Triglyceride-glucose index predicts sepsis-associated acute kidney injury and length of stay in sepsis: A MIMIC-IV cohort study.

Background: Inflammation and stress response may be related to the occurrence of sepsis-associated acute kidney injury (SA-AKI) in patients with sepsis.Insulin resistance (IR) is closely related to the stress response, inflammatory response, immune response and severity of critical diseases. We assume that the triglyceride-glucose (TyG) index, an alternative indicator for IR, is associated with the occurrence of SA-AKI in patients with sepsis. Methods: Data were obtained from The Medical Information Mart for Intensive Care-IV(MIMIC-IV) database in this retrospective cohort study. Univariate and multivariate logistic regression analysis and multivariate restricted cubic spline(RCS) regression were conducted to evaluate the association between TyG index and SA-AKI, length of stay (LOS). Subgroup and sensitivity analyses were performed to verify the robustness of the results. Results: The study ultimately included data from 1426 patients with sepsis, predominantly of white ethnicity (59.2%) and male sex (56.4%), with an SA-AKI incidence rate of 78.5%. A significant linear association was observed between the TyG index and SA-AKI (OR, 1.40; 95% confidence interval(CI) [1.14-1.73]). Additionally, the TyG index demonstrated a significant correlation with the length of stay (LOS) in both the hospital (ß, 1.79; 95% CI [0.80-2.77]) and the intensive care unit (ICU) (ß, 1.30; 95% CI [0.80-1.79]). Subgroup and sensitivity analyses confirmed the robustness of these associations. Conclusion: This study revealed a strong association between the TyG index and both SA-AKI and length of stay in patients with sepsis. These findings suggest that the TyG index is a potential predictor of SA-AKI and the length of hospitalization in sepsis cases, broadening its application in this context. However, further research is required to confirm whether interventions targeting the TyG index can genuinely enhance the clinical outcomes of patients with sepsis.

Tunable electrical properties and multiple-phases of ferromagnetic GdS2, GdSe2 and Janus GdSSe monolayers.

With the continuous miniaturization and integration of spintronic devices, the two-dimensional (2D) ferromagnet coupling of ferromagnetic and diverse electrical properties has become increasingly important. Herein, we report three ferromagnetic monolayers: GdS2, GdSe2 and Janus GdSSe. They are bipolar magnetic semiconductors and demonstrate ferroelasticity with a large reversible strain of 73.2%. Three monolayers all hold large magnetic moments of about 8µB f.u.-1 and large spin-flip energy gaps in both the conduction and valence bands, which are highly desirable for applications in bipolar field effect spin filters and spin valves. Our calculations have testified to the feasibility of the experimental achievement of the three monolayers and their stability. Additionally, intrinsic valley polarization occurs in the three monolayers owing to the cooperative interplay between spin-orbit coupling and magnetic exchange interaction. Moreover, we identified square lattices for GdS2 and GdSe2 monolayers. The new and stable square lattices of GdS2 and GdSe2 monolayers show robust ferromagnetism with high Curie temperatures of 648 and 312 K, respectively, and the characteristics of spin-gapless semiconductors. Overall, these findings render GdS2, GdSe2 and Janus GdSSe monolayers promising candidate materials for multifunctional spintronic devices at the nanoscale.

Lung ultrasound for evaluating perioperative atelectasis and aeration in the post-anesthesia care unit.

PURPOSE: Lung ultrasound is widely accepted as a reliable, noninvasive tool for evaluating lung status at the bedside. We assessed the impact of perioperative variables on atelectasis and lung aeration using lung ultrasound, and their correlation with postoperative oxygenation in patients undergoing general anesthesia. METHODS: This prospective observational study evaluated 93 consecutive patients scheduled to undergo elective non-cardiothoracic surgery under general anesthesia. Lung ultrasound was performed 5 min after admission to the post-anesthesia care unit (PACU). Twelve pulmonary quadrants were selected for each ultrasound examination. The lung ultrasound scores and atelectasis status were calculated. The oxygenation assessment was obtained by arterial blood gas analysis before discharge from the PACU. RESULTS: Thirty-two patients (34%) had atelectasis in at least one of the 12 evaluated segments, whereas 12 patients (13%) had atelectasis in at least three segments. The proportion of B-lines (≥ 3) and atelectasis in the inferolateral and posterior regions was significantly higher than in other regions. Patients with lung ultrasound scores ≥ 5 had a higher body mass index and lower PaO2 before discharge from the PACU than those with scores < 5. Patients with atelectasis had higher body mass indices and lung ultrasound scores. The presence of ≥ 2 regions of atelectasis was associated with lower PaO2. Using multivariate analysis, body mass index, intraoperative body position, and sex independently correlated with lung ultrasound scores. Age and lung ultrasound scores independently correlated with hypoxemia. CONCLUSION: Lung ultrasound enables early postoperative evaluation of atelectasis and lung aeration, which are closely associated with postoperative oxygenation.

A randomised trial evaluating mask ventilation using electrical impedance tomography during anesthetic induction: one-handed technique versus two-handed technique.

Objective.Mask positive-pressure ventilation could lead to lung ventilation inhomogeneity, potentially inducing lung function impairments, when compared with spontaneous breathing. Lung ventilation inhomogeneity can be monitored by chest electrical impedance tomography (EIT), which could increase our understanding of mask ventilation-derived respiratory mechanics. We hypothesized that the two-handed mask holding ventilation technique resulted in better lung ventilation, reflected by respiratory mechanics, when compared with the one-handed mask holding technique.Approach.Elective surgical patients with healthy lungs were randomly assigned to receive either one-handed mask holding (one-handed group) or two-handed mask holding (two-handed group) ventilation. Mask ventilation was performed by certified registered anesthesiologists, during which the patients were mechanically ventilated using the pressure-controlled mode. EIT was used to assess respiratory mechanics, including ventilation distribution, global and regional respiratory system compliance (CRS), expiratory tidal volume (TVe) and minute ventilation volume. Hemodynamic parameters and the PaO2-FiO2ratio were also recorded.Main results.Eighty adult patients were included in this study. Compared with spontaneous ventilation, mask positive-pressure ventilation caused lung ventilation inhomogeneity with both one-handed(global inhomogeneity index: 0.40 ± 0.07 versus 0.50 ± 0.15;P < 0.001) and two-handed mask holding (0.40 ± 0.08 versus 0.50 ± 0.13;P < 0.001). There were no differences in the global inhomogeneity index (P = 0.948) between the one-handed and two-handed mask holding. Compared with the one-handed mask holding, the two-handed mask holding was associated with higher TVe (552.6 ± 184.2 ml versus 672.9 ± 156.6 ml,P = 0.002) and higher globalCRS(46.5 ± 16.4 ml/cmH2O versus 53.5 ± 14.5 ml/cmH2O,P = 0.049). No difference in PaO2-FiO2ratio was found between both holding techniques (P = 0.743).Significance.The two-handed mask holding technique could not improve the inhomogeneity of lung ventilation when monitored by EIT during mask ventilation although it obtained larger expiratory tidal volumes than the one-handed mask holding technique.

The effect of propofol on hypoxia-modulated expression of heat shock proteins: potential mechanism in modulating blood-brain barrier permeability.

Heat shock proteins (HSPs) may be induced by hypoxia and alleviate blood-brain barrier (BBB) damage. The neuroprotective effect of propofol has been reported. We aimed to identify whether propofol induced HSPs expression and protected BBB integrity. Mouse astrocytes and microglia cells were cultured and exposed to hypoxia and propofol. The expression of HSP27, HSP32, HSP70, and HSP90, and the translocation of heat shock factor 1 (HSF1) and Nuclear factor-E2-related factor 2 (Nrf2) were investigated. Mouse brain microvascular endothelial cells, astrocytes, and microglial cells were co-cultured to establish in vitro BBB model, and the effects of hypoxia and propofol as well as HSPs knockdown/overexpression on BBB integrity were measured. Hypoxia (5% O2, 5% CO2, 90% humidity) treatment for 6 h and 12 h induced HSP27, HSP32, and HSP70 expression. Propofol (25 µΜ) increased HSP27 and HSP32 expression, starting with exposure to hypoxia for 3 h. Propofol induced HSF1 translocation from cytoplasmic to nuclear compartment, and blockade of HSF1 inhibited HSP27 expression in mouse astrocytes when they were exposed to hypoxia for 3 h. Propofol induced Nrf2 translocation, and blockade of Nrf2 inhibited HSP32 expression in mouse microglial cells when they were exposed to hypoxia for 3 h. Propofol protected hypoxia-impaired BBB integrity, and the effects were abolished by blockade of HSF1 and Nrf2. Overexpression of HSP27 and HSP32 alleviated hypoxia-impaired BBB integrity, and blockade of HSP27 and HSP32 expression ameliorated propofol-mediated protection against BBB impairment. Propofol may protect hypoxia-mediated BBB impairment. The mechanisms may involve HSF1-mediated HSP27 expression and Nrf2-mediated HSP32 expression.

Propofol attenuates high glucose-induced P66shc expression in human umbilical vein endothelial cells through Sirt1.

Perioperative hyperglycemia is a common metabolic disorder in clinic settings. Hyperglycemia leads to endothelial inflammation, endothelial cell apoptosis, and dysfunction, thus resulting in endothelial injury. Propofol (2,6-diisopropylphenol) is a widely used intravenous anesthetic in clinic settings. Our previous study indicated that propofol inhibits mitochondrial reactive oxygen species (ROS) production via down-regulation of phosphatase A2 (PP2A) expression, inhibition of Ser36-p66shc dephosphorylation and mitochondrial translocation, thus improving high glucose-induced endothelial injury. The expression of p66shc was inhibited by propofol in hyperglycemic human umbilical vein endothelial cells (HUVECs). However, the mechanism by which propofol inhibits p66shc expression in hyperglycemic HUVECs is still obscure. In the present study, we mainly examined how propofol inhibited high glucose-induced p66shc expression in HUVECs. Compared with 5 mM glucose treatment, high glucose increased p66shc expression and decreased sirt1 expression, which was inhibited by propofol treatment. Moreover, EX527 (a sirt1 inhibitor) reversed the effect of propofol against high glucose-induced p66shc expression. However, EX527 did not reverse the effects of propofol against high glucose-induced ROS accumulation, endothelial inflammation, and apoptosis. Furthermore, when cells were incubated with propofol, EX527, and FTY720 (a PP2A activator) simultaneously, the effects of propofol against high glucose-induced ROS accumulation, inflammation, and apoptosis were reversed. Our results suggested that propofol inhibited high glucose-induced p66shc expression via upregulation of sirt1 expression in hyperglycemic HUVECs. Moreover, propofol protects against high glucose-mediated ROS accumulation and endothelial injury via both inhibition of p66shc expression and dephosphorylation of Ser36-p66shc.