Identifying the risk factors associated with perioperative mortality is crucial, particularly in older patients. Predicting 6-month mortality risk in older patients based on large datasets can assist ...patients and surgeons in perioperative clinical decision-making. This study aimed to develop a risk prediction model of mortality within 6 months after noncardiac surgery using the clinical data from 11 894 older patients in China.
A multicentre, retrospective cohort study was conducted in 20 tertiary hospitals. The authors retrospectively included 11 894 patients (aged ≥65 years) who underwent noncardiac surgery between April 2020 and April 2022. The least absolute shrinkage and selection operator model based on linear regression was used to analyse and select risk factors, and various machine learning methods were used to build predictive models of 6-month mortality.
The authors predicted 12 preoperative risk factors associated with 6-month mortality in older patients after noncardiac surgery. Including laboratory-associated risk factors such as mononuclear cell ratio and total blood cholesterol level, etc. Also including medical history associated risk factors such as stroke, history of chronic diseases, etc. By using a random forest model, the authors constructed a predictive model with a satisfactory accuracy (area under the receiver operating characteristic curve=0.97).
The authors identified 12 preoperative risk factors associated with 6-month mortality in noncardiac surgery older patients. These preoperative risk factors may provide evidence for a comprehensive preoperative anaesthesia assessment as well as necessary information for clinical decision-making by anaesthesiologists.
Random-pattern skin flap is a vital technique frequently applied in reconstruction surgeries for its convenience and effectiveness in solving skin defects. However, ischemic necrosis, especially in ...the distal areas of the flap, still needs extra attention after surgery. Earlier evidence has suggested that paeoniflorin (PF) could stimulate angiogenesis and suppress ischemic cardiovascular disease. However, few studies have focused on the role of PF in flap survival. In this study, we have demonstrated that the human umbilical vein endothelial cells (HUVECs) treated with PF can alleviate tert-butyl hydroperoxide (TBHP)-stimulated cellular dysfunction and apoptosis. To better evaluate, HUVECs’ physiology, cell tube formation, migration, and adhesion were assessed. Mechanistically, PF protects HUVECs against apoptosis
via
stimulating the nuclear factor (erythroid-derived 2)-like 2 (Nrf2)/heme oxygenase 1 (HO-1) pathway. PF also downregulates mitochondrial ROS production to reduce excessive intracellular ROS production induced by TBHP and restore TBHP-induced mitochondrial depolarization. As a result, silencing Nrf2 partially abolishes the protective effect of PF exposure on HUVECs. In
in vivo
experiments, the oral administration of PF was shown to have enhanced the vascularization of regenerated tissues and promote flap survival. However, the PF-mediated protection was partially lost after co-treatment with ML385, a selective Nrf2 inhibitor, suggesting that PF is a crucial modulator regulating the Nrf2/HO-1 signaling pathway. In summary, our data have provided a new insight into PF as a potential therapy for enhancing random-pattern flap viability.
Nephrotoxicity is a major adverse effect of cisplatin-mediated chemotherapy in cancer patients. The pathogenesis of cisplatin-induced nephrotoxicity remains largely unclear, making it difficult to ...design effective renoprotective approaches. Here, we have examined the role of microRNAs (miRNAs) in cisplatin-induced nephrotoxicity. We show that cisplatin nephrotoxicity was not affected by overall depletion of both beneficial and detrimental miRNAs from kidney proximal tubular cells in mice in which the miRNA-generating enzyme Dicer had been conditionally knocked out. To identify miRNAs involved in cisplatin nephrotoxicity, we used microarray analysis to profile miRNA expression and identified 47 up-regulated microRNAs and 20 down-regulated microRNAs in kidney cortical tissues. One up-regulated miRNA was miR-375, whose expression was also induced in cisplatin-treated renal tubular cells. Interestingly, inhibition of miR-375 decreased cisplatin-induced apoptosis, suggesting that miR-375 is a cell-damaging or pro-apoptotic agent. Blockade of P53 or NF-κB attenuated cisplatin-induced miR-375 expression, supporting a role of P53 and NF-κB in miR-375 induction. We also identified hepatocyte nuclear factor 1 homeobox B (HNF-1β) as a key downstream target of miR-375. Of note, we further demonstrated that HNF-1β protected renal cells against cisplatin-induced apoptosis. Together, these results suggest that upon cisplatin exposure, P53 and NF-κB collaboratively induce miR-375 expression, which, in turn, represses HNF-1β activity, resulting in renal tubular cell apoptosis and nephrotoxicity.
Tree crown width relates directly to wood quality and tree growth. The traditional method used to measure crown width is labor-intensive and time-consuming. Pairing imagery taken by an unmanned ...aerial vehicle (UAV) with a deep learning algorithm such as a faster region-based convolutional neural network (Faster-RCNN) has the potential to be an alternative to the traditional method. In this study, Faster-RCNN outperformed single-shot multibox detector (SSD) for crown detection in a young loblolly pine stand but performed poorly in a dense, mature loblolly pine stand. This paper proposes a novel Faster-RCNN algorithm for tree crown identification and crown width extraction in a forest stand environment with high-density loblolly pine forests. The new algorithm uses Residual Network 101 (ResNet101) and a feature pyramid network (FPN) to build an FPN_ResNet101 structure, improving the capability to model shallow location feature extraction. The algorithm was applied to images from a mature loblolly pine plot in eastern Texas, USA. The results show that the accuracy of crown recognition and crown width measurement using the FPN_ResNet101 structure as the backbone network in Faster-RCNN (FPN_Faster-RCNN_ResNet101) was high, being 95.26% and 0.95, respectively, which was 4.90% and 0.27 higher than when using Faster-RCNN with ResNet101 as the backbone network (Faster-RCNN_ResNet101). The results fully confirm the effectiveness of the proposed algorithm.
The COVID-19 pandemic has a heavy impact on the mental health of elderly surgical patients worldwide. In particular, the elderly patients faced considerable psychological stress due to various ...environmental and medical factors during the outbreak. This study aims to examine changes in mental health trends among non-cardiac surgical patients aged 65 and above in China during the COVID-19 pandemic.
This multi-center, convenient sampling, longitudinal observational study was conducted from April 1, 2020 to April 30, 2022. Primary outcome was the prevalence of postoperative depression. Secondary outcome was the prevalence of postoperative anxiety. Follow-up was conducted separately at 7 days and 30 days after surgery. Depression symptoms were assessed using the Patient Health Questionnaire 9 (PHQ-9) scale. Anxiety symptoms were assessed using Generalized Anxiety Disorder-7 (GAD-7) scale, with scores of ≥5 defining positive depression or anxiety symptoms. Multivariate logistic regression analysis was used to investigate risk factors of mental health status in more elderly patients undergoing non-cardiac surgery.
A total of 4639 patients were included, of whom 2279 (46.0 %) were male, 752 (15.2 %) were over the age of 75, and 4346 (93.7 %) were married. The monthly prevalence trends demonstrated that compared to the outbreak period, a significant reduction in the prevalence of depression and anxiety symptoms in elderly patients who underwent surgery during the post-pandemic period. In post-pandemic period, a statistically significant decrease in the prevalence of all severity depression and anxiety patients was noted at the 7-day follow-up, but no significant decrease was observed for severe depression and anxiety in the 30-day follow-up. In COVID-19 low-risk area, a significant overall decrease in prevalence of mental health was observed during the post-pandemic period compared to the outbreak period, including 7-day depression, 7-day anxiety, 30-day depression, and 30-day anxiety (all with P < 0.001). Female and patients with ≥2 comorbidities appeared to be more susceptible to postoperative depression and anxiety during the pandemic.
The absence of data from the early days of the COVID-19 outbreak.
This study analyzed the prevalence of depression and anxiety in elderly non-cardiac patients during and after the COVID-19 pandemic, focusing on dimensions such as severity, risk-areas, gender, and comorbidity. Our findings revealed a significant decrease in the prevalence of depression and anxiety in elderly surgery patients during the post-pandemic period.
•This study was a multi-center, convenient sampling, longitudinal observational study which focused on the changes in mental health symptoms in the post-pandemic era of elderly patients in China.•We found that female and patients with more comorbidities were more likely to experience symptoms of depression and anxiety during the pandemic.•We showed a significant decrease in depression and anxiety prevalence of postoperative 7-day and 30-day compared to during the epidemic.
Cinnamomum camphora (L.) J. Presl has been used for the traditional medicine as a therapeutic agent of inflammation-related diseases, including sprains, rheumatic arthritis, abdominal pain, cough and ...bronchitis, for a long history. The aim of the present study was to illustrate anti-inflammatory substances of C. camphora and their mechanism of action, and to establish the correlations between chemical constituents and traditional uses of this plant.
Chemical constituents were purified by chromatographic methods, and their structures were established based on spectroscopic analysis. Lipopolysaccharide (LPS)-stimulated RAW 264.7 macrophages was adopted for evaluating the anti-inflammatory activity in vitro. The nitric oxide (NO) production assay and nuclear factor kappa B (NF-κB) dual luciferase reporter assay were used to screen anti-inflammatory constituents. The mRNA and protein levels of inflammation-related cytokines and enzymes were determined by real-time reverse transcription-polymerase chain reaction (RT-PCR), immunoblot analysis, and enzyme linked immunosorbent assay (ELISA), respectively.
Twenty-five constituents were isolated from the EtOH extract of C. camphora. Eight constituents, covering phenylpropanoid (7), lignans (10 and 22), flavonoids (16–18), coumarin (21), and terpenoid (24) significantly inhibited LPS-stimulated NO production with maximum inhibition rates (MIRs) of ≥ 80%, and thus were verified to be the anti-inflammatory substances of this ethnomedical plant. (+)-Episesaminone (SMO, 22) and 3S-(+)−9-oxonerolidol (NLD, 24) blocked NF-κB activation via inducing IκBα expression. Moreover, SMO and NLD inhibited productions of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and prostaglandin E2 (PGE2), and alleviated increased mRNA and protein levels of inducible nitric oxide synthase (iNOS), cyclooxygenase (COX-2), and matrix metallopeptidase-9 (MMP-9) in LPS-stimulated RAW 264.7 macrophages.
The ethnomedical use of C. camphora for the treatment of inflammation-related diseases was attributed to the combined in vitro anti-inflammatory activities of phenylpropanoid, lignan, flavonoid, coumarin, and terpenoid. SMO and NLD were found to be new molecules with in vitro anti-inflammatory activities, which are achieved by inhibiting NF-κB regulated inflammatory response.
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Eleven fumiquinazoline-type alkaloids, namely, versiquinazolines A–K (1–11), along with cottoquinazolines B–D, were isolated from the gorgonian-derived fungus Aspergillus versicolor LZD-14-1. Their ...structures were determined by extensive analyses of the spectroscopic data (1D and 2D NMR, HRESIMS), in addition to the experimental and calculated ECD data and X-ray single-crystal diffraction analysis for the assignments of the absolute configurations. Versiquinazolines A, B, and F (1, 2, and 6), bearing a methanediamine or an aminomethanol unit and representing a unique subtype of fumiquinazolines, were found from nature for the first time. Possible biogenetic relationships of the versiquinazolines are postulated. In addition, the structures of cottoquinazolines B (12), D (13), and C (14) should be revised to the enantiomers. Compounds 1, 2, 7, and 11 exhibited inhibitory activities against thioredoxin reductase (IC50 values ranging from 12 to 20 μM).
A pair of enantiomeric 15-nordolabellane diterpenoids, (−)- and (+)-caseadolabellols A (1a and 1b), three dolabellane diterpenoids, caseadolabellols B–D (2–4), two dolastane diterpenoids, ...caseadolastols A and B (5 and 6), 10 clerodane diterpenoids, caseakurzins A–J (7–16), and nine known diterpenoids (17–25) were isolated from the twigs and leaves of Casearia kurzii. The structures of the new compounds were established on the basis of extensive spectroscopic data, and those of compounds 1a, 1b, and 2 were verified by single-crystal X-ray crystallographic analysis. The enantiomers 1a and 1b were separated by chiral-phase HPLC. The absolute configurations were determined by experimental and calculated ECD data, the modified Mosher’s method, or literature comparison. Compounds 1a and 5 showed significant quinone reductase-inducing activity in Hepa 1c1c7 cells, while 1b showed moderate activity. Molecular docking studies showed that 1a had greater binding affinity with Nrf2 protein (5FNQ) than 1b. The cytotoxic activity of compounds 1a, 1b, 2–12, 15, and 16 was evaluated, among which compounds 8 and 16 exhibited significant inhibitory activity against the A549 cell line. Compounds 8 and 16 induced the A549 cells to arrest at G2/M and S phases, respectively, and both compounds induced apoptosis in A549 cells.
reaction: see text A phytochemical study of the secondary metabolites produced by the species of Isodon rubescens has led to the isolation of three new dimeric ent-kauranoids and two known ones. The ...most important of these compounds are bisrubescensin A (1), which contains an unprecedented C(23) ent-kaurane unit, and bisrubescensin C (3), which is the precursor of bisrubescensin B (2) from the viewpoint of biosynthesis. Their structures were determined on the basis of extensive spectroscopic analysis and chemical evidence.
The reported prevalence of unruptured cerebral aneurysms (UCAs) varies widely.
To measure the prevalence of UCAs by using 3-dimensional time-of-flight magnetic resonance angiography in adults aged 35 ...to 75 years.
Cross-sectional study done between June 2007 and June 2011.
Two communities chosen at random from 2 districts (1 urban and 1 suburban) in Shanghai, China.
4813 adults aged 35 to 75 years.
Three-dimensional time-of-flight magnetic resonance angiography, interpreted by 3 observers blinded to the participants' information, was used to identify the location and size of UCAs and to estimate the overall, age-specific, and sex-specific prevalence.
369 UCAs were found in 336 participants (130 men and 206 women); 4477 participants had no evidence of UCAs. The prevalence was 7.0% overall (95% CI, 6.3% to 7.7%), with 5.5% for men (CI, 4.6% to 6.4%) and 8.4% for women (CI, 7.3% to 9.5%). The overall prevalence of UCAs was higher in women than in men (P < 0.001) and peaked at ages 55 to 64 years in men and women. The UCAs were mostly located in the internal carotid artery (81%), and 90.2% had a maximum diameter less than 5 mm. Mean diameter was larger in women than in men (3.7 mm vs. 3.2 mm; P < 0.009).
Participants were from 2 communities selected from 2 districts in Shanghai, and adults older than 75 years were not studied.
The overall prevalence of UCAs was 7.0% in Chinese adults aged 35 to 75 years, and most lesions had a diameter less than 5 mm.
National Natural Science Foundation of China.
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