Unveiling the nexus of postoperative fever and delirium in cardiac surgery: identifying predictors for enhanced patient care.

Background: Postoperative delirium (POD) is a significant complication observed in cardiac surgery patients, characterized by acute cognitive decline, fluctuating mental status, consciousness impairment, and confusion. Despite its impact, POD often goes undiagnosed. Postoperative fever, a common occurrence after cardiac surgery, has not been comprehensively studied in relation to delirium. This study aims to identify perioperative period factors associated with POD in patients undergoing cardiopulmonary bypass, with the potential for implementing preventive interventions. Methods: In a prospective observational study conducted between February 2023 and April 2023 at the Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, a total of 232 patients who underwent cardiac surgery were enrolled. POD assessment utilized the Confusion Assessment Method for the ICU (CAM-ICU), while high fever was defined as a bladder temperature exceeding 39°C. Statistical analysis included univariate and multivariate analyses, logistic regression, nomogram development, and internal validation. Result: The overall incidence of postoperative delirium was found to be 12.1%. Multivariate analysis revealed that postoperative lactate levels [odds ratio (OR) = 1.787], maximum temperature (OR = 11.290), and cardiopulmonary bypass time (OR = 1.015) were independent predictors of POD. A predictive nomogram for POD was developed based on these three factors, demonstrating good discrimination and calibration. The prediction model exhibited a C-statistic value of 0.852 (95% CI, 0.763-0.941), demonstrating excellent discriminatory power. Sensitivity and specificity, based on the area under the receiver operating characteristic (AUROC) curve, were 91.2% and 67.9%, respectively. Conclusion: This study underscores the high prevalence of POD in cardiac surgery patients and identifies postoperative lactate levels, cardiopulmonary bypass duration, and postoperative fever as independent predictors of delirium. The association between postoperative fever and POD warrants further investigation. These findings have implications for implementing preventive strategies in high-risk patients, aiming to mitigate postoperative complications and improve patient outcomes.

Increased number of intratumoral IL-17+ cells, a harbinger of the adverse prognosis of triple-negative breast cancer.

INTRODUCTION: Triple negative breast cancer (TNBC) is an aggressive cancer subtype and lack of effective targeted therapies. It has been recently reported that Interleukin 17 (IL-17), a family of cytokines secreted in tumor microenvironment, affects tumor progression through a variety of molecular pathways. Its role in TNBC is so far still poorly explored. MATERIALS AND METHODS: We employed immunohistochemistry to evaluate the distribution of IL-17+ cells in TNBC with no special type features (TNBC-NST), their association with tumor microangiogenesis, as well as their impact on prognosis of the patients. RESULTS: In comparison to medullary carcinoma with triple-negative molecular features (TNBC-MC), we found a significant increase in IL-17+ cell infiltrates in intratumoral stroma and extratumoral stroma of TNBC-NST. Similarly, stromal cells with co-expression of CD4 and IL-17 were noted in intratumoral and extratumoral stroma in both TNBC-NST and TNBC-MC. In addition, intratumoral IL-17+ cells were positively associated with tumor cell expression of vascular endothelial growth factor A (VEGFA) and with intratumoral tumor microvascular density (MVD). Multivariate analysis identified that intratumoral IL-17+ cells (P = 0.018), MVD (P = 0.039), and TNM stage (P = 0.002) were independent prognostic factors for predicting poor PFS. CONCLUSION: The study indicates that IL-17 is overexpressed in intratumoral stromal cells of TNBC-NST. The overexpression of IL-17 might engage in active tumor microangiogenesis through its signal transduction pathways resulting in increased tumor secretion of VEGFA, and then promote tumor progression. IL-17 might serve as a potential new target for individualized therapy to TNBC-NST patients by development of specific antibodies. Additional study is deemed to further explore the role of IL-17+ stromal cells in breast cancer.

[Hydrochemical and Isotopic Characteristics of the Lake Balkhash Catchment, Kazakhstan].

Lake Balkhash is one of the largest lakes in the world. It is located in arid Central Asia and receives major water from the Ili River, which is an international river flowing across China and Kazakhstan. Hydrochemical and isotopic measurements of waters can provide an improved understanding of hydrogeochemical processes and environmental characteristics, which is useful for water resource management in arid regions. In this study, δD, δ18 O, and major ions in water samples from the Lake Balkhash catchment were analyzed using an integration of mathematical statistics, Piper diagrams, Gibbs model, and principal component analysis (PCA). Water types and main mechanisms controlling the hydrochemistry presented a clear spatial heterogeneity. The chemical composition of lake waters was dominated by SO4-Na and Cl-Na type, whereas river waters were classified as a HCO3-Ca type. The chemical composition downstream of the Ili River evolved from HCO3-Ca to SO4-Na-Cl type. Gibbs model suggested that the main mechanisms controlling the lake water chemistry were evaporation-crystallization processes, and that major ions in the river water were affected by rock-weathering and evaporation processes. The main controlling factors of the water chemistry changed from the upstream to the downstream, and may have related to spatial differences whereby the upstream area experienced higher rainfall and snow melt, and the downstream area experienced relatively higher evaporation. PCA analysis showed that human activities also played an important role in the chemical composition of water sampled from the lake, middle and lower reaches of the Ili River, and other rivers. The isotopic compositions of the lake and river waters varied spatially. In the lake waters, positive isotopic ratios and negative deuterium-excess values indicated that evaporitic enrichment dominated the changes in the isotopic signature of the lake water. In river waters, isotope values located near the global meteoric water line (GMWL) and lower slopes of the regression lines (r=0.91, P<0.001 for Ili River, and r=0.63, P<0.001 for other rivers), were associated with a stronger influence of rainfall and weaker evaporation. Correlation analysis showed that there were significant relationships between isotope values and chemical parameters in the lake water, especially in the eastern area, thus suggesting that extensive evaporation led to simultaneous enrichment of isotopes and ions in the lake water.

[Distribution of n-alkanes from Lake Wanghu Sediments in Relation to Environmental Changes].

Concentrations and distribution of n-alkanes (n-C14 to n-C33) in Lake Wanghu sediment core were analyzed to investigate the environmental changes in the lake during the past~100 years. Relatively higher concentrations of mid-and long-chain n-alkanes with a strong odd-over-even carbon number predominance indicated organic matter contributions dominated by aquatic macrophytes and terrestrial plants. The lower values of 2n-C31/(n-C27+n-C29) highlighted a type of landscape dominated by woody plants. The environmental changes that have been happening over the past 100 years in Lake Wanghu can be divided into three stages, based on the organic matter sources inferred from the changes in n-alkane parameters in the sediments. Before the 1950s, higher values of terrigenous/aquatic ratio (TAR) and high-/low-molecular weight n-alkanes (H/L) indicated vascular, plant-derived sediments deposited during a low-nutrient, clear-water phase with frequent water exchange between the lake and the Yangtze River. Between the 1950s and 1980s, decrease in values of H/L and TAR, and increase in the proportion of mid-and short-chain n-alkanes indicated a shift towards mid-and shorter-chain components likely associated with the increasing contribution of macrophytes and algae. Lower 2n-C17/(n-C23+n-C25) values indicated a relatively low algal abundance. In that stage, the lake trophic state increased slightly with the decreasing influence of the Yangtze River flow. After the 1980s,H/L and TAR values increased and then decreased, total n-alkane concentrations and 2n-C17/(n-C23+n-C25) increased significantly, especially after 2000s, suggesting the main contributor to high organic matter input most likely shifted to algae because of the eutrophication caused by anthropogenic activities.

[Over One Hundred Year Sediment Record of Polycyclic Aromatic Hydrocarbons in the Lake Bosten, Xinjiang].

The vertical distributions of 16 polycyclic aromatic hydrocarbons (PAHs) were investigated from a sediment core in the Lake Bosten, Xinjiang. Meanwhile, the possible source and risk assessment of PAHs in Lake Bosten were also discussed. The total PAHs concentration in the sediment core ranged from 37.5 ng x g(-1) to 184.5 ng x g(-1), and Naphthalene and Phenanthrene were the dominant compounds throughout the core. Over the one hundred year, the vertical profile of PAHs underwent significant changes around 1950s. The vertical distributions of PAHs had little change and low molecular weight PAHs were dominant PAHs before 1950s. Since then, the high molecular weight PAHs appeared and increased with fluctuations. A sharp increase in PAHs level and individuals was observed especially after 1990s and a maximum was found in the surface sediment. The results suggested PAHs in Lake Bosten were from the local sources, which were dominated by the low temperature combustion. Besides, the abundance of PAHs from high temperature combustion processes, such as combustion of industrial coal and vehicle emission, increased significantly in recent years. However, based on the results of risk assessment, the PAHs may not induce adverse biological effects on the aquatic ecosystem in Lake Bosten.

[Abdominal adipose area, serum adiponectin and leptin levels of nonalcoholic fatty liver disease in elderly males.].

OBJECTIVE: To study the abdominal adipose area, serum adiponectin and leptin levels of nonalcoholic fatty liver disease in elderly males. METHODS: A total of 238 elderly males (more than 60 years) were enrolled and divided into three groups: Nonalcoholic fatty liver disease (NAFLD) group (n = 76), matching group (age and body mass index matching with NAFLD group, n = 77), normal control group (n = 85). Serum levels of adiponectin and leptin were measured by RIA (radiological immunological assay). Abdominal adipose area was detected by computer tomography. RESULT: (1) body mass index (BMI), abdominal subcutaneous adipose area, visceral adipose area, total adipose area of NAFLD group and matching group were (26.87+/-2.62) kg/m2 and (26.63+/-1.97) kg/m2, (166.59+/-54.27) cm2 and (147.89+/-50.14) cm2, (148.94+/-53.72) cm2 and (150.06+/-45.47) cm2, (315.25+/-89.42) cm2 and (297.93+/-75.12) cm2, respectively; and were higher than those in control group (P less than 0.01). The abdominal subcutaneous adipose area is higher in NAFLD group than in matching group, however, the abdominal visceral adipose area and total adipose area were not significantly different between those two groups. (2) The serum leptin level in NAFLD group and matching group was significantly higher than that in control group, and serum leptin level was not significantly different between NAFLD group and matching group. The serum adiponectin of NAFLD group [(6.31+/-3.31)mug/ml] was significantly lower than that of matching group [(9.87+/-7.071)mug/ml, P less than 0.01] and control group (P less than 0.01). There was no difference in adiponectin level between matching group and control group. 3) AST, TG, abdominal subcutaneous adipose area, abdominal visceral adipose area were risk factors of NAFLD, while serum adiponectin was protective factor of NAFLD. CONCLUSION: These data indicate that elderly male NAFLD patients manifest abdominal obesity, high serum leptin, low serum adiponecin, and suggest that adiponectin may play a crucial role in the pathogenesis of NAFLD in elderly males.