Deep learning prediction of survival in patients with heart failure using chest radiographs.

Heart failure (HF) is associated with high rates of morbidity and mortality. The value of deep learning survival prediction models using chest radiographs in patients with heart failure is currently unclear. The aim of our study is to develop and validate a deep learning survival prediction model using chest X-ray (DLSPCXR) in patients with HF. The study retrospectively enrolled a cohort of 353 patients with HF who underwent chest X-ray (CXR) at our institution between March 2012 and March 2017. The dataset was randomly divided into training (n = 247) and validation (n = 106) datasets. Univariate and multivariate Cox analysis were conducted on the training dataset to develop clinical and imaging survival prediction models. The DLSPCXR was trained and the selected clinical parameters were incorporated into DLSPCXR to establish a new model called DLSPinteg. Discrimination performance was evaluated using the time-dependent area under the receiver operating characteristic curves (TD AUC) at 1, 3, and 5-years survival. Delong's test was employed for the comparison of differences between two AUCs of different models. The risk-discrimination capability of the optimal model was evaluated by the Kaplan-Meier curve. In multivariable Cox analysis, older age, higher N-terminal pro-B-type natriuretic peptide (NT-ProBNP), systolic pulmonary artery pressure (sPAP) > 50 mmHg, New York Heart Association (NYHA) functional class III-IV and cardiothoracic ratio (CTR) ≥ 0.62 in CXR were independent predictors of poor prognosis in patients with HF. Based on the receiver operating characteristic (ROC) curve analysis, DLSPCXR had better performance at predicting 5-year survival than the imaging Cox model in the validation cohort (AUC: 0.757 vs. 0.561, P = 0.01). DLSPinteg as the optimal model outperforms the clinical Cox model (AUC: 0.826 vs. 0.633, P = 0.03), imaging Cox model (AUC: 0.826 vs. 0.555, P < 0.001), and DLSPCXR (AUC: 0.826 vs. 0.767, P = 0.06). Deep learning models using chest radiographs can predict survival in patients with heart failure with acceptable accuracy.

Strong, bacteriostatic and transparent polylactic acid-based composites by incorporating quaternary ammonium cellulose nanocrystals.

Renewable natural fibers (e.g., cellulose nanocrystals (CNCs)) are being applied for reinforcing bio-based polylactic acid (PLA). For improvement in the interfacial compatibility between CNCs and PLA and the dispersibility of CNCs, a quaternary ammonium salt-coated CNCs (Q-CNCs) hybrid was prepared in this study based on an esterification self-polymerization method, and such hybrid was further utilized as a new strengthening/toughening nanofiller for producing the Q-CNCs-reinforced PLA composite. The results confirmed that quaternary ammonium salt coatings could efficiently enhance CNCs/PLA interfacial compatibility via mechanical interlocking and semi-interpenetrating networks. Attributing to the synergistic effect of quaternary ammonium salts and CNCs, a considerable enhancement in processing, mechanical, and thermal properties was gained in the obtained Q-CNCs-reinforced PLA composite. With the addition of 0.5 wt% Q-CNCs, the tensile strength, Young's modulus, and elongation at break of the Q-CNCs-reinforced PLA composite was raised by approximately 23 %, 37 % and 18 %, respectively; compared with pure PLA, the obtained composite had excellent bacteriostatic properties and good transparency. This work discusses the development of high-performance, low-cost and sustainable PLA-based composites on a potential application in packaging materials.

Assessing Surgical Benefits and Creating a Prognostic Model for Breast Cancer with Lung-only Metastasis: An Analysis of the National Cancer Database.

AIM: The decision to perform surgery on breast cancer patients with lung-only metastasis is a subject of ongoing debate. Our investigation seeks to assess the survival rates following surgical intervention among individuals diagnosed with breast cancer experiencing isolated metastasis to the lungs. Additionally, we endeavor to devise a predictive nomogram aimed at forecasting the long-term survival. METHODS: We analyzed patients diagnosed with primary lung metastases from breast cancer between 2010 and 2015, utilizing datasets obtained from the National Cancer Database (NCDB). We employed the Cox proportional hazards regression model and the Kaplan-Meier method to analyze survival data. Additionally, we constructed nomograms to forecast survival outcomes. RESULTS: The study comprised 2403 patients, with 1058 (44.0%) undergoing breast-specific surgery and 1345 (56.0%) not receiving surgical treatment. The group that underwent surgical procedures exhibited a significantly enhanced overall survival (OS) compared to the non-surgery group (multivariate analysis: hazard ratio [HR] = 0.64; 95% confidence interval [CI], 0.54-0.75; p < 0.001). Surgical intervention consistently improved survival across nearly all patient subgroups. The research successfully established a predictive nomogram designed to calculate the likelihood of long-term survival, attaining a concordance index (C-index) of approximately 0.7 in both validation and training cohorts. By integrating multiple clinicopathological variables, the nomogram efficiently classified patients into categories reflecting different survival forecasts. CONCLUSIONS: The findings of this investigation support the notion that surgical treatment can enhance the overall survival of patients with initial lung-only metastasis from breast cancer. The investigation further introduces a nomogram demonstrating reasonable accuracy in forecasting long-term survival of patients in this cohort.

Architecting O3/P2 layered oxides by gradient Mn doping for sodium-ion batteries.

O3 phase layered oxides are highly attractive cathode materials for sodium-ion batteries because of their high capacity and decent initial Coulombic efficiency. However, their rate capability and long cycling life are unsatisfactory due to the narrow Na+ transfer channel and irreversible phase transitions of O3 phase during sodiation/desodiation process. Constructing O3/P2 multiphase structures has been proven to be an effective strategy to overcome these challenges. In this study, we synthesized bi-phasic structured O3/P2 Na(Ni2/9Fe1/3Cu1/9Mn1/3)1-xMnxO2 (x = 0.01, 0.02, 0.03, 0.04, 0.05) materials through Mn doping during sodiation process. Benefiting from surface P2 phase layer with the enhanced Na+ transfer dynamics and high structural stability, the Na(Ni2/9Fe1/3Cu1/9Mn1/3)0.98Mn0.02O2 (NFCM-M2) cathode delivers a reversible capacity of 139.1 mA h g-1 at 0.1 C, and retains 71.4 % of its original capacity after 300 cycles at 1 C. Our work provides useful guidance for designing multiphase cathodes and offers new insights into the structure-performance correlation for sodium-ion cathode materials.

Association of hepatic steatosis and liver fibrosis with chronic obstructive pulmonary disease among adults.

With high prevalence and substantial mortality, metabolic dysfunction-associated steatotic liver disease and chronic obstructive pulmonary disease (COPD) are significant public health concerns. Utilizing a large, population-based dataset from the National Health and Nutrition Examination Survey, our study probes the relationship between COPD prevalence and hepatic steatosis and fibrosis, as measured by Vibration-Controlled Transient Elastography. We analyzed data from 693 individuals with COPD and 7229 without. Through weighted multivariate logistic regression analysis, a restricted cubic spline curve, and threshold effect analysis, we investigated the correlation between the severity of hepatic steatosis and fibrosis and the presence of COPD. Our findings revealed a positive correlation between the controlled attenuation parameter (CAP) and COPD prevalence [OR = 1.03 (95% CI 1.01, 1.05)], even after multivariate adjustment. Furthermore, we observed a U-shaped association between CAP and COPD, where the inflection point, CAP value of 264.85 dB/m, corresponded to the lowest COPD prevalence. Our study emphasizes a substantial and complex link between hepatic steatosis and COPD. These findings urge healthcare professionals to factor liver health into COPD management and prompt further exploration into the underlying mechanisms. This could pave the way for the development of improved prevention and treatment strategies.

Epidemiological investigation and diagnostic analysis of osteonecrosis of the femoral head in three northeastern provinces of China.

BACKGROUND: In this retrospective case investigation, we analysed the data of patients with osteonecrosis of the femoral head (ONFH) to reveal demographic and clinical diagnostic features of ONFH in three northeastern provinces of China and provide a reference for its prevention, diagnosis, and treatment. METHODS: We collected data from patients in Beijing Orthopaedic Hospital of Liaoning, focusing on the aetiology and diagnosis of ONFH. Medical records and self-designed questionnaires were used to collect information for statistical analysis, including age, aetiology, reason for glucocorticoid use, hospital level at first visit, and diagnosis. RESULTS: In total, 906 patients with complete medical records were included in the analysis. The mean patient age was 47.65 ± 12.12 years. The peak age distribution was in the 40s for men and the 50s for women. Among the total cohort, 72 patients (7.95%; 40 men and 32 women) had traumatic ONFH, 198 (21.85%; 131 men and 67 women) had steroid-induced ONFH, 230 (25.39%; 121 men and 109 women) had idiopathic ONFH, and 406 (44.81%; 397 men and 9 women) had alcohol-induced ONFH. Six hundred and twenty patients were diagnosed with ONFH at the first visit, while 286 patients were misdiagnosed, with a diagnosis rate of 68.43%. The diagnosis rate at the first visit in tertiary hospitals was 76.14%. The diagnosis rate at the first visit in second-class hospitals was 52.07%.ONFH was most likely to be misdiagnosed as lumbar disc herniation. CONCLUSIONS: Most patients with ONFH in three northeastern provinces of China were middle-aged, male, and had alcohol-induced ONFH. The misdiagnosis rate of ONFH at the first visit was very high, especially for misdiagnosis of lumbar disc herniation, indicating that the diagnosis of ONFH requires further improvement.

Radiomics Analysis of Pericoronary Adipose Tissue From Baseline Coronary Computed Tomography Angiography Enables Prediction of Coronary Plaque Progression.

PURPOSE: The relationship between plaque progression and pericoronary adipose tissue (PCAT) radiomics has not been comprehensively evaluated. We aim to predict plaque progression with PCAT radiomics features and evaluate their incremental value over quantitative plaque characteristics. PATIENTS AND METHODS: Between January 2009 and December 2020, 500 patients with suspected or known coronary artery disease who underwent serial coronary computed tomography angiography (CCTA) ≥2 years apart were retrospectively analyzed and randomly stratified into a training and testing data set with a ratio of 7:3. Plaque progression was defined with annual change in plaque burden exceeding the median value in the entire cohort. Quantitative plaque characteristics and PCAT radiomics features were extracted from baseline CCTA. Then we built 3 models including quantitative plaque characteristics (model 1), PCAT radiomics features (model 2), and the combined model (model 3) to compare the prediction performance evaluated by area under the curve. RESULTS: The quantitative plaque characteristics of the training set showed the values of noncalcified plaque volume (NCPV), fibrous plaque volume, lesion length, and PCAT attenuation were larger in the plaque progression group than in the nonprogression group ( P < 0.05 for all). In multivariable logistic analysis, NCPV and PCAT attenuation were independent predictors of coronary plaque progression. PCAT radiomics exhibited significantly superior prediction over quantitative plaque characteristics both in the training (area under the curve: 0.814 vs 0.615, P < 0.001) and testing (0.736 vs 0.594, P = 0.007) data sets. CONCLUSIONS: NCPV and PCAT attenuation were independent predictors of coronary plaque progression. PCAT radiomics derived from baseline CCTA achieved significantly better prediction than quantitative plaque characteristics.

TFAP2A Upregulates SKA3 to Promote Glycolysis and Reduce the Sensitivity of Lung Adenocarcinoma Cells to Cisplatin.

INTRODUCTION: Studies have shown that glycolysis metabolism affects the resistance or sensitivity of tumors to chemotherapy drugs. Emerging from recent research, a paradigm-shifting revelation has unfolded, elucidating the oncogenic nature of SKA3 within the context of lung adenocarcinoma (LUAD). Consequently, this work was designed to delve into the effects of SKA3 on glycolysis and cisplatin (CDDP) resistance in LUAD cells and to find new possibilities for individualized treatment of LUAD. METHODS: LUAD mRNA expression data from the TCGA database were procured to scrutinize the differential expression patterns of SKA3 in both tumor and normal tissues. GSEA and Pearson correlation analyses were employed to elucidate the impact of SKA3 on signaling pathways within the context of LUAD. In order to discern the upstream regulatory mechanisms, the ChEA and JASPAR databases were utilized to predict the transcription factors and binding sites associated with SKA3. qRT-PCR and Western blot were implemented to assay the mRNA and protein expression levels of SKA3 and TFAP2A. Chromatin immunoprecipitation and dual-luciferase assays were performed to solidify the binding relationship between the two. Extracellular acidification rate, glucose consumption, lactate production, and glycolysis-related proteins (HK2, GLUT1, and LDHA) were used to evaluate the level of glycolysis. Cell viability under CDDP treatment was determined utilizing the CCK-8, allowing for the calculation of IC50. The expression levels of SKA3 and TFAP2A proteins were detected by immunohistochemistry (IHC). RESULTS: SKA3 exhibited upregulation in LUAD tissues and cell lines, establishing a direct linkage with glycolysis pathway. Overexpression of SKA3 fostered glycolysis in LUAD, resulting in reduced sensitivity toward CDDP treatment. The upstream transcription factor of SKA3, TFAP2A, was also upregulated in LUAD and could promote SKA3 transcription. Overexpression of TFAP2A also fostered the glycolysis of LUAD. Rescue assays showed that TFAP2A promoted glycolysis in LUAD cells by activating SKA3, reducing the sensitivity of LUAD cells to CDDP. The IHC analysis revealed a positive correlation between high expression of SKA3 and TFAP2A and CDDP resistance. CONCLUSION: In summary, TFAP2A can transcriptionally activate SKA3, promote glycolysis in LUAD, and protect LUAD cells from CDDP treatment, indicating that targeting the TFAP2A/SKA3 axis may become a plausible and pragmatic therapeutic strategy for the clinical governance of LUAD.

Prediction by a multiparametric magnetic resonance imaging-based radiomics signature model of disease-free survival in patients with rectal cancer treated by surgery.

Objective: The aim of this study was to assess the ability of a multiparametric magnetic resonance imaging (MRI)-based radiomics signature model to predict disease-free survival (DFS) in patients with rectal cancer treated by surgery. Materials and methods: We evaluated data of 194 patients with rectal cancer who had undergone radical surgery between April 2016 and September 2021. The mean age of all patients was 62.6 ± 9.7 years (range: 37-86 years). The study endpoint was DFS and 1132 radiomic features were extracted from preoperative MRIs, including contrast-enhanced T1- and T2-weighted imaging and apparent diffusion coefficient values. The study patients were randomly allocated to training (n=97) and validation cohorts (n=97) in a ratio of 5:5. A multivariable Cox regression model was used to generate a radiomics signature (rad score). The associations of rad score with DFS were evaluated using Kaplan-Meier analysis. Three models, namely a radiomics nomogram, radiomics signature, and clinical model, were compared using the Akaike information criterion. Result: The rad score, which was composed of four MRI features, stratified rectal cancer patients into low- and high-risk groups and was associated with DFS in both the training (p = 0.0026) and validation sets (p = 0.036). Moreover, a radiomics nomogram model that combined rad score and independent clinical risk factors performed better (Harrell concordance index [C-index] =0.77) than a purely radiomics signature (C-index=0.73) or clinical model (C-index=0.70). Conclusion: An MRI radiomics model that incorporates a radiomics signature and clinicopathological factors more accurately predicts DFS than does a clinical model in patients with rectal cancer.

Quaternary ammonium salts for water treatment with balanced rate of sterilization and degradation.

The growing number of infections caused by drug-resistant bacteria which arise from the overuse of antibiotics has severely affected the normal operation of human society. The high antibacterial activity of QAS makes it promising as an alternative to antibiotics, but it suffers from secondary pollution due to its non-degradation. Here we have synthesized a class of gemini quaternary ammonium salts (GQAS) with different carbon chain lengths containing ester groups by using facile methylation reaction. Quaternary ammonium groups contribute to insert negatively charged bacterial membranes, resulting in membrane damage and bacteria death. Compared with conventional single-chain QAS, except for the more efficient antibacterial efficiency attribute to the presence of the second carbon chain, GQAS with alterable antibacterial properties can minimize the possibility of bacterial resistance and reduce the accumulation of GQAS in the environment through the introduction of degradable ester groups. GQAS is completely superior to the commercial bactericide benzalkonium chloride (BAC) in both antibacterial activity and degrade performance, which can be used as a more environmentally friendly bactericide.

Water solubility differentiates the impact of tea polyphenols and rutin on the postprandial glycemic response to cooked maize starch.

Postprandial hyperglycemia is an independent risk factor for cardiovascular diseases, and the impact of tea polyphenols (TP) and rutin, representative phenolic compounds with different water solubilities, on the postprandial glycemic response to cooked normal corn starch (CCS) was investigated. Comparatively, TP (DPPH50 = 0.12 mmol L-1) are more potent than rutin (DPPH50 = 0.50 mmol L-1) in scavenging the free radicals of DPPH, but both TP and rutin inhibited the activity of porcine pancreatic α-amylase (PPA), the major enzyme in starch digestion, with an IC50 of 4.09 mmol L-1 and 2.71 mmol L-1, respectively. However, an in vivo study showed that a significant reduction in postprandial blood glucose was only observed in the presence of rutin, and TP had no effect on the glycemic response to CCS. To find out the underlying mechanism, fluorescence spectroscopy and molecular docking were carried out and they showed that, compared to TP, rutin bound to the active site of PPA with higher affinity and a lower free energy (ΔG) driven by hydrogen bonds and π-stacking, and rutin also greatly increased the viscosity of starch. Collectively, water-soluble TP have a higher antioxidant property and a lower potency to inhibit PPA compared to water-insoluble rutin, and the weaker interaction between TP and PPA, and starch as well might synergistically contribute to TP's ineffectiveness in lowering the postprandial glycemic response, and water solubility linking the molecular structures and functions of phenolic compounds might be the fundamental basis for the observed difference in their biological functions, and water solubility can also be used to enrich specific phenolic compounds for desired functions.

Referral to hepatologists or a second-line examination requirement is common in patients with type 2 diabetes mellitus.

BACKGROUND AND AIMS: To estimate the number of patients who required a referral to hepatologists following the 2016 EASL-EASD-EASO guideline and a second-line vibration controlled transient elastography (VCTE) examination following the 2021 EASL guideline according to obesity, glycated hemoglobin (HbA1c), blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) control status in patients with type 2 diabetes mellitus (T2DM). METHODS AND RESULTS: A total of 2515 T2DM patients who were hospitalized were cross-sectionally assessed. When we applied the 2016 EASL-EASD-EASO guideline, 26.8 %-46.4 % (depending on the scores used for diagnosing fibrosis) of T2DM patients needed a referral to hepatologists. When we applied the 2021 EASL guideline, a VCTE examination was required in 10.9 %-35 % (depending on the scores used for diagnosing fibrosis) of T2DM patients. The referral rates and the VCTE requirement were even higher in patients who were obese and/or had poor HbA1c, BP, and/or LDL-C control. CONCLUSIONS: Application of the screening guidelines would lead to a referral to hepatologists or a second-line VCTE examination requirement for a substantial number of T2DM patients, regardless of obesity and metabolic goal attainment status.

A comparative study of synthetic and venous hematocrit for calculating cardiovascular magnetic resonance-derived extracellular volume.

The extracellular volume (ECV) fraction derived from cardiac magnetic resonance (CMR) can reflect various pathologies. The application of ECVs was limited by the strict requirement that hematocrit (Hct0) should be obtained within 24 hours of CMR scan. The aim of this study was to obtain accurate and convenient ECV calculated from the venous Hct and synthetic Hct in CMR. A total of 839 subjects were retrospectively enrolled. The subjects were divided into derivation cohort for local sex-specific models and validation cohort for assessing the accuracy of different ECVs. In the validation cohort, venous Hcts from 7 days before the scan (Hct1 - 7), outside 7 days (Hct> 7), the closest day (Hctclosest), and Hctsyn were compared with Hct0. The agreement and correlation of the conventional ECV (ECV0) with the corresponding ECVs were analyzed. The factors affecting the accuracy of ECVsyn were assessed. ECV1-7 and ECVclosest had the best correlation and smallest bias with ECV0 (R = 0.959 and 0.951, bias = 0.02% and - 0.03%). When using an absolute 2% error as the standard, the performance of ECV1-7 was the best, with an accuracy of 81.0%, followed by ECVclosest (78.8%), ECV> 7 (77.2%) and ECVsyn (70.7%). Abnormally low and high Hcts and decreased left ventricular ejection fractions were associated with miscalculation of ECVsyn, especially patients with dilated cardiomyopathy. We recommend extending the time interval between a Hct and a CMR scan to 7 days for ECV calculation. The synthetic ECV should be used cautiously, especially for patients with extremely low or high Hcts, decreased cardiac function, and dilated cardiomyopathy.

Construction of brain metastasis prediction model in limited stage small cell lung cancer patients without prophylactic cranial irradiation.

INTRODUCTION: Small cell lung cancer (SCLC) is a highly aggressive lung cancer variant known for its elevated risk of brain metastases (BM). While earlier meta-analyses supported the use of prophylactic cranial irradiation (PCI) to reduce BM incidence and enhance overall survival, modern MRI capabilities raise questions about PCI's universal benefit for limited-stage SCLC (LS-SCLC) patients. As a response, we have created a predictive model for BM, aiming to identify low-risk individuals who may not require PCI. METHODS: A total of 194 LS-SCLC patients without PCI treated between 2009 and 2021 were included. We conducted both univariate and multivariate analyses to pinpoint the factors associated with the development of BM. A nomogram for predicting the 2- and 3-year probabilities of BM was then constructed. RESULTS: Univariate and multivariate analyses revealed several significant independent risk factors for the development of BM. These factors include TNM stage, the number of chemotherapy (ChT) cycles, Ki-67 expression level, pretreatment serum lactate dehydrogenase (LDH) levels, and haemoglobin (HGB) levels. These findings underscore their respective roles as independent predictors of BM. Based on the results of the final multivariable analysis, a nomogram model was created. In the training cohort, the nomogram yielded an area under the receiver operating characteristic curve (AUC) of 0.870 at 2 years and 0.828 at 3 years. In the validation cohort, the AUC values were 0.897 at 2 years and 0.789 at 3 years. The calibration curve demonstrated good agreement between the predicted and observed probabilities of BM. CONCLUSIONS: A novel nomogram has been developed to forecast the likelihood of BM in patients diagnosed with LS-SCLC. This tool holds the potential to assist healthcare professionals in formulating more informed and tailored treatment plans.

Feasibility of using chest computed tomography (CT) imaging at the first lumbar vertebra (L1) level to assess skeletal muscle mass: a retrospective study.

Background: Skeletal muscle mass is an essential parameter for diagnosing sarcopenia. The gold standard for assessing skeletal muscle mass is using computed tomography (CT) to measure skeletal muscle area at the third lumbar vertebra (L3) level. This study aims to investigate whether skeletal muscle mass could be evaluated at the first lumbar vertebra (L1) level using images obtained from routine chest CT scans. Methods: Skeletal muscle index (SMI, cm2/m2) and skeletal muscle density (SMD, HU) are commonly used to measure relative muscle mass and the degree of fat infiltration. This study used CT images at the L1 level to measure the skeletal muscle area (SMA, cm2) in 815 subjects from the health examination center. Linear regression analysis was used to explore the association between L1 and L3 measurements. The receiver operating characteristic (ROC) analysis was used to assess the predictive performance of L1 SMI for sarcopenia. The sex-specific cut-off values for low skeletal muscle mass in patients under the age of 60 were determined using the following formula: "mean - 1.28 × standard deviation." A multivariate linear regression model was established. Results: A significantly higher SMI at the L1 level was found in males than in females (43.88 ± 6.33 cm2/m2 vs 33.68 ± 5.03 cm2/m2; P < 0.001). There were strong correlations between measures at the L1 and L3 levels in both the total subject and sex-specific analyses. A negative association was found between age and L3 SMI in males (r = -0.231, P = 0.038). Both body mass index (BMI) and body surface area (BSA) were positively associated with L1 SMI in both males and females. A multivariate analysis was used to establish a prediction rule to predict SMI at the L3 level. The assessment of consistency and interchangeability between predicted and actual SMI at the L3 level yielded moderately good results. Considering the significant differences observed between male and female participants, the sex-specific cut-off values of the L1 SMI for defining low skeletal muscle mass were 36.52 cm2/m2 in males and 27.29 cm2/m2 in females. Conclusions: Based on a population from central China, the correlated indicators obtained at the L1 level from routine chest CT scans may serve as effective surrogate markers for those at the L3 level in assessing overall skeletal muscle mass.

Associations of advanced liver fibrosis with heart failure with preserved ejection fraction in type 2 diabetic patients according to obesity and metabolic goal achievement status.

Background: Heart failure with preserved ejection fraction (HFpEF), a major cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM), is frequently coexisted with obesity, poor glycemic, blood pressure (BP), and/or lipid control. We aimed to investigate the associations of nonalcoholic fatty liver disease (NAFLD) and its advanced fibrosis with HFpEF according to obesity, glycated hemoglobin A1c (HbA1c), BP, and low-density lipoprotein cholesterol (LDL-C) goal achievement status in T2DM patients. Methods: A total of 2,418 T2DM patients who were hospitalized were cross-sectionally assessed. Liver fibrosis was evaluated by non-invasive biomarkers. Logistic regression analysis was used to evaluate the independent and combined associations of fibrosis status and diabetic care goal attainments with HFpEF risk. Results: Simple steatosis was not associated with HFpEF risk compared with patients without steatosis, while advanced liver fibrosis was found to have significantly higher odds for HFpEF risk (odds ratio,1.59; 95% confidence interval, 1.22-2.08). Advanced fibrosis in NAFLD was significantly associated with an increased risk of HFpEF, regardless of obesity status, HbA1c, BP, and LDL-C goal achievement status. P values for the interactions between fibrosis status and HbA1c control status, fibrosis status and BP control status, fibrosis status and LDL-C control status, and fibrosis status and body mass index (BMI) status on HFpEF risk were 0.021, 0.13, 0.001, and 0.23, respectively. Conclusion: In patients with T2DM, advanced hepatic fibrosis was significantly associated with HFpEF risk, irrespective of obesity status, HbA1c, BP, and LDL-C goal attainment status. Further, HbA1c and LDL-C goal attainment status modified this association.

Bioinspired porous three-coordinated single-atom Fe nanozyme with oxidase-like activity for tumor visual identification via glutathione.

Inspired by structures of natural metalloenzymes, a biomimetic synthetic strategy is developed for scalable synthesis of porous Fe-N3 single atom nanozymes (pFeSAN) using hemoglobin as Fe-source and template. pFeSAN delivers 3.3- and 8791-fold higher oxidase-like activity than Fe-N4 and Fe3O4 nanozymes. The high catalytic performance is attributed to (1) the suppressed aggregation of atomically dispersed Fe; (2) facilitated mass transfer and maximized exposure of active sites for the created mesopores by thermal removal of hemoglobin (2 ~ 3 nm); and (3) unique electronic configuration of Fe-N3 for the oxygen-to-water oxidation pathway (analogy with natural cytochrome c oxidase). The pFeSAN is successfully demonstrated for the rapid colorimetric detection of glutathione with a low limit of detection (2.4 nM) and wide range (50 nM-1 mM), and further developed as a real-time, facile, rapid (~6 min) and precise visualization analysis methodology of tumors via glutathione level, showing its potentials for diagnostic and clinic applications.

Fear of missing out and problematic smartphone use among Chinese college students: The roles of positive and negative metacognitions about smartphone use and optimism.

BACKGROUND: Problematic smartphone use (PSU) has become a common phenomenon among college students. Fear of missing out (FoMO) is an important factor affecting PSU, but how FoMO affects PSU is not clear. Therefore, the mediating effect of positive and negative metacognitions about smartphone use (PMSU and NMSU) and the moderating effect of optimism are explored. METHODS: 514 Chinese college students aged 17 to 25 from 6 Chinese universities were investigated with the Trait-State FoMO Scale, the Metacognitions about Smartphone Use Questionnaire, the Temperament Optimism Scale, and the Smartphone Addiction Scale for College Students. The data were analyzed with SPSS software. RESULTS: FoMO was positively associated with PSU, PMSU and NMSU mediated this association. Optimism moderated the relationship between FoMO and PSU, i.e., FoMO had a less prominent positive effect on PSU for college students with a high level of optimism. CONCLUSIONS: There is a positive relationship which exists between FoMO and PSU among college students. In addition, PMSU and NMSU play mediating roles in FoMO and PSU, and optimism plays an moderating role in FoMO and PSU. These findings can help not only educators understand the predictors of PSU and develop interventions to effectively prevent PSU among college students but also college students reduce the level of PSU by improving their understanding of PMSU and NMSU and optimism level.

Prediction model for cognitive impairment in maintenance hemodialysis patients.

PURPOSE: To explore the risk factors for cognitive impairment in patients undergoing maintenance hemodialysis (MHD) and construct a predictive model for cognitive impairment. METHODS: A total of 146 patients with end-stage renal disease (ESRD) undergoing MHD were recruited at our hospital between December 2021 and April 2022. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and scores of < 26 were considered indicative of cognitive impairment. Risk factors were identified using a multivariate logistic regression model, and a receiver operating characteristic curve was applied to construct the prediction model. Cognitive impairment risk was categorized using a multifactorial prediction model based on the weight of evidence. RESULTS: 46 patients with cognitive impairment were identified, with a prevalence of 31.5% in ESRD patients undergoing MHD. Multivariate logistic regression analyses indicated that the following factors were associated with an increased risk of cognitive impairment in patients undergoing MHD: aged 55.0-64.0 years (OR:6.24; 95%CI:1.81-21.48; P = 0.001), aged 65.0-74.0 years (OR:16.10; 95%CI:4.03-64.37; P < 0.001), aged ≥ 75.0 years (OR:90.22; 95%CI:16.86-482.86; P < 0.001), duration of dialysis ≥ 5 years (OR:3.99; 95%CI:1.58-10.04; P = 0.003), and current smoker (OR:4.61; 95%CI:1.46-14.57; P = 0.009). The predictive value of the constructed model based on the aforementioned factors for cognitive impairment was 84% (95%CI,77-91%). The prevalence of cognitive impairment for patients at low, moderately low, moderately high, and high risk was 0% (95%CI:0-17%), 10% (95%CI:3-22%), 32% (95%CI:16-52%), and 65% (95%CI:50-78%), respectively. CONCLUSIONS: This study constructed a multifactorial prediction model with a high predictive value for cognitive impairment in patients with ESRD undergoing MHD.

C-C Bond Cleavage Mediated Reaction for Constructing 3-Carbonyl Imidazo[1,5-a] Pyridines from 1,3-Dicarbonyl Compounds and Pyridin-2-ylmethanamines.

A [4 + 1] cyclization and C-C bond cleavage process mediated reaction for constructing 3-carbonyl imidazo[1,5-a] pyridines from 1,3-dicarbonyl compounds and pyridin-2-ylmethanamines has been developed. Various 1,3-dicarbonyl compounds are applicable, and selectivity could be achieved. Importantly, this strategy could be extended to an atom economy method by employing a cyclic 1,3-dicarbonyl compound, and it provided a new view for C-C bond cleavage reactions.