Development and verification of a nomogram for predicting short-term mortality in elderly ischemic stroke populations.

Stroke is a major healthcare problem worldwide, particularly in the elderly population. Despite limited research on the development of prediction models for mortality in elderly individuals with ischemic stroke, our study aimed to address this knowledge gap. By leveraging data from the Medical Information Mart for Intensive Care IV database, we collected comprehensive raw data pertaining to elderly patients diagnosed with ischemic stroke. Through meticulous screening of clinical variables associated with 28-day mortality, we successfully established a robust nomogram. To assess the performance and clinical utility of our nomogram, various statistical analyses were conducted, including the concordance index, integrated discrimination improvement (IDI), net reclassification index (NRI), calibration curves and decision curve analysis (DCA). Our study comprised a total of 1259 individuals, who were further divided into training (n = 894) and validation (n = 365) cohorts. By identifying several common clinical features, we developed a nomogram that exhibited a concordance index of 0.809 in the training dataset. Notably, our findings demonstrated positive improvements in predictive performance through the IDI and NRI analyses in both cohorts. Furthermore, calibration curves indicated favorable agreement between the predicted and actual incidence of mortality (P > 0.05). DCA curves highlighted the substantial net clinical benefit of our nomogram compared to existing scoring systems used in routine clinical practice. In conclusion, our study successfully constructed and validated a prognostic nomogram, which enables accurate short-term mortality prediction in elderly individuals with ischemic stroke.

IRX1 hypermethylation promotes heart failure by inhibiting CXCL14 expression.

To identify the mechanism and functions of IRX1 in heart failure (HF) and provide evidence for new therapies. Bioinformatic analysis was performed to select target genes in HF cells compared to normal groups. Experimental rats were treated in a controllable manner to explore how IRX1 methylation accounted for this disease in vivo. Cardiac ultrasonic and morphologic examinations were conducted to test the mouse heart and evaluate the degree of cardiac impairment at in the level of organization. GSEA analysis revealed the relative enrichment of functions. Immunofluorescent assays, western blotting and qRT-PCR were used to determine the DNA methylation and expression levels. IRX1 was hypermethylated in heart failure and identified as a target gene by bioinformatic analysis. Transverse aortic constriction (TAC) induced heart failure in rats, while 5-aza-2'-deoxycytidine (5-Aza) alleviated heart failure in rats according to medical cardiac indexes. Western blotting and qRT-PCR revealed that a conspicuous difference in the expression of IRX1 and CXCL14 between HF and normal cardiac cells. As a result of gene methylation, left ventricular hypertrophy and cardiac fibrosis is usually accompanied by heart failure. Moreover, is the results implied that the demethylation of IRX1 improves heart failure in vivo and in vitro. IRX1 methylation induced damaged cardiac function and even heart failure, which has important implications for HF treatment and diagnosis.

[Observation on the application of ventilator internal circuit disinfection in mechanically ventilated patients].

OBJECTIVE: To understand the internal circuit contamination of ventilator in mechanical ventilation patients, to evaluate the effect of ventilator internal circuit disinfection and the impact on the incidence of ventilator-associated pneumonia (VAP). METHODS: A total of 39 patients with mechanical ventilation admitted to intensive care unit (ICU) of Hangzhou Geriatric Hospital from January 2017 to June 2018 were enrolled. Routine mechanical ventilation treatments for patients included pipeline replacement, aseptic operation, prevention of infection, etc. After 2 weeks of mechanical ventilation, the internal circuit of the ventilator was disinfected using the internal circuit sterilizer of the ventilator. Microorganism sampling and detection at 3 cm to the exhalation port of the internal circuit of the ventilator was performed before and after disinfection. The number of colonies was < 5 cfu/cm2 and no pathogenic bacteria could be detected. During the observation period, if the patient was complicated by VAP for anti-infective treatment, the ventilator with internal loop disinfection was replaced after infection control, and was incorporated again into the group for observation. The number of microbial colonies in the internal circuit of the ventilator before and after disinfection, the microbiological test pass rate and the incidences of VAP during the 2 weeks were observed. RESULTS: All 39 patients were included in the analysis, with 23 male and 16 female; with age of 65-97 years old, average (78.7±7.6) years old. Before the disinfection, 9 604 strains were detected in the internal circuit of the ventilator, including 8 687 strains of Gram-negative bacilli (90.4%), 902 strains of Gram-positive cocci (9.4%), and 15 strains of fungi (0.2%), which were detected in the lower respiratory tract of the patients. The strain concordance rate was 41%. The qualified rate of microbial detection in the internal circuit of the ventilator was 5.1%; 13 cases (33.3%) of VAP occurred during 2 weeks of mechanical ventilation. After disinfection, 785 strains of pathogens were detected in the internal circuit of the ventilator, and the number of colonies was significantly reduced compared with that before disinfection [cfu/cm2: 0 (0, 20) vs. 150 (15, 500), P < 0.01], of which 688 strains of Gram-negative bacilli (87.7%), 92 strains of Gram-positive cocci (11.7%) and 5 strains of fungi (0.6%) were found; the qualified rate of microbial detection in the internal circuit of ventilator reached 71.8%, which was significantly higher than that before disinfection (P < 0.01); 2 weeks after mechanical ventilation the incidence of VAP decreased slightly during the period [20.5% (8/39) vs. 33.3% (13/39)], but there was no significant difference (P > 0.05). CONCLUSIONS: The internal circuit of the ventilator can be used to detect the pathogen and the sputum culture of the patients on mechanical ventilation with a high consistency. The disinfection of the pathogen could significantly reduce the air pollution of the ventilator and reduce the occurrence of VAP in the patients.