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Heliyon Jun 2024Septic shock is a clinical syndrome characterized by the progression of sepsis to a severe stage. Elderly patients with urosepsis in the intensive care unit (ICU) are...
BACKGROUND
Septic shock is a clinical syndrome characterized by the progression of sepsis to a severe stage. Elderly patients with urosepsis in the intensive care unit (ICU) are more likely to progress to septic shock. This study aimed to establish and validate a nomogram model for predicting the risk of progression to septic shock in elderly patients with urosepsis.
METHODS
We extracted data from the Medical Information Mart for Intensive Care (MIMIC-IV) and the eICU Collaborative Research Database (eICU-CRD). The MIMIC-IV dataset was split into a training set for model development and an internal validation set to assess model performance. Further external validation was performed using a distinct dataset sourced from the eICU-CRD. Predictors were screened using least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression analyses. The evaluation of model performance included discrimination, calibration, and clinical usefulness.
RESULTS
The study demonstrated that the Glasgow Coma Scale (GCS), white blood count (WBC), platelet, blood urea nitrogen (BUN), calcium, albumin, congestive heart failure (CHF), and invasive ventilation were closely associated with septic shock in the training cohort. Nomogram prediction, utilizing eight parameters, demonstrated strong predictive accuracy with area under the curve (AUC) values of 0.809 (95 % CI 0.786-0.834), 0.794 (95 % CI 0.756-0.831), and 0.723 (95 % CI 0.647-0.801) in the training, internal validation, and external validation sets, respectively. Additionally, the nomogram demonstrated a promising calibration performance and significant clinical usefulness in both the training and validation sets.
CONCLUSION
The constructed nomogram is a reliable and practical tool for predicting the risk of progression to septic shock in elderly patients with urosepsis. Its implementation in clinical practice may enhance the early identification of high-risk patients, facilitate timely and targeted interventions to mitigate the risk of septic shock, and improve patient outcomes.
PubMed: 38961944
DOI: 10.1016/j.heliyon.2024.e32454 -
Heliyon Jun 2024This study aimed to identify the risk factors associated with mortality among patients co-infected with human immunodeficiency virus (HIV) and Talaromyces marneffei (TM)...
BACKGROUND
This study aimed to identify the risk factors associated with mortality among patients co-infected with human immunodeficiency virus (HIV) and Talaromyces marneffei (TM) in China, and develop a risk prediction model.
METHODS
In this retrospective cohort analysis conducted from 2013 to 2024, comprehensive clinical data from 160 patients were analyzed using a logistic regression model to identify mortality predictors and construct a predictive model. An additional 36 patients constituted the validation cohort, which was specifically designed to evaluate the predictive value of the model. Model performance was assessed using the area under the curve (AUC).
RESULTS
The overall mortality rate for hospitalized patients with HIV/TM co-infection was 17.35 %. The median age was 35.0 years, and 89.30 % were male. Additionally, 89.80 % of the patients reported fever and 87.76 % presented with lymphadenopathy. Key independent risk factors associated with mortality included age (odds ratio (OR): 1.103, 95 % confidence interval (CI) = 1.033-1.178, P = 0.003), procalcitonin (PCT) levels (OR: 1.270, 95 % CI = 1.052-1.534, P = 0.013), and urea to albumin ratio (UAR) (OR: 1.491, 95 % CI = 1.175-1.892, P < 0.001). Advanced age, elevated PCT levels, and increased UAR were identified as independent risk factors of mortality. Furthermore, the mortality prediction probability combining age, PCT, and UAR exhibited a high predictive value in patients with HIV/TM co-infection. Additionally, the AUC showed a good discrimination ability in the validation group (AUC, 0.898).
CONCLUSIONS
Advanced age, elevated PCT levels, and increased UAR significantly determine mortality in patients with HIV/TM co-infection. These findings underscore the potential of using laboratory parameters as predictive indicators of mortality, facilitating the early identification of HIV/TM co-infection cases in clinical practice.
PubMed: 38961941
DOI: 10.1016/j.heliyon.2024.e32560 -
Heliyon Jun 2024The flow field geometry mainly affects the electrochemical reaction, the mass transfer, and gas diffusion layers. All these parameters affect the performance of a PEM...
The flow field geometry mainly affects the electrochemical reaction, the mass transfer, and gas diffusion layers. All these parameters affect the performance of a PEM fuel cell. In this study, a three-dimensional model is used for all parts of the fuel cell such as the flow channels, gas-diffusion electrodes, catalyst layers, and the membrane. These equations are numerically solved using a finite volume-based computational fluid dynamics technique to investigate the effect of using new geometries such as tubular, rectangular, elliptical, and triangular compared to planner-type fuel cells. Also, a test bench was designed and constructed for checking the cell and a series of experiments were done. The results show that there is good agreement between the numerical and experimental results. In summary, the tubular geometry has the best performance compared to others which can increase the execution of the fuel cell maximum by 43 %.
PubMed: 38961929
DOI: 10.1016/j.heliyon.2024.e32026 -
Heliyon Jun 2024Leber hereditary optic neuropathy (LHON) is the most frequent mitochondrial disease causing dyschromatopsia and progressive central visual loss that is subacute in...
INTRODUCTION
Leber hereditary optic neuropathy (LHON) is the most frequent mitochondrial disease causing dyschromatopsia and progressive central visual loss that is subacute in progression and painless. Several studies have been published assessing QoL in patients with LHON, but no estimate of the economic burden has been reported to date. This study aims to quantify direct non-medical and indirect costs (productivity loss) incurred by LHON patients and their informal caregivers in Czechia and Slovakia, as well as to assess their quality of life.
METHODS
The study was performed in 27 adults and children with LHON. To determine the socioeconomic burden of LHON, separate questionnaires for adults, children, and their parents were developed, including demographic and socioeconomic data. The following data were collected: age, education, family size, severity of LHON, non-medical direct and indirect costs of LHON.
RESULTS
The mean age of adult respondents was 36.1 years (SD 13.1; n = 21). The total cost of absenteeism was EUR 1003 per person/year in adult employees, and EUR 2711 per person/year in children's parents. The productivity loss as a consequence of LHON due to combined relative absenteeism and relative presenteeism was estimated at EUR 9840 per an adult patient/year, and EUR 6298 per a parent/year, respectively. The mean cost of informal care was estimated at EUR 4502 (SD 4772; n = 6) per person/year. The mean VFQ-25 score for adult patients with LHON was 43.47 (SD 15.86).
CONCLUSION
The results of this study clearly show that patients with LHON and their families face an extensive socioeconomic burden related to this rare disease. Early, timely and appropriate access to diagnosis, treatment, and reimbursement decisions, but also to psychological counselling and services may help the patients and their relatives adapt and cope with the challenging aspects of vision loss and life with the disease.
PubMed: 38961918
DOI: 10.1016/j.heliyon.2024.e32296 -
Heliyon Jun 2024Acute Myeloid Leukemia (AML) exhibits a wide array of phenotypic manifestations, progression patterns, and heterogeneous responses to immunotherapies, suggesting...
BACKGROUND
Acute Myeloid Leukemia (AML) exhibits a wide array of phenotypic manifestations, progression patterns, and heterogeneous responses to immunotherapies, suggesting involvement of complex immunobiological mechanisms. This investigation aimed to develop an integrated prognostic model for AML by incorporating cancer driver genes, along with clinical and phenotypic characteristics of the disease, and to assess its implications for immunotherapy responsiveness.
METHODS
Critical oncogenic driver genes linked to survival were identified by screening primary effector and corresponding gene pairs using data from The Cancer Genome Atlas (TCGA), through univariate Cox proportional hazard regression analysis. This was independently verified using dataset GSE37642. Primary effector genes were further refined using LASSO regression. Transcriptomic profiling was quantified using multivariate Cox regression, and the derived prognostic score was subsequently validated. Finally, a multivariate Cox regression model was developed, incorporating the transcriptomic score along with clinical parameters such as age, gender, and French-American-British (FAB) classification subtype. The 'Accurate Prediction Model of AML Overall Survival Score' (APMAO) was developed and subsequently validated. Investigations were conducted into functional pathway enrichment, alterations in the gene mutational landscape, and the extent of immune cell infiltration associated with varying APMAO scores. To further investigate the potential of APMAO scores as a predictive biomarker for responsiveness to cancer immunotherapy, we conducted a series of analyses. These included examining the expression profiles of genes related to immune checkpoints, the interferon-gamma signaling pathway, and m6A regulation. Additionally, we explored the relationship between these gene expression patterns and the Tumor Immune Dysfunction and Exclusion (TIDE) dysfunction scores.
RESULTS
Through the screening of 95 cancer genes associated with survival and 313 interacting gene pairs, seven genes (ACSL6, MAP3K1, CHIC2, HIP1, PTPN6, TFEB, and DAXX) were identified, leading to the derivation of a transcriptional score. Age and the transcriptional score were significant predictors in Cox regression analysis and were integral to the development of the final APMAO model, which exhibited an AUC greater than 0.75 and was successfully validated. Notable differences were observed in the distribution of the transcriptional score, age, cytogenetic risk categories, and French-American-British (FAB) classification between high and low APMAO groups. Samples with high APMAO scores demonstrated significantly higher mutation rates and pathway enrichments in NFKB, TNF, JAK-STAT, and NOTCH signaling. Additionally, variations in immune cell infiltration and immune checkpoint expression, activation of the interferon-γ pathway, and expression of m6A regulators were noted, including a negative correlation between CD160, m6A expression, and APMAO scores.
CONCLUSION
The combined APMAO score integrating transcriptional and clinical parameters demonstrated robust prognostic performance in predicting AML survival outcomes. It was linked to unique phenotypic characteristics, distinctive immune and mutational profiles, and patterns of expression for markers related to immunotherapy sensitivity. These observations suggest the potential for facilitating precision immunotherapy and advocate for its exploration in upcoming clinical trials.
PubMed: 38961904
DOI: 10.1016/j.heliyon.2024.e32154 -
Heliyon Jun 2024Anterior shoulder dislocation is the most common type of shoulder dislocation and is easy to develop into recurrent type, causing economic burden to society. This study...
BACKGROUND
Anterior shoulder dislocation is the most common type of shoulder dislocation and is easy to develop into recurrent type, causing economic burden to society. This study uses the bibliometric method to analyze the global research status, hotspots and trends of anterior shoulder dislocation, aiming to promote the exploration of anterior shoulder dislocation.
METHODS
The literature on anterior shoulder dislocation in the past two decades were retrieved and downloaded from the Web of Science Core Collection (WOSCC) database. CiteSpace, VOSviewer and bibliometrix package of R software were used to conduct scientific bibliometric analysis of the literature. Finally, some statistical graphics were performed in Graphpad Prism.
RESULTS
A total of 3914 publications related to anterior shoulder dislocation from 2003 to 2022 were retrieved and screened from the WOSCC database. The ranking of the analysis results showed that Provencher MT was the author with the highest frequency of occurrence. Rush University was the most notable contributor. The American Journal of Sports Medicine was the most comprehensive journal. The United States was the most prominent country. Keywords related to surgical treatment were more significant than others.
CONCLUSION
In the past two decades, the research output on anterior shoulder dislocation have been increasing year by year. The focus has gradually shifted to surgical treatment. Surgical treatment may continue to be the research hotspots in this field in the future.
PubMed: 38961893
DOI: 10.1016/j.heliyon.2024.e32488 -
Heliyon Jun 2024Traffic accidents are caused by several interacting risk factors. This study aimed to investigate the interactions among risk factors associated with death at the...
AIM
Traffic accidents are caused by several interacting risk factors. This study aimed to investigate the interactions among risk factors associated with death at the accident scene (DATAS) as an indicator of the crash severity, for pedestrians, passengers, and drivers by adopting "Logic Regression" as a novel approach in the traffic field.
METHOD
A case-control study was designed based on the police data from the Road Traffic Injury Registry in northwest of Iran during 2014-2016. For each of the pedestrians, passengers, and drivers' datasets, logic regression with "logit" link function was fitted and interactions were identified using Annealing algorithm. Model selection was performed using the cross-validation and the null model randomization procedure.
RESULTS
regarding pedestrians, "The occurrence of the accident outside a city in a situation where there was insufficient light" (OR = 6.87, -value<0.001) and "the age over 65 years" (OR = 2.97, -value<0.001) increased the chance of DATAS "Accidents happening in residential inner-city areas with a light vehicle, and presence of the pedestrians in the safe zone or on the non-separate two-way road" combination lowered the chance of DATAS (OR = 0.14, -value<0.001). For passengers, "Accidents happening in outside the city or overturn of the vehicle" combination (OR = 8.55, -value<0.001), and "accidents happening on defective roads" (OR = 2.18, value<0.001) increased the odds of DATAS; When "driver was not injured or the vehicle was two-wheeled", chance of DATAS decreased for passengers (OR = 0.25, p-value<0.001). The odds of DATAS were higher for "drivers who had a head-on accident, or drove a two-wheeler vehicle, or overturned the vehicle" (OR = 4.03, P-value<0.001). "Accident on the roads other than runway or the absence of a multi-car accident or an accident in a non-residential area" (OR = 6.04, P-value<0.001), as well "the accident which occurred outside the city or on defective roads, and the drivers were male" had a higher risk of DATAS for drivers (OR = 5.40, P-value<0.001).
CONCLUSION
By focusing on identifying interaction effects among risk factors associated with DATAS through logic regression, this study contributes to the understanding of the complex nature of traffic accidents and the potential for reducing their occurrence rate or severity. According to the results, the simultaneous presence of some risk factors such as the quality of roads, skill of drivers, physical ability of pedestrians, and compliance with traffic rules play an important role in the severity of the accident. The revealed interactions have practical significance and can play a significant role in the problem-solving process and facilitate breaking the chain of combinations among the risk factors. Therefore, practical suggestions of this study are to control at least one of the risk factors present in each of the identified combinations in order to break the combination to reduce the severity of accidents. This may have, in turn, help the policy-makers, road users, and healthcare professionals to promote road safety through prioritizing interventions focusing on effect size of simultaneous coexistence of crash severity determinants and not just the main effects of single risk factors or their simple two-way interactions.
PubMed: 38961891
DOI: 10.1016/j.heliyon.2024.e32469 -
Frontiers in Cell and Developmental... 2024The classical concept of brain sex differentiation suggests that steroid hormones released from the gonads program male and female brains differently. However, several...
The classical concept of brain sex differentiation suggests that steroid hormones released from the gonads program male and female brains differently. However, several studies indicate that steroid hormones are not the only determinant of brain sex differentiation and that genetic differences could also be involved. In this study, we have performed RNA sequencing of rat brains at embryonic days 12 (E12), E13, and E14. The aim was to identify differentially expressed genes between male and female rat brains during early development. Analysis of genes expressed with the highest sex differences showed that was highly expressed in females having XX genotype with an increasing expression over time. Analysis of genes expressed with the highest male expression identified three early genes, , and . The observed sex-specific expression of genes at early development confirms that the rat brain is sexually dimorphic prior to gonadal action on the brain and identifies and as early genes contributing to male brain development.
PubMed: 38961864
DOI: 10.3389/fcell.2024.1343800 -
Journal of Pregnancy 2024This study is aimed at evaluating the conservative surgical treatment of patients with placenta accreta spectrum (PAS) disorder and at presenting the experience of a...
This study is aimed at evaluating the conservative surgical treatment of patients with placenta accreta spectrum (PAS) disorder and at presenting the experience of a single surgeon. This retrospective study included 245 patients with placenta previa accompanied by PAS disorders operated at a university hospital between June 2013 and December 2023. The diagnosis of PAS was made by a single perinatologist using a combination of transvaginal and transabdominal ultrasonography. All patients were operated with conservative surgical technique by the same surgeon. The demographic and clinical characteristics of the patients, the anesthesia and incision types used, and the details of the surgical technique were evaluated. Of the patients, 165 were operated on at the scheduled time, 80 were operated on under emergency conditions, and 232 (94.69%) of them were operated on under spinal anesthesia. All patients were operated on with a Pfannenstiel incision followed by a transverse incision to the upper border of the placenta to enter into the uterus. An average of 0.52 units of red blood cells per patient was transfused to all patients. Spontaneous intra-abdominal bleeding developed in five patients, and surgical complications occurred in eight patients. No cesarean hysterectomy was performed, and no maternal mortality was detected in any of the cases. The mean time duration of surgery was 54.44 ± 11.37 (30-90) min, and the mean length of hospital stay was 1.71 ± 1.30 (1-9) days. We recommend this procedure as a novel technique and a robust and safe alternative to peripartum hysterectomy and other conservative surgical management procedures for cases with complete PP accompanied with PAS. This technique preserves the uterus as well as reduces blood loss, and transfusion requirement, and thus maternal morbidity and mortality in PAS cases.
Topics: Humans; Female; Placenta Accreta; Pregnancy; Retrospective Studies; Adult; Conservative Treatment; Placenta Previa; Treatment Outcome; Young Adult
PubMed: 38961859
DOI: 10.1155/2024/9910316 -
International Journal of Public Health 2024We aimed to assess later-life health responses to childhood and lifetime adversity in a cohort of rural, Black South African adults.
OBJECTIVES
We aimed to assess later-life health responses to childhood and lifetime adversity in a cohort of rural, Black South African adults.
METHODS
We performed ordinary least squares regression using two waves of data from Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) to estimate a decline in cognitive, mental, and physical health over approximately 3 years. Our analytic sample consisted of 1,993 women and 1,496 men.
RESULTS
Associations between several types of adversity and health outcomes point to declines in health. At the same time, many adverse experiences are associated with improvements in cognitive, mental, and physical health in later life. The direction of the association varied by type of exposure, health outcome, and gender.
CONCLUSION
In populations exposed to many adversities during life, specific adverse experiences may sometimes be associated with greater improvements (and not just greater decline) in health in later life. Further research is needed to unpack the mechanisms at play in these populations.
Topics: Humans; Male; Female; South Africa; Longitudinal Studies; Health Status; Middle Aged; Mental Health; Aged; Cognition; Adult; Adverse Childhood Experiences; Rural Population
PubMed: 38961855
DOI: 10.3389/ijph.2024.1606499