Background: Early identification of diabetic foot infection (DFI) patients at risk for clinical deterioration is critical for timely intervention. Serum lactate reflects tissue hypoperfusion, whereas hypoalbuminemia indicates systemic inflammation and poor nutritional status. Thus, the aim of this study was to evaluate the ability of the lactate-to-albumin ratio (LAR) to predict ICU admission. Methods: This retrospective study was conducted in the emergency department of a tertiary care center between [start date] and [end date]. Adult patients (≥ 18 years) with confirmed DFI and available admission lactate and albumin measurements were included. Patients with chronic liver failure, nephrotic syndrome, pregnancy, or incomplete records were excluded. Demographics, comorbidities, vital signs, and laboratory data were retrieved from electronic records. LAR was calculated as lactate (mmol/L) divided by albumin (g/dL). The primary outcome was intensive care unit (ICU) admission. Receiver operating characteristic (ROC) analyses assessed the predictive performance of LAR compared with lactate and albumin. Independent predictors of ICU admission were identified using multivariable logistic regression. Results: Among 494 patients (median age, 64 years; 40.3% female), 91 (18.4%) required ICU admission. ICU patients had higher lactate (2.5 vs. 1.8 mmol/L, P <.001), lower albumin (3.2 vs. 3.4 g/dL, P <.001), and higher LAR (0.8 vs. 0.5, P <.001). LAR demonstrated the best discrimination for ICU admission (area under the curve [AUC], 0.717; 95% CI, 0.658–0.777), outperforming albumin (AUC, 0.626; P = .009) and similar to lactate (AUC, 0.702; P = .134). A cut-off of ≥ 0.73 yielded 57.1% sensitivity and 78.2% specificity. LAR (odds ratio [OR], 1.36; 95% CI, 1.16–1.58; P <.001), older age, lower mean arterial pressure, and lower ankle–brachial index were independent predictors of ICU admission. Conclusions: The lactate-to-albumin ratio is a simple, cost-effective biomarker that independently predicts ICU admission in DFI patients and may aid early risk stratification.
OBJECTIVE:Accurate estimation of left ventricular ejection fraction (LVEF) after ST-segment elevation myocardial infarction (STEMI) is essential for optimizing long-term management and cardiovascular risk stratification. This study aimed to identify predictors of LVEF at six months after STEMI and to develop a clinically applicable nomogram for individualized prognostic assessment. METHOD:This prospective, single-center cohort study included consecutive patients admitted with STEMI between July 2018 and October 2018. Baseline clinical, laboratory, and angiographic variables were collected. LVEF was assessed by transthoracic echocardiography during the index hospitalization and at six-month follow-up. Patients were categorized into four groups according to follow-up LVEF. Predictors of six-month LVEF were identified using proportional odds logistic regression, and a nomogram was constructed based on the final multivariable model. RESULTS:A total of 231 patients were analyzed (median age: 57 years; 83% male). At baseline, 119 patients (51%) had an LVEF < 50%, whereas at six months 115 patients (49%) had an LVEF < 50%. Multivariable analysis identified baseline LVEF, peak creatine kinase-myocardial band (CKMB) level, age, hypertension, and final Thrombolysis in Myocardial Infarction (TIMI) flow grade as independent predictors of follow-up LVEF (all P < 0.05). CONCLUSION:Baseline LVEF and peak CK-MB level were the strongest independent predictors of six-month LVEF following STEMI. Age, hypertension, and final TIMI flow grade were identified as additional predictors. The proposed nomogram provides a practical tool for individualized follow-up planning and risk assessment in STEMI survivors.
Metabolic and bariatric surgery (MBS) is the most effective intervention for severe obesity and its metabolic complications, including dyslipidemia. Although several surgical techniques are available, evidence regarding their differential effects on lipid profiles remains inconsistent. To compare the effects of sleeve gastrectomy (SG), primary Roux-en-Y gastric bypass (RYGB), and revisional RYGB (R-RYGB) on postoperative lipid profiles during the first year after surgery. This retrospective cohort study included 200 patients with severe obesity who underwent SG (n = 120), RYGB (n = 38), or R-RYGB (n = 42) between 2019 and 2023. Demographic characteristics, BMI, and lipid parameters [total cholesterol (TC), triglycerides (TG), LDL-C, and high-density lipoprotein cholesterol] were assessed at baseline, 6 months, and 12 months. Between-group comparisons were performed using the Kruskal–Wallis test, and within-group changes were analyzed using mixed-effects and Δ-change models. All three surgical groups achieved significant reductions in BMI, TC, TG, and LDL-C, along with increases in HDL-C at 6 and 12 months (all p < 0.001 within groups). Between-group analyses revealed no statistically significant differences in lipid improvements, although patients who underwent SG showed numerically greater HDL elevation and TG reduction. Δ-change analysis confirmed that lipid improvements were comparable across the SG, RYGB, and R-RYGB groups, whereas BMI reduction at 12 months was slightly greater in the SG group (p = 0.010). SG, RYGB, and R-RYGB each produced substantial and clinically relevant improvements in dyslipidemia during the first postoperative year, with no evidence of superiority among the techniques. For people with obesity and dyslipidemia, the decisive factor is the performance of metabolic and bariatric surgery rather than the choice of procedure. All approaches confer meaningful reductions in atherogenic lipids and improvements in cardioprotective parameters, thereby contributing to long-term cardiovascular risk reduction.
AIMS:Fragmented QRS (fQRS) is an electrocardiographic marker of myocardial injury associated with adverse outcomes in acute coronary syndromes. This study aimed to examine its prognostic value within the acute coronary occlusion myocardial infarction (ACOMI) classification framework. METHODS:We retrospectively analyzed 996 patients with Type 1a or Type 1b ACOMI-compatible ECGs. The primary endpoint was all-cause mortality. A prespecified multivariable Cox regression model with 10 covariates was used. Model discrimination was assessed using the area under the ROC curve (AUC). RESULTS:fQRS was present in 237 patients (23.7%). During a median follow-up of 618 days (IQR: 398-725 days), 127 deaths occurred (12.6%). Kaplan-Meier analysis showed significantly lower survival in fQRS-positive patients (79.3% vs. 89.7%; P < 0.001). On multivariable Cox regression, fQRS was an independent predictor of mortality [hazard ratio (HR): 1.702; 95% confidence interval (CI) 1.050-2.760; P = 0.032], alongside the GRACE risk score (HR: 1.021; P < 0.001) and left ventricular ejection fraction (HR: 0.955; P < 0.001). fQRS improved model discrimination (AUC: 0.784-0.800; ΔAUC = +0.016). In the Type 1a subgroup, a signal toward increased fQRS-associated mortality was observed (HR: 1.662; P = 0.056), though this did not reach statistical significance. The fQRS × ECG type interaction was nonsignificant (P-interaction = 0.733); subgroup findings should be regarded as hypothesis-generating. CONCLUSION:fQRS on admission ECG is independently associated with all-cause mortality in ACOMI patients and may serve as a simple adjunctive marker for risk stratification, though prospective validation is needed.
Parathyroid allotransplantation is a promising treatment for hypoparathyroidism, yet immune rejection and fibrosis remain significant barriers. This study evaluates a novel immunoprotective culture system utilizing a moderate-intensity static magnetic field (SMF) to modulate lymphocyte migration without compromising graft functionality. Human parathyroid cells were encapsulated and divided into 10 experimental groups, co-cultured with Jurkat T-lymphocytes, and either exposed to SMF or maintained as controls. Over 72 h, we analyzed parathormone (PTH) secretion, cell viability (via proliferation assays), and molecular expression patterns of key markers (VitDR, PTH, GCM2, and CaSR). Lymphocyte dynamics were monitored through comparative imaging and cytokine profiling (IL-1α, IL-1β, and IL-2). SMF exposure significantly altered Jurkat cell behavior; while lymphocytes in unexposed groups aggregated around microcapsules, they were effectively repelled and migrated away from the graft interface under SMF exposure. Crucially, this biophysical manipulation was safe: no significant differences in PTH secretion or viability were observed across groups. All groups maintained essential genetic markers. Our findings demonstrate that SMF exposure induces lymphocyte migration away from the capsule without compromising parathyroid cell characteristics or functionality. Integrating encapsulation with SMF represents a novel, non-pharmacological, non-invasive immunoprotective strategy for parathyroid allotransplantation, offering a technological alternative to systemic immunosuppression.
