Evaluation of residual cognition in patients with disorders of consciousness based on functional near-infrared spectroscopy.

Significance: Accurate evaluation of consciousness in patients with prolonged disorders of consciousness (DOC) is critical for designing therapeutic plans, determining rehabilitative services, and predicting prognosis. Effective ways for detecting consciousness in patients with DOC are still needed. Aim: Evaluation of the residual awareness in patients with DOC and investigation of the spatiotemporal differences in the hemodynamic responses between the minimally conscious state (MCS) and the unresponsive wakefulness syndrome (UWS) groups using active command-driven motor imagery (MI) tasks. Approach: In this study, functional near-infrared spectroscopy (fNIRS) was used to measure the changes of hemodynamic responses in 19 patients with DOC (9 MCS and 10 UWS) using active command-driven MI tasks. The characteristics of the hemodynamic responses were extracted to compare the differences between the MCS and UWS groups. Moreover, the correlations between the hemodynamic responses and the clinical behavioral evaluations were also studied. Results: The results showed significant differences in the spatiotemporal distribution of the hemodynamic responses between the MCS and UWS groups. For the patients with MCS, significant increases in task-evoked hemodynamic responses occurred during the "YES" questions of the command-driven MI tasks. Importantly, these changes were significantly correlated with their coma-recovery scale-revised (CRS-R) scores. However, for the patients with UWS, no significant changes of the hemodynamic responses were found. Additionally, the results did not show any statistical correlation between the hemodynamic responses and their CRS-R scores. Conclusions: The fNIRS-based command-driven MI tasks can be used as a promising tool for detecting residual awareness in patients with DOC. We hope that the findings and the active paradigm used in this study will provide useful insights into the diagnosis, therapy, and prognosis of this challenging patient population.

Acceptance and commitment therapy reduces psychological distress in patients with cancer: a systematic review and meta-analysis of randomized controlled trials.

Objective: This study aimed to systematically review and meta-analyze the clinical efficacy of acceptance and commitment therapy (ACT) in patients with cancer and psychological distress. Methods: Randomized controlled trials (RCTs) from seven English electronic databases were systematically investigated from inception to 3 October 2023. A total of 16 RCTs from 6 countries with 711 participants were included in this study. Estimated pooled effect sizes (ESs) were calculated via inverse-variance random-effects or fixed-effects (I2 ≤ 50%) model and presented by standardized mean difference (SMD). Subgroup analyses were performed to reduce confounding factors and heterogeneity, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to evaluate the quality of the pooled ESs. Results: The pooled ESs revealed that statistically significant improvements in anxiety [postintervention SMD = -0.41 (95% confidence interval (CI), -0.71, -0.11); p = 0.008; I2 = 65%; follow-up SMD = -0.37 (95% CI, -0.66, -0.08); p = 0.01; I2 = 29%], depression [postintervention SMD = -0.45 (95% CI, -0.63, -0.27); p < 0.001; I2 = 49%; follow-up SMD = -0.52 (95% CI, -0.77, -0.28); p < 0.001; I2 = 0%], and psychological flexibility [postintervention SMD = -0.81 (95% CI, -1.50, -0.11); p = 0.02; I2 = 84%; follow-up SMD = -0.71 (95% CI, -1.12, -0.31); p = 0.0006; I2 = 38%] in ACT-treated participants were observed compared to patients treated with control conditions. However, other outcomes, such as physical symptom alleviation, were not significantly associated. Conclusion: The findings of this systematic review and meta-analysis suggest that ACT is associated with improvements in anxiety, depression, and psychological flexibility in patients with cancer. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022320515.

A Prediction Rule Including Interleukin-6 in Pericardial Drainage Improves Prediction of New-Onset Atrial Fibrillation After Coronary Artery Bypass Grafting.

OBJECTIVE: To test the hypothesis that a prediction rule including levels of interleukin-6 in pericardial drainage (pdIL-6) would improve the discrimination in classifying patients undergoing coronary artery bypass grafting (CABG) into different postoperative atrial fibrillation (POAF) risk levels. DESIGN: Prospective cohort study. SETTING: A university-affiliated tertiary hospital. PARTICIPANTS: Patients undergoing CABG. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We prospectively recruited patients who underwent CABG into derivation and validation cohorts. The independent predictors were identified in the derivation cohort using multiple logistic regression and tested in the validation cohort. The performance of the predictive model was tested using area under the receiver operating characteristic curve (AUC) in both cohorts. A prediction rule was created by assigning points to each predictor. Patients were classified in various risk levels according to their total risk scores. We enrolled 302 and 207 patients in the derivation and validation cohorts, respectively. Multiple logistic regression analysis identified six predictors: age ≥61 y, left atrial diameter ≥49 mm, right atrial diameter ≥45 mm, number of grafts ≥3, and serum uric acid ≥226 µmol/L and pdIL-6 levels ≥166 ng/mL at postoperative 12 h. The AUC of the model was 0.78 and 0.77 for the derivation and validation cohort, respectively, which was greatly increased by adding pdIL-6. Patients were stratified into low-risk, moderate-risk and high-risk groups. CONCLUSIONS: A POAF prediction rule including pdIL-6 had good performance for stratifying CABG patients into various risk groups for POAF. The inclusion of pdIL-6 resulted in clinically meaningful improvement in risk prediction.

Delirium screening for patients in the intensive care unit: A prospective validation study of the iCAM-ICU by nurse researchers and bedside nurses in routine practice.

BACKGROUND: Daily delirium assessment using the Confusion Assessment Method for the Intensive Care Unit was recommended for patients in the intensive care unit, yet implementation may be difficult because of lack of simple and standardized data collection schemes which may result in low sensitivities when used by bedside nurses. OBJECTIVE: This study was to validate the diagnostic accuracy of the intelligent Confusion Assessment Method for the Intensive Care Unit (iCAM-ICU) used by both nurse investigators and bedside nurses in Chinese patients in the intensive care unit. DESIGN: Prospective cohort study. SETTING: A university affiliated tertiary hospital in China. PARTICIPANTS: A total of 373 hospitalized patients (181 in phase I and 192 in phase II) in the intensive care units met the inclusion criteria and participated in the study. There were two nursing researchers (phase I) and 24 bedside nurses (phase II) used the iCAM-ICU to assess delirium among patients. METHODS: Two prospective cohort studies were conducted to validate the diagnostic accuracy of iCAM-ICU on delirium screening when it was used by nurse investigators and bedside nurses in the intensive care unit. Using the Diagnostic and Statistical Manual of Mental Disorders as the gold standard, the sensitivity, specificity, predictive values along with the likelihood ratios were determined to estimate the performance of the iCAM-ICU in patients in the intensive care setting. The Kappa consistency test was examined to determine the inter-rater consistency. Subgroup analysis in terms of different age, level of education, severity of illness and cognitive status were also conducted to evaluate potential variations of the iCAM-ICU performance in different patient groups. RESULTS: A total of 373 patients were included in the validation studies. In comparing with the gold standard, the sensitivities of the iCAM-ICU demonstrated by the two nurse investigators were 95.2 % and 93.7%, while the specificities of the iCAM-ICU were 93.3% and 93.2%. The Kappa consistency between two nurse investigators was 0.96. The sensitivity and specificity of the iCAM-ICU demonstrated by bedside nurses in intensive care patients were 86.7% and 97.7%, respectively. Subgroup analysis also revealed that the sensitivities and specificities in those different subgroups were acceptable, with all statistics being above 80%. CONCLUSIONS: The iCAM-ICU, an information technology enabled delirium screening tool, showed highly acceptable accuracy in detecting delirium in the intensive care units. It can assist bedside nurses to detect delirium reliably and identify potential patients with delirium accurately. REGISTRATION NUMBER: ChiCTR-OCH-13003050.

LncRNA SNHG9 is downregulated in osteoarthritis and inhibits chondrocyte apoptosis by downregulating miR-34a through methylation.

BACKGROUND: Our preliminary RNA-Seq data revealed altered expression of small nucleolar RNA host gene 9 (SNHG9) in osteoarthritis (OA) and its reverse correlation with miR-34a, which can regulate chondrocyte apoptosis in rat OA model. This study was therefore carried out to investigate the potential interaction between SNHG9 and miR-34a in OA. METHODS: A total of 60 healthy volunteers (Control group) as well as 60 OA patients (OA group) were enrolled in this study. Transfections, RT-qPCR, methylation-specific PCR (MSP) and cell apoptosis assay were performed. RESULTS: We found that SNHG9 was downregulated in OA and its expression was reversely correlated with the expression of miR-34a only across OA samples but not healthy control samples. In chondrocytes from OA patients, overexpression of SNHG9 led to downregulation of miR-34a and increased methylation of miR-34a gene. In contrast, in chondrocytes from healthy controls, overexpression of SNHG9 did not affect the expression of miR-34a and the methylation of miR-34a gene. Cell apoptosis analysis showed that overexpression of SNHG9 led to decreased apoptotic rate of chondrocytes from OA patients but not chondrocytes from the healthy controls through miR-34a. CONCLUSION: In conclusion, SNHG9 is downregulated in OA and inhibits chondrocyte apoptosis by downregulating miR-34a through methylation.

LncRNA CTBP1-AS2 is upregulated in osteoarthritis and increases the methylation of miR-130a gene to inhibit chondrocyte proliferation.

OBJECTIVES: LncRNA CTBP1-AS2 has been reported to be involved in type 2 diabetes and cardiomyocyte hypertrophy, while its roles in other human diseases are unknown. Our preliminary deep sequencing analysis showed altered expression of CTBP1-AS2 in osteoarthritis (OA). In addition, CTBP1-AS2 was inversely correlated with miR-130a. This study was therefore carried out to investigate the interactions between CTBP1-AS2 and miR-130a in OA. METHODS: Synovial fluid was collected from 62 OA patients and 62 healthy controls. RT-qPCR was performed to determine the expression levels of CTBP1-AS2 and miR-130a in synovial fluid. Cell transfections were performed to investigate the interactions between CTBP1-AS2 and miR-130a. Methylation-specific PCR (MSP) was performed to assess the effects of CTBP1-AS2 on the methylation of miR-130a. Cell counting Kit-8 (CCK-8) assay was performed to evaluate the roles of CTBP1-AS2 and miR-130a in regulating proliferation of chondrocytes. RESULTS: The results showed that CTBP1-AS2 was upregulated in OA and inversely correlated with miR-130a. In chondrocytes of OA patients, overexpression of CTBP1-AS2 led to increased methylation of miR-130a gene and downregulated expression of miR-130a, while overexpression of miR-130a did not affect the expression of CTBP1-AS2. In contrast, no interaction between CTBP1-AS2 and miR-130a was observed in chondrocytes from healthy adults. Analysis of chondrocyte proliferation showed that overexpression of miR-130a led to increased proliferation rate of chondrocytes extracted from OA patients. Overexpression of CTBP1-AS2 led to decreased proliferation rate of chondrocytes and reversed the effects of overexpressing miR-130a. CONCLUSION: Therefore, CTBP1-AS2 is upregulated in OA and may increase the methylation of miR-130a gene to inhibit chondrocyte proliferation. Key Points • CTBP1-AS2 is overexpressed in OA and may downregulate miR-130a through methylation to suppress the proliferation of chondrocytes. • The interaction between CTBP1-AS2 and miR-130a is indirect and mediated by certain pathological mediators.

Change in Serum Level of Interleukin 6 and Delirium After Coronary Artery Bypass Graft.

BACKGROUND: Serum level of interleukin 6 (IL-6) is known to be associated with postoperative delirium. However, no consensus has emerged on the postoperative time point at which IL-6 level may predict postoperative delirium after coronary artery bypass graft surgery. OBJECTIVES: To compare trends in IL-6 levels in patients with and without postoperative delirium and to examine the relationship between IL-6 levels at different times and postoperative delirium after coronary artery bypass graft. METHODS: A prospective cohort study of patients who underwent their first elective isolated coronary artery bypass graft between November 2013 and August 2015 at a cardiac intensive care unit in Beijing, China. Concentrations of IL-6 were measured before the operation and at the 6th, 12th, and 18th postoperative hours. Participants were assessed for postoperative delirium twice daily for 5 days. Univariate and multivariate logistic regression analyses were done to determine associations between IL-6 levels at different time points, postoperative changes in IL-6 levels, and the occurrence of postoperative delirium. RESULTS: Postoperative delirium was diagnosed in 85 of 266 patients (32%). Levels of IL-6 were significantly higher in patients with postoperative delirium than in patients without it at the 6th, 12th, and 18th postoperative hours (P = .03, .004, and .001, respectively). Change in IL-6 level (odds ratio, 2.97; 95% CI, 1.20-7.31; P = .02) and IL-6 level of 583 pg/mL or higher at the 18th postoperative hour (odds ratio, 5.20; 95% CI, 1.84-14.70; P = .002) were associated with higher incidence of postoperative delirium. CONCLUSION: Interleukin 6 level (≥ 583 pg/mL) at the 18th postoperative hour may serve as a potent predictor of postoperative delirium in coronary artery bypass graft patients.

Highly sensitive SERS detection of As3+ ions in aqueous media using glutathione functionalized silver nanoparticles.

A highly sensitive surface-enhanced Raman scattering (SERS) platform for the selective trace analysis of As(3+) ions was reported based on glutathione (GSH)/4-mercaptopyridine (4-MPY)-modified silver nanoparticles (AgNPs). Here, GSH conjugated on the surface of AgNPs for specifical binding with As(3+) ions in aqueous solution through As-O linkage and 4-MPY was used as a Raman reporter. When As(3+) ions were added to the system, the binding of As(3+) with GSH resulted in the aggregation of AgNPs, and excellent Raman signal of 4-MPY reporters was obtained which can reflect the concentration of As(3+) indirectly. Under optimal assay conditions, the limit of detection (LOD) was estimated to be as low as 0.76 ppb, which is lower than the WHO defined limit (10 ppb), and an excellent linear range of 4-300 ppb was obtained. The practical application had been carried out for determination of As(3+) in real water samples.