OBJECTIVE: To explore the correlation between albumin (Alb) combined with diuretic treatment and the mortality risk of septic patients with pre-existing congestive heart failure based on the United States Critical Care Medical Information Database-IV (MIMIC-IV), and to conduct the external validation. METHODS: A retrospective cohort study was conducted. The clinical data of septic patients with pre-existing congestive heart failure admitted to the intensive care unit (ICU) from 2008 to 2019 in the MIMIC-IV 2.0 were extracted, including demographic characteristics, comorbidities, laboratory indicators on the first day of ICU admission, severity of illness, treatment measures, etc. For external validation, clinical data were collected from septic patients with pre-existing congestive heart failure admitted to the ICU of the Second People's Hospital of Shenzhen from October 2022 to December 2023. The patients were divided into Alb alone group and Alb combined with diuretic group. The ICU mortality was defined as the primary outcome event, and the 30-day and 60-day mortality were defined as the secondary outcomes. Multivariate Cox proportional hazard regression analysis was conducted to investigate the relationship between Alb combined with diuretic treatment and the mortality risk of ICU and 30 days in septic patients with pre-existing congestive heart failure, and subgroup analysis was performed. Kaplan-Meier survival curve was plotted to compared the 60-day cumulative survival rate between the Alb alone group and Alb combined with diuretic group. RESULTS: (1) Analysis results of data from MIMIC-IV: a total 1 754 patients were enrolled, of which 378 in the Alb alone group, and 1 376 in the Alb combined with diuretic group. Compared with the Alb alone group, the patients in the Alb combined with diuretic group had significantly lower ICU, 30-day, and 60-day mortality [ICU mortality: 19.11% (263/1 376) vs. 30.42% (115/378), 30-day mortality: 18.90% (260/1 376) vs. 32.54% (123/378), 60-day mortality: 24.49% (337/1 376) vs. 39.15% (148/378), all P < 0.05]. Based on the multivariate Cox proportional hazard regression adjusted models considering demographic characteristics, comorbidities, laboratory indicators, severity of illness, and treatment measures, it was shown that the use of Alb combined with diuretic was significantly associated with a reduced risk death of ICU and 30 days [ICU mortality risk: hazard ratio (HR) = 0.597, 95% confidence interval (95%CI) was 0.460-0.774, P < 0.001; 30-day mortality risk: HR = 0.557, 95%CI was 0.433-0.716, P < 0.001]. Subgroup analysis revealed that after adjusting for variables, regardless of gender, age, and whether or not patients had comorbidities such as hypertension, diabetes, severe liver disease, acute renal insufficiency, and sequential organ failure assessment (SOFA) score, the ICU mortality risk was significantly reduced in patients treated with Alb combined with diuretic (all HR < 1, P < 0.05), with no interaction observed (all P > 0.05). Kaplan-Meier survival curve showed the 60-day cumulative survival rate of patients in the Alb combined with diuretic group was significantly higher than that in the Alb alone group (Log-rank test: χ ² = 49.62, P < 0.05). (2) External validation: a total of 385 patients were enrolled, of which 144 in the Alb alone group, and 241 in the Alb combined with diuretic group. Compared with the Alb alone group, the patients of the Alb combined with diuretic group had significantly lower ICU, 30-day, and 60-day mortality [ICU mortality: 19.92% (48/241) vs. 31.25% (45/144), 30-day mortality: 19.09% (46/241) vs. 28.47% (41/144), 60-day mortality: 24.07% (58/241) vs. 34.03% (49/144), all P < 0.05]. The results of multivariate Cox proportional hazard regression analysis, subgroup analysis, and Kaplan-Meier survival curve analysis were consistent with the data analysis of the MIMIC-IV database. CONCLUSIONS Combination therapy of Alb and diuretic was associated with reduced mortality risk in septic patients with pre-existing congestive heart failure.
Humans ; Heart Failure/mortality* ; Retrospective Studies ; Sepsis/drug therapy* ; Intensive Care Units ; Diuretics/therapeutic use* ; Male ; Female ; Aged ; Middle Aged ; Proportional Hazards Models ; Hospital Mortality

Mass spectrometry imaging (MSI), a label-free molecular imaging technique, has been applied widely in the spatial localization of small molecule metabolites, lipids, peptides, and proteins, with its unique advantage of high spatial resolving power compared to traditional liquid chromatography-mass spectrometry (LC-MS).With the nonstop advancement of its achievable sensitivity and spatial resolution, MSI technique has been providing novel perspectives into the preclinical studies of drugs, such as in vivo localization of drugs and their metabolites, visualization of drug metabolism, and drug delivery tracking.This review introduces the basics of MSI techniques, including basic principles, key features, technical advantages, and limitations, with particular highlight of the recent applications of MSI in drug efficacy and safety evaluation, drug distribution research, drug delivery research, and analysis of Chinese medicine from recent publications, aiming to promote the utilization and further expansion of MSI in the research and development of drugs.

Objective:To evaluate the histological changes of the retrodiscal tissue in the patients with temporomandibular disorders (TMD).Methods:Thirty-three TMD patients were performed with temporomandibular joint (TMJ) MRI examinations from April 2018 to April 2020 in TMD clinic, Hainan Hospital of General Hospital of Chinese PLA. The patients groups were classified according to the disc position as follows: normal position (NP) (29 TMJ), disk displacement with reduction (DDwR) (14 TMJ) and disk displacement without reduction (DDwoR) (23 TMJ). The gray-level co-occurrence matrix (GLCM) analysis was applied with the retrodiscal tissue on the open oblique sagittal proton weighted images. The texture parameters included as follows: angular second moment (ASM), contrast, correlation, inverse difference moment (IDM) and entropy. The statistical methods mainly included Kruskal-Wallis H test, one-way analysis of variance and receiver operating characteristic curve (ROC), to analyze the texture characteristic parameters of the retrodiscal tissue are statistically significant. Results:There was no significant difference of the retrodiscal tissue′s ASM, contrast, correlation and IDM among 3 groups ( P>0.05). The entropy in NP group (3.98±0.44) and DDwR group (4.20±0.52) presented significant higher than that in DDwoR group (3.70±0.38) ( P<0.05). ROC analysis for the entropy demonstrated that the area under the curve was 0.70 when differentiating NP and DDwR (cut-off value 0.38, sensitivity 82.61%, specificity 55.17%), and was 0.79 when differentiating DDwR and DDwoR (cut-off value 0.47, sensitivity 82.61%, specificity 64.29%). Conclusions:Texture entropy could be primarily used to evaluate the histological and pathological changes of the retrodiscal tissue in the TMD patients.

Objective:To evaluate the functional changes of lateral pterygoid muscle (LPM) in the patients with temporomandibular disorders (TMD) using histogram texture analysis.Methods:A total of 28 TMD patients, including 15 males and 13 females, aged (26.2±12.1) years (15-62 years), were enrolled in the outpatient clinic of Department of Radiology, Hainan Hospital of Chinese PLA General Hospital from May 2016 to April 2020. At the same time, 13 volunteers with normal temporomandibular joint [6 males and 7 females, aged (23.5±3.3) years (20-30) years] were recruited. All participants were performed with temporomandibular joint MRI scan, and the subjects were classified into 3 groups according to the disc displacement: TMD with disc without displacement (TMD-DwoD), TMD with disc displacement without reduction (TMD-DDwoR) and NC with disc displacement without reduction (NC-DwoD) for each temporomandibular joint. The area, signal intensity, coefficient of variation (CV) of mean signal intensity and histogram texture of the superior belly of LPM (SBLPM) and inferior belly of LPM (IBLPM) were measured using regions of interests.Results:The area of SILPM presented significantly smaller in TMD-DwoD [(67.36±30.23) mm 2] compared with that in NC-DwoD [(91.42±45.01) mm 2] ( P<0.05) and in TMD-DDwoR group [(72.27±37.53) mm 2] ( P>0.05). The mean signal intensity of SBLPM was identified significantly higher in TMD-DwoD (304.20±29.90) and TMD-DDwoR (315.06±40.20) compared with that in NC-DwoD (269.79±25.54) ( P<0.05). The CV of mean signal intensity of SBLPM presented significantly higher in TMD-DwoD (8.89±2.60) compared with that in NC-DwoD (6.76±1.82) and TMD-DDwoR (7.63±1.62) ( P<0.05). The skew and kurtosis showed no significantly differences among three groups for SBLPM ( P>0.05). The mean signal intensity and CV for IBLPM presented significantly higher in TMD-DwoD (286.69±23.48 and 9.96±2.24, respectively) and TMD-DDwoR (275.98±30.55 and 10.25±1.96, respectively) compared with that in NC-DwoD (243.56±17.04 and 8.49±1.94, respectively) ( P<0.05). The skewness showed significantly lower in TMD-DwoD (0.90±0.94) and TMD-DDwoR (0.73±0.97) compared with that in NC-DwoD (1.40±1.03) ( P<0.05). The area and kurtosis for IBLPM showed no significant differences among three groups ( P>0.05). Conclusions:The MR histogram texture analysis could primarily be considered as a tool to evaluate the LPM function in TMD patients.