Predictive value of geriatric nutritional risk index in stroke-associated pneumonia / 中华老年心脑血管病杂志

Objective To investigate the predictive value of geriatric nutritional risk index(GNRI)for stroke-associated pneumonia in elderly patients with acute ischemic stroke(AIS).Methods A total of 1505 elderly patients with AIS admitted to Department of Neurology of the Second Affili-ated Hospital of Nanchang University from January 2017 to October 2022 were included in this retrospective study.According to GNRI nutritional assessment,they were divided into T1(high nutritional risk,GNRI＜82,n=49),T2(moderate nutritional risk,GNRI 82-91,n=305),T3(low nutritional risk,GNRI 92-98,n=555),and T4(no nutritional risk,GNRL＞98,n=596)groups.Additionally,based on the discharge diagnosis,they were further classified into pulmonary infection group(150 cases)and non-infection group(1355 cases).These subjects were also ran-domly assigned into training,validation,and testing sets in a ratio of 16∶4∶5.Multivariate logis-tic regression analysis was performed to identify the risk factors for pulmonary infection in stroke patients.Logistic regression and XGBoost algorithms were used to establish prediction models for pulmonary infection.The models were evaluated with their AUC value,accuracy,sensitivity,and specificity based on ROC curve analysis.Results Multivariate logistic regression analysis revealed that hypertension,invasive procedures,consciousness disorders,CRP,lymphocyte count,hemoglo-bin and GNRI were independent risk factors for pulmonary infection in stroke patients(P＜0.05).The AUC value of the GNRI model for predicting pulmonary infection in the testing set was 0.742(95％CI:0.651-0.833),with an accuracy of 71.8％,sensitivity of 76.7％,and specificity of 71.2％.The combined model of clinical indicators(hypertension,invasive procedures,conscious-ness disorders,CRP,lymphocyte count,hemoglobin)and GNRI achieved an AUC value of 0.776(95％CI:0.700-0.853),accuracy of 74.8％,sensitivity of 83.3％,and specificity of 73.8％in the test set.Conclusion GNRI is an independent risk factor for pulmonary infection in elderly pa-tients with AIS and has a certain value in predicting pulmonary infection after AIS.

XGboost model in predicting readmission of patients with ischemic stroke recurrence within 90 d / 中华神经医学杂志

Objective To explore the predictive efficacy of XGboost model in predicting risk of relapse and re-admission within 90 d in patients with ischemic stroke,and provide basis for early screening and prevention of high-risk population with ischemic stroke.Methods The clinical data of 6070 primary ischemic stroke patients admitted to our hospital from January 2007 to July 2017 were retrospectively collected.XGboost model and multivariate Logistic regression model were utilized to screen out the influencing factors of relapse and re-admission within 90 d in patients with ischemic stroke.A predictive model was set up.Receiver operating characteristic (ROC) curve was drawn and compared.Sensitivity,specificity and Youden index were calculated and compared to evaluate the prediction performance of XGboost model.Results During the observation period,a total of 520 patients with relapsed ischemic stroke were observed within a period of 90 d,and the incidence density was 8.57％.Multivariate Logistic regression analysis showed that length of first hospital stay,hypertension,pulmonary infection,neutrophil percentage,red blood cell distribution width (variable coefficient),and alkaline phosphatase level were independent influencing factors for re-hospitalization within 90 d of ischemic stroke,(OR=1.016,P=0.000,95％CI:1.008-1.025;OR=4.598,P=0.000,95％CI:3.717-5.687;OR=1.452,P=0.025,95％CI:1.048-2.012;OR=1.013,P=0.006,95％CI:1.004-1.022;OR=1.161,P=0.000,95％CI:1.090-1.237;OR=1.003,P=0.023,95％CI:1.000-1.005).Analysis of importance of risk factors for re-admission of ischemic stroke using XGboost model showed that the top 6 factors were hypertension,red blood cell distribution width,direct bilirubin,length of hospital stay,pulmonary infection,and alkaline phosphatase,and the corresponding importance scores were 32,20,19,18,15 and 14,respectively.ROC curve analysis results indicated that the area under the ROC for re-admission for XGboost model was 0.792 (95％CI:0.717-0.762),which was improved by 5％ as compared with that for multivariate Logistic regression model (0.739 [95％CI:0.764-0.818]).The sensitivity was 89.30％ and the Youden index was 0.444 for XGboost model,which were significantly higher than those for multivariate Logistic regression model (77.3％,0.405).Conclusions XGboost model is superior to multivariate Logistic regression model in predicting recurrence and re-admission of first ischemic stroke patients within 90 d.This model is suitable for prediction and early diagnosis of re-admission of ischemic stroke,which is of great clinical value.

The key roles of clinicians in Translational medicine development / 中华医学科研管理杂志

Clinicians,as the finders of clinical problems,the refiners of scientific questions and the cooperators of basic and clinic research,play key roles in translational medicine.Clinicians' playing an important part in the process will give the promotion of both the development of translational medicine and improvement of the health condition of the people.

The molecular mechanisms underlying the inhibiting effects of lanthanum on lipopolysaccharide induced NF-κB activation / 中华微生物学和免疫学杂志

ObjectiveTostudythemolecularmechanismoflanthanumonblocking lipopolysaccharide(LPS)-mediated activation of nuclear factor-kappaB (NF-κB)signaling in macrophages.MethodsThe RAW264.7 macrophages were cultured routinely and divided into 4 groups randomly:LaCl3 +LPS group,LPS group,LaCl3 group and control group.The nuclear translocation of p65 protein was detected by immunocytochemistry.Total,cytoplasmic and nuclear proteins were extracted respectively,and then the binding activity of p65 with the target gene was measured by ELISA.Western blot assays were also performed to detect the expression levels of the proteins,including nuclear p65,IκBα and IKK kinase,the phosphorylation status of IκBα and IKK kinase.ResultsLanthanum can block LPS-induced activation of p65 protein through various ways,such as inhibiting its nuclear translocation,reducing its expression in the nuclei and decreasing its binding activity with the target genes.Lanthanum inhibited the degradation of LPS-induced IκBα,but the phosphorylation of LPS-induced IKKβ can not be blocked by lanthanum,nor did the phosphorylation ability of p-IKKβ on IκBα.Conclusion Lanthanum inhibited the degradation of IκBα,nuclei translocation of p65 protein and its binding activity with the target genes,thereby inhibited LPS-induced NFκB activation,which might be one of the inhibition mechanisms of lanthanum on nuclear activation.