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Pakistan Journal of Medical Sciences Jul 2024To investigate risk factors for severe maternal morbidity (SMM) in pregnant women with hypertensive disorders of pregnancy (HDP) and to develop a risk prediction model.
OBJECTIVES
To investigate risk factors for severe maternal morbidity (SMM) in pregnant women with hypertensive disorders of pregnancy (HDP) and to develop a risk prediction model.
METHODS
A prospective observational cohort study was conducted among pregnant women who were hospitalized for hypertensive disorders of pregnancy (HDP) between January 2016 and December 2020 in Fujian College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Province, China (a training set), and a risk predictive model was constructed. Pregnant women with HDP who were hospitalized between January 2021 and December 2021 were selected as a validation set. Concordance index (C-index) and calibration curves were used to test predictive model discrimination and calibration.
RESULTS
We included 970 pregnant women (790 in the training set and 180 in the validation set). Least absolute shrinkage and selection operator regression was used to screen for nine related variables such as intra-uterine growth retardation (IUGR), diastolic blood pressure (DBP) and systolic blood pressure (SBP) at suspected diagnosis, total bilirubin, albumin (ALB), uric acid, total cholesterol, serum magnesium, and suspected gestational age. SBP at suspected diagnosis (OR =1.22, 95%CI:1.08-1.42) and total cholesterol (OR = 1.78, 95%CI:1.17-2.80) were independent risk factors of severe maternal morbidity in pregnant women with HDP. A nomogram was constructed, and internal validation of the nomogram model was done using the bootstrap self-sampling method. C-index in the training and the validation set was 0.798 and 0.909, respectively.
CONCLUSION
Our prediction model can be used to determine gestational hypertension severity in pregnant women.
PubMed: 38952510
DOI: 10.12669/pjms.40.6.9095 -
Health Science Reports Jul 2024Postoperative delirium (POD) is a common postoperative complication, especially in patients over 60 years, with an incidence ranging from 15% to 50%. In most cases, POD...
BACKGROUND
Postoperative delirium (POD) is a common postoperative complication, especially in patients over 60 years, with an incidence ranging from 15% to 50%. In most cases, POD manifests in the first 5 days after surgery. Multiple contributing risk factors for POD have been detected. Besides the predisposing factors such as higher age, cognitive impairment, high blood pressure, atrial fibrillation, and past stroke, pathophysiological mechanisms like neuroinflammation are also considered as contributing factors.
METHODS
In a subanalysis of the "PRe- Operative Prediction of postoperative DElirium by appropriate SCreening" (PROPDESC) study, the preoperative laboratory values of sodium, potassium, total protein, hemoglobin concentration (Hgb), and white blood cells as well as the biomarkers creatinine, HbA1c, NT-pro-BNP, high sensitive Troponin T (hsTnT), and C-reactive protein (CRP) were assessed to investigate a possible relationship to the occurrence of POD.
RESULTS
After correction for age, physical status classification, surgery risk after Johns Hopkins, and operative discipline (cardiac surgery vs. noncardiac surgery), male patients with a Hgb <13 g/dL had significantly higher odds for POD ( = 0.025). Furthermore, patients with CRP ≥ 10 mg/L, HbA1c value ≥ 8.5% as well as patients with hypernatraemia (>145 mmol/L) presented significantly higher odds to develop POD ( = 0.011, < 0.001, and = 0.021, respectively). A raised (>14-52 ng/L) or high (>52 ng/L) hsTnT value was also associated with a significantly higher chance for POD compared to the patient group with hsTnT <14 ng/L ( < 0.001 and = 0.016, respectively).
CONCLUSIONS
Preoperative Hgb, CRP, HbA1c, sodium, and hsTnT could be used to complement and refine the preoperative screening for patients at risk for POD. Further studies should track these correlations to investigate the potential of targeted POD protection and enabling hospital staff to initiate POD-preventing measures in time.
PubMed: 38952405
DOI: 10.1002/hsr2.2219 -
Heliyon Jun 2024Radiotherapy causes apoptosis mainly through direct or indirect damage to DNA via ionizing radiation, leading to DNA strand breaks. However, the efficacy of radiotherapy... (Review)
Review
Radiotherapy causes apoptosis mainly through direct or indirect damage to DNA via ionizing radiation, leading to DNA strand breaks. However, the efficacy of radiotherapy is attenuated in malignant tumor microenvironment (TME), such as hypoxia. Tumor vasculature, due to the imbalance of various angiogenic and anti-angiogenic factors, leads to irregular morphology of tumor neovasculature, disordered arrangement of endothelial cells, and too little peripheral coverage. This ultimately leads to a TME characterized by hypoxia, low pH and high interstitial pressure. This deleterious TME further exacerbates the adverse effects of tumor neovascularization and weakens the efficacy of conventional radiotherapy. Whereas normalization of blood vessels improves TME and thus the efficacy of radiotherapy. In addition to describing the research progress of radiotherapy sensitization and vascular normalization, this review focuses on the strategy and application prospect of modulating vascular normalization to improve the efficacy of radiotherapy sensitization.
PubMed: 38952362
DOI: 10.1016/j.heliyon.2024.e32598 -
Journal of Korean Medical Science Jul 2024A 30-year-old Korean man with myelodysplastic syndrome admitted hospital due to undifferentiated fever and recurrent skin lesions. He received combination therapy with...
A 30-year-old Korean man with myelodysplastic syndrome admitted hospital due to undifferentiated fever and recurrent skin lesions. He received combination therapy with high doses of meropenem, tigecycline and amikacin, yielding carbapenem resistant (CRKP) harboring carbapenemase (KPC)-2 from blood cultures on hospital day (HD) 23. Ceftazidime/avibactam was started at HD 37 and CRKP was eradicated from blood cultures after 5 days. However, ceftazidime/avibactam-resistant CRKP carrying KPC-44 emerged after 26 days of ceftazidime/avibactam treatment and then ceftazidime/avibactam-resistant, carbapenem-susceptible carrying KPC-135 was isolated on HD 65. The 3-D homology of KPC protein showed that hot spot changes in the omega loop could be attributed to ceftazidime/avibactam resistance and loss of carbapenem resistance. Whole genome sequencing of serial isolates supported that phenotypic variation was due to clonal evolution than clonal replacement. The treatment regimen was changed from CAZ/AVI to meropenem-based therapy (meropenem 1 g iv q 8 hours and amikacin 600 mg iv per day) starting with HD 72. CAZ/AVI-susceptible CRKP was presented again from blood cultures on HD 84, and the patient expired on HD 85. This is the first Korean report on the acquisition of ceftazidime/avibactam resistance through the emergence of variants.
Topics: Humans; Ceftazidime; Klebsiella pneumoniae; Male; Azabicyclo Compounds; Drug Combinations; Adult; Anti-Bacterial Agents; beta-Lactamases; Klebsiella Infections; Bacteremia; Microbial Sensitivity Tests; Carbapenems; Whole Genome Sequencing; Bacterial Proteins; Meropenem; Drug Resistance, Multiple, Bacterial
PubMed: 38952349
DOI: 10.3346/jkms.2024.39.e208 -
Janus Flexible Device with Microcone Channels for Sampling and Analysis of Biological Microfluidics.Langmuir : the ACS Journal of Surfaces... Jul 2024Controlling the spontaneous directional transport of droplets plays an important role in the application of microchemical reactions and microdroplet detection. Although...
Controlling the spontaneous directional transport of droplets plays an important role in the application of microchemical reactions and microdroplet detection. Although the relevant technologies have been widely studied, the existing spontaneous droplet transport strategies still face problems of complex structure, single function, and poor flexibility. Inspired by the spontaneous droplet transport strategy in nature, an asymmetric wettability surface with microcone channels (AWS-MC) is prepared on a flexible fabric by combining surface modification and femtosecond laser manufacturing technology. On this surface, the capillary force and Laplace pressure induced by the wettability gradient and the geometric structure gradient drive the droplet transport from the hydrophobic surface to the hydrophilic surface. Notably, droplets in adjacent hydrophilic regions do not exchange substances even if the gap in the hydrophilic region is only 1 mm, which provides an ideal platform for numerous detections by a single drop. The droplet transport strategy does not require external energy and can adapt to the manipulation of various droplet types. Application of this surface in the blood of organisms is demonstrated. This work provides an effective method for microdroplet-directed self-transport and microdroplet detection.
Topics: Wettability; Hydrophobic and Hydrophilic Interactions; Microfluidic Analytical Techniques; Animals; Surface Properties
PubMed: 38952282
DOI: 10.1021/acs.langmuir.4c01251 -
Veterinary Medicine and Science Jul 2024Although research on the mechanism and control of pain and inflammation in fish has increased in recent years, the use of analgesic drugs is limited due to the lack of...
BACKGROUND
Although research on the mechanism and control of pain and inflammation in fish has increased in recent years, the use of analgesic drugs is limited due to the lack of pharmacological information about analgesic drugs. Tolfenamic acid is a non-steroidal anti-inflammatory drug and can be used in fish due to its low side effect profile and superior pharmacokinetic properties.
OBJECTIVES
The pharmacokinetics, bioavailability and plasma protein binding of tolfenamic acid were investigated following single intravascular (IV), intramuscular (IM) and oral administration of 2 mg/kg in rainbow trout at 13 ± 0.5°C.
METHODS
The experiment was carried out on a total of 234 rainbow trout (Oncorhynchus mykiss). Tolfenamic acid was administered to fish via IV, IM and oral route at a dose of 2 mg/kg. Blood samples were taken at 13 different sampling times until the 72 h after drug administration. The plasma concentrations of tolfenamic acid were quantified using high pressure liquid chromatography-ultraviolet (UV) and pharmacokinetic parameters were assessed using non-compartmental analysis.
RESULTS
The elimination half-life (t) of tolfenamic acid for IV, IM and oral routes was 3.47, 6.75 and 9.19 h, respectively. For the IV route, the volume of distribution at a steady state and total body clearance of tolfenamic acid were 0.09 L/kg and 0.03 L/h/kg, respectively. The peak plasma concentration and bioavailability for IM and oral administration were 8.82 and 1.24 µg/mL, and 78.45% and 21.48%, respectively. The mean plasma protein binding ratio of tolfenamic acid in rainbow trout was 99.48% and was not concentration dependent.
CONCLUSIONS
While IM route, which exhibits both the high plasma concentration and bioavailability, can be used in rainbow trout, oral route is not recommended due to low plasma concentration and bioavailability. However, there is a need to demonstrate the pharmacodynamic activity of tolfenamic acid in rainbow trout.
Topics: Animals; Oncorhynchus mykiss; ortho-Aminobenzoates; Biological Availability; Anti-Inflammatory Agents, Non-Steroidal; Administration, Oral; Blood Proteins; Injections, Intramuscular; Protein Binding; Injections, Intravenous; Half-Life
PubMed: 38952278
DOI: 10.1002/vms3.1533 -
Journal of Clinical Hypertension... Jul 2024The E-proteinoid 3 receptor (PTGER3), a member of the prostaglandin E2 (PGE2) subtype receptor, belongs to the G-protein-coupled superfamily of receptors. Animal studies...
The E-proteinoid 3 receptor (PTGER3), a member of the prostaglandin E2 (PGE2) subtype receptor, belongs to the G-protein-coupled superfamily of receptors. Animal studies have demonstrated its involvement in salt sensitivity by regulating sodium reabsorption. This study aimed to investigate the association between genetic variants of PTGER3 and salt sensitivity, longitudinal blood pressure (BP) changes, and the incidence of hypertension in Chinese adults. A chronic salt intake intervention was conducted involving 514 adults from 124 families in the 2004 Baoji Salt-Sensitivity Study Cohort in northern China. These participants followed a 3-day regular baseline diet, followed by a 7-day low-salt diet (3.0 g/d) and a 7-day high-salt diet (18 g/d), and were subsequently followed for 14 years. The findings revealed a significant relationship between the single nucleotide polymorphism (SNP) rs17482751 of PTGER3 and diastolic blood pressure (DBP) response to high salt intervention. Additionally, SNPs rs11209733, rs3765894, and rs2268062 were significantly associated with longitudinal changes in systolic blood pressure (SBP), DBP, and mean arterial pressure (MAP) during the 14-year follow-up period. SNP rs6424414 was significantly associated with longitudinal changes in DBP over 14 years. Finally, SNP rs17482751 showed a significant correlation with the incidence of hypertension over 14 years. These results emphasize the significant role of PTGER3 gene polymorphism in salt sensitivity, longitudinal BP changes, and the development of hypertension in the Chinese population.
PubMed: 38952049
DOI: 10.1111/jch.14859 -
Skin Research and Technology : Official... Jul 2024Consumer products such as electrical shavers exert a combination of dynamic loading in the form of pressure and shear on the skin. This mechanical stimulus can lead to...
BACKGROUND
Consumer products such as electrical shavers exert a combination of dynamic loading in the form of pressure and shear on the skin. This mechanical stimulus can lead to discomfort and skin tissue responses characterised as "Skin Sensitivity". To minimise discomfort following shaving, there is a need to establish specific stimulus-response relationships using advanced tools such as optical coherence tomography (OCT).
OBJECTIVE
To explore the spatial and temporal changes in skin morphology and microvascular function following an electrical shaving stimulus.
METHODS
Ten healthy male volunteers were recruited. The study included a 60-s electrical shaving stimulus on the forearm, cheek and neck. Skin parameters were recorded at baseline, 20 min post stimulus and 24 h post stimulus. Structural and dynamic skin parameters were estimated using OCT, while transepidermal water loss (TEWL) was recorded to provide reference values for skin barrier function.
RESULTS
At baseline, six of the eight parameters revealed statistically significant differences between the forearm and the facial sites, while only surface roughness (Rq) and reflectivity were statistically different (p < 0.05) between the cheek and neck. At 20 min post shaving, there was a significant increase in the TEWL values accompanied by increased blood perfusion, with varying magnitude of change dependent on the anatomical site. Recovery characteristics were observed 24 h post stimulus with most parameters returning to basal values, highlighting the transient influence of the stimulus.
CONCLUSIONS
OCT parameters revealed spatial and temporal differences in the skin tissue response to electrical shaving. This approach could inform shaver design and prevent skin sensitivity.
Topics: Humans; Male; Tomography, Optical Coherence; Adult; Skin; Forearm; Young Adult; Microvessels; Cheek; Water Loss, Insensible; Healthy Volunteers; Skin Physiological Phenomena; Electric Stimulation; Neck; Microcirculation
PubMed: 38951871
DOI: 10.1111/srt.13830 -
BMC Pregnancy and Childbirth Jun 2024Hypertensive disorders of pregnancy (HDP) are a significant cause of maternal mortality worldwide. The classification and treatment of hypertension in pregnancy remain...
Does the implementation of revised American College of Cardiology and American Heart Association (ACC/AHA) guidelines improve the identification of stillbirths and preterm births in hypertensive pregnancies: a population-based cohort study from South Asia and sub-Saharan Africa.
BACKGROUND
Hypertensive disorders of pregnancy (HDP) are a significant cause of maternal mortality worldwide. The classification and treatment of hypertension in pregnancy remain debated. We aim to compare the effectiveness of the revised 2017 ACC/AHA blood pressure threshold in predicting adverse pregnancy outcomes.
METHODS
We conducted a secondary data analysis of the Alliance for Maternal and Newborn Health Improvement (AMANHI) biorepository study, including 10,001 pregnant women from Bangladesh, Pakistan, and Tanzania. Blood pressure was measured using validated devices at different antenatal care visits. The blood pressure readings were categorized as: normal blood pressure (systolic blood pressure (sBP) < 120 mm Hg and diastolic blood pressure (dBP) < 80 mm Hg), elevated blood pressure (sBP 120-129 and dBP < 80), stage 1 hypertension (sBP 130-139 or dBP 80-89, or both), and stage 2 hypertension (sBP ≥ 140 or dBP ≥ 90, or both). We estimated risk ratios for stillbirths and preterm births, as well as diagnostic test properties of both the pre-existing JNC7 (≥ 140/90) and revised ACC/AHA (≥ 130/80) thresholds using normal blood pressure as reference group.
RESULTS
From May 2014 to June 2018, blood pressure readings were available for 9,448 women (2,894 in Bangladesh, 2,303 in Pakistan, and 4,251 in Tanzania). We observed normal blood pressure in 70%, elevated blood pressure in 12.4%, stage 1 hypertension in 15.2%, and stage 2 hypertension in 2.5% of the pregnant women respectively. Out of these, 310 stillbirths and 9,109 live births were recorded, with 887 preterm births. Using the ACC/AHA criteria, the stage 1 hypertension cut-off revealed 15.3% additional hypertension diagnoses as compared to JNC7 criteria. ACC/AHA defined hypertension was significantly associated with stillbirths (RR 1.8, 95% CI 1.4, 2.3). The JNC 7 hypertension cut-off of ≥ 140/90 was significantly associated with a higher risk of preterm births (RR 1.6, 95% CI 1.2, 2.2) and stillbirths (RR 3.6, 95% CI 2.5, 5.3). Both criteria demonstrated low sensitivities (8.4 for JNC-7 and 28.1 for ACC/AHA) and positive predictive values (11.0 for JNC7 and 5.2 for ACC/AHA) in predicting adverse outcomes.
CONCLUSION
The ACC/AHA criteria (≥ 130/80) identified additional cases of hypertension but had limited predictive accuracy for stillbirths and preterm births, highlighting the ongoing need for improved criteria in managing pregnancy-related hypertension.
Topics: Humans; Female; Pregnancy; Premature Birth; Stillbirth; Adult; Hypertension, Pregnancy-Induced; Practice Guidelines as Topic; United States; Pakistan; Cohort Studies; American Heart Association; Bangladesh; Tanzania; Young Adult; Blood Pressure; Infant, Newborn; Asia, Southern
PubMed: 38951766
DOI: 10.1186/s12884-024-06637-2 -
Scientific Reports Jul 2024Life's Essential 8 (LE8) is a score that includes modifiable risk factors for cardiovascular disease. Four health behaviors (diet, physical activity, nicotine exposure...
Life's Essential 8 (LE8) is a score that includes modifiable risk factors for cardiovascular disease. Four health behaviors (diet, physical activity, nicotine exposure and sleep health) and four health factors (non-HDL cholesterol, blood glucose, blood pressure and body mass index) are included. These modifiable risk factors promote inflammation, and inflammation is one of the biological mechanisms of cardiovascular disease development. Thus, we examined the relationship between cardiovascular health measured by LE8 and low-grade inflammation measured by high-sensitivity C-reactive protein (hs-CRP) in the cross-sectional population-based Swedish CArdioPulmonary bioImage Study (SCAPIS). The study consisted of 28,010 participants between 50 and 64 years (51.5% women, mean age 57.5 years). All individual LE8 components were assigned a score between 0 (unhealthy) and 100 (healthy) points, and a global score was calculated. The association between LE8 scores and high-risk hs-CRP (defined as > 3.0 mg/L) was analyzed using adjusted logistic regression with spline analyses. There was a strong, dose response and inverse association between LE8 scores and levels of hs-CRP. Thus, those with a low LE8 score (= 50.0 points) had 5.8 higher (95% confidence interval [CI] 5.2-6.4) odds ratio (OR) of having high hs-CRP as compared to those with a high LE8 score (= 80.0 points). In conclusion, our findings show strong inverse associations between LE8 scores and levels of hs-CRP.
Topics: Humans; C-Reactive Protein; Female; Middle Aged; Male; Cardiovascular Diseases; Cross-Sectional Studies; Risk Factors; Sweden; Inflammation; Body Mass Index; Exercise; Health Behavior; Blood Pressure; Blood Glucose
PubMed: 38951604
DOI: 10.1038/s41598-024-65977-3