Group-Based Trajectory Modeling of Fluid Balance in Elderly Patients with Acute Ischemic Stroke: Analysis from Multicenter ICUs.

INTRODUCTION: Acute ischemic stroke (AIS) significantly contributes to severe disability and mortality among the elderly. This study aims to explore the association between longitudinal fluid balance (FB) trajectories and clinical outcomes in elderly patients with AIS. Our hypothesis posits the existence of multiple latent trajectories of FB in patients with AIS during the initial 7 days following ICU admission. METHODS: Patients (age ≥ 65 years) with AIS and continuous FB records were identified from two large databases. Group-based trajectory modeling identified latent groups with similar 7-day FB trajectories. Subsequently, multivariable logistic and quasi-Poisson regression were employed to evaluate the relationship between trajectory groups and outcomes. Additionally, nonlinear associations between maximum fluid overload (FO) and outcomes were analyzed using restricted cubic spline models. To further validate our findings, subgroup and sensitivity analysis were conducted. RESULTS: A total of 1146 eligible patients were included in this study, revealing three trajectory patterns were identified: low FB (84.8%), decreasing FB (7.2%), and high FB (7.9%). High FB emerged as an independent risk factor for in-hospital mortality. Compared with those without FO, patients with FO had a 1.57-fold increased risk of hospital mortality (adjusted odd ratio (OR) 1.57, 95% confidence interval (CI) 1.08-2.27), 2.37-fold increased risk of adverse kidney event (adjusted OR 2.37, 95% CI 1.56-3.59), and 1.33-fold increased risk of prolonged ICU stay (adjusted incidence rate ratio (IRR) 1.33, 95% CI 1.19-1.48). The risk of hospital mortality and adverse kidney event increased linearly with rising maximum FO (P for non-linearity = 0.263 and 0.563, respectively). CONCLUSION: Daily FB trajectories were associated with adverse outcomes in elderly patients with AIS. Regular assessment of daily fluid status and restriction of FO are crucial for the recovery of critically ill patients.

Infrared image target detection for substation electrical equipment based on improved faster region-based convolutional neural network algorithm.

Substation electrical equipment generates a massive number of infrared images during operation. However, the overall quality of the infrared images is low and it lacks image detail information. When using traditional target detection algorithms for detection, feature extraction poses great difficulties. Therefore, to address this problem, this paper proposes a target detection algorithm based on the improved faster region-based convolutional neural network (Faster R-CNN). It achieves the correct identification of different types of electrical equipment in infrared images. First, the algorithm improves the backbone network of Faster R-CNN for feature extraction. An InResNet structure is proposed to replace the residual block structure of the original ResNet-34 network, which enhances the richness of feature extraction. Second, the rectified linear unit activation function in the original feature extraction network is replaced by the exponential linear unit activation function, and group normalization is used instead of batch normalization as the network normalization method. Then, the dense connection structure is introduced into the ResNet-34 network, and the whole network is called residual dense connection network. Finally, the improved Faster R-CNN is compared to the original Faster R-CNN, a single-shot multibox detector, and you only look once v3 plus spatial pyramid pooling. The experimental results show that the improved algorithm has the highest mean average precision and average recall for most of the substation electrical equipment in infrared images. Moreover, from the confidence level of the detected electrical equipment and the accuracy of the prediction box, the improved Faster R-CNN has the best performance.

Systemic inflammation response index as a prognostic factor for patients with sepsis-associated acute kidney injury: a retrospective observational study.

OBJECTIVE: To assess the association between the systemic inflammation response index (SIRI) and the prognosis in patients with sepsis-associated acute kidney injury (SA-AKI). METHODS: In this observational study, adult patients with SA-AKI were categorized into three groups based on SIRI tertiles. Survival outcomes were compared across the three groups using Kaplan-Meier survival curves. Various Cox proportional hazards regression models were developed to determine the association between the SIRI and mortality in patients with SA-AKI. Subgroup analyses were also performed to explore the association between different SIRI tertiles and all-cause mortality. RESULTS: After adjusting for several confounders, the second SIRI tertile (2.5 < SIRI < 7.6) was found to be an independent risk factor for 30-day mortality [hazard ratio (95% confidence interval): 1.19 (1.01-1.40)], 90-day mortality [1.22 (1.06-1.41)], and 365-day mortality [1.24 (1.09-1.40)]. Furthermore, high SIRI values were associated with increased risks of 30-day, 90-day, and 365-day mortality in patients with SA-AKI across all three models. The third tertile showed a significant association with adverse outcomes in most subgroups. CONCLUSIONS: The SIRI serves as a comprehensive biomarker for predicting all-cause mortality of critically ill patients with SA-AKI.

Effects of Cooling Interventions with Different Target Temperatures on Heat Stroke Rats.

Purpose: To investigate the optimal target temperature of cooling intervention in heat stroke (HS) rats and explore the potential mechanisms of cooling intervention in alleviating heat stroke-induced damage. Materials and Methods: A total of 32 Sprague-Dawley rats were randomly divided into 4 groups (n=8/group), including control, HS[core body temperature (Tc)], HS(Tc-1°C) and HS(Tc+1°C) group. Heat stroke model was established in rats of HS(Tc), HS(Tc-1°C) and HS(Tc+1°C) group. Rats in HS(Tc) group were cooled to baseline core body temperature after establishing heat stroke model, HS(Tc-1°C) group to baseline core body temperature minus 1°C and HS(Tc+1°C) group to baseline core body temperature plus 1°C. We compared the histopathological changes of lung, liver and renal tissue, as well as cell apoptosis and expression of critical proteins in phosphatidylinositol 3´-kinase (PI3K)/Akt signaling pathway. Results: Heat stroke caused the histopathological damage and cell apoptosis of lung, liver and renal tissue, which could be alleviated by cooling intervention to a certain extent. Notably, HS(Tc+1°C) group demonstrated a better effect on alleviating cell apoptosis although the differences were not significant. Heat stroke lead to the elevated expression of p-Akt, which subsequently induced the elevated expression of Caspase-3 and Bax, as well as the decreased expression of Bcl-2. Cooling intervention could reverse this trend. Notably, the expression level of Bax in lung tissue of HS(Tc+1°C) group was significantly lower than that of HS(Tc) and HS(Tc-1°C) group. Conclusion: The mechanisms of cooling intervention in alleviating heat stroke-induced damage were associated with the expression changes of p-Akt, Caspase-3, Bax and Bcl-2. The better effect of Tc+1°C might be associated with low expression of Bax.

Establishment and external validation of a nomogram for predicting 28-day mortality in patients with skull fracture.

Background: Skull fracture can lead to significant morbidity and mortality, yet the development of effective predictive tools has remained a challenge. This study aimed to establish and validate a nomogram to evaluate the 28-day mortality risk among patients with skull fracture. Materials and methods: Data extracted from the Medical Information Mart for Intensive Care (MIMIC) database were utilized as the training set, while data from the eICU Collaborative Research Database were employed as the external validation set. This nomogram was developed using univariate Cox regression, best subset regression (BSR), and the least absolute shrinkage and selection operator (LASSO) methods. Subsequently, backward stepwise multivariable Cox regression was employed to refine predictor selection. Variance inflation factor (VIF), akaike information criterion (AIC), area under the receiver operating characteristic curve (AUC), concordance index (C-index), calibration curve, and decision curve analysis (DCA) were used to assess the model's performance. Results: A total of 1,527 adult patients with skull fracture were enrolled for this analysis. The predictive factors in the final nomogram included age, temperature, serum sodium, mechanical ventilation, vasoactive agent, mannitol, extradural hematoma, loss of consciousness and Glasgow Coma Scale score. The AUC of our nomogram was 0.857, and C-index value was 0.832. After external validation, the model maintained an AUC of 0.853 and a C-index of 0.829. Furthermore, it showed good calibration with a low Brier score of 0.091 in the training set and 0.093 in the external validation set. DCA in both sets revealed that our model was clinically useful. Conclusion: A nomogram incorporating nine features was constructed, with a good ability in predicting 28-day mortality in patients with skull fracture.

Effect of sepsis on the action potential and cardiac serotonin response in rats.

The current study aimed to investigate the effect of sepsis on rat serotonin (5-HT) responses and cardiac action potentials. A total of 20 rats were randomly divided into a sepsis and control group (each, n=10). Rat hearts were harvested and perfused using the Langendorff method 18-h after the induction of sepsis, which was assessed using cecal puncture. Cardiac action potential was subsequently measured using a multichannel electrophysiology instrument. Immunohistochemistry and quantitative analysis were performed to identify the effect of sepsis on myocardial 5-HT expression. The results revealed that mitochondrial changes were present in septic rat hearts. Heart rate (361.10±12.29 bpm vs. 348.60±12.38 bpm; P<0.05) was significantly higher, atrial action potential duration (106.40±2.95 ms vs. 86.60±4.12 ms; P<0.01) was significantly longer and the area (0.62±0.06 µm2 vs. 0.39±0.05 µm2; P<0.05) and number (0.92±0.02/field vs. 0.46±0.01/field; P<0.01) of myocardial cells were significantly higher in the septic compared with the control group. These results demonstrated that 5-HT prolongs the atrial action potential, increases heart rate and aggravates myocardial injury, indicating that it may therefore be one of the factors that leads to cardiac dysfunction in sepsis.

Tropisetron inhibits sepsis by repressing hyper-inflammation and regulating the cardiac action potential in rat models.

OBJECTIVE: The objective of the present investigation was to explore the possible effect of the 5-HT3 receptor antagonist tropisetron on the expression levels of the inflammatory factors interleukin 6 (IL-6), creatine kinase isoenzyme (CK-MB), soluble growth stimulating gene 2 protein (sST2) and immunoglobulin E (IgE), as well as the cardiac action potential in septic rats. METHODS: The cecal ligation and perforation (CLP) method was utilized to construct abdominal infarction in rats. A total of 68 male adult Sprague Dawley rats were used, including 40 for assessing survival and 28 for detecting the expression levels of IL-6 and IgE, myocardial injury, cardiac dysfunction and the cardiac action potential. These 28 rats were divided into the sham (6 rats), sham + Tropisetron (6 rats), CLP (8 rats) and CLP + Tropisetron (8 rats) groups. Twenty-four hours after establishment of the sepsis rat model, immunohistochemistry was used to analyze 5-HT3 receptor protein expression, and enzyme-linked immunosorbent assay (ELISA) was employed to monitor the serum levels of IL-6, CKMB, sST2 and IgE. Furthermore, the structure of the myocardium in various groups was examined by H&E staining. RESULTS: The levels of IL-6, CK-MB, sST2 and IgE in the sepsis group were significantly higher than those of the sham group (P < 0.01). Furthermore, the heart rate in the sepsis group was lower than that of the sham group (P < 0.01), and the time of atrial ventricular action potential in the sepsis group was longer than that of the sham group (P < 0.05). In addition, immunohistochemical analyses showed that the area, intensity and index of 5-HT3 receptor in the sepsis group were significantly lower than those of the sham group (P < 0.01). Importantly, the 5-HT3 receptor antagonist Tropisetron exhibited significant inhibitory effects IL-6, CK-MB, sST2 and IgE expression levels, and inductive effects on atrial ventricular action potential in the sepsis group. CONCLUSIONS: Sepsis leads to systemic inflammatory reaction, resulting in myocardial injury, structural changes and immune imbalance. The inhibitory effect of tropisetron on inflammation, and the regulatory inflammatory disorder by the efferent vagus nerve may be one of the important mechanisms leading to cardiac electrophysiological changes in sepsis.

Choosing the filter for catenary image enhancement method based on the non-subsampled contourlet transform.

The quality of image enhancement plays an important role in the catenary fault diagnosis system based on the image processing technique. It is necessary to enhance the low contrast image of catenary for better detecting the state of catenary part. The Non-subsampled Contourlet transform (NSCT) is the improved Contourlet transform (CT), which can effectively solve the problem of artifact phenomenon in the enhanced catenary image. Besides, choosing the enhancement function and the filter of the NSCT will directly influence the image enhancement effect. In this paper, the proposed method is implemented by combining the NSCT with the nonlinear enhancement function to enhance the catenary image. First, how to choose the filter of the NSCT is discussed. Second, the NSCT is used to decompose the image. Then, the chosen nonlinear enhancement function is used to process the decomposed coefficient of the NSCT. Finally, the NSCT is inversed to obtain the enhanced image. In this paper, we evaluate our algorithm using the lifting wavelet transform, retinex enhancement method, dark channel enhancement method, curvelet transform, and CT method as a comparison to enhance a group of randomly selected low contrast catenary images, respectively. The results of comparative experiments conducted show that the proposed method can effectively enhance the catenary image, the contrast of image is improved, the catenary parts are obvious, and the artifact phenomenon is effectively eliminated, where image details (edges, textures, or smooth areas) are also well preserved. Besides, the values (detail variance-background variance, signal-to-noise ratio, and edge preservation index) of measuring the image enhancement capacity are improved, while the mean squared error value is decreased when compared to the CT method. These indicate that the proposed method is an excellent catenary image enhancement approach.

[The identification of the "Beijing family" strain of clinical isolated Mycobacterium tuberculosis in the south region of Xinjiang].

OBJECTIVE: To identify the Beijing family strain of Mycobacterium tuberculosis (M. tuberculosis) in order to find out the distribution of the Beijing family strain in the south region of Xinjiang, and therefore to provide scientific basis for the prevention and treatment of tuberculosis and the study of molecular epidemiology. METHODS: From Kashi and Hetian Pulmonary Hospitals and Centers for Disease Control and Prevention, the M. tuberculosis strain were collected and isolated from the sputum of inpatients and registered cases infected with M. tuberculosis, from January to June of 2009. The Beijing family strain was identified by RD105 deletion test. The statistical description was performed using frequency and percentage. RESULTS: A total of 200 clinical isolates of M. tuberculosis was collected. By means of RD105 deletion test, these strains were typed into 2 groups: the Beijing family and the non-Beijing family. Seventy-nine strains belonged to the Beijing family (79/200, 39.5%) and 121 strains to the non-Beijing family (121/200, 60.5%). CONCLUSION: M. tuberculosis of the Beijing family strain is prevalent at a common level in Uygur living in the south region of Xinjiang. It needs to be investigated whether the Beijing family strain of M. tuberculosis is the predominant strain in the whole region.