Long-term albumin infusion improves survival in patients with cirrhosis and ascites: An unblinded randomized trial

AIM： To investigate the effects of long-term albumin administration on survival, recurrence of ascites and onset of other complications. METHODS： One hundred consecutive patients admitted for first-onset ascites were randomized to receive diuretics plus human albumin 25 g/wk in the first year and 25 g every two wk thereafter （group 1） or diuretics alone （group 2）. The primary endpoint was survival without liver transplantation. Secondary endpoints were recurrence of ascites and occurrence of other complications. RESULTS： Median follow-up was 84 （2-120） mo. Albu- min-treated patients had significantly greater cumulative survival rate （Breslow test= 7.05, P= 0.0078） and lower probability of ascites recurrence （51% versus 94%, P〈0.0001）. Chronic albumin infusion resulted in a mean increase in survival of 16 mo. CONCLUSION： Long-term albumin administration after first-onset ascites significantly improves patients＇ survival and decreases the risk of ascites recurrence.

Long-term albumin infusion in decompensated cirrhosis:A review of current literature

Decompensated cirrhosis is characterized by chronic inflammation and severe portal hypertension leading to systemic circulatory dysfunction.Albumin infusion has been widely used in decompensated cirrhosis in patients with spontaneous bacterial peritonitis,large-volume paracentesis and hepatorenal syndrome.Emerging data suggest long-term albumin infusion has both oncotic and non-oncotic properties which may improve the clinical outcomes in decompensated cirrhosis patients.We review the current literature on both the established and potential role of albumin,and specifically address the controversies of long-term albumin infusion in decompensated cirrhosis patients.

Imperative for long-term management and surveillance in Kawasaki disease

Kawasaki disease(KD)is a significant pediatric vasculitis known for its potential to cause severe coronary artery complications.Despite the effectiveness of initial treatments,such as intravenous immunoglobulin,KD patients can experience long-term cardiovascular issues,as evidenced by a recent case report of an adult who suffered a ST-segment elevation myocardial infarction due to previous KD in the World Journal of Clinical Cases.This editorial emphasizes the critical need for long-term management and regular surveillance to prevent such complications.By drawing on recent research and case studies,we advocate for a structured approach to follow-up care that includes routine cardiac evaluations and preventive measures.

Post-operative albumin-bilirubin grade predicts long-term outcomes among Child–Pugh grade A patients with hepatocellular carcinoma after curative resection

Background: Although Child–Pugh grade A patients with hepatocellular carcinoma(HCC) are candidates for curative resection, some may have a poor prognosis. The albumin-bilirubin(ALBI) grade, a measure of liver function based on albumin and bilirubin, has the potential to detect Child–Pugh grade A HCC patients with poor prognosis. Because components of the ALBI grade can be measured easily even after surgery, we explored the predictive values of ALBI in patient prognosis after HCC resection. Methods: In this retrospective case-control study, we included 136 HCC patients who underwent curative resection between January 2004 and December 2013 at our hospital. ALBI grade was calculated from laboratory data recorded the day before surgery and at post-operative day 5. Results: Pre-and post-operative ALBI grade predicted patients’ long-term outcomes( P = 0.020 and P < 0.001, respectively, for overall survival, and P = 0.012 and P = 0.015, respectively, for recurrence-free survival). Post-operative ALBI grade was associated with patients’ surgical factors of repeated hepatic resection( P = 0.012), intra-operative bleeding( P = 0.006), and surgery duration( P = 0.033). Furthermore, post-operative ALBI grade, rather than pre-operative ALBI grade, was an independent predictive factor of long-term outcome of Child–Pugh grade A patients with HCC. Conclusions: Post-operative ALBI grade is useful to predict the prognosis in patients after HCC resection.

Clinical manifestations,diagnosis and long-term prognosis of adult autoimmune enteropathy:Experience from Peking Union Medical College Hospital

BACKGROUND Autoimmune enteropathy(AIE)is a rare disease whose diagnosis and long-term prognosis remain challenging,especially for adult AIE patients.AIM To improve overall understanding of this disease’s diagnosis and prognosis.METHODS We retrospectively analyzed the clinical,endoscopic and histopathological characteristics and prognoses of 16 adult AIE patients in our tertiary medical center between 2011 and 2023,whose diagnosis was based on the 2007 diagnostic criteria.RESULTS Diarrhea in AIE patients was characterized by secretory diarrhea.The common endoscopic manifestations were edema,villous blunting and mucosal hyperemia in the duodenum and ileum.Villous blunting(100%),deep crypt lymphocytic infiltration(67%),apoptotic bodies(50%),and mild intraepithelial lymphocytosis(69%)were observed in the duodenal biopsies.Moreover,there were other remarkable abnormalities,including reduced or absent goblet cells(duodenum 94%,ileum 62%),reduced or absent Paneth cells(duodenum 94%,ileum 69%)and neutrophil infiltration(duodenum 100%,ileum 69%).Our patients also fulfilled the 2018 diagnostic criteria but did not match the 2022 diagnostic criteria due to undetectable anti-enterocyte antibodies.All patients received glucocorticoid therapy as the initial medication,of which 14/16 patients achieved a clinical response in 5(IQR:3-20)days.Immunosuppressants were administered to 9 patients with indications of steroid dependence(6/9),steroid refractory status(2/9),or intensified maintenance medication(1/9).During the median of 20.5 months of followup,2 patients died from multiple organ failure,and 1 was diagnosed with non-Hodgkin’s lymphoma.The cumulative relapse-free survival rates were 62.5%,55.6%and 37.0%at 6 months,12 months and 48 months,respectively.CONCLUSION Certain histopathological findings,including a decrease or disappearance of goblet and Paneth cells in intestinal biopsies,might be potential diagnostic criteria for adult AIE.The long-term prognosis is still unsatisfactory despite corticosteroid and immunosuppressant medications,which highlights the need for early diagnosis and novel medications.

Development of a new Cox model for predicting long-term survival in hepatitis cirrhosis patients underwent transjugular intrahepatic portosystemic shunts

BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)placement is a procedure that can effectively treat complications of portal hypertension,such as variceal bleeding and refractory ascites.However,there have been no specific studies on predicting long-term survival after TIPS placement.AIM To establish a model to predict long-term survival in patients with hepatitis cirrhosis after TIPS.METHODS A retrospective analysis was conducted on a cohort of 224 patients who un-derwent TIPS implantation.Through univariate and multivariate Cox regression analyses,various factors were examined for their ability to predict survival at 6 years after TIPS.Consequently,a composite score was formulated,encompassing the indication,shunt reasonability,portal venous pressure gradient(PPG)after TIPS,percentage decrease in portal venous pressure(PVP),indocyanine green retention rate at 15 min(ICGR15)and total bilirubin(Tbil)level.Furthermore,the performance of the newly developed Cox(NDC)model was evaluated in an in-ternal validation cohort and compared with that of a series of existing models.RESULTS The indication(variceal bleeding or ascites),shunt reasonability(reasonable or unreasonable),ICGR15,post-operative PPG,percentage of PVP decrease and Tbil were found to be independent factors affecting long-term survival after TIPS placement.The NDC model incorporated these parameters and successfully identified patients at high risk,exhibiting a notably elevated mortality rate following the TIPS procedure,as observed in both the training and validation cohorts.Additionally,in terms of predicting the long-term survival rate,the performance of the NDC model was significantly better than that of the other four models[Child-Pugh,model for end-stage liver disease(MELD),MELD-sodium and the Freiburg index of post-TIPS survival].CONCLUSION The NDC model can accurately predict long-term survival after the TIPS procedure in patients with hepatitis cirrhosis,help identify high-risk patients and guide follow-up management after TIPS implantation.

Long-term outcomes after endoscopic removal of malignant colorectal polyps:Results from a 10-year cohort

BACKGROUND Choosing an optimal post-polypectomy management strategy of malignant colorectal polyps is challenging,and evidence regarding a surveillance-only strategy is limited.AIM To evaluate long-term outcomes after endoscopic removal of malignant colorectal polyps.METHODS A single-center retrospective cohort study was conducted to evaluate outcomes after endoscopic removal of malignant colorectal polyps between 2010 and 2020.Residual disease rate and nodal metastases after secondary surgery and local and distant recurrence rate for those with at least 1 year of follow-up were invest-igated.Event rates for categorical variables and means for continuous variables with 95%confidence intervals were calculated,and Fisher’s exact test and Mann-Whitney test were performed.Potential risk factors of adverse outcomes were RESULTS In total,135 lesions(mean size:22.1 mm;location:42%rectal)from 129 patients(mean age:67.7 years;56%male)were enrolled.The proportion of pedunculated and non-pedunculated lesions was similar,with en bloc resection in 82%and 47%of lesions,respectively.Tumor differentiation,distance from resection margins,depth of submucosal invasion,lymphovascular invasion,and budding were reported at 89.6%,45.2%,58.5%,31.9%,and 25.2%,respectively.Residual tumor was found in 10 patients,and nodal metastasis was found in 4 of 41 patients who underwent secondary surgical resection.Univariate analysis identified piecemeal resection as a risk factor for residual malignancy(odds ratio:1.74;P=0.042).At least 1 year of follow-up was available for 117 lesions from 111 patients(mean follow-up period:5.59 years).Overall,54%,30%,30%,11%,and 16%of patients presented at the 1-year,3-year,5-year,7-year,and 9-10-year surveillance examinations.Adverse outcomes occurred in 9.0%(local recurrence and dissemination in 4 patients and 9 patients,respectively),with no difference between patients undergoing secondary surgery and surveillance only.CONCLUSION Reporting of histological features and adherence to surveillance colonoscopy needs improvement.Long-term adverse outcome rates might be higher than previously reported,irrespective of whether secondary surgery was performed.

Epicatechin attenuates lead(Pb)-induced cognitive impairment in mice:regulation on Nrf2 signaling pathway,and interference on the interaction between Pb with albumin

Epicatechin(EC)was used in this study to antagonize the cognitive dysfunction caused by lead(Pb)exposure in mice.Eight-week-old male Kunming mice were treated with PbCl_(2)(20 mg/kg)and/or EC(50 mg/kg)by gavage administration for 4 weeks.Morris water maze test showed that EC could improve memory dysfunction induced by Pb.EC antagonized Ca^(2+)overload,activated Nrf2 signaling pathway and reduced the accumulation of Pb in the brain and serum,which suggested that EC might alter Pb distribution in mice.In vitro,spectroscopic analysis,potentiometric titration and docking studies were applied to inquiry into the interaction between bovine serum albumin(BSA)and Pb^(2+)in presence or absence of EC.EC was proved to chelate Pb^(2+)and reduced the interaction between BSA and Pb^(2+).In summary,EC might protect Pb-induced cognitive impairment by activating Nrf2 signaling pathway,and suppressing Pb accumulation via interference on the binding of Pb to albumin.

Tailoring Iron-Ion Release of Cellulose-Based Aerogel-Coated Iron Foam for Long-Term High-Power Microbial Fuel Cells

The presence of iron(Fe) has been found to favor power generation in microbial fuel cells(MFCs). To achieve long-term power production in MFCs, it is crucial to effectively tailor the release of Fe ions over extended operating periods. In this study, we developed a composite anode(A/IF) by coating iron foam with cellulose-based aerogel. The concentration of Fe ions in the anode solution of A/IF anode reaches 0.280 μg/mL(Fe^(2+) vs. Fe^(3+) = 61%:39%) after 720 h of aseptic primary cell operation. This value was significantly higher than that(0.198 μg/mL, Fe^(2+) vs. Fe^(3+) = 92%:8%) on uncoated iron foam(IF), indicating a continuous release of Fe ions over long-term operation. Notably, the resulting MFCs hybrid cell exhibited a 23% reduction in Fe ion concentration(compared to a 47% reduction for the IF anode) during the sixth testing cycle(600-720 h). It achieved a high-power density of 301 ± 55 mW/m^(2) at 720 h, which was 2.62 times higher than that of the IF anode during the same period. Furthermore, a sedimentary microbial fuel cell(SMFCs) was constructed in a marine environment, and the A/IF anode demonstrated a power density of 103 ± 3 mW/m^(2) at 3240 h, representing a 75% improvement over the IF anode. These findings elucidate the significant enhancement in long-term power production performance of MFCs achieved through effective tailoring of Fe ions release during operation.

Combining systemic inflammatory response index and albumin fibrinogen ratio to predict early serious complications and prognosis after resectable gastric cancer

BACKGROUND Gastric cancer has a high incidence and fatality rate,and surgery is the preferred course of treatment.Nonetheless,patient survival rates are still low,and the incidence of major postoperative complications cannot be disregarded.The systemic inflammatory response,nutritional level,and coagulation status are key factors affecting the postoperative recovery and prognosis of gastric cancer patients.The systemic inflammatory response index(SIRI)and the albumin fibrinogen ratio(AFR)are two valuable comprehensive indicators of the severity and prognosis of systemic inflammation in various medical conditions.AIM To assess the clinical importance and prognostic significance of the SIRI scores and the AFR on early postoperative outcomes in patients undergoing radical gastric cancer surgery.METHODS We conducted a retrospective analysis of the clinicopathological characteristics and relevant laboratory indices of 568 gastric cancer patients from January 2018 to December 2019.We calculated and compared two indicators of inflammation and then examined the diagnostic ability of combined SIRI and AFR values for serious early postoperative complications.We scored the patients and categorized them into three groups based on their SIRI and AFR levels.COX analysis was used to compare the three groups of patients the prognostic value of various preoperative SIRI-AFR scores for 5-year overall survival(OS)and disease-free survival(DFS).RESULTS SIRI-AFR scores were an independent risk factor for prognosis[OS:P=0.004;hazards ratio(HR)=3.134;DFS:P<0.001;HR=3.543]and had the highest diagnostic power(area under the curve:0.779;95%confidence interval:0.737-0.820)for early serious complications in patients with gastric cancer.The tumor-node-metastasis stage(P=0.001),perioperative transfusion(P=0.044),positive carcinoembryonic antigen(P=0.014)findings,and major postoperative complications(P=0.011)were factors associated with prognosis.CONCLUSION Preoperative SIRI and AFR values were significantly associated with early postoperative survival and the occurrence of severe complications in gastric cancer patients.

Combined preoperative albumin bilirubin score and hepatectomy percentage for evaluate the liver regeneration after partial hepatectomy

Surgical resection is a pivotal therapeutic approach for addressing hepatic space-occupying lesions,with liver volume restoration and hepatic functional recovery being crucial for assessing surgical prognosis.The preoperative albumin-bilirubin(ALBI)score,encompassing serum albumin and bilirubin levels,can be determined via blood analysis,effectively mitigating human error and providing an accurate depiction of liver function.The hepatectomy ratio,which is the proportion of the liver volume removed to the total liver volume,is critical in preserving an adequate liver tissue volume to ensure postoperative hepatic functional compensation,minimize surgical complications,and reduce mortality rates.Incorporating the preoperative ALBI score and hepatectomy ratio aids surgeons in assessing the optimal timing and extent of partial hepatectomy.The introduction of preoperative albumin bilirubin score and hepatectomy percentage is beneficial for the surgeons to evaluate the timing and magnitude of partial liver resection.

Long-Term Performance and Microstructural Characterization of Dam Concrete in the Three Gorges Project

This study investigates the long-term performance of laboratory dam concrete in different curing environments over ten years and the microstructure of 17-year-old laboratory concrete and actual concrete cores drilled from the Three Gorges Dam.The mechanical properties of the laboratory dam concrete,whether cured in natural or standard environments,continued to improve over time.Furthermore,the laboratory dam concrete exhibited good resistance to diffusion and a refined microstructure after 17 years.However,curing and long-term exposure to the local natural environment reduced the frost resistance.Microstructural analyses of the laboratory concrete samples demonstrated that moderate-heat cement and fine fly ash(FA)particles were almost fully hydrated to form compact micro structures consisting of large quantities of homogeneous calcium(alumino)silicate hydrate(C-(A)-S-H)gels and a few crystals.No obvious interfacial transition zones were observed in the microstructure owing to the longterm pozzolanic reaction.This dense and homogenous microstructure was the crucial reason for the excellent long-term performance of the dam concrete.A high FA volume also played a significant role in the microstructural densification and performance growth of dam concrete at a later age.The concrete drilled from the dam surface exhibited a loose microstructure with higher microporosity,indicating that concrete directly exposed to the actual service environment suffered degradation caused by water and wind attacks.In this study,both macro-performance and microstructural analyses revealed that the application of moderate-heat cement and FA resulted in a dense and homogenous microstructure,which ensured the excellent long-term performance of concrete from the Three Gorges Dam after 17 years.Long-term exposure to an actual service environment may lead to microstructural degradation of the concrete surface.Therefore,the retained long-term dam concrete samples need to be further researched to better understand its microstructural evolution and development of its properties.

Red cell distribution width-to-albumin ratio is a simple promising prognostic marker in acute cholangitis requiring biliary drainage

Background: It is crucial to assess the severity of acute cholangitis(AC). There are currently several prognostic markers. However, the accuracies of these markers are not satisfied. The present study aimed to investigate the predictive value of the red cell distribution width(RDW)-to-albumin ratio(RAR) for the prognosis of AC. Methods: We retrospectively evaluated consecutive patients diagnosed with AC between May 2019 and March 2022. RAR was calculated, and its predictive ability for in-hospital mortality, intensive care unit(ICU) admission, bacteremia, and the length of hospitalization were analyzed. Results: Out of 438 patients, 34(7.8%) died. Multivariate analysis showed that malignant etiology [odds ratio(OR) = 4.816, 95% confidence interval(CI): 1.936-11.980], creatinine(OR = 1.649, 95% CI: 1.095-2.484), and RAR(OR = 2.064, 95% CI: 1.494-2.851) were independent risk factors for mortality. When adjusted for relevant covariates, including age, sex, malignant etiology, Tokyo severity grading(TSG), Charlson comorbidity index, and creatinine, RAR significantly predicted mortality(adjusted OR = 1.833, 95% CI: 1.280-2.624). When the cut-off of RAR was set to 3.8, its sensitivity and specificity for mortality were 94.1% and 56.7%, respectively. Patients with an RAR of > 3.8 had a 20.9-fold(OR = 20.9, 95% CI: 4.9-88.6) greater risk of mortality than the remaining patients. The area under the curve value of RAR for mortality was 0.835(95% CI: 0.770-0.901), which was significantly higher than that of TSG and the other prognostic markers, such as C-reactive protein-to-albumin ratio, and procalcitonin-to-albumin ratio. Lastly, RAR was not inferior to TSG in predicting ICU admission, bacteremia, and the length of hospitalization. Conclusions: RAR successfully predicted the in-hospital mortality, ICU admission, bacteremia, and the length of hospitalization of patients with AC, especially in-hospital mortality. RAR is a promising marker that is more convenient than TSG and other prognostic markers for predicting the prognosis of patients with AC.

Soil bacterial and fungal communities resilience to long-term nitrogen addition in subtropical forests in China

Atmospheric nitrogen(N)deposition is predicted to increase,especially in the subtropics.However,the responses of soil microorganisms to long-term N addition at the molecular level in N-rich subtropical forests have not been clarified.A long-term nutrient addition experiment was conducted in a subtropical evergreen old-growth forest in China.The four treatments were:control,low N(50 kg N ha^(-1)a^(-1)),high N(100 kg N ha^(-1)a^(-1)),and combined N and phosphorus(P)(100 kg N ha^(-1)a^(-1)+50 kg P ha^(-1)a^(-1)).Metagenomic sequencing characterized diversity and composition of soil microbial communities and used to construct bacterial/fungal co-occurrence networks.Nutrient-treated soils were more acidic and had higher levels of dissolved organic carbon than controls.There were no significant differences in microbial diversity and community composition across treatments.The addition of nutrients increased the abundance of copiotrophic bacteria and potentially beneficial microorganisms(e.g.,Gemmatimonadetes,Chaetomium,and Aureobasidium).Low N addition increased microbiome network connectivity.Three rare fungi were identified as module hubs under nutrient addition,indicating that low abundance fungi were more sensitive to increased nutrients.The results indicate that the overall composition of microbial communities was stable but not static to long-term N addition.Our findings provide new insights that can aid predictions of the response of soil microbial communities to long-term N addition.

Long-term thinning decreases the contribution of heterotrophic respiration to soil respiration in subalpine plantations

Interest in the dynamics of soil respiration(R_(S))in subalpine forest ecosystems is increasing due to their high soil carbon density and potential sensitivity to environmental changes.However,as a principal silvicultural practice,the long-term impacts of thinning on R_(S) and its heterotrophic and autotrophic respiration components(R_(h) and Ra,respectively)in subalpine plantations are poorly understood,espe-cially in winter.A 3-year field observation was carried out with consideration of winter CO_(2) efflux in middle-aged sub-alpine spruce plantations in northwestern China.A trench-ing method was used to explore the long-term impacts of thinning on Rs,Rn and R_(a).Seventeen years after thinning,mean annual Rs,Rn and R_(a) increased,while the contribu-tion of R_(h) to R_(s) decreased with thinning intensity.Thinning significantly decreased winter R,because of the reduction in R_(n) but had no significant effect on Ra.The temperature sensitivity(Q_(10))of R_(h) and R_(a) also increased with thinning intensity,with lower Q_(10) values for R_(h)(2.1-2.6)than for Ra(2.4-2.8).The results revealed the explanatory variables and pathways related to R_(n) and R_(a) dynamics.Thinning increased soil moisture and nitrate nitrogen(NO_(3)^(-)-N),and the enhanced nitrogen and water availability promoted R_(h) and R_(a) by improving fine root biomass and microbial activity.Our results highlight the positive roles of NO_(3)^(-)-N in stimulating R_(s) components following long-term thinning.Therefore,applications of nitrogen fertilizer are not recommended while thinning subalpine spruce plantations from the perspective of reducing soil CO_(2) emissions.The increased Q_(10) values of R_(s) components indicate that a large increase in soil CO_(2) emissions would be expected following thinning because of more pronounced climate warming in alpineregions.

A data and physical model dual-driven based trajectory estimator for long-term navigation

Long-term navigation ability based on consumer-level wearable inertial sensors plays an essential role towards various emerging fields, for instance, smart healthcare, emergency rescue, soldier positioning et al. The performance of existing long-term navigation algorithm is limited by the cumulative error of inertial sensors, disturbed local magnetic field, and complex motion modes of the pedestrian. This paper develops a robust data and physical model dual-driven based trajectory estimation(DPDD-TE) framework, which can be applied for long-term navigation tasks. A Bi-directional Long Short-Term Memory(Bi-LSTM) based quasi-static magnetic field(QSMF) detection algorithm is developed for extracting useful magnetic observation for heading calibration, and another Bi-LSTM is adopted for walking speed estimation by considering hybrid human motion information under a specific time period. In addition, a data and physical model dual-driven based multi-source fusion model is proposed to integrate basic INS mechanization and multi-level constraint and observations for maintaining accuracy under long-term navigation tasks, and enhanced by the magnetic and trajectory features assisted loop detection algorithm. Real-world experiments indicate that the proposed DPDD-TE outperforms than existing algorithms, and final estimated heading and positioning accuracy indexes reaches 5° and less than 2 m under the time period of 30 min, respectively.

RuO_(2)/CoMO_(2)O_(x) Catalyst with Low Ruthenium Loading for Long-Term Acidic Oxygen Evolution

We must urgently synthesize highly efficient and stable oxygen-evolution reaction(OER) catalysts for acidic media. Herein, we constructed a series of Ti mesh(TM)-supported RuO_(2)/CoMo_(y)O_(x) catalysts(RuO_(2)/CoMo_(y)O_(x)/TM) with heterogeneous structures. By optimizing the ratio of Co to Mo, RuO_(2)/CoMO_(2)O_(x)/TM with low Ru loading(0.079 mg/cm^(2)) achieves remarkable OER performance(η = 243 mV at 10 mA/cm^(2)) and high stability(300 h @ 10 mA/cm^(2)) in 0.5 mol/L H_(2)SO_(4) electrolyte. The activity of RuO_(2)/CoMo_yO_x/TM can be maintained for 50 h at 100 mA/cm^(2), and a water electrolyzer with RuO_(2)/CoMO_(2)O_(x)/TM as anode can operate for 40 h at 100 mA/cm~2, suggesting the remarkable OER durability of RuO_(2)/CoMo__(y)O__(x)/TM in acidic electrolyte. Owing to the heterogeneous interface between CoMO_(2)O_(x) and RuO_(2), the electronic structure of Ru atoms was optimized and electron-rich Ru was formed. With modulated electronic properties, the dissociation energy of H_(2)O is weakened, and the OER barrier is lowered. This study provides the design of low-cost noble metal catalysts with long-term stability in an acidic environment.

Circulating glycated albumin levels and gestational diabetes mellitus

BACKGROUND Gestational diabetes mellitus(GDM)is characterized by glucose intolerance that is first diagnosed during pregnancy,making it the most common complication associated with this period.Early detection and targeted treatment of GDM can minimize foetal exposure to maternal hyperglycaemia and subsequently reduce the associated adverse pregnancy outcomes.Previous studies have inconsistently suggested that the level of glycated albumin(GA)might predict GDM.AIM To review and synthesize existing evidence to evaluate the relationship between GA levels and the development of GDM.METHODS We sought to compare GA levels between GDM and control groups in this metaanalysis by systematically searching the Web of Science,PubMed,Cochrane Library,and Embase databases for articles published up to June 2023.The analysis utilized the weighted mean difference(WMD)as the primary metric.The data were meticulously extracted,and the quality of the included studies was assessed.Additionally,we conducted a subgroup analysis based on study region and sample size.We assessed heterogeneity using I2 statistics and evaluated publication bias through funnel plots.Additionally,trim-and-fill analysis was employed to detect and address any potential publication bias.RESULTS The meta-analysis included a total of 11 studies involving 5477 participants,comprising 1900 patients with GDM and 3577 control individuals.The synthesized results revealed a notable correlation between elevated GA levels and increased susceptibility to GDM.The calculated WMD was 0.42,with a 95%confidence interval(95%CI)ranging from 0.11 to 0.74,yielding a P value less than 0.001.Concerning specific GA levels,the mean GA level in the GDM group was 12.6,while for the control group,it was lower,at 11.6.This discrepancy underscores the potential of GA as a biomarker for assessing GDM risk.Moreover,we explored the levels of glycated haemoglobin(HbA1c)in both cohorts.The WMD for HbA1c was 0.19,with a 95%CI ranging from 0.15 to 0.22 and a P value less than 0.001.This observation suggested that both GA and HbA1c levels were elevated in individuals in the GDM group compared to those in the control group.CONCLUSION Our meta-analysis revealed a substantial correlation between elevated GA levels and increased GDM risk.Furthermore,our findings revealed elevated levels of HbA1c in GDM patients,emphasizing the significance of monitoring both GA and HbA1c levels for early GDM detection and effective management.

Preoperative Serum Albumin Levels and Postoperative Acute Kidney Injury in Off-Pump Coronary Artery Bypass Surgery: A Single-Center Study in Bangladesh

Background: Serum albumin, a vital plasma protein, helps maintain intravascular colloidal osmotic pressure, cardiac output, and renal function. Low preoperative serum albumin is linked to poor outcomes, including acute kidney injury (AKI), after off-pump coronary artery bypass (OPCAB) surgery. This study aimed to assess the relationship between preoperative serum albumin levels and early postoperative renal injury. Methods: This prospective comparative cross-sectional study was conducted from August 2019 to February 2021 at the National Heart Foundation Hospital & Research Institute, Bangladesh. It included 160 adult patients with normal preoperative renal function undergoing OPCAB. Patients were divided into two groups: Group A (serum albumin ≥ 4.0 gm/dl) and Group B (serum albumin Results: Preoperative serum albumin was significantly different between groups (Group A: 4.21 ± 0.05 gm/dl, Group B: 3.69 ± 0.04 gm/dl, p = 0.028). Group B had a higher incidence of hypertension (71.25% vs. 51.25%, p st and 3rd postoperative days were higher in Group B (p th day. Postoperative AKI occurred in 18.75% of Group A and 36.25% of Group B. Multivariate regression indicated that low preoperative serum albumin is an independent risk factor for postoperative AKI (p = 0.012, OR = 1.815, CI: 0.675 - 1.162). Conclusion: Preoperative serum albumin level is a valuable predictor of postoperative renal function. Ensuring high normal serum albumin levels before surgery can help minimize the risk of postoperative AKI.

Optimism,Social Support,and Caregiving Burden among the Long-Term Caregivers:The Mediating Effect of Psychological Resilience

Background:As the elderly population grows,the demand for long-term care services is increasing.Despite significant investments in care quality and workforce training,long-term care workers often face challenges such as work fatigue,heavy workloads,and inadequate support.These issues can impact job satisfaction,mental health,and care quality,leading to staff turnover.This study examines how optimism,social support,and psychological resilience relate to caregiving burden,aiming to understand their effects on caregivers’well-being and performance to enhance the quality of long-term care services.Methods:The participants were 542 long-term care workers.Descriptive statistics,t-tests,one-way ANOVA,and hierarchical regression were used for data analysis.Results:(1)Optimism and social support were significantly and positively correlated with psychological resilience and significantly and negatively associated with caregiving burden.(2)Regarding differences in optimism,social support,psychological resilience,and caregiving burden among long-term care workers,females scored significantly higher than males in“social support;”married workers scored significantly higher than unmarried workers in“optimism,”“social support,”and“psychological resilience”;workers aged 45–65 scored significantly higher than those aged 25–45 in“optimism”;workers aged 25–45 scored significantly higher than those aged 45–65 in“caregiving burden”;social workers scored significantly higher than nursing staff in“optimism.”(3)Psychological resilience partially mediated the relationship between social support and caregiving burden concerning explanatory and predictive power.Conclusions:These findings suggest that optimism,social support,and psychological resilience are essential factors in reducing the caregiving burden among long-term care workers.The study highlights the importance of promoting psychological resilience and providing social support to alleviate the burden of caregiving.