Complement Proteins in Serum Astrocyte-Derived Exosomes Are Associated with Poststroke Cognitive Impairment in Type 2 Diabetes Mellitus Patients.

Background: The complement system plays crucial roles in cognitive impairment and acute ischemic stroke (AIS). High levels of complement proteins in plasma astrocyte-derived exosomes (ADEs) were proven to be associated with Alzheimer's disease. We aimed to investigate the relationship of complement proteins in serum ADEs with poststroke cognitive impairment in type 2 diabetes mellitus (T2DM) patients. Methods: This study analyzed 197 T2DM patients who suffered AIS. The Beijing version of the Montreal Cognitive Assessment (MoCA) was used to assess cognitive function. Complement proteins in serum ADEs were quantified using ELISA kits. Results: Mediation analyses showed that C5b-9 and C3b in serum ADEs partially mediate the impact of obstructive sleep apnea (OSA), depression, small vessel disease (SVD), and infarct volume on cognitive function at the acute phase of AIS in T2DM patients. After adjusting for age, sex, time, and interaction between time and complement proteins in serum ADEs, the mixed linear regression showed that C3b and complement protein Factor B in serum ADEs were associated with MoCA scores at three-, six-, and twelve-months after AIS in T2DM patients. Conclusions: Our study suggested that the impact of OSA, depression, SVD, and infarct volume on cognitive impairment in the acute stage of AIS may partially mediate through the complement proteins in serum ADEs. Additionally, the complement proteins in serum ADEs at the acute phase of AIS associated with MoCA scores at three-, six-, twelve months after AIS in T2DM patients.REGISTRATION: URL: http://www.chictr.org.cn/,ChiCTR1900021544.

[Etiology composition and prognosis of pediatric chronic critical illness in a pediatric intensive care unit]. / å„¿ç«¥é‡ç—‡ç›‘æŠ¤å®¤å„¿ç«¥æ ¢æ€§å±é‡ç—‡çš„ç— å› ç»„æˆåŠé¢„åŽåˆ†æž.

OBJECTIVES: To explore the etiology composition and outcomes of pediatric chronic critical illness (PCCI) in the pediatric intensive care unit (PICU). METHODS: The children who were hospitalized in the PICU of Dongguan Children's Hospital Affiliated to Guangdong Medical University and met the diagnostic criteria for PCCI from January 2017 to December 2022 were included in the study. The etiology of the children was classified based on their medical records and discharge diagnoses. Relevant clinical data during hospitalization were collected and analyzed. RESULTS: Among the 3 955 hospitalized children in the PICU from January 2017 to December 2022, 321 cases (8.12%) met the diagnostic criteria for PCCI. Among the 321 cases, the most common etiology was infection (71.3%, 229 cases), followed by unintentional injury (12.8%, 41 cases), postoperation (5.9%, 19 cases), tumors/immune system diseases (5.0%, 16 cases), and genetic and chromosomal diseases (5.0%, 16 cases). Among the 321 cases, 249 cases (77.6%) were discharged after improvement, 37 cases (11.5%) were discharged at the request of the family, and 35 cases (10.9%) died in the hospital. Among the deaths, infection accounted for 74% (26/35), unintentional injury accounted for 17% (6/35), tumors/immune system diseases accounted for 6% (2/35), and genetic and chromosomal diseases accounted for 3% (1/35). From 2017 to 2022, the proportion of PCCI in PICU diseases showed an increasing trend year by year (P<0.05). Among the 321 children with PCCI, there were 148 infants and young children (46.1%), 57 preschool children (17.8%), 54 school-aged children (16.8%), and 62 adolescents (19.3%), with the highest proportion in the infant and young children group (P<0.05). The in-hospital mortality rates of the four age groups were 14.9% (22/148), 8.8% (5/57), 5.6% (3/54), and 8.1% (5/62), respectively. The infant and young children group had the highest mortality rate, but there was no statistically significant difference among the four groups (P>0.05). CONCLUSIONS: The proportion of PCCI in PICU diseases is increasing, and the main causes are infection and unintentional injury. The most common cause of death in children with PCCI is infection. The PCCI patient population is mainly infants and young children, and the in-hospital mortality rate of infant and young children with PCCI is relatively high.

Machine Learning Explains Long-Term Trend and Health Risk of Air Pollution during 2015-2022 in a Coastal City in Eastern China.

Exposure to air pollution is one of the greatest environmental risks for human health. Air pollution level is significantly driven by anthropogenic emissions and meteorological conditions. To protect people from air pollutants, China has implemented clean air actions to reduce anthropogenic emissions, which has led to rapid improvement in air quality over China. Here, we evaluated the impact of anthropogenic emissions and meteorological conditions on trends in air pollutants in a coastal city (Lianyungang) in eastern China from 2015 to 2022 based on a random forest model. The annual mean concentration of observed air pollutants, including fine particles, inhalable particles, sulfur dioxide, nitrogen dioxide, and carbon monoxide, presented significant decreasing trends during 2015-2022, with dominant contributions (55-75%) by anthropogenic emission reduction. An increasing trend in ozone was observed with an important contribution (28%) by anthropogenic emissions. The impact of meteorological conditions on air pollution showed significant seasonality. For instance, the negative impact on aerosol pollution occurred during cold months, while the positive impact was in warm months. Health-risk-based air quality decreased by approximately 40% in 8 years, for which anthropogenic emission made a major contribution (93%).

Joint semiparametric models for case-cohort designs.

Two-phase studies such as case-cohort and nested case-control studies are widely used cost-effective sampling strategies. In the first phase, the observed failure/censoring time and inexpensive exposures are collected. In the second phase, a subgroup of subjects is selected for measurements of expensive exposures based on the information from the first phase. One challenging issue is how to utilize all the available information to conduct efficient regression analyses of the two-phase study data. This paper proposes a joint semiparametric modeling of the survival outcome and the expensive exposures. Specifically, we assume a class of semiparametric transformation models and a semiparametric density ratio model for the survival outcome and the expensive exposures, respectively. The class of semiparametric transformation models includes the proportional hazards model and the proportional odds model as special cases. The density ratio model is flexible in modeling multivariate mixed-type data. We develop efficient likelihood-based estimation and inference procedures and establish the large sample properties of the nonparametric maximum likelihood estimators. Extensive numerical studies reveal that the proposed methods perform well under practical settings. The proposed methods also appear to be reasonably robust under various model mis-specifications. An application to the National Wilms Tumor Study is provided.

Case Report: Transvertebral transposition of the spinal cord for recovery after paraplegia during kyphoscoliosis surgery.

Introduction: Neurological impairment during spinal deformity surgery is the most serious possible complication. When confronting intraoperative neurophysiological monitoring alerts, various surgical management methods such as the release of implants and decompression of the spinal cord are always performed. Transvertebral transposition of the spinal cord is rarely performed, and its role in the management of acute paraplegia is seldom reported. Case description: The authors present two patients with kyphoscoliosis who experienced neurological deficits and abnormal neurological monitoring intraoperatively or post-operatively that were detected during correction surgery. Acute paraplegia was confirmed by a wake-up test. Subsequent spinal cord transposition was performed. Intraoperative neurophysiological monitoring motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SEPs) were performed to detect the changes during the process. After transvertebral transposition of the spinal cord, the MEPs and SEPs were significantly improved in both patients during surgery. The spinal cord function was restored post-operatively and recovered to normal at the final follow-up in two patients. Conclusion: This case demonstrated that instead of decreasing the correction ratio of kyphoscoliosis, transvertebral transposition of the spinal cord under intraoperative neurophysiological monitoring may be an alternative therapeutic strategy for acute spinal cord dysfunction caused by deformity correction surgeries.

Inflammatory markers in postoperative cognitive dysfunction for patients undergoing total hip arthroplasty: a meta-analysis.

BACKGROUND: Postoperative cognitive dysfunction (POCD) is a poorly understood disorder, very common even after total hip arthroplasty (THA). It is widely considered that inflammation response play a role in the pathogenesis of POCD. AIMS: The aim of the present study was to investigate whether inflammation cytokine concentrations could serve as biomarkers for POCD in patients undergoing THA. METHODS: A systematic search of databases was conducted to retrieve publications measuring circulating inflammatory markers of patients with and without POCD after THA. Inflammatory markers identified in more than two studies were pooled. The standardized mean difference (SMD) and the 95% confidence interval (95% CI) were calculated for each outcome. Fail-safe N statistics was calculated to estimate possible publication bias. RESULTS: The pooled incidence rate of POCD after THA by combining 11 cohort studies was 31%. A total of five inflammatory markers, CRP, S-100B, IL-1ß, IL-6 and TNF-α, were assessed. Significantly higher pre-operative CRP (P = 0.012) and S-100B (P < 0.0001) as well as post-operative CPR (P = 0.005) and IL-6 (P < 0.0001) at 6 h were found in POCD compared with non-POCD patients undergoing THA. Fail-safe N statistics revealed that these results are robust. DISCUSSION: The current evidence suggests that some of the inflammatory markers, including CRP, S-100B, and IL-6, were correlated with the occurrence of POCD after THA. CONCLUSION: Monitor of inflammatory markers might help early diagnosis of POCD after THA and development of preventive strategies.

Synthesis and characterization of multifunctional organic-inorganic composite hydrogel formed with tissue-adhesive property and inhibiting infection.

Organic-inorganic composite hydrogel materials have been widely studied. In order to expand the application of organic-inorganic composite hydrogel materials, in this work, we prepared a viscous hydrogel with antibacterial properties (OSA-GelDA@ACP/DA/Ag). First, we used polydopamine coating to deposit elemental silver on the surface of amorphous calcium phosphate (ACP) particles to prepare ACP/DA/Ag particles. Next, dopamine was grafted on the gelatin molecular chain by EDC/NHS to activate the carboxyl group to obtain dopamine-modified gelatin (GelDA). The content of DA in GelDA is about 14.09% by standard curve method. Then, the Schiff base reaction took place between the amino group on the GelDA molecular chain and the aldehyde group on the OSA molecular chain, and an OSA-GelDA viscous hydrogel was prepared. Finally, by changing the content of ACP/DA/Ag3 particles added to the OSA-GelDA gel, the corresponding performance of material was investigated. The results show that the introduction of dopamine provides wet viscosity for the hydrogel, and the ACP/DA/Ag3 particles introduced in the viscous hydrogel provide antibacterial properties. This hydrogel with antibacterial and wet viscosity is expected to become an injectable bone repair material for clinical use.

Wire templated electrodeposition of vessel-like structured chitosan hydrogel by using a pulsed electrical signal.

Herein, by performing a templated electrodeposition process with an oscillating electrical signal stimulation, a vessel-like structured chitosan hydrogel (diameter about 0.4 mm) was successfully prepared in the absence of salt conditions. Experimental results demonstrated that the hydrogel growth (e.g. the thickness) is linearly correlated with the imposed charge transfer and can be well quantified by using a theoretical moving front model. Morphological observations indicated that the heterogeneous multilayer structure was spatially and temporally controlled by an externally employed electrical signal sequence while the channel structure could be determined by the shaped electrode. Moreover, the oscillating ON-OFF cycles were proved to strongly affect the film structure, leading to a more compact hydrogel coating with a lower water content, higher crystallinity, complex layer architecture and relatively strong mechanical properties that could be easily peeled off as a free-standing hollow tube. Importantly, all the experiments were conducted under mild conditions that allowed additional enhancing materials to be added in to further improve the mechanical and/or biological properties. Thus, this work advances a very promising self-assembly technology for the construction of a multi-functional hydrogel coating and artificial blood vessel regeneration.

Biomechanical evaluation of autologous bone-cage in posterior lumbar interbody fusion: a finite element analysis.

BACKGROUND: An autologous bone-cage made from the spinous process and laminae might provide a stability in posterior lumbar interbody fusion (PLIF) close that of the traditional-cage made of polyetheretherketone (PEEK) or titanium. The biomechanical effect of autologous bone-cages on cage stability, stress, and strains, and on the facet contact force has not been fully described. This study aimed to verify whether autologous bone-cages can achieve similar performance as that of PEEK cages in PLIF by using a finite element analysis. METHODS: The finite element models of PLIF with an autologous bone-cage, a titanium cage, and a PEEK cage were constructed. The autologous bone-cage was compared with the titanium and PEEK cages. The mechanical properties of the autologous bone-cage were obtained through mechanical tests. The four motion modes were simulated. The range of motion (ROM), the stress in the cage-end plate interface, and the facet joint force (FJF) were compared. RESULTS: The ROM was increased at adjacent levels but decreased over 97% at the treated levels, and the intradiscal pressure at adjacent levels was increased under all conditions in all models. The FJF disappeared at treated levels and increased under extension, lateral bending, and lateral rotation in all models. The maximum stress of the cage-endplate interface was much lower in the autologous bone-cage model than those in the PEEK and titanium cage models. CONCLUSIONS: In a finite model of PLIF, the autologous bone-cage model could achieve stability close that of traditional titanium or PEEK cages, reducing the risk of subsidence.

A Multi-Task Group Bi-LSTM Networks Application on Electrocardiogram Classification.

BACKGROUND: Cardiovascular diseases (CVD) are the leading cause of death globally. Electrocardiogram (ECG) analysis can provide thoroughly assessment for different CVDs efficiently. We propose a multi-task group bidirectional long short-term memory (MTGBi-LSTM) framework to intelligent recognize multiple CVDs based on multi-lead ECG signals. METHODS: This model employs a Group Bi-LSTM (GBi-LSTM) and Residual Group Convolutional Neural Network (Res-GCNN) to learn the dual feature representation of ECG space and time series. GBi-LSTM is divided into Global Bi-LSTM and Intra-Group Bi-LSTM, which can learn the features of each ECG lead and the relationship between leads. Then, through attention mechanism, the different lead information of ECG is integrated to make the model to possess the powerful feature discriminability. Through multi-task learning, the model can fully mine the association information between diseases and obtain more accurate diagnostic results. In addition, we propose a dynamic weighted loss function to better quantify the loss to overcome the imbalance between classes. RESULTS: Based on more than 170,000 clinical 12-lead ECG analysis, the MTGBi-LSTM method achieved accuracy, precision, recall and F1 of 88.86%, 90.67%, 94.19% and 92.39%, respectively. The experimental results show that the proposed MTGBi-LSTM method can reliably realize ECG analysis and provide an effective tool for computer-aided diagnosis of CVD.

A nanofiber based artificial electronic skin with high pressure sensitivity and 3D conformability.

Pressure sensors with 3D conformability are highly desirable components for artificial electronic skin or e-textiles that can mimic natural skin, especially for application in real-time monitoring of human physiological signals. Here, a nanofiber based electronic skin with ultra-high pressure sensitivity and 3D conformability is designed and built by interlocking two elastic patterned nanofibrous membranes. The patterned membrane is facilely prepared by casting conductive nanofiber ink into a silicon mould to form an array of semi-spheroid-like protuberances. The protuberances composed of intertwined elastic POE nanofibers and PPy@PVA-co-PE nanofibers afford a tunable effective elastic modulus that is capable of capturing varied strains and stresses, thereby contributing to a high sensitivity for pressure sensing. This electronic skin-like sensor demonstrates an ultra-high sensitivity (1.24 kPa(-1)) below 150 Pa with a detection limit as low as about 1.3 Pa. The pixelated sensor array and a RGB-LED light are then assembled into a circuit and show a feasibility for visual detection of spatial pressure. Furthermore, a nanofiber based proof-of-concept wireless pressure sensor with a bluetooth module as a signal transmitter is proposed and has demonstrated great promise for wireless monitoring of human physiological signals, indicating a potential for large scale wearable electronic devices or e-skin.

Prevalence, causes and risk factors of hospital readmissions after acute stroke and transient ischemic attack: a systematic review and meta-analysis.

Acute stroke and transient ischemic attack (TIA) is a great burden not only during hospitalization but also after hospital discharge. The objective of this meta-analysis was to evaluate the hospital readmissions, causes and risk factors after survival of acute stroke and TIA. Pubmed, Web of Science, Cochrane Library, OVID and EMBASE databases were searched to identify studies reporting hospital readmissions after acute stroke and TIA. The primary outcomes were hospital readmission rates during 30 days and 1 year after discharge. The primary causes and risk factors of hospital readmissions were also identified. Ten studies with 253,680 patients were eligible for inclusion. The pooled 30-day and 1-year hospital readmission rates were 17.4 % (95 % CI, 12.7-23.5 %) and 42.5 % (95 % CI, 34.1-51.3 %), respectively. The three major causes of 30-day hospital readmissions were infection (19.9 %), coronary artery disease (CAD) (17.8 %) and recurrent stroke (16.0 %) successively, while the three major causes were recurrent stroke (19.4 %), infection (19.3 %) and CAD (16.3 %) during 1 year's follow-up. There were more patients with CAD in readmits group than that in control group (p = 0.030). The length of index admission, defined as any eligible admission to an acute care hospital assessed in the measure for the outcome, was longer (p = 0.000) and admission National Institutes of Health Stroke Score (NIHSS) was higher (p = 0.002) in readmits group than these in control group. In conclusion, there is high risk of early and long-term hospital readmissions after survival of acute stroke and TIA. These patients with coronary artery disease, longer length of index admission and higher NIHSS deserve deep attention after hospital discharge.

Effect of minimally invasive surgery for cerebral hematoma evacuation in different stages on motor evoked potential and thrombin in dog model of intracranial hemorrhage.

OBJECTIVE: To observe the effect of minimally invasive surgery for cerebral hematoma evacuation in different stages on motor evoked potential (MEP) and thrombin in dog model of intracranial hemorrhage. METHODS: Twenty dogs were selected to prepare the intracranial hemorrhage model, which were randomly divided into 6, 12, 18 and 24 hour groups, respectively. The animals in each group underwent a minimally invasive surgery to evacuate the cerebral hematoma after the models were prepared. Before and after procedures, Purdy score, MEP and thrombin in hematoma region were determined and compared. RESULTS: Significant decreases in Purdy score, latency of MEP and thrombin expression were observed in 6 and 12 hour groups as compared with the 18 and 24 hour groups (p<0.01). DISCUSSION: In the present experiment, we established a dog model of intracranial hemorrhage, which was minimally invasive, easy to operate, highly repeated, simulating the pathological and physiological changes of clinical hypertensive intracranial hemorrhage. Both the latency of MEP and the expression of thrombin decreased after evacuation of intracranial hematoma in early stages by minimally invasive procedures, indicating that minimally invasive procedures for cerebral hematoma in ultra-early and early stages might be more effective to limit brain injury and decrease the latency of MEP and thrombin expression.