The relationship between plasma amino acids and circulating albumin and haemoglobin in postabsorptive stroke patients

Optimizing acute stroke outcome prediction models: Comparison of generalized regression neural networks and logistic regressions

Background

Generalized regression neural network (GRNN) and logistic regression (LR) are extensively used in the medical field; however, the better model for predicting stroke outcome has not been established. The primary goal of this study was to compare the accuracies of GRNN and LR models to identify the most optimal model for the prediction of acute stroke outcome, as well as explore useful biomarkers for predicting the prognosis of acute stroke patients.

Method

In a single-center study, 216 (80% for the training set and 20% for the test set) acute stroke patients admitted to the Shenzhen Second People’s Hospital between December 2019 to June 2021 were retrospectively recruited. The functional outcomes of the patients were measured using Barthel Index (BI) on discharge. A training set was used to optimize the GRNN and LR models. The test set was utilized to validate and compare the performances of GRNN and LR in predicting acute stroke outcome based on the area under the receiver operating characteristic curve (AUROC), accuracy, sensitivity, and the Kappa value.

Result

The LR analysis showed that age, the National Institute Health Stroke Scale score, BI index, hemoglobin, and albumin were independently associated with stroke outcome. After validating in test set using these variables, we found that the GRNN model showed a better performance based on AUROC (0.931 vs 0.702), sensitivity (0.933 vs 0.700), specificity (0.889 vs 0.722), accuracy (0.896 vs 0.729), and the Kappa value (0.775 vs 0.416) than the LR model.

Conclusion

Overall, the GRNN model demonstrated superior performance to the LR model in predicting the prognosis of acute stroke patients. In addition to its advantage in not affected by implicit interactions and complex relationship in the data. Thus, we suggested that GRNN could be served as the optimal statistical model for acute stroke outcome prediction. Simultaneously, prospective validation based on more variables of the GRNN model for the prediction is required in future studies.

Association between BIA-derived Phase Angle and Sarcopenia and Improvement in Activities of Daily Living and Dysphagia in Patients undergoing Post-Stroke Rehabilitation

OBJECTIVES

To investigate the predictive value of the BIA-derived phase angle with respect to the functional prognosis and baseline sarcopenia in patients undergoing post-stroke rehabilitation.

DESIGN

Retrospective cohort study.

SETTING AND PARTICIPANTS

Overall, 577 Japanese patients admitted to a post-acute care hospital from 2016 to 2020 were recruited.

MEASUREMENTS

Body composition analysis, which included BIA-derived phase angle and skeletal muscle mass, was performed using bioelectrical impedance analysis (BIA). Study outcomes included physical function assessed using the Functional Independence Measure (FIM-motor) and the level of dysphagia assessed using the Food Intake LEVEL Scale (FILS). Sarcopenia was defined as the loss of skeletal muscle mass and decreased muscle strength. Receiver operating characteristic curves were used to calculate the optimal cutoff value of BIA-derived phase angle to diagnose sarcopenia. Multivariate analyses were used to determine whether the BIA-derived phase angle at admission was associated with outcomes at discharge and baseline sarcopenia.

RESULTS

After enrollment, 499 patients (mean age: 74.0 ± 13.1 years; 52.0% men) were examined. The median FIM-motor and FILS scores at admission were 47 (20-69) and 8 (7-10), respectively. Sarcopenia was observed in 43.2% of patients. After adjusting for potential confounders, BIA-derived phase angle was positively associated with FIM-motor scores at discharge (β = 0.134, P < 0.001), FIM-motor score gain (β = 2.504, P < 0.001), and FILS scores at discharge (β = 0.120, P = 0.039). BIA-derived phase angle was negatively associated with the sarcopenia diagnosis at baseline (odds ratio = -0.409, P < 0.001); its cutoff value was 4.76° (sensitivity 0.800, specificity 0.790, P < 0.001) for sarcopenia diagnosis in men and 4.11° (sensitivity 0.735, specificity 0.829, P < 0.001) in women.

CONCLUSION

BIA-derived phase angle was positively associated with the recovery of physical function and dysphagia level and negatively associated with baseline sarcopenia in patients undergoing post-stroke rehabilitation. The BIA-derived phase angle cutoff for sarcopenia diagnosis was 4.76° for men and 4.11° for women.

Altered Amino Acid Metabolism in Patients with Cardiorenal Syndrome Type 2: Is It a Problem for Protein and Exercise Prescriptions?

The goal of this retrospective study was to document any alterations in plasma amino acids (AAs) in subjects with cardiorenal syndrome type 2 (CRS 2). We analyzed data from sixteen patients with CRS 2 and eight healthy subjects (control group, C), whose plasma arterial (A) and venous (V) AA concentrations had been measured. Compared to C, the group of CRS 2 patients showed significant reductions by more than 90% in A (p < 0.01) and V (p < 0.01) individual AAs, whereas negative A-V differences that indicated a net muscle AA release (muscle hypercatabolism) were found in 59% of CRS 2 patients (p < 0.03). No significant differences in plasma A and V AA concentrations nor in A-V differences were found between patients with mild kidney damage (N = 5; estimated glomerular filtration rate, eGFR ≥ 60 mL/min/1.73 m²) and patients with moderate-severe kidney damage (N = 11; eGFR < 60 mL/min/1.73 m²). Several plasma arterial AAs correlated with hemodynamic variables, but not with GFR. The study showed that patients with CRS 2 had very low concentrations of circulating AAs, independent of the degree of GFR damage.

Evaluation of Analytes Characterized with Potential Protective Action after Rat Exposure to Lead

Lead (Pb) was revealed for its role as a neurodevelopmental toxin. The determination of neurotransmitters (NTs) in particular brain regions could ameliorate the precise description and optimization of therapeutic protocols able to restore the harmony of signaling pathways in nervous and immune systems. The determination of selected analytes from the group of NTs based on the liquid chromatography (LC)-based method was carried out to illustrate the changes of amino acid (AA) and biogenic amine (BA) profiles observed in chosen immune and nervous systems rat tissues after Pb intoxication. Also, a protective combination of AA was proposed to correct the changes caused by Pb intoxication. After the administration of Pb, changes were observed in all organs studied and were characterized by a fluctuation of NT concentrations in immune and nervous systems (hypothalamus samples). Using a protective mixture of bioactive compounds prevented numerous changes in the balance of NT. The combined analysis of the immune and nervous system while the normalizing effect of curative agents on the level of differentially secreted NTs and AA is studied could present a new approach to the harmonization of those two essential systems after Pb intoxication.

A monolithic single-chip point-of-care platform for metabolomic prostate cancer detection

There is a global unmet need for rapid and cost-effective prognostic and diagnostic tools that can be used at the bedside or in the doctor's office to reduce the impact of serious disease. Many cancers are diagnosed late, leading to costly treatment and reduced life expectancy. With prostate cancer, the absence of a reliable test has inhibited the adoption of screening programs. We report a microelectronic point-of-care metabolite biomarker measurement platform and use it for prostate cancer detection. The platform, using an array of photodetectors configured to operate with targeted, multiplexed, colorimetric assays confined in monolithically integrated passive microfluidic channels, completes a combined assay of 4 metabolites in a drop of human plasma in under 2 min. A preliminary clinical study using l-amino acids, glutamate, choline, and sarcosine was used to train a cross-validated random forest algorithm. The system demonstrated sensitivity to prostate cancer of 94% with a specificity of 70% and an area under the curve of 0.78. The technology can implement many similar assay panels and hence has the potential to revolutionize low-cost, rapid, point-of-care testing.

Management of Anaemia of Chronic Disease: Beyond Iron-Only Supplementation

Chronic diseases are characterised by altered autophagy and protein metabolism disarrangement, resulting in sarcopenia, hypoalbuminemia and hypo-haemoglobinaemia. Hypo-haemoglobinaemia is linked to a worse prognosis independent of the target organ affected by the disease. Currently, the cornerstone of the therapy of anaemia is iron supplementation, with or without erythropoietin for the stimulation of haematopoiesis. However, treatment strategies should incorporate the promotion of the synthesis of heme, the principal constituent of haemoglobin (Hb) and of many other fundamental enzymes for human metabolism. Heme synthesis is controlled by a complex biochemical pathway. The limiting step of heme synthesis is D-amino-levulinic acid (D-ALA), whose availability and synthesis require glycine and succinil-coenzyme A (CoA) as precursor substrates. Consequently, the treatment of anaemia should not be based only on the sufficiency of iron but, also, on the availability of all precursor molecules fundamental for heme synthesis. Therefore, an adequate clinical therapeutic strategy should integrate a standard iron infusion and a supply of essential amino acids and vitamins involved in heme synthesis. We reported preliminary data in a select population of aged anaemic patients affected by congestive heart failure (CHF) and catabolic disarrangement, who, in addition to the standard iron therapy, were treated by reinforced therapeutic schedules also providing essential animo acids (AAs) and vitamins involved in the maintenance of heme. Notably, such individualised therapy resulted in a significantly faster increase in the blood concentration of haemoglobin after 30 days of treatment when compared to the nonsupplemented standard iron therapy.

Supplementation of Spring Pasture with Harvested Fodder Beet Bulb Alters Rumen Fermentation and Increases Risk of Subacute Ruminal Acidosis during Early Lactation

Simple Summary

Fodder beet (FB) is widely used in grazing dairy systems of New Zealand to support early- and late-lactation milk production, however, the large fraction of water-soluble carbohydrate present in FB bulbs presents a risk of subacute and acute ruminal acidosis. Despite widespread use of FB across New Zealand, the incidence of ruminal acidosis using industry-recommended methods of feeding FB has not been investigated. This study analyzed the time-dependent changes to rumen fermentation, apparent dry matter intake, milk production, milk composition and plasma amino acid concentration of grazing dairy cows supplemented with moderate amounts (40% of dry matter intake) of FB during early lactation. Our findings indicate that incidence of subacute ruminal acidosis due to FB is greater than currently realized, as 25% of cows developed severe subacute ruminal acidosis following transition to target FB allocation (40% of daily intake). Across all cows, FB reduced rumen pH, feed conversion efficiency and was not advantageous to milk production. These results suggest methods for adapting cows to a diet containing FB require further evaluation to reduce the risk of subacute ruminal acidosis (SARA) experienced by individuals within the herd.

Abstract

In a cross-over design, eight rumen cannulated dairy cows were used to explore the industry-recommended method for dietary transition to fodder beet (FB: Beta vulgaris L.) on changes to rumen fermentation and pH, milk production, dry matter intake (DMI) and the risk of subacute ruminal acidosis (SARA) during early lactation. Cows were split into two groups and individually allocated a ryegrass (Lolium Perenne L.) and white clover (Trifolium repens L.) diet (HO) or the same herbage supplemented with 6 kg DM/cow of harvested fodder beet bulbs (FBH). Dietary adaptation occurred over 20 days consisting of: stage 1: gradual transition to target FB intake (days 1–12, +0.5 kg DM of FB/d); stage 2: acclimatization (days 13–17) and stage 3: post-adaption sampling (days 18–20). Response variables were analyzed as a factorial arrangement of diet and stage of adaption using a combination of ANOVA and generalized linear mixed modelling. Dietary proportion of FB represented 22, (stage 1), 32 (stage 2) and 38% (stage 3) of daily DMI. One cow during each period developed SARA from FB and the duration of low pH increased with FBH compared to the HO treatment (p < 0.01). Rumen concentrations of lactic and butyric acid increased with FBH but concentrations of acetate, propionate and total volatile fatty acids (VFA) declined by 9.3% at day 20, compared to the HO treatment (p < 0.01). Treatments did not affect milk production but total DMI with supplemented cows increased during the final stage of adaptation and feed conversion efficiency (FCE kg milk/kg DM) declined with the FBH treatment. The occurrence of SARA in 25% of animals fed FB suggest it is a high-risk supplement to animal health and further evaluation of industry-recommended methods for feeding FB at the individual- and herd-scale are needed.

Oxaliplatin-Fluoropyrimidine Combination (XELOX) Therapy Does Not Affect Plasma Amino Acid Levels and Plasma Markers of Oxidative Stress in Colorectal Cancer Surgery Patients: A Pilot Study

Chemotherapy for colorectal cancer may lower muscle protein synthesis and increase oxidative stress. We hypothesize that chemotherapy may worsen plasma amino acids (AAs) and markers of oxidative stress (MOS). Therefore, this study aimed to document plasma AAs and MOS before, during and after chemotherapy in colorectal cancer (CRC) surgery patients. Fourteen normal-weight CRC patients were enrolled one month after surgery and scheduled for oxaliplatin-fluoropyrimidine combination (XELOX) therapy. Venous blood samples for AA and MOS (malondialdehyde, MDA; 8-hydroxy-2’-deoxyguanosine, 8-OHdG) measurements were drawn in fasting patients before each oxaliplatin infusion at initiation (A), 1 month (B) and 3 months (C) of the therapy, and after XELOX had finished (6 months, D). The results showed that during XELOX therapy (from phase B to phase D), in comparison to baseline (phase A), the branched chain amino acid/essential amino acid ratio, branched chain amino acids expressed as a percentage of total AAs, and arginine expressed as a percentage of total AAs significantly decreased (p = 0.017, p = 0.028, p = 0.028, respectively). Plasma levels of MOS did not change significantly. This study indicates that XELOX therapy does not affect plasma AA levels or worsen oxidative stress.