Abstract Background There is conflicting evidence on association between quick sequential organ failure assessment (qSOFA) and sepsis mortality in ICU patients. The primary aim of this study was to determine the association between qSOFA and 28-day mortality in ICU patients admitted for sepsis. Association of qSOFA with early (3-day), medium (28-day), late (90-day) mortality was assessed in low and lower middle income (LLMIC), upper middle income (UMIC) and high income (HIC) countries/regions. Methods This was a secondary analysis of the MOSAICS II study, an international prospective observational study on sepsis epidemiology in Asian ICUs. Associations between qSOFA at ICU admission and mortality were separately assessed in LLMIC, UMIC and HIC countries/regions. Modified Poisson regression was used to determine the adjusted relative risk (RR) of qSOFA score on mortality at 28 days with adjustments for confounders identified in the MOSAICS II study. Results Among the MOSAICS II study cohort of 4980 patients, 4826 patients from 343 ICUs and 22 countries were included in this secondary analysis. Higher qSOFA was associated with increasing 28-day mortality, but this was only observed in LLMIC ( p < 0.001) and UMIC ( p < 0.001) and not HIC ( p = 0.220) countries/regions. Similarly, higher 90-day mortality was associated with increased qSOFA in LLMIC ( p < 0.001) and UMIC ( p < 0.001) only. In contrast, higher 3-day mortality with increasing qSOFA score was observed across all income countries/regions ( p < 0.001). Multivariate analysis showed that qSOFA remained associated with 28-day mortality (adjusted RR 1.09 (1.00–1.18), p = 0.038) even after adjustments for covariates including APACHE II, SOFA, income country/region and administration of antibiotics within 3 h. Conclusions qSOFA was independently associated with 28-day mortality in ICU patients admitted for sepsis. In LLMIC and UMIC countries/regions, qSOFA was associated with early to late mortality but only early mortality in HIC countries/regions. Graphical Abstract
Platelets are non-nucleated blood effector cells, which plays an important role in coagulation, hemostasis, and thrombosis. However, platelets are extremely susceptible to activation by external stimuli, which in turn damages the platelet's natural biological activity and affects its biological function. Platelet biological activity has become a hotspot in the field of vascular diseases. In this study, ultrasound parameters (ultrasound intensity and duration time) were used to intervene in the biological activity of platelets. The response of platelets to ultrasound energy was explored from the aspects of platelet morphology, aggregation ability and particle release (the expression of P-selectin and the number of particles). The results showed that the ultrasound intensity of 0.25 W/cm 2 (1 MHz, 60 s) had no effect on the morphology, aggregation ability and particle release of platelets. When the ultrasonic intensity was increased to greater than 0.25 W/cm 2, the generation of platelet pseudopods, morphological changes, increase of particle release, as well as effect on aggregation were observed. When the ultrasound duration time was 60 s (1 MHz, 0.25 W/cm 2), it had no effect on the biological activity of platelets. However, when the ultrasound time was greater than 60 s, the morphology, aggregation ability and microparticles release would been induced with no effect on the secretion of CD62P and total protein components. Therefore, when the ultrasound parameters were 1 MHz and 0.25 W/cm 2 with 60 s duration time, the ultrasound energy had no effect on the biological activity of platelets. The results in this study are of great significant for ultrasound energy intervention for the treatment of platelet-related diseases.血小板是无核的血液效应细胞，在凝血、止血和血栓形成等方面发挥了重要的作用，但血小板极易受外源性刺激而活化，进而损害血小板天然的生物活性，影响其生物学功能，因此血小板生物活性成为血管类疾病领域研究的热点之一。本文研究了超声参数（超声声强和作用时间）对血小板生物活性的影响，探究了超声能量对血小板的形貌、聚集能力、微粒释放［P 选择素（CD62P）的表达量和微粒个数］等方面的作用。结果表明，在超声频率为 1 MHz、作用 60 s 时间条件下，当声强为 0.25 W/cm 2时，血小板的形貌、聚集能力以及微粒释放均未被影响；当超声声强大于 0.25 W/cm 2时，除血小板的聚集能力被影响外，血小板伪足的产生、形态的改变以及微粒释放的增加等效应亦被发现，且这些效应随着超声声强的进一步增加而加剧。在超声频率为 1 MHz、声强为 0.25 W/cm 2条件下，60 s 的超声时间对血小板的生物活性不会产生影响；但当超声时间大于 60 s 时，血小板的形貌、聚集能力及微粒的释放会被影响，血小板的 α 颗粒分泌 CD62P 和总蛋白成分不会被影响。因此，超声参数为 1 MHz、0.25 W/cm 2、60 s 时，超声能量对血小板的生物活性没有影响。该研究结果对超声能量参与介导血小板相关疾病的治疗具有重要的意义。.
Abstract Background: In line with aging populations and increased application of anesthesia and surgery, perioperative neurocognitive disorder (PND) has received growing attention worldwide. Considerable research into PND is being conducted; however, the quantity and quality of such research have not been reported. Through a retrospective bibliometric analysis, this study aimed to identify and characterize the top 100 cited publications on PND. Methods: We searched the Web of Science database to find the top 100 cited articles focusing on PND. We collected bibliographic information, including year of publication, country of origin, article type, published journal, citation count, and authorship. To determine changes with time, we compared older and newer articles. Results: The top 100 cited articles were published between 1955 and 2016; the number of citations ranged from 111 to 1248. The United States had the most published papers; clinical trials were the most common article type. The specialty journals of Anesthesiology and Anesthesia & Analgesia were the two most cited journals. Newer papers had a comparable number of citations to older articles, but the former had higher citation rates, greater funding disclosures, more focus on basic research, and more open access publications. Conclusions: This study provides a comprehensive overview of the most cited articles and highlights the increasing attention on PND. High-quality clinical trials with a greater journal impact factor received more citations. However, there has been growth in the number of basic science studies as an area of research with respect to the pathogenesis of PND.
Abstract Objective Tacrolimus (TAC), a narrow therapeutic window drug, several population pharmacokinetic (PopPK) models of TAC have been established to explore its optimized treatment regimen after hematopoietic stem cell transplantation (HSCT). However, there is no evidence of the predictive performance of these models when extrapolated to different clinical centers. We aimed to perform a systematic external evaluation of the published TAC PopPK models and to identify underlying influence elements. Methods Published population pharmacokinetic models of oral TAC after HSCT were searched for external assessment using TAC blood trough concentrations of pediatrics with β-thalassemia major (β-TM) after HSCT at the First Affiliated Hospital of Guangxi Medical University. The effect of prior information on model predictability was determined by Prediction error (PE%)、Visual predictive check (VPC)、Normalized prediction distribution error (NPDE) test and Bayesian prediction. Results Two published population pharmacokinetic models were evaluated by including 296 oral TAC blood concentrations from 46 children. Evaluation results on the basis of prediction errors, simulations, and Bayesian founded that population of published model may affect the transferability of the model. TAC bioassay methods in different centers may also result in an undesirable predictive performance of model extrapolation. Conclusion Individualized dosing with frequent therapeutic drug monitoring during the use of TAC was confirmed to be of clinical value. The two published models of oral TAC after HSCT have performed unsatisfactorily in all aspects of predictive diagnostics and are therefore not suitable for direct extrapolation to use in children with β-TM in our center.
Alcohol addiction is regarded as a series of dynamic changes to neural circuitries. A comparison of the global network during different stages of alcohol addiction could provide an efficient way to understand the neurobiological basis of addiction. Two animal models (P-rats screened from an alcohol preference family, and NP-rats screened from an alcohol non-preference family) were trained for alcohol preference with a two-bottle free choice method for 4 weeks. To examine the changes in the neural response to alcohol during the development of alcohol preference and acute stimulation, different trials were studied with resting-state fMRI methods during different periods of alcohol preference. The correlation coefficients of 28 regions in the whole brain were calculated, and the results were compared for alcohol preference related to the genetic background/training association. The variety of coherence patterns was highly related to the state and development of alcohol preference. We observed significant special brain connectivity changes during alcohol preference in P-rats. The comparison between the P- and NP-rats highlighted the role of genetic background in alcohol preference. The results of this study support the alterations of the neural network connection during the formation of alcohol preference and confirm that alcohol preference is highly related to the genetic background. This study could provide an effective approach for understanding the neurobiological basis of alcohol addiction.
Background: The selection of the maintenance of general anesthesia may affect the development of postoperative delirium (POD), notably for Parkinson’s disease (PD) patients, due to their lower cognitive reserve. The present study was designed to compare the potential impact of propofol vs. sevoflurane based general anesthesia maintenance methods on the development of POD in PD patients following deep brain stimulation (DBS) surgery. Methods: A total of 125 PD patients who were scheduled to undergo DBS surgery were randomly divided into the propofol (n = 63) and the sevoflurane groups (n = 62). The patients in the two groups randomly received propofol- or sevoflurane-based general anesthesia. The Confusion Assessment Method (CAM) was employed by an investigator who was blinded to the anesthesia regimen and was administered twice per day from postoperative day 1 until discharge. Results: The incidence of POD was 22.22% (14/63) with propofol anesthesia and 20.97% (13/62) with sevoflurane anesthesia (p = 0.865). In addition, no difference was noted in the duration and severity of delirium between the propofol and sevoflurane groups. Conclusions: In the present study, propofol- and sevoflurane-based general anesthesia exhibited comparable results with regard to the POD incidence in PD patients undergoing deep brain stimulation surgery.
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