Aetiological distribution of pulmonary hypertension and the value of transthoracic echocardiography screening in the respiratory department: A retrospective analysis from China.

METHODS: The aetiological composition and clinical characteristics of patients with pulmonary hypertension (PH) hospitalised in the respiratory department were retrospectively analysed, as well as the correlation between transthoracic echocardiography (TTE) and right heart catheterization (RHC) for evaluating pulmonary artery systolic pressure (PASP) and mean pulmonary artery pressure (mPAP). RESULTS: Of 731 patients, 544 (74.42%) were diagnosed with PH by RHC. Pulmonary arterial hypertension (PAH) was the most common type of PH, accounting for 30.10%; PH due to lung disease and/or hypoxia accounted for 20.79%, and PH due to pulmonary artery obstructions accounted for 19.29%. TTE has the highest specificity for diagnosing PH due to pulmonary artery obstructions. The specificity was 0.9375, the sensitivity was 0.7361 and the area under the ROC curve (AUC) was 0.836. PASP, and mPAP estimated by TTE were different for various types of PH. In terms of PASP, TTE overestimated PASP in PH due to lung disease and/or hypoxia, but there was no significant difference compared with RHC (P > 0.05). TTE underestimates PAH patients' PASP compared with RHC. In terms of mPAP, TTE underestimated the mPAP of all types of PH, as there was a significant difference in the TTE-estimated mPAP of patients with PAH compared with RHC but not on other types of PH. Pearson correlation analysis of TTE and RHC showed a moderate overall correlation (rPASP 0.598, P < 0.001; rmPAP 0.588, P < 0.001). CONCLUSIONS: Among the patients with PH in the respiratory department, patients with PAH accounted for the majority. TTE has high sensitivity and specificity for the diagnosis of PH due to pulmonary artery obstructions in the respiratory department.

Prevalence of Urolithiasis in a China Hospital: A Cross-Sectional Study.

BACKGROUND: This study aimed to investigate the prevalence of urolithiasis and its association with systemic diseases among inpatients in a top hospital of China. METHODS: This cross-sectional study included all inpatients in Peking Union Medical College Hospital (PUMCH) from 1 January 2017 to 31 December 2017. Patients were divided in two groups, the urolithiasis group and non-urolithiasis group. Subgroup analysis according to payment type (General or VIP ward), hospitalization department (surgical or not) and age was performed with patients in the urolithiasis group. Additionally, Univariable and multivariable regression analyses were performed to determine factors associated with urolithiasis prevalence. RESULTS: 69518 hospitalized cases were included in this study. The age was 53.40 ± 15.05 and 48.00 ± 18.12 years, and the male-to-female ratio was 1.7:1 and 0.55:1 in the urolithiasis and non-urolithiasis groups, respectively (p < 0.01). Among all patients, urolithiasis had a prevalence of 1.78%. The rate depending on payment type (5.73% versus 9.05%, p < 0.01) and hospitalization department (56.37% versus 70.91%, p < 0.01) were significantly lower in urolithiasis group compared to the non-urolithiasis. Urolithiasis rate also showed age differences. Female was independent protective factor of urolithiasis, while age, hospitalization in the non-surgical department and payment type of general ward were risk factors of urolithiasis (all p < 0.01). CONCLUSIONS: Gender, age, hospitalization in the non-surgical department and the socioeconomic status, specifically, the payment type of general ward, are independently associated with urolithiasis.

Predictive model for early functional outcomes following acute care after traumatic brain injuries: A machine learning-based development and validation study.

INTRODUCTION: Few studies on early functional outcomes following acute care after traumatic brain injury (TBI) are available. The aim of this study was to develop and validate a predictive model for functional outcomes at discharge for TBI patients using machine learning methods. PATIENTS AND METHODS: In this retrospective study, data from 5281 TBI patients admitted for acute care who were identified in the Beijing hospital discharge abstract database were analysed. Data from 4181 patients in 52 tertiary hospitals were used for model derivation and internal validation. Data from 1100 patients in 21 secondary hospitals were used for external validation. A poor outcome was defined as a Barthel Index (BI) score ≤ 60 at discharge. Logistic regression, XGBoost, random forest, decision tree, and back propagation neural network models were used to fit classification models. Performance was evaluated by the area under the receiver operating characteristic curve (AUC), the area under the precision-recall curve (AP), calibration plots, sensitivity/recall, specificity, positive predictive value (PPV)/precision, negative predictive value (NPV) and F1-score. RESULTS: Compared to the other models, the random forest model demonstrated superior performance in internal validation (AUC of 0.856, AP of 0.786, and F1-score of 0.724) and external validation (AUC of 0.779, AP of 0.630, and F1-score of 0.604). The sensitivity/recall, specificity, PPV/precision, and NPV of the model were 71.8%, 69.2%, 52.2%, and 84.0%, respectively, in external validation. The BI score at admission, age, use of nonsurgical treatment, neurosurgery status, and modified Charlson Comorbidity Index were identified as the top 5 predictors for functional outcome at discharge. CONCLUSIONS: We established a random forest model that performed well in predicting early functional outcomes following acute care after TBI. The model has utility for informing decision-making regarding patient management and discharge planning and for facilitating health care quality assessment and resource allocation for TBI treatment.

Prevalence of Urolithiasis in a China Hospital: A Cross-Sectional Study

Background: This study aimed to investigate the prevalence of urolithiasis and its association with systemic diseases among inpatients in a top hospital of China. Methods: This cross-sectional study included all inpatients in Peking Union Medical College Hospital (PUMCH) from 1 January 2017 to 31 December 2017. Patients were divided in two groups, the urolithiasis group and non-urolithiasis group. Subgroup analysis according to payment type (General or VIP ward), hospitalization department (surgical or not) and age was performed with patients in the urolithiasis group. Additionally, Univariable and multivariable regression analyses were performed to determine factors associated with urolithiasis prevalence. Results: 69518 hospitalized cases were included in this study. The age was 53.40 ± 15.05 and 48.00 ± 18.12 years, and the male-to-female ratio was 1.7:1 and 0.55:1 in the urolithiasis and non-urolithiasis groups, respectively (p < 0.01). Among all patients, urolithiasis had a prevalence of 1.78%. The rate depending on payment type (5.73% versus 9.05%, p < 0.01) and hospitalization department (56.37% versus 70.91%, p < 0.01) were significantly lower in urolithiasis group compared to the non-urolithiasis. Urolithiasis rate also showed age differences. Female was independent protective factor of urolithiasis, while age, hospitalization in the non-surgical department and payment type of general ward were risk factors of urolithiasis (all p < 0.01). Conclusions: Gender, age, hospitalization in the non-surgical department and the socioeconomic status, specifically, the payment type of general ward, are independently associated with urolithiasis (AU)

CXCL10 levels in diagnosis and improved hemodynamics in patients with chronic thromboembolic pulmonary hypertension undergoing balloon pulmonary angioplasty.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive pulmonary vascular disease characterized by pulmonary artery stenosis or obstructions resulting from insufficient thrombus resolution. Chemokine (C-X-C motif) ligand 10 (CXCL10) is a chemokine that contributes to the pathogenesis of many autoimmune diseases and cancers. The present study aims to investigate the levels of CXCL10 in patients with CTEPH throughout balloon pulmonary angioplasty (BPA) and its correlation with the improvement of pulmonary hemodynamics. Plasma CXCL10 levels were measured in 38 CTEPH patients with 100 BPA sessions and in 28 healthy controls. Correlations between CXCL10 and pulmonary hemodynamics were investigated. Receiver operating characteristic (ROC) curves were plotted to display the diagnostic value and the predictive ability for perioperative complications of CXCL10 and CXCL10-related models. Nomograms were plotted to visualize the diagnostic value and the predictive ability for perioperative complications of CXCL10 and CXCL10-related models. CXCL10 levels are higher in CTEPH patients compared with healthy controls (36.5 [95% confidence interval {CI}: 25.0-51.1] vs. 14.8 [95% CI: 11.1-30.9], p < 0.0001) and decreased significantly after BPA treatment (36.5 [95% CI: 25.0-51.1] vs. 24.7 [95% CI: 17.2-36.6], p < 0.0005). Preoperative CXCL10 levels positively correlated with mean right atrial pressure (r = 0.25), systolic pulmonary artery pressure (PAP; r = 0.28), diastolic PAP (r = 0.33), mean PAP (r = 0.36), pulmonary vascular resistance (r = 0.31), and N-terminal pro-B-type natriuretic peptide (NT-proBNP; r = 0.46). Furthermore, plasma CXCL10 levels adjusting for age and sex displayed a sensitivity of 86.0% and a specificity of 67.9% for discriminating CTEPH patients from healthy controls. Preoperative CXCL10 levels, in combination with NT-proBNP, predicted perioperative complications with a sensitivity of 100.0% and a specificity of 46.9% as displayed in ROC analysis. In conclusion, circulating CXCL10 might contribute to the evaluation of disease severity in CTEPH patients and be useful to evaluate the treatment effect of BPA. Future studies are warranted to further study the relationship between pulmonary hemodynamics and circulating CXCL10.

Bilateral versus unilateral balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension.

BACKGROUND: To evaluate the safety and efficacy of bilateral balloon pulmonary angioplasty (BPA) as compared with unilateral BPA for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). METHOD: We reviewed 210 consecutive BPA sessions for 92 CTEPH patients, including 124 unilateral BPA sessions and 86 bilateral BPA sessions. Radiation exposure, operation details, lesions characteristics and the occurrence of complications were compared between unilateral BPA and bilateral BPA. 131 BPA sessions with a hemodynamics follow-up were included for efficacy analysis, in which hemodynamics changes were compared. Logistic regression analysis was used to identify factors associated with the occurrence of complications. RESULT: Bilateral BPA treated more lobes, arteries and lesions [3 (2, 4) vs. 2 (1, 3) lobes, p < 0.001; 8 (5.5, 10) vs. 6 (4, 8) vessels, p = 0.003; 9 (7, 12) vs. 8 (5, 10) lesions, p = 0.01] in one single session than unilateral BPA in a comparable operation duration and amount of contrast media given. Overall, the occurrence of complications was similar between bilateral BPA and unilateral BPA [9 (10.5%) vs. 12 (9.7%), p = 0.83]. Hemodynamics effects didn't differ significantly between bilateral BPA and unilateral BPA in a single session [mPAP, - 4.5 ± 8.6 vs. - 3.6 ± 7.3 mmHg, p = 0.52; PVR, - 1.1 (- 3.5, 0.8) vs. - 1.8 (- 5.2, 0.3) Wood units, p = 0.21]. For the initial BPA session, bilateral BPA also treated more lobes, arteries and lesions than unilateral BPA [3 (2, 4) vs. 2 (1, 2) lobes, p < 0.001; 8.0 (5.8, 9.3) vs. 6.0 (4.0, 8.0) vessels, p = 0.04; 9 (6, 12) vs. 7 (4, 10) lesions, p = 0.02]. The occurrence of complications was also similar [5 (13.2%) vs. 5 (9.3%), p = 0.80], even in patients with poor baseline hemodynamics. Univariate regression analysis reveals the number of lobes treated/session, but not bilateral BPA, as predictive factors of complications. CONCLUSION: Bilateral BPA may be safely and effectively performed in patients with CTEPH without increasing operation duration and radiation burden, even in patients with unfavorable baseline hemodynamics.

A Meta-analysis of the efficacy of pulmonary artery denervation in the treatment of pulmonary hypertension.

BACKGROUND: Pulmonary hypertension (pH) is a progressive and fatal disease with poor long-term prognosis and high mortality. Although great progress has been made in current treatment methods, the survival rate is still poor. Therefore, we need to find an effective treatment for pH. OBJECTIVE: pH is a type of refractory, progressive, and fatal pulmonary vascular disease which involves a variety of clinical conditions and may complicate most cardiovascular and respiratory diseases. Pulmonary artery denervation (PADN) therapy for pH has become the current trend, but its clinical application still faces a series of problems, and its efficacy remains controversial. The purpose of the study is to evaluate the literature on the effects of PADN for pH. METHOD: The PubMed, Embase, and Web of Science databases were searched by two researchers until April 9th, 2021. The literature was read and screened, and effective data(6-minute walking distance, cardiac output, mPAP, PVR,Left ventricular end-systolic diameter,Cardiac output,Readmission rate,Mortality,Cardiac function,and so on) was extracted, collated, and analyzed. The literature was managed by Endnote 9.3 software and evaluated by RevMan 5.3 software. RESULTS: The meta-analysis included five controlled experiments with a total of 339 patients. The literature quality evaluations were all Level B. The meta-analysis results showed that compared with the control group, PADN treatment could improve the 6-minute walking distance of pH patients [WMD = 103.72, 95%CI (49.63, 157.82), P < 0.05], reduce mean pulmonary artery pressure (mPAP) [WMD = -7.26, 95%CI (-10.86, -3.66), P < 0.05], reduce pulmonary vascular resistance (PVR) [WMD = -4.53, 95%CI (-8.23, -0.83), P < 0.05], and improve cardiac output [WMD = 0.48, 95%CI (0.23, 0.73), P < 0.05]. There was no significant effect on the left ventricular end-systolic diameter [WMD = -0.13, 95%CI (-0.49, 0.24), P > 0.05], readmission rate [OR = 0.14, 95%CI (0.01, 1.87), P > 0.05], mortality rate [OR = 0.77, 95%CI (0.22, 2.69), P > 0.05], or cardiac function [OR = 0.32, 95%CI (0.05, 2.10), P > 0.05]. CONCLUSION: PADN is an effective method for the treatment of pH which is worthy of clinical promotion.

A meta-analysis of the diagnostic value of NoSAS in patients with sleep apnea syndrome.

OBJECTIVE: The NoSAS score is a new tool widely used in recent years to screen for obstructive sleep apnea. A number of studies have shown that the NoSAS score is more accurate than previous tools, such as the Berlin, STOP-Bang, and STOP questionnaires. Therefore, this meta-analysis assessed the diagnostic value of the NoSAS score for sleep apnea syndrome in comparison to polysomnography. METHODS: Two researchers searched the PubMed, EMBASE, Cochrane, and Web of Science databases through November 13, 2020. This paper used Endnote9.3 software to manage the literature and RevMan 5.3 and STATA12.0 software to perform the meta-analysis. RESULTS: A total of 10 studies were included in this meta-analysis, including 14,510 patients. The meta-analysis showed that the pooled sensitivity was 0.798 (95% CI 0.757, 0.833), the pooled specificity was 0.582 (95% CI 0.510, 0.651), the positive likelihood ratio was 1.909 (95% CI 1.652, 2.206), the negative likelihood ratio was 0.347 (95% CI 0.300, 0.403), the diagnostic OR was 5.495 (95% CI 4.348, 6.945), and the area under the SROC curve was 0.77 (95% CI 0.73, 0.80). The NoSAS score has good efficacy in identifying patients likely to have obstructive sleep apnea. CONCLUSION: The NoSAS score can accurately identify patients likely to have obstructive sleep apnea. Therefore, in the absence of polysomnography, one should use the NoSAS score to evaluate patients with suspected sleep apnea syndrome.

Efficacy and safety of selexipag, an oral prostacyclin receptor agonist for the treatment of pulmonary hypertension: A meta-analysis.

BACKGROUND AND OBJECTIVE: This meta-analysis was performed to evaluate the effect and safety of selexipag in the treatment of pulmonary hypertension and to explore the effect of selexipag on cardiac function indexes in PAH patients. METHODS: Electronic databases, including the Cochrane Library, EMBASE, and PubMed databases, were searched. Endnote software X9 was used for study selection, and the Cochrane Risk of Bias Tool was used for literature screening and quality assessment. Data analysis was performed using RevMan 5.3 software, and GRADE was used to assess the evidence level. RESULTS: Ten studies were finally selected in accordance with the standard. A total of 10 papers were included. A total of 1322 patients were included, including 723 in the trial group and 599 in the control group. Patients with PAH treated with selexipag were included in the trial group, and patients with PAH treated with placebo were included in the control group. The results of the study showed that selexipag was effective in reducing mortality in patients (WMD=0.70, 95% CI: 0.53-0.94, P = 0.02). Selexipag effectively increased the 6-min walk distance (WMD=33.79, 95% CI: 2.69-64.90, P=0.03). Selexipag also effectively increased the 6-min distance between baseline and follow-up (WMD = 15.28, 95% CI: 7.76-22.80, P < 0.0001). Selexipag effectively reduced PVR (WMD = -230.96, 95% CI: 445.94 to -15.97, P = 0.04). Selexipag significantly reduced PVR between baseline and follow-up (WMD = -139.62, 95% CI: 215.32 to -63.91, P = 0.0003). The adverse reactions of selexipag were mild with headache, diarrhea and nausea reported as the main symptoms. CONCLUSION: Selexipag is a new drug with mild adverse reactions and is safe for the treatment of PAH. This drug significantly prolongs the level of 6MWD in PAH patients, reduces the fatality rate, improves WHO FC and reduces PVR. The effects of this drug on CI, mPAP, MRAP, SvO2 and other indicators still need to be further confirmed. PROSPERO REGISTRATION: CRD42021245557.

Imaging Features of Breast Periductal Stromal Tumor: A Case Report.

Breast periductal stromal tumor (PDST) is a rare biphasic tumor, with both benign ductal epithelium and non-phyllodes sarcomatous stroma. Its imaging features were rarely reported due to the rarity. In this study, we describe the case of a 48-year-old female who presented with a palpable mass in the right breast. Presurgery imaging evaluations of full-field digital mammography (FFDM), digital breast tomosynthesis (DBT), and ultrasonography (US) were performed. The imaging features include the following: 1. multiple solid lobulated lesions comprising nearly the entire right breast; 2. hypoechoic heterogeneous masses with internal separations and abundant blood flow; 3. FFDM and DBT showed multiple irregular high-density masses with lobulated margin, partially integrated. The patient underwent extended mastectomy of the right breast. The surgical pathology confirmed a PDST. After excision of the mass, she was followed up in the outpatient clinic for 25 months without local recurrence or distant metastasis.

Atomic-level tungsten doping triggered low overpotential for electrocatalytic water splitting.

The design of electrocatalysts with lower overpotential is of great significance for water splitting. Herein, cobalt hydroxide carbonate (CCH) has been used as a model to demonstrate the boost of its oxygen evolution reaction (OER) activity by atomic doping of W6+ (W-CCH). The 5 at % W doping reduced the OER overpotential of CCH by 95.3 mV at 15 mA cm-2, and increased the current density by 2.8 times at 1.65 V. 5%W-PCCH || 5%W-CCH-based electrolyzer only required a potential of 1.65 V to afford 10 mA cm-2 for full water splitting. The W6+ in CCH are active sites for O2- adsorption and induced an incesaed electron density near the Fermi level, which facilitates the charge transfer during electrocatalysis. The W6+ doping has been validated as an efficient booster for transition-metal carbonate hydroxides-based electrocatalysts, which has half or more than half-filled d-bands.

Epidemiology, mortality and risk factors for patients with K. pneumoniae bloodstream infections: Clinical impact of carbapenem resistance in a tertiary university teaching hospital of Beijing.

BACKGROUND: This study compared the epidemiology of carbapenem-resistant (CRKP) and carbapenem-sensitive (CSKP) K. pneumoniae bloodstream infections (BSIs), and assessed risk factors for 28-day mortality of patients with K. pneumoniae BSIs. METHODS: A retrospective cohort study was conducted in a 2000-bed tertiary teaching hospital of Beijing between Jan 1st 2013 to Dec 31st, 2019. All patients with K. pneumoniae BSI were identified through the Hospital Information System. The endpoints included incidence rate, mortality and risk factors for mortality of patients with K. pneumoniae BSIs. RESULTS: 496 patients with K. pneumoniae BSIs were included in the analysis, with 108 CRKP BSIs. The incidence rate of K. pneumoniae BSI was 10.6 (CI: 9.7, 11.6) per 100 000 patient-days, with the rate for CRKP BSI was 2.3 (95% CI: 1.9, 2.8). The 28-day mortality was 38.0% for CRKP BSI and 8.8% for CSKP BSI, respectively. Logistic analysis showed, higher Charlson Comorbidity Index score (OR = 1.26, 95%CI 1.12-1.43, p < 0.001), respiratory failure (OR = 2.73, 95%CI1.28-5.84, p = 0.010), renal failure (OR = 4.13, 95%CI1.93-8.83, p < 0.001), septic shock (OR = 8.77, 95%CI3.60-21.32, p < 0.001), mechanical ventilation (OR = 4.41, 95%CI1.59-12.25, p = 0.004) and CRKP infection (OR = 3.04, 95%CI1.28-7.22, p = 0.012) were independently associated with 28-day mortality. CONCLUSIONS: Considerable incidence rate and remarkable mortality of patients with K. pneumoniae (especially CRKP) BSI was declared in the study. Patient conditions before (higher CCI) and after presentation (respiratory failure, renal failure, septic shock), and healthcare factors (mechanical ventilation and CRKP infection) were independently associated with 28-day mortality. Understanding these risks helps better establishment of infection control strategies.

Catalysts confined inside CNTs derived from 2D metal-organic frameworks for electrolysis.

Two-dimensional metal-organic framework (MOF) nanosheets have attracted considerable research interest as electrocatalysts, and thermal annealing is important to boost their conductivity. The effect of annealing atmosphere on the electrochemical performance of 2D MOFs and their catalytic center structure have been investigated. The Co-MOF/H2 synthesized by annealing of 2D MOF under a H2 atmosphere has shown a significantly enhanced catalytic activity compared with those annealed under an Ar atmosphere (Co-MOF/Ar). The Co-MOF/H2 has 2-3 graphitic layers of graphitic carbon coating and presents a large amount of high valent Co2+. H2 annealing leads to a fast reduction of Co-MOF to Co/CoOx nanoparticles and catalyzes the growth of CNTs with MOF feed as carbon source. The Co-MOF/H2 shows a high electrocatalytic activity which requires an overpotential of 312 mV to reach a current density of 10 mA cm-2. A Co-MOF/H2-based water electrolyzer requires a potential of 1.619 V to reach a current density of 10 mA cm-2 for overall water splitting in 1.0 M KOH. After 25 h of continuous operation for water electrolysis, the Co-MOF/H2-based cell has shown a negligible increase in the overpotential, indicating its superior durability compared to the 2D Co-MOF.