Development and validation of a clinical prediction model for early ventilator weaning in post-cardiac surgery.

Background: Weaning patients from mechanical ventilation is a critical clinical challenge post cardiac surgery. The effective liberation of patients from the ventilator significantly improves their recovery and survival rates. This study aimed to develop and validate a clinical prediction model to evaluate the likelihood of successful extubation in post-cardiac surgery patients. Method: A predictive nomogram was constructed for extubation success in individual patients, and receiver operating characteristic (ROC) and calibration curves were generated to assess its predictive capability. The superior performance of the model was confirmed using Delong's test in the ROC analysis. A decision curve analysis (DCA) was conducted to evaluate the clinical utility of the nomogram. Results: Among 270 adults included in our study, 107 (28.84%) experienced delayed extubation. A predictive nomogram system was derived based on five identified risk factors, including the proportion of male patients, EuroSCORE II, operation time, pump time, bleeding during operation, and brain natriuretic peptide (BNP) level. Based on the predictive system, five independent predictors were used to construct a full nomogram. The area under the curve values of the nomogram were 0.880 and 0.753 for the training and validation cohorts, respectively. The DCA and clinical impact curves showed good clinical utility of this model. Conclusion: Delayed extubation and weaning failure, common and potentially hazardous complications following cardiac surgery, vary in timing based on factors such as sex, EuroSCORE II, pump duration, bleeding, and postoperative BNP reduction. The nomogram developed and validated in this study can accurately predict when extubation should occur in these patients. This tool is vital for assessing risks on an individual basis and making well-informed clinical decisions.

Application of neutrophil-to-lymphocyte-to-monocyte ratio in predicting mortality risk in adult patients with septic shock: A retrospective cohort study conducted at a single center.

Background: Sepsis is a life-threatening condition characterized by an aberrant host response to infection, resulting in multi-organ dysfunction. The application of currently available prognostic indicators for sepsis in primary hospitals is challenging. In this retrospective study, we established a novel index, the neutrophil-to-lymphocyte-to-monocyte ratio (NLMR), based on routine blood examination upon admission, and assessed its prognostic value for early mortality risk in adult patients with septic shock. Methods: This study included clinical data from adult patients with septic shock who were admitted to the hospital between January 1, 2018, and December 31, 2022. Training and validation sets were constructed, and patients were categorized into "survival" and "death" groups based on their survival status within the 28-day hospitalization period. Baseline data, including demographic characteristics and comorbidities, and laboratory results, such as complete blood count parameters, were collected for analysis. The Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were documented.The NLMR was determined through the utilization of multivariate binary logistic regression analysis, leading to the development of a risk model aimed at predicting early mortality in adult patients suffering from septic shock. Results: Overall, 112 adult patients with septic shock were enrolled in this study, with 84 and 28 patients in the training and validation sets, respectively. Multivariate binary logistic analysis revealed that the neutrophil, lymphocyte, and monocyte counts independently contributed to the mortality risk (odds ratios = 1.22, 0.08, and 0.16, respectively). The NLMR demonstrated an area under the receiver operating characteristic curve (ROC-AUC) of 0.83 for internal validation in the training set and 0.97 for external validation in the validation set. Both overall model quality values were significantly high at 0.74 and 0.91, respectively (P < 0.05). NLMR exhibited a higher ROC-AUC value of 0.88 than quick SOFA (ROC-AUC = 0.71), SOFA (ROC-AUC = 0.83), and APACHE II (ROC-AUC = 0.78). Conclusion: NLMR may be a potential marker for predicting the risk of early death in adult patients with septic shock, warranting further exploration and verification.

Inhibition of colon C5a/C5a receptor signalling pathway confers protection against LPS-induced acute kidney injury via gut microbiota-kidney axis.

Acute kidney injury (AKI) is a critical condition often associated with systemic inflammation and dysregulated gut microbiota. This study aimed to investigate the effects of the C5a receptor antagonist W54011 on lipopolysaccharide (LPS)-induced AKI, focusing on the colon's C5a/C5a receptor pathway, intestinal barrier integrity, and gut microbiota. Our findings demonstrate that W54011 effectively ameliorated kidney injury in the LPS-induced AKI model by selectively inhibiting the colon's C5a/C5a receptor signalling pathway. Additionally, C5a receptor blockade resulted in the inhibition of colonic inflammation and the reconstruction of the intestinal mucosal barrier. Furthermore, W54011 administration significantly impacted the composition and stability of the gut microbiota, restoring the abundance of dominant bacteria to levels observed in the normal state of the intestinal flora and reducing the abundance of potentially harmful bacterial groups. In conclusion, W54011 alleviates LPS-induced AKI by modulating the interplay between the colon, gut microbiota, and kidneys. It preserves the integrity of the intestinal barrier and reinstates gut microbiota, thereby mitigating AKI symptoms. These findings suggest that targeting the colon and gut microbiota could be a promising therapeutic strategy for AKI treatment.

Transesophageal echocardiography-guided percutaneous closure of the patent foramen ovale only uses the sheath.

Background: Percutaneous closure of the patent foramen ovale (PFO) is primarily guided by fluoroscopy in the catheter room, during which procedure both the guidewire and sheath need to pass through the PFO. We performed PFO closure using a transesophageal echocardiography (TEE)-guided approach and only the sheath was passed through the PFO during the procedure. This study aimed to evaluate the feasibility and safety of PFO closure using this technique. Methods: A retrospective observational study was performed. A total of 117 consecutive adult patients underwent percutaneous PFO closure without fluoroscopy, under the sole guidance of TEE in our hospital between December 2018 and December 2021. The data of each patient consisted of preoperative, operative, and postoperative variables collected. The primary outcome is that the occluder was successfully released. The secondary outcomes included perioperative and follow-up transthoracic echocardiography (TTE), Headache impact test-6 (HIT-6) score and clinical symptoms. Results: Transvenous PFO closure under TEE guidance was successful in all cases. The sample consisted of 93 females and 24 males with an average age of 42.3±7.8 years. There were 28 patients with preoperative cerebral infarction [Risk of Paradoxical Embolism (RoPE) score >6 points] and 89 patients with migraine. All patients underwent a preoperative TEE to confirm the presence of PFO, and contrast-enhanced transcranial Doppler (c-TCD) acoustic contrast suggested grades 3 to 4. The average time of surgery for patients (puncture to removal of the sheath) was 32 minutes. Three cases of vagus nerve reflex manifestations during surgery and two cases of transient ventricular arrhythmia all improved after symptomatic treatment. There were no instances of metal allergy, hemolysis, or other acute vascular procedural complications. For all 89 patients with migraine, significant relief or resolution was achieved during the first six-month follow-up (P<0.001). Conclusions: As a monotherapy, percutaneous closure of PFO guided by TEE where only the sheath passes through the PFO during the operation is an effective procedure with a high success rate and a low complication rate.

Both epilepsy and anti-seizure medications affect bone metabolism in children with self-limited epilepsy with centrotemporal spikes.

OBJECTIVE: Bone metabolism can be influenced by a range of factors. We selected children with self-limited epilepsy with centrotemporal spikes (SeLECTS) and lifestyles similar to those of healthy children to control for the confounding factors that may influence bone metabolism. We aimed to identify the specific effects of epilepsy and/or anti-seizure medications (ASMs) on bone metabolism. METHODS: Patients with SeLECTS were divided into an untreated group and a monotherapy group, and the third group was a healthy control group. We determined the levels of various biochemical markers of bone metabolism, including procollagen type I nitrogenous propeptide (PINP), alkaline phosphatase (ALP), osteocalcin (OC), collagen type I cross-linked C-telopeptide (CTX), calcium, magnesium, phosphorus, parathyroid hormone (PTH), and vitamin D3 (VD3 ). RESULTS: A total of 1487 patients (from 19 centers) were diagnosed with SeLECTS; 1032 were analyzed, including 117 patients who did not receive any ASMs (untreated group), 643 patients who received only one ASM (monotherapy group), and 272 children in the healthy control group. Except for VD3 , other bone metabolism of the three groups were different (p < .001). Bone metabolism was significantly lower in the untreated group than the healthy control group (p < .05). There were significant differences between the monotherapy and healthy control group in the level of many markers. However, when comparing the monotherapy and untreated groups, the results were different; oxcarbazepine, levetiracetam, and topiramate had no significant effect on bone metabolism. Phosphorus and magnesium were significantly lower in the valproic acid group than the untreated group (adjusted p < .05, Cliff's delta .282-.768). CTX was significantly higher in the lamotrigine group than in the untreated group (adjusted p = .012, Cliff's delta = .316). SIGNIFICANCE: Epilepsy can affect many aspects of bone metabolism. After controlling epilepsy and other confounders that affect bone metabolism, we found that the effects of ASMs on bone metabolism differed. Oxcarbazepine, levetiracetam, and topiramate did not affect bone metabolism, and lamotrigine corrected some of the abnormal markers of bone metabolism in patients with epilepsy.

[Evaluation of the clinical efficacy of implant-supported overdenture with edentulous mandible in elderly patients].

The aging society of the global population has led to an increase in the number of patients with edentulous jaw, a common multiple disease. Given the developments in implant techniques, the method of implant denture has received a positive and good response in terms of the quality of life and psychological well-being of patients. Implant-supported overdenture in mandible has two main advantages. 1) It has better retention and chewing efficiency than those of mandibular conventional denture. The required implant site of implant-supported overdenture is less than that of fixed implant-supported denture and can repair more defect tissues to help restore beauty and pronunciation. The price of the former is more acceptable than that of the latter. Therefore, this article aimed to systemically analyze and further discuss the clinical effect of implant-supported overdenture in elderly patients; combine existing related studies on the selection of number, site, and upper restoration of implants; and illustrate the advantages of removable implant-supported protheses in the repair of toothless mandible.

Expression of surfactant protein-A in exhaled breath condensate of patients with chronic obstructive pulmonary disease.

Pulmonary surfactant protein A (SP-A) has been associated with host defense in the lung, and contributes to the pathogenesis of chronic obstructive pulmonary disease (COPD). The present study aimed to determine a non­invasive method of measurement of SP­A, and further examine the expression levels of SP­A in patients with COPD. SP­A was detected in the exhaled breath condensate (EBC) obtained from patients with COPD and from non­COPD subjects. The individuals recruited for the present study comprised 60 subjects with and without COPD, who underwent lobectomy for a solitary peripheral lung nodule. EBC was collected using a condenser, and an enzyme­linked immunosorbent assay (ELISA) was used to measure the levels of SP­A. Tissue samples were obtained during lobectomy through resection of the adjacent lung tissues, located >5 cm from the nodule. Western blot analysis and immunohistochemistry were used to measure SP­A and SP­A­positive type II pneumocytes. The results demonstrated that SP­A was detectable in the EBC of all subjects. The results of the ELISA and western blotting demonstrated that the expression levels of SP­A were significantly decreased in patients with COPD, compared with the non­COPD subjects. The reduction of SP­A­positive type II pneumocytes was associated with the expression levels of SP­A. Decreased expression levels of SP­A in EBC were associated with a higher degree of airway limitation. These results suggested that the measurement of SP­A levels in the EBC may serve as a method for monitoring airway obstruction in patients with COPD. Further investigations are required in order to examine these observations further and to elucidate the underlying mechanisms.

[Effect of removable partial dentures restoration on oral health-related quality of life of patients with shortened dental arch].

OBJECTIVE: To assess the effect of removable partial dentures (PRD) restoration on oral health-related quality of life (OHRQOL) of subjects with shortened dental arches (SDA) using the Chinese version of the Oral Health Impact Profile (OHIP-14). METHODS: Consecutive patients with shortened dental arches were recruited from the Department of Prosthodontics, Foshan Chancheng Hospital of Stomatology. The Chinese version of OHIP-14 was administered to each subject before treatment and after treatment. The subjective outcomes of removable partial dentures therapy on SDA were collected and the pre- and post-treatment scores of the Chinese version of OHIP-14 were compared. RESULTS: After treatment, significant decrease in patients' total score of OHRQOL [before: 9 (6, 12) ; after: 4 (2.25, 6)] was detected, as well as physical pain subscale, physical disability subscale and handicap subscale; and the score of OHRQOL in function limitation subscale increased [before: 0(0,0); after: 2(1, 2)]. CONCLUSIONS: The main impacts of shortened dental arch with intact anterior region affecting patients' OHRQOL are physical disability.From a quality-of-life perspective, patients with SDA can perceive benefits from RPD.

[Finite element contact stress analysis of simulating teeth with wedge-shaped defects in the cervical region].

PURPOSE: To study the distribution of stress of simulating teeth with wedge-shaped defects in the cervical region. METHODS: The models of anisotropic enamel of the mandibular first premolar and the opposite maxillary first premolar crown were created. A defect was introduced into the model of mandibular premolar in the buccal cervical region along the enamelo-dentinal junction. The stress distribution in the cervical region of the mandibular premolar was investigated with regard to different loading conditions simulating working, nonworking and vertical micromotions. In each case, the stroke was applied to the mandibular premolars in a stepping procedure using nonlinear contact analysis. RESULTS: The stresses were concentrated in the defect of the enamel and dentin at the enamelo-dentinal junction(EDJ) in the condition of different loading, especially in the condition of simulating lateral excursion on one contact. CONCLUSION: Undermined cervical EDJ had a significant effect on the stress distribution in the buccal cervical region.

[The surface roughness analysis of the titanium casting founding by a new titanium casting investment material].

OBJECTIVE: To investigate the surface roughness property of the titanium castings cast in a new investment for titanium casting. METHODS: Six wax patterns (20 mm × 20 mm × 0.5 mm) were invested using two investments: three in a new titanium investment material and three in the control material (Rematitan Plus). Six titanium specimens were obtained by conventional casting. After casting, surface roughness of the specimens were evaluated with a surface profilometer. RESULTS: The surface roughness of the specimens cast in new titanium investment material was (1.72 ± 0.08) µm, which was much smaller than that from Rematitan Plus [(1.91 ± 0.15) µm, P < 0.05]. CONCLUSIONS: The surfaces of titanium cast using these two investment materials are both smooth enough to fulfill the demand of the titanium precision-casting for prosthodontic clinical use.

High Serum CEA and CYFRA21-1 Levels after a Two-Cycle Adjuvant Chemotherapy for NSCLC: Possible Poor Prognostic Factors.

OBJECTIVE: The aim of this study was to test whether carcinoembryonic antigen (CEA) and cytokeratin 19 fragments (CYFRA21-1) can be used as a prognostic factor for non-small-cell lung cancer (NSCLC) after two cycles of adjuvant chemotherapy in NSCLC patients. METHODS: A total of 169 patients underwent at least two cycles of adjuvant chemotherapy. The serum levels of CEA and CYFRA21-1 were recorded after the second cycle of chemotherapy, and the patient follow-up was conducted. Overall survival (OS) and disease-free survival (DFS) were used as the primary endpoint and the secondary endpoint, respectively. RESULTS: The high levels of CEA and CYFRA21-1 after two cycles of adjuvant chemotherapy were poor prognostic factors for OS, with risk ratios (RR) of 2.003 and 1.702, respectively. A high CEA level was a poor prognostic factor (RR 1.152) for DFS. The median survival time (MST) of the high CEA level group was 26 months, whereas that of the normal group was 61 months (P<0.0001). The median DFS time of the high CEA group and the normal group was 34 and 53 months, respectively (P<0.0001). The MST of the high CYFRA21-1 group and the normal group was 43 and 56 months, respectively (P<0.0001). CONCLUSIONS: The high serum levels of CEA or CYFRA21-1 after two cycles of adjuvant chemotherapy are poor prognostic factors for NSCLC patients.

Characteristics of temporomandibular joint vibrations in anterior disk displacement with reduction in adults.

The objective to the present study was to compare temporomandibular joint (TMJ) vibration in anterior disk displacement with reduction (ADDWR) in adults and to explore the diagnostic value of frequency spectrography of TMJ vibrations. Twenty-one patients with ADDWR formed the case group and were further divided into three subgroups according to the degree of disk displacement, and 26 symptomless adults formed the control group. The joint vibration was recorded during rhythmic maximal open-close jaw movement using JVA/JT, BioPAK (Bioresearch, Inc., Brown Deer, WI)). The sensitivity and specificity of the total integral for diagnosis of ADDWR was calculated. All TMJ vibration parameters, including total integral, integral>300Hz, integral<300Hz, >300/<300 ratio, peak amplitude, peak and median frequencies of the case group were significantly higher than that of the control group. Along with the degree of disk displacement, the amplitude and frequency of TMJ vibrations increased, and the total integral significantly increased. The total integral demonstrated high sensitivity and specificity for diagnosis of ADDWR (85.7% and 84.6%, respectively). TMJ vibration was significantly higher in adults with ADDWR than that in the symptomless control group. Different pathological stages of disk displacement have different TMJ vibrations.

[Finite element contact stress analysis of simulating teeth with wedge shaped defects in the cervical region].

OBJECTIVE: To study the distribution of stress of simulating teeth with wedge shaped defects in the cervical region. METHODS: The models of anisotropic enamel of the mandibular first premolar and the opposite maxillary first premolar crown were created. A defect was introduced into the model of mandibular premolar in the buccal cervical region along the enamelo-dentinal junction (DEJ). The stress distribution in the cervical region of the mandibular premolar was investigated considering lateral condition simulating working micromotions. In this case, the stroke was applied to the maxillary first mandibular in a stepping procedure using nonlinear contact analysis. RESULTS: The stresses were concentrated in the defect of the enamel and dentin at the DEJ in the condition of lateral loading. As the defect length increased in size, the peak maximum principal stress (MPS) value and the magnitude of the stress field along the DEJ both increased. CONCLUSION: Undermined cervical DEJ had a significant effect on the stress distribution in the buccal cervical region.

[Relationship between occlusal plane and masticatory path in youth with individual normal occlusion].

OBJECTIVE: To investigate the characteristics of and relationship between occlusal plane and masticatory path in young adults with individual normal occlusion, and to provide clinical implications on both morphological and functional reference of occlusal plane location. METHODS: Forty-three young adults with individual normal occlusion were included. Lateral projections of cephalometric radiographs were taken. The parameters of anatomical landmarks were analyzed. The BioEGN mandibular kinesiography analyzer was used to record the path of incisal edge of mandibular central incisor movement during mastication. The Pearson's linear correlation analysis was performed to analyze the relationship of inclination of occlusal plane and data mentioned above with SPSS13.0 software. RESULTS: The inclination of occlusal plane (the angle between occlusal plane and Camper's line OP-CP) was (2.1 ± 3.8)° in youth with normal occlusion. Means of maximal distances of 3-dimensional masticatory mandibular movement paths were as follow: the vertical length was (20.22 ± 4.28) mm, the anterior-posterior width was (11.42 ± 2.45) mm, and the lateral width was (8.62 ± 1.52) mm. The inclination of occlusal plane was negatively correlated to the lateral width of masticatory path in frontal plane (r = -0.39, P < 0.05). Occlusal plane was approximately vertical to the opening and closing path in the vicinity of intercuspal position during mastication. The inclination of occlusal plane was positively related to occlusal plane-closing angles in the upper segments of closing path during mastication (P < 0.05). Masticatory axis angle was (66.50 ± 7.98)° with no significant correlation to the inclination of occlusal plane (P > 0.05). CONCLUSIONS: These results suggest that the sagittal inclination of occlusal plane can influence 3-dimensional morphology of masticatory path.The inclination of occlusal plane has a guiding effect on masticatory movement in the upper segments of closing path.

[The characteristics of masticatory muscle activity in bruxers].

OBJECTIVE: To evaluate the effects of bruxism on masticatory muscle electromyographic (EMG) activity. METHODS: Twenty-four bruxers and sixteen asymptomatic control subjects were included through questionnaire and clinical examination. EMG activity was recorded by placing surface electrodes on bilateral anterior temporalis (TA), masseters (MM), anterior digastrics (DA) and sternocleidomastoid (SCM) muscles. EMG activities at rest, during maximal voluntary clenching in intercuspal position and swallowing were recorded by means of Bio PAK system. RESULTS: EMG activities of TA and MM at rest were significantly higher in bruxism group than in control group (P<0.05). When subjects clenched their teeth in intercuspal position, the activities of TA and MM were much lower in bruxism group than in control one (P<0.05). EMG activity during swallowing was no significant difference between the two groups. The asymmetry index of bilateral TA and MM in bruxism group was a little higher than the control group, but there was no significant difference between the two groups (P>0.05). CONCLUSION: Masticatory muscle dysfunction of bruxers is mainly represented as higher potential in postural position and lower potential during maximal voluntary clenching in intercuspal position of anterior temporalis and masseters.

[Investigation on relationship between wedge-shaped defects and occlusal interference].

OBJECTIVE: To investigate the relationship between wedge-shaped defects and occlusal interference. METHODS: Following examination from 46 patients, a total of 157 teeth were identified to have the criteria set for wedge-shaped defects and regarded as the experiment group. Also, 157 adjacent teeth exhibiting no such noncarious cervical lesions were randomly selected from the same group of patients and regarded as the control group. The distribution of occlusal force and time were examined with T-Scan II system in 46 patients with wedge-shaped defects in intercuspal occlusion position, protrusive movement and lateral movement. Occlusal interference and premature contact were evaluated and compared between the two groups. RESULTS: The proportion of the teeth with premature contact in experiment group was 6.37%, while the control group was 2.55%, there was no significant difference between the two groups (P > 0.05). The total proportion with occlusal interferences in experiment group was 23.57%, which was significantly higher than that of the control group (10.19%, P < 0.05), in experiment group the proportion with working side interferences was 15.92%, and in control group, the proportion was 3.82%, there was significant difference between the two groups (P < 0.01). At the same time, the teeth with occlusal interferences had more serious degree of the wedge-shape defects than those with no occlusal interference. CONCLUSION: The increased occlusal force has relation to the formation as well as severity of wedge-shaped defects.