Objective: A low albumin concentration is known to be associated with poor prognosis in patients with sepsis, but the benefits of albumin administration in these patients are unclear. This study was performed to investigate the effect of albumin administration on the outcomes of patients suffering from sepsis or septic shock. Methods: This was a retrospective, propensity score-matched cohort study of septic patients with an initial serum albumin level < 3.0 g/dL admitted to the emergency department (ED) of an urban tertiary university hospital. Patients who received 20% albumin within 24 hours of admission to the ED were compared with those who did not. We performed a 1:1 propensity score-matched analysis. The primary outcome was the 28-day mortality rate and the secondary outcomes were the Sequential Organ Failure Assessment (SOFA) score at 24, 48, and 72 hours, the need for mechanical ventilation and renal replacement therapy (RRT), and admission to the intensive care unit (ICU). Results: A total of 1,284 patients were included in the study, and the overall mortality rate was 29.4%. After propensity score matching, 192 patients in the albumin group and 192 in the control group were included in the final analysis. There was no significant difference in the 28-day mortality rates. The SOFA scores at 24, 48, and 72 hours were higher in the albumin group than in the control group. The rates of RRT and admission to the ICU were also higher in the albumin group. Conclusion In patients with sepsis and hypoalbuminemia, albumin replacement was not associated with higher 28-day mortality, but was associated with the higher SOFA scores, higher rates of RRT application and admission to the ICU.

Objective: This study sought to investigate the association between plasma cell-free hemoglobin (pHb) and mortality in sepsis or septic shock. Methods: We performed a retrospective analysis of the prospective collected data of patients with sepsis or septic shock. Patients were divided into 4 groups according to their pHb concentrations using a restricted cubic spline: group I (pHb ≤20 mg/dL), group II (20 < pHb ≤40 mg/dL), group III (40 < pHb ≤60 mg/dL), and group IV (pHb >60 mg/dL). The primary outcome was the 28-day mortality, and a multivariate Cox proportional hazard regression method was used for analysis. Results: A total of 372 patients were included in the analysis and the overall 28-day mortality rate was 16.7%. The median pHb concentration of the patients was 24.8 mg/dL (reference range, 0-5). The mortality rate did not increase in proportion to the pHb concentrations and was the lowest in group II (20.3%, 11.0%, 16.3%, and 26.7% in groups I, II, III, and IV, respectively). In the Cox proportional hazard regression analysis, group I was independently associated with 28-day mortality compared with group II (hazard ratio, 2.19; 95% confidence interval, 1.18-4.07). Group IV had a higher mortality rate compared to group II, but it was not statistically significant (hazard ratio, 2.17; 95% confidence interval, 0.85-5.56). Conclusion A low concentration of pHb (pHb ≤20 mg/dL) was associated with 28-day mortality in patients with sepsis or septic shock.

Longitudinal imaging of murine pancreas is technically challenging due to the mechanical softness of the tissue influenced by peristalsis. Here, we report a novel pancreatic imaging window for long-term stabilized cellular-level observation of the islets in the pancreas in vivo. By spatially separating the pancreas from the bowel movement and physiologic respiration with a metal plate integrated in the imaging window, we successfully tracked the pancreatic islets up to three weeks and visualized the dumbbell-shape transformation from the single islet. This window can be a useful tool for long-term cellular-level visualization of the microstructure in the pancreas.

PURPOSE: The association of serum albumin concentration on hospital arrival with long-term mortality in survivors from out-of-hospital cardiac arrest (OHCA) was investigated. METHODS: A retrospective analysis was conducted of patients presumed to have cardiac cause of arrest and achieved sustained return of spontaneous circulation (ROSC) from prospective OHCA. The individual medical records were reviewed for data, including initial serum albumin. The primary outcome was survival at 6 months and the secondary outcome was Cerebral Performance Category (CPC) at 6 months. Differences in variables between survivors and non-survivors at 6 months after cardiac arrest were analyzed. Albumin was categorized into tertiles of <2.9 g/dL, 2.9 to 3.7 g/dL, and >3.7 g/dL. Hazard ratios (HRs) were estimated using Cox-proportional hazard models in both univariate and multivariate analysis. All prognostic variables with p value<0.1 in univariate analysis were used in multivariate analysis for adjustment. Receiver operating curve (ROC) analysis was performed to evaluate the discriminative power of albumin. RESULTS: In a total of 547 OHCA patients, 136 patients had a presumed cardiac cause of arrest and sustained ROSC with available initial serum albumin. The survival rate at 6 months was significantly higher in patients in the higher albumin group and neurological outcomes were also more favorable in the higher albumin group (log rank test, p<0.05). In a Cox proportional hazard regression analysis, initial serum lactate and albumin levels were independently associated with 6-month mortality and albumin levels showed moderate discriminative power for 6-month mortality by ROC analysis (AUC=0.738, 95% CI: 0.652-0.825). CONCLUSION: Serum albumin is associated with long-term mortality and neurological outcome in patients with presumed cardiac cause of arrest and sustained ROSC from OHCA.
Heart Arrest ; Humans ; Lactic Acid ; Medical Records ; Mortality* ; Multivariate Analysis ; Out-of-Hospital Cardiac Arrest* ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; Retrospective Studies ; ROC Curve ; Serum Albumin* ; Survival Rate ; Survivors

PURPOSE: The association of serum albumin concentration on hospital arrival with long-term mortality in survivors from out-of-hospital cardiac arrest (OHCA) was investigated. METHODS: A retrospective analysis was conducted of patients presumed to have cardiac cause of arrest and achieved sustained return of spontaneous circulation (ROSC) from prospective OHCA. The individual medical records were reviewed for data, including initial serum albumin. The primary outcome was survival at 6 months and the secondary outcome was Cerebral Performance Category (CPC) at 6 months. Differences in variables between survivors and non-survivors at 6 months after cardiac arrest were analyzed. Albumin was categorized into tertiles of <2.9 g/dL, 2.9 to 3.7 g/dL, and >3.7 g/dL. Hazard ratios (HRs) were estimated using Cox-proportional hazard models in both univariate and multivariate analysis. All prognostic variables with p value<0.1 in univariate analysis were used in multivariate analysis for adjustment. Receiver operating curve (ROC) analysis was performed to evaluate the discriminative power of albumin. RESULTS: In a total of 547 OHCA patients, 136 patients had a presumed cardiac cause of arrest and sustained ROSC with available initial serum albumin. The survival rate at 6 months was significantly higher in patients in the higher albumin group and neurological outcomes were also more favorable in the higher albumin group (log rank test, p<0.05). In a Cox proportional hazard regression analysis, initial serum lactate and albumin levels were independently associated with 6-month mortality and albumin levels showed moderate discriminative power for 6-month mortality by ROC analysis (AUC=0.738, 95% CI: 0.652-0.825). CONCLUSION: Serum albumin is associated with long-term mortality and neurological outcome in patients with presumed cardiac cause of arrest and sustained ROSC from OHCA.
Heart Arrest ; Humans ; Lactic Acid ; Medical Records ; Mortality* ; Multivariate Analysis ; Out-of-Hospital Cardiac Arrest* ; Prognosis ; Proportional Hazards Models ; Prospective Studies ; Retrospective Studies ; ROC Curve ; Serum Albumin* ; Survival Rate ; Survivors

Objective: Although fluid resuscitation is the cornerstone of treatment for sepsis, the role of body water status in sepsis is poorly understood. This study aimed to understand how body water and its distribution are modified in patients with sepsis and those with non-septic infection compared to healthy individuals. Methods: Two groups of adults presumed to have non-septic infection (n=87) and sepsis (n=54) were enrolled in this prospective study in a single emergency department, and they were compared to sex-, age-, and height-matched (1:3 ratio) healthy controls (n=11,190) from retrospective data in a health promotion center. Total body water (TBW), intracellular water (ICW), and extracellular water (ECW), determined using direct segmental multi-frequent bioelectrical impedance analysis (InBody S10) were expressed as indices for normalization by body weight (BW). The ratio of ECW to TBW (ECW/TBW) was evaluated to determine body water distribution. Results: TBW/BW, ICW/BW, and ECW/BW were significantly higher in the non-septic infection group than in the healthy group (P<0.001), but ECW/TBW was not significantly different (P=0.690). There were no differences in TBW/BW and ICW/BW between the sepsis and healthy groups (P=0.083 and P=0.963). However, ECW/BW and ECW/TBW were significantly higher in the sepsis group than in the healthy group (P<0.001). Conclusion Compared to the healthy group, the ratio of body water to BW was significantly increased in the non-septic infection group, while ECW/BW and ECW/TBW were significantly increased in the sepsis group. These indices could be utilized as diagnostic variables of body water deficit in septic patients.

Objective: Although fluid resuscitation is the cornerstone of treatment for sepsis, the role of body water status in sepsis is poorly understood. This study aimed to understand how body water and its distribution are modified in patients with sepsis and those with non-septic infection compared to healthy individuals. Methods: Two groups of adults presumed to have non-septic infection (n=87) and sepsis (n=54) were enrolled in this prospective study in a single emergency department, and they were compared to sex-, age-, and height-matched (1:3 ratio) healthy controls (n=11,190) from retrospective data in a health promotion center. Total body water (TBW), intracellular water (ICW), and extracellular water (ECW), determined using direct segmental multi-frequent bioelectrical impedance analysis (InBody S10) were expressed as indices for normalization by body weight (BW). The ratio of ECW to TBW (ECW/TBW) was evaluated to determine body water distribution. Results: TBW/BW, ICW/BW, and ECW/BW were significantly higher in the non-septic infection group than in the healthy group (P<0.001), but ECW/TBW was not significantly different (P=0.690). There were no differences in TBW/BW and ICW/BW between the sepsis and healthy groups (P=0.083 and P=0.963). However, ECW/BW and ECW/TBW were significantly higher in the sepsis group than in the healthy group (P<0.001). Conclusion Compared to the healthy group, the ratio of body water to BW was significantly increased in the non-septic infection group, while ECW/BW and ECW/TBW were significantly increased in the sepsis group. These indices could be utilized as diagnostic variables of body water deficit in septic patients.

Background: Hyperkalemia is a potentially fatal condition that mandates rapid identification in emergency departments (EDs). Although a 12-lead electrocardiogram (ECG) can indicate hyperkalemia, subtle changes in the ECG often pose detection challenges. An artificial intelligence application that accurately assesses hyperkalemia risk from ECGs could revolutionize patient screening and treatment. We aimed to evaluate the efficacy and reliability of a smartphone application, which utilizes camera-captured ECG images, in quantifying hyperkalemia risk compared to human experts. Methods: We performed a retrospective analysis of ED hyperkalemic patients (serum potassium ≥ 6 mmol/L) and their age- and sex-matched non-hyperkalemic controls. The application was tested by five users and its performance was compared to five board-certified emergency physicians (EPs). Results: Our study included 125 patients. The area under the curve (AUC)-receiver operating characteristic of the application’s output was nearly identical among the users, ranging from 0.898 to 0.904 (median: 0.902), indicating almost perfect interrater agreement (Fleiss’ kappa 0.948). The application demonstrated high sensitivity (0.797), specificity (0.934), negative predictive value (NPV) (0.815), and positive predictive value (PPV) (0.927). In contrast, the EPs showed moderate interrater agreement (Fleiss’ kappa 0.551), and their consensus score had a significantly lower AUC of 0.662. The physicians’ consensus demonstrated a sensitivity of 0.203, specificity of 0.934, NPV of 0.527, and PPV of 0.765. Notably, this performance difference remained significant regardless of patients’ sex and age (P < 0.001 for both). Conclusion Our findings suggest that a smartphone application can accurately and reliably quantify hyperkalemia risk using initial ECGs in the ED.

Immunoreactive dynamics of tumor-infiltrating lymphocytes (TILs) within the tumor microenvironment in breast cancer are not well understood. This study aimed to investigate the spatiotemporal cellular dynamics of TILs in breast cancer models. Breast cancer cells were implanted into the dorsal skinfold chamber of BALB/c nude mice, and T lymphocytes were adoptively transferred. Longitudinal intravital imaging was performed, and the spatiotemporal dynamics of TILs were assessed. In the 4T1 model, TILs progressively exhibited increased motility, and their motility inside the tumor was significantly higher than that outside the tumor. In the MDA-MB-231 model, the motility of TILs progressively decreased after an initial increase. TIL motility in the MDA-MB-231 and MCF-7 models differed significantly, suggesting an association between programmed death-ligand 1 expression levels and TIL motility, which warrants further investigation. Furthermore, intravital imaging of TILs can be a useful method for addressing dynamic interactions between TILs and breast cancer cells.