Correlation between serum phosphate and all-cause mortality in critically ill patients with coronary heart disease accompanied by chronic kidney disease: a retrospective study using the MIMIC-IV database

BackgroundThe adverse clinical endpoints of cardiovascular and kidney diseases are correlated with increased serum phosphate levels. However, in critically ill patients with coronary heart disease (CHD) accompanied by chronic kidney disease (CKD), the prognostic value of serum phosphate remains unclear.MethodsPatients' medical records from the Medical Information Mart for Intensive Care IV database who had concomitant CKD and CHD were classified into four distinct groups in this large retrospective observational cohort study based on the quartiles of serum phosphate levels. Vital status and the duration of hospital and ICU stays within the short-term follow-up periods of 30 and 90 days constituted the primary outcomes. All-cause mortality in the intensive care unit (ICU) and hospital constituted the secondary outcomes. Further, the Cox proportional hazard and restricted cubic spline (RCS) regression models were employed to ascertain how serum phosphate levels correlated with the primary outcomes. In addition, the occurrence rate of the secondary outcomes across the four quartiles was determined utilizing the Kaplan–Meier method.ResultsAmong the total 3,557 patients (67.6% male) included, the hospital and ICU all-cause mortality rates were 14.6% and 10%, separately. Higher quartiles of serum phosphate concentrations were associated with shorter short-term survival rates, as shown by the Kaplan–Meier curves. Additionally, the Cox proportional hazards analysis illustrated that serum phosphate was independently linked to a higher death risk in the hospital [HR, 1.10 (95% CI: 1.03–1.18), P = 0.007] and ICU [HR, 1.14 (95% CI: 1.07–1.22), P < 0.001]. Lastly, the RCS regression models suggested a robust non-linear correlation between serum phosphate concentrations and death risk in the ICU and hospital (both P for non-linearity <0.001).ConclusionsThe prognostic value of serum phosphate is significant in critically ill patients with CHD accompanied by CKD. Furthermore, serum phosphate is potentially valuable for identifying patients with this concomitant condition

Numerical and experimental investigations of self-piercing riveting

Self-pierce riveting (SPR) is a new high-speed mechanical fastening technique which is suitable for point joining dissimilar sheet materials, as well as coated and pre-painted sheet materials. With increasing application of SPR in different industrial fields, the demand for a better understanding of the knowledge of static and dynamic characteristics of the SPR joints is required. In this paper, the SPR process has been numerically simulated using the commercial finite element (FE) software LS-Dyna. For validating the numerical simulation of the SPR process, experimental tests on specimens made of aluminium alloy have been carried out. The online window monitoring technique was introdu introdu ced in the tests for evaluating the quality of SPR joints. Good agreements between the simulations and the tests have been found, both with respect to the force-travel (time) curves as well as the deformed shape on the cross-section of SPR joint. Monotonic tensile tests were carried out to measure the ultimate tensile strengths for SPR joints with different material combinations. Deformation and failure of the SPR joints under monotonic tensile loading were studied. The normal hypothesis tests were performed to examine the rationality of the test data. This work was also aimed at evaluating experimentally and comparing the strength and energy absorption of SPR joints and SPR-bonded hybrid joints

The interaction between XBP1 and eNOS contributes to endothelial cell migration

Trabalho final de mestrado integrado em Medicina área científica de Urologia, apresentado á Faculdade de Medicina da Universidade de CoimbraINTRODUÇÃO: Nas últimas décadas a nefrectomia parcial tem assumido um papel de destaque no tratamento do carcinoma de células renais. Esta técnica, também denominada cirurgia poupadora de nefrónios, permite remover o tumor na totalidade, preservando o parênquima renal adjacente. As suas indicações tornaram-se mais abrangentes à medida que os resultados se mostraram cada vez mais promissores. Assim, actualmente a nefrectomia parcial é o tratamento padrão do carcinoma de células renais, em detrimento da tradicional nefrectomia radical. Discute-se agora qual das duas, nefrectomia parcial aberta ou laparoscópica, é a melhor opção. OBJECTIVOS: Rever as evidências científicas relativas ao tratamento do carcinoma de células renais pela nefrectomia parcial, aberta e laparoscópica, definindo o papel actual de cada uma delas nesta área. MÉTODOS: Pesquisa na PubMed e Medline de artigos relativos a nefrectomia radical e nefrectomia parcial aberta e laparoscópica, publicados entre 1997 e 2009. Consulta das “Guidelines” da Associação Europeia de Urologia. DESENVOLVIMENTO: A nefrectomia parcial mostra resultados oncológicos semelhantes aos da nefrectomia radical, permitindo uma menor morbilidade renal a longo prazo. A nefrectomia parcial aberta é agora o tratamento recomendado pelas “Guidelines” da Associação Europeia de Urologia para o tratamento de tumores com diâmetro inferior a 4 cm, limitados ao rim, mesmo quando o rim contralateral é normal. As indicações poderão ainda ser alargadas para tumores até 7 cm de diâmetro, dependendo das características do tumor. A nefrectomia parcial laparoscópica, embora tecnicamente mais exigente, é uma boa opção de tratamento em centros com experiência na realização da técnica, revelando bons resultados a curto prazo. CONCLUSÕES: A nefrectomia parcial aberta é actualmente o tratamento padrão do carcinoma de células renais. A nefrectomia parcial laparoscópica revela resultados a curto prazo semelhantes aos da nefrectomia parcial aberta, contudo são necessários estudos confirmando esses resultados a longo prazoINTRODUCTION: In the last decades partial nephrectomy have had an important role in the treatment of renal cell carcinoma. This surgery, also known as nephron-sparing surgery, allows to remove the tumor and to preserve the surrounding healthy renal parenchyma. Moreover, with the evolution of the technique its indications got more comprehensive. So, nowadays, partial nephrectomy is the standard treatment for renal cell carcinoma, instead of the traditional radical nephrectomy. There is now a discussion between which of the two, open or laparoscopic partial nephrectomy, is the best option. OBJECTIVES: Review the scientific evidences related to the treatment of renal cell carcinoma through open and laparoscopic partial nephrectomy, defining the actual role of both in this area. METHODS: Research articles related to radical nephrectomy, open and laparoscopic partial nephrectomies at PubMed and Medline publications between 1997 and 2009. Consult of the Guidelines of European Urology Association. DEVELOPMENT: Partial nephrectomy shows oncological outcomes similar to those of radical nephrectomy with less renal morbidity at long-term follow-up. Open partial nephrectomy is now the recommended treatment by the Guidelines of European Urology Association for the treatment of tumors less than 4 cm, limited to the kidney, even when the other kidney is normal. Indications can also include tumors less than 7 cm, depending on the characteristics of the tumor. Laparoscopic partial nephrectomy, although technically more demanding, is a good option in specialized centers and reveals similar results in a short-term. CONCLUSIONS: Nowadays open partial nephrectomy is the standard treatment of renal cell carcinoma. Laparoscopic partial shows similar results as open surgery in a short-term, however, more studies are needed to confirm this results at long-term. Key-words: Open partial nephrectomy, laparoscopic partial nephrectomy, renal cell carcinoma, indications, results

DEVELOPMENT IN RESEARCH ON THE MECHANICAL PROPERTY OF ADHESIVE JOINTS

The need to design lightweight structures and the increased use of lightweight materials in industrial field,has led to wide use of adhesive bonding. In order to improve the mechanical strength and reliability of adhesive joints,the research results of mechanical property of adhesive joints at home and abroad was summarized,including the static analysis,fatigue analysis and dynamic analysis. The problems and development trend of mechanical property of adhesive joints have been pointed out

CircRNA mmu_circ_0000021 regulates microvascular function via the miR-143-3p/NPY axis and intracellular calcium following ischemia/reperfusion injury

Abstract Cardiac ischemia-reperfusion (I/R) is associated with a high rate of complications. Restoring microvascular function is crucial for cardiac repair. However, the molecular mechanisms by which the circRNAs repairs microvascular dysfunction are unknown. High-throughput RNA sequencing and quantitative real-time PCR (qRT-PCR) were used to measures circRNA levels in cardiac tissue samples. We found a total of 80 up-regulated and 54 down-regulated differentially expressed circRNAs, of which mmu_circ_0000021 were consistent with bioinformatics predictions. Next, mmu_circ_0000021 knockdown and overexpression were performed to indicate the functional role of mmu_circ_0000021. The interaction of mmu_circ_0000021, miR-143-3p and NPY were evaluated using dual-luciferase assays, RNA pull-down assays and RNA immunoprecipitation (RIP). Immunohistochemistry, transmission electron microscopy, and immunofluorescence were used to determine the presence of leukocytes and changes in microvascular morphology and function. Mechanistically, mmu_circ_0000021 involved in regulating microvascular dysfunction via miR-143-3p by targeting NPY. However, the contraction of microvascular spasm caused by NPY is related to calmodulin. By regulating NPY, Circular RNA (circRNA) further affects microvascular spasm, regulates microcirculation disorders, and restores cardiac function. Our findings highlight a novel role for mmu_circ_0000021 by regulating microvascular function following I/R injury

Echocardiography-based machine learning algorithm for distinguishing ischemic cardiomyopathy from dilated cardiomyopathy

Abstract Background Machine learning (ML) can identify and integrate connections among data and has the potential to predict events. Heart failure is primarily caused by cardiomyopathy, and different etiologies require different treatments. The present study examined the diagnostic value of a ML algorithm that combines echocardiographic data to automatically differentiate ischemic cardiomyopathy (ICM) from dilated cardiomyopathy (DCM). Methods We retrospectively collected the echocardiographic data of 200 DCM patients and 199 ICM patients treated in the First Affiliated Hospital of Guangxi Medical University between July 2016 and March 2022. All patients underwent invasive coronary angiography for diagnosis of ICM or DCM. The data were randomly divided into a training set and a test set via 10-fold cross-validation. Four ML algorithms (random forest, logistic regression, neural network, and XGBoost [ML algorithm under gradient boosting framework]) were used to generate a training model for the optimal subset, and the parameters were optimized. Finally, model performance was independently evaluated on the test set, and external validation was performed on 79 patients from another center. Results Compared with the logistic regression model (area under the curve [AUC] = 0.925), neural network model (AUC = 0.893), and random forest model (AUC = 0.900), the XGBoost model had the best identification rate, with an average sensitivity of 72% and average specificity of 78%. The average accuracy was 75%, and the AUC of the optimal subset was 0.934. External validation produced an AUC of 0.804, accuracy of 78%, sensitivity of 64% and specificity of 93%. Conclusions We demonstrate that utilizing advanced ML algorithms can help to differentiate ICM from DCM and provide appreciable precision for etiological diagnosis and individualized treatment of heart failure patients