that VFCWs by adding biochar can be a useful technology for treating low C/N wastewaters.

Spectral characteristics of dissolved organic matter in various agricultural soils throughout China.

Dissolved organic matter (DOM) plays an essential role in many environmental processes, particularly in soil ecosystems. In the present study, ultraviolet-visible (UV-Vis) spectroscopy and parallel factor analysis (PARAFAC) of three-dimensional fluorescence excitation-emission matrices (3D-EEMs) were used to characterize DOM extracted from various agricultural soils across four climate regions of China. The maximum (86.01 mg L-1) and minimum (17.39 mg L-1) dissolved organic carbon (DOC) concentrations were found in soils from Jiangsu and Yunnan, respectively. Specific UV-Vis absorption at 254 nm (SUVA254) for soil DOM from the temperate continental climate (TCC) region was higher than that of soil DOM in other climate regions. Three fluorescence components including UVC humic-like substances (excitation peak at 400 nm, emission peak at 525 nm), UVA humic-like substances (250(330)/430 nm), and tyrosine-like materials (220(275)/320 nm) were identified in soil DOM using PARAFAC analysis. However, there were no significant differences in the distributions of these three components for soil DOM from different climate regions. Positive correlations were found among the humification index (HIX), fluorescence index (FI), and autochthonous index (BIX). Our results demonstrate that EEMs-PARAFAC could be a feasible approach for characterizing DOM in agricultural soils from different crop systems and can be used to further study complex DOM in agricultural environments.

Chronic subdural haematoma in young and extremely aged adults: a comparative study of two age groups.

To compare the clinical presentation, etiological factors and the outcome of chronic subdural haematoma (CSDH) in young and old adults, a retrospective analysis was performed by differentiating young adults, age<40 years (n=24) versus extremely aged adults, age>75 years (n=51). The clinical data, computed tomography (CT) findings and surgical outcome were recorded for analysis. We observed certain characteristics particular to young CSDH patients, higher incidence of headache (P<0.001) and vomiting (P=0.009), the shorter duration from trauma to operation (P=0.018) and more severe traumatic episodes (P=0.001). The older patients had a higher frequency of mental change (P=0.006), motor deficits (P=0.014) and larger haematomas (P<0.001). The surgical complication rate was not statistically different between the two age groups. An understanding of the varied clinical presentation of CSDH is essential to stimulate clinical suspicion and prompt evaluation, particularly for the differences between young and extremely aged patients.