Identifying key risk factors for acute compartment syndrome in tibial diaphysis fracture patients

Acute compartment syndrome (ACS) is a severe orthopedic issue that, if left untreated, can result in lasting nerve and muscle damage or even necessitate amputation. The association between admission laboratory blood test indicators and the occurrence of ACS in patients with tibial diaphysis fractures is currently a subject of debate. The objective of this research was to identify the contributing factors for ACS in individuals suffering from tibial diaphysis fractures. In this retrospective study, we collected data on a total of 705 individuals from our hospital, comprising 86 ACS patients and 619 non-ACS patients with tibial diaphysis fractures. These participants were categorized into two distinct groups: the ACS group and the non-ACS group. Despite the inherent limitations associated with retrospective analyses, such as potential biases in data collection and interpretation, we conducted a comprehensive analysis of demographics, comorbidities, and admission lab results. Our analytical approach included univariate analysis, logistic regression, and receiver operating characteristic (ROC) curve analysis techniques, aiming to mitigate these limitations and provide robust findings. The statistical analysis revealed several predictors of ACS, including gender (p = 0.011, OR = 3.200), crush injuries (p = 0.004, OR = 4.622), lactic dehydrogenase (LDH) levels (p < 0.001, OR = 1.003), and white blood cell (WBC) count (p < 0.001, OR = 1.246). Interestingly, the study also found that certain factors, such as falls on the same level (p = 0.007, OR = 0.334) and cholinesterase (CHE) levels (p < 0.001, OR = 0.721), seem to provide a degree of protection against ACS. In order to better predict ACS, the ROC curve analysis was employed, which determined threshold values for LDH and WBC. The established cut-off points were set at 266.26 U/L for LDH and 11.7 × 109 cells per liter for WBC, respectively. Our research has successfully pinpointed gender, crush injuries, LDH levels, and white blood cell (WBC) count as crucial risk factors for the development of ACS in patients experiencing tibial diaphysis fractures. Furthermore, by establishing the cut-off values for LDH and WBC, we have facilitated a more personalized assessment of ACS risk, enabling clinical doctors to implement targeted early interventions and optimize patient outcomes.

One-year mortality prediction for patients with sepsis: a nomogram integrating lactic dehydrogenase and clinical characteristics

BACKGROUND

To explore the association between myocardial enzymes and one-year mortality, and establish a nomogram integrating myocardial enzymes and clinical characteristics to predict one-year mortality among sepsis patients.

METHODS

Data of 1,983 sepsis patients were extracted from Medical Information Mart for Intensive Care III database in this retrospective cohort study. All participants were randomly split into the training set for the development of model and testing set for the internal validation at the ratio of 7:3. Univariate logistic regression was used to screen variables with statistical differences which were made for stepwise regression, obtaining the predictors associated with one-year mortality of sepsis patients. Adopted multivariate logistic regression to assess the relationship between myocardial enzymes and one-year mortality of sepsis patients. A nomogram was established in predicting the one-year survival status of sepsis patients, and the performance of developed model were compared with LDH alone, sequential organ failure assessment (SOFA), simplified acute physiology score II (SAPS II) by receiver operator characteristic, calibration, and decision curves analysis.

RESULTS

The result found that LDH was associated with one-year mortality of sepsis patients [odds ratio = 1.28, 95% confidence interval (CI): 1.18-1.52]. Independent predictors, including age, gender, ethnicity, potassium, calcium, albumin, hemoglobin, alkaline phosphatase, vasopressor, Elixhauser score, respiratory failure, and LDH were identified and used to establish the nomogram (LDH-model) for predicting one-year mortality for sepsis patients. The predicted performance [area under curve (AUC) = 0.773, 95%CI: 0.748-0.798] of this developed nomogram in the training and testing sets (AUC = 0.750, 95%CI: 0.711-0.789), which was superior to that of LDH alone, SOFA score, SAPS II score. Additionally, calibration curve indicated that LDH-model may have a good agreement between the predictive and actual outcomes, while decision curve analysis demonstrated clinical utility of the LDH-model.

CONCLUSION

LDH level was related to the risk of one-year mortality in sepsis patients. A prediction model based on LDH and clinical features was developed to predict one-year mortality risk of sepsis patients, surpassing the predictive ability of LDH alone as well as conventional SAPS II and SOFA scoring systems.

Prognostic implication of lactic dehydrogenase-to-albumin ratio in critically ill patients with acute kidney injury

BACKGROUND

No studies have been published on the correlation between lactic dehydrogenase-to-albumin ratio (LAR) and poor prognosis of acute kidney injury (AKI) patients, warranting further research. This analysis sought to investigate the prognostic implication of LAR in critically ill patients with AKI.

METHODS

The present study enrolled 11,046 and 5180 adults with AKI from the Medical Information Mart for Intensive Care III (MIMIC III) and MIMIC IV, respectively. Data from MIMIC IV were identified as the training cohort, and those from MIMIC III were identified as the validation cohort. We applied multivariate regression analysis to identify the link between LAR and all-cause mortality. Restricted cubic spline (RCS) was conducted to figure out the correlation between LAR and in-hospital mortality. Furthermore, we carried out stratification analyses to examine if the effects of LAR on in-hospital mortality were consistent across various subclasses.

RESULTS

The level of LAR was remarkably higher in the in-hospital non-survivor group (p < 0.001). Furthermore, the increased LAR group presented a remarkably higher rate of in-hospital mortality at AKI stages 1, 2, and 3 compared with the decreased LAR group (all p < 0.001). Multivariate regression analyses exhibited the independent prognostic significance of LAR for all-cause mortality (all p < 0.001). MIMIC III observed concordant results. RCS indicated a non-linear correlation between LAR and in-hospital death (P for non-linearity < 0.001). The relationship between LAR and in-hospital mortality was still significant in patients with various subclasses.

CONCLUSIONS

Elevated LAR at admission is a prognostic risk factor for critically ill patients with AKI.

Clinical characteristics and a decision tree model to predict death outcome in severe COVID-19 patients

Background

The novel coronavirus disease 2019 (COVID-19) spreads rapidly among people and causes a pandemic. It is of great clinical significance to identify COVID-19 patients with high risk of death.

Methods

A total of 2169 adult COVID-19 patients were enrolled from Wuhan, China, from February 10th to April 15th, 2020. Difference analyses of medical records were performed between severe and non-severe groups, as well as between survivors and non-survivors. In addition, we developed a decision tree model to predict death outcome in severe patients.

Results

Of the 2169 COVID-19 patients, the median age was 61 years and male patients accounted for 48%. A total of 646 patients were diagnosed as severe illness, and 75 patients died. An older median age and a higher proportion of male patients were found in severe group or non-survivors compared to their counterparts. Significant differences in clinical characteristics and laboratory examinations were found between severe and non-severe groups, as well as between survivors and non-survivors. A decision tree, including three biomarkers, neutrophil-to-lymphocyte ratio, C-reactive protein and lactic dehydrogenase, was developed to predict death outcome in severe patients. This model performed well both in training and test datasets. The accuracy of this model were 0.98 in both datasets.

Conclusion

We performed a comprehensive analysis of COVID-19 patients from the outbreak in Wuhan, China, and proposed a simple and clinically operable decision tree to help clinicians rapidly identify COVID-19 patients at high risk of death, to whom priority treatment and intensive care should be given.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-021-06478-w.

Evaluation of pigeon egg yolk for post thaw quality, enzyme leakage and fertility of buffalo (Bubalus bubalis) bull spermatozoa

Egg yolk is used as a cryoprotectant in semen preservation. However, its composition varies according to the species which may influence its effectiveness during the freeze-thaw process. Therefore, study was conducted to identify the optimum level of pigeon egg yolk (PEY) in Tris citric acid (TCA) extender for freezability and in vivo fertility of buffalo semen. Semen was collected at weekly intervals for a period of three weeks (replicates) from 6 Nili Ravi buffalo bulls (2 ejaculates/bull/replicate) and diluted with TCA extender (50 × 10⁶ motile spermatozoa ml^-1) containing 5%, 10%, 15% and 20% PEY or 20% CEY (control) and cryopreserved. Post-thaw sperm quality and extracellular enzymes leakage was assessed after thawing. Sperm motility, plasma membrane integrity, livability and viability was significantly higher in extenders containing 10% and 15% PEY compared to 5% PEY, 20% PEY or 20% CEY (controls). A dose-dependent decrease was recorded in the chromatin damage for the PEY, being lowest for the 15% and 20% PEY which was significantly less compared to controls (20% CEY). The extracellular GOT and LDH leakage was significantly lower (P < 0.05) in extender containing 10% and 15% PEY compared to the controls. Semen collected from 2 bulls, cryopreserved in extenders containing 15% PEY or 20% chicken egg yolk was assessed for fertility after artificial inseminations. A total of 400 buffaloes were inseminated (100 inseminations/extender/bull). The overall fertility rate was significantly higher (P < 0.05) with semen cryopreserved in extender containing 15% PEY (56%) compared to 20% CEY (42%; controls). In conclusion, pigeon egg yolk at 15% offers advantages over 20% chicken egg yolk in terms of in vitro post-thaw semen quality and in vivo fertility of buffalo.

Using Both Lactic Dehydrogenase Levels and the Ratio of Involved to Uninvolved Free Light Chain Levels as Risk Factors Improves Risk Assessment in Patients With Newly Diagnosed Multiple Myeloma

BACKGROUND

This study aimed to evaluate the prognostic value of the ratio of involved to uninvolved free light chain (rFLC) levels and lactic dehydrogenase (LDH) levels in the risk stratification of patients with multiple myeloma (MM).

MATERIALS AND METHODS

Clinical data of 283 patients with newly diagnosed MM were retrospectively analyzed.

RESULTS

In the traditional chemotherapy group, patients with an rFLC < 100 had a better prognosis than those with an rFLC ≥ 100 (40 months versus 6 months, P = 0.022), as did patients with an LDH ≤ upper limit of normal (ULN) compared to those with an LDH > ULN (29 months versus 6 months, P = 0.023). In patients who underwent novel drug-combined therapy, no significant difference was observed between the rFLC < 100 group and the rFLC ≥ 100 group (54 months versus median not reached, P = 0.508). However, patients with an LDH ≤ ULN had a better prognosis than those with an LDH > ULN (60 months versus 21 months, P = 0.004). Using an rFLC ≥ 100 and an LDH ≥ ULN as adverse risk factors, patients were classified into 3 groups: group 1 (no adverse risk factors), group 2 (1 adverse risk factor) and group 3 (2 adverse risk factors). The median overall survival (OS) of groups 1, 2 and 3 was 52 months, 34 months and 15 months, respectively (P = 0.001).

CONCLUSIONS

rFLC and LDH levels were sensitive prognostic factors in MM patients, combining them could improve the risk stratification and treatment choice of patients in clinical practice.

Inhibitory effects of ionic liquids on the lactic dehydrogenase activity

Ionic liquids (ILs) were widely used in scientific and industrial application and have been reported to possess potential toxicity to the environment and human health. The effects of six typical N-methylimidazolium-based ILs ([Cnmim]X, n=4, 6, 8; X=Br(-), Cl(-), BF4(-), CF3SO3(-)) on the lactic dehydrogenase (LDH) activity and the molecular interaction mechanism of ILs and the LDH were investigated with the aid of spectroscopic techniques. Experimental results showed that the LDH activity was inhibited in the presence of ILs. For the ILs with the same anion but different cations, their inhibitory ability on the LDH activity increased with increasing the alkyl chain length on the IL cation. Thermodynamic parameters, enthalpy change (ΔH) and entropy change (ΔS) were obtained by analyzing the fluorescence behavior of LDH with the addition of ILs. Both positive ΔH and ΔS suggested that hydrophobicity was the major driven force in the interaction process as expected.

Ethanol Production and Utilization by Aphelenchus avenae and Caenorhabditis sp

In microaerobic and anaerobic environments the principal glycolytic end-product of A. avenae and Caenorhabditis sp. was lactic acid during the first 12-16 hr, after which it was ethanol. Upon return to aerobiosis, (1)C-labeled ethanol in the medium was utilized by the nematodes; (1)CO and some (1)C-labeled glycogen was detected. Total dry weight loss of non-feeding nematodes was 25% greater in the absence of alcohol than in the presence of ethanol or n-propanol. Physical movement and respiration increased and reproduction was extended by alcohol in the bathing solution.