Background Exosome from adipose-derived stem cells (ADSCs-Exo) has been shown to inhibit the progression of human diseases, including sepsis-related acute kidney injury (AKI). CircVMA21 is considered to be an important regulator for sepsis-related AKI. However, whether ADSCs-Exo affected sepsis-induced AKI by delivering circVMA21 is not clear. Methods ADSCs was identified by alizarin red staining, oil red O staining, and flow cytometry. ADSCs-Exo was authenticated by transmission electron microscopy, nanoparticle tracking analysis, western blot analysis, and immunofluorescence assay. Cell apoptosis was assessed by flow cytometry, and inflammation cytokine levels were determined by ELISA. Lactate production was assessed using Lactate Acid Content Assay Kit. The expression levels of aerobic glycolysis-related markers, circVMA21 and miR-16-5p were evaluated by qRT-PCR. Dual-luciferase reporter assay and RIP assay were employed to detect RNA interaction. Animal experiments were used to evaluate the role of ADSCs-Exo on renal function and cell injury in LPS-induced AKI mice model. Results ADSCs-Exo inhibited LPS-induced HK-2 cell apoptosis, inflammation and aerobic glycolysis. Knockdown of exosomal circVMA21 derived from ADSCs enhanced HK-2 cell injury induced by LPS. In terms of mechanism, circVMA21 could serve as sponge for miR-16-5p. Besides, miR-16-5p inhibitor reversed the promotion effect of Exo-sh-circVMA21 on LPS-induced cell injury. In addition, ADSCs-Exo protected LPS-induced AKI in mice by increasing circVMA21 expression and decreasing miR-16-5p expression. Conclusion Exosomal circVMA21 derived by ADSCs relieved LPS-induced AKI through targeting miR-16-5p, which provided a potential molecular target for treating sepsis-related AKI.
Objective: To establish a prediction Nomogram based on prognostic factors for children with hemophagocytic lymphohistiocytosis (HLH). Methods: A retrospective analysis of pediatric HLH cases diagnosed at the Affiliated Hospital of Zunyi Medical University between January 2012 and December 2022 was conducted. Cox regression analysis was used to identify prognostic factors for pediatric HLH patients. The C-index, ROC curve, and AUC were used to evaluate the discrimination of the model. The DCA was used to evaluate the clinical application value of the model. Results: A total of 133 cases of secondary pediatric HLH patients were included in this study, with 45 deaths and 88 survivors. Univariate analysis showed that age ≤ 2 years, PLT ≤ 50×10 /L, HB ≤90 g/L, AST ≥ 200 U/L, CK-MB ≥ 50 U/L, LDH ≥ 1000 U/L, SF ≥1500 μg/L, PT ≥ 20 s, APTT ≥ 40 s, hypoalbuminemia, hypofibrinogenemia, mechanical ventilation, splenomegaly, ARDS, respiratory failure,CNSL, shock, DIC, pulmonary hemorrhage, and gastrointestinal bleeding are risk factors for the survival of those secondary pediatric HLH patients ( P <0.05), while blood purification therapy may be a protective factor for HLH prognosis ( P = 0.049). Multivariable Cox showed that CNSL (HR = 3.18, 95%CI = 1.72-5.89), PLT ≤ 50×10^9/L (HR = 2.16, 95%CI = 1.11-4.19), hypoalbuminemia (HR=2.65, 95%CI=1.14-5.17), and hypofibrinogenemia (HR = 2.48, 95%CI = 1.19-5.14) were independent risk factors for the outcome of children with HLH, while the use of blood purification therapy (HR = 0.32, 95%CI = 0.16-0.64) was an independent protective factor. A Nomogram prediction model was constructed using R software, and the ROC curve , C-index, and calibration curve showed good discrimination and fit of the model. The DCA curve showed that the model had good clinical applicability. Finally, based on the Nomogram score and HR value, the subjects were divided into three groups, and it was found that the mortality rate in the high-risk group was significantly higher than that in the low-risk group. Conclusion: The development of a Nomogram to predict the prognosis of secondary pediatric HLH patients has good discrimination and accuracy and may have good clinical application value.
Objective To investigate the clinical characteristics of neonatal necrotizing enterocolitis (NEC) complicated by intestinal perforation and predict the incidence of intestinal perforation in NEC. Methods Neonates diagnosed with NEC at the Affiliated Hospital of Zunyi Medical University from January 2012 to May 2022 were enrolled, and the clinical data were collected and analyzed retrospectively. The patients were divided into two groups based on intestinal perforation occurrence or not. Mann-Whitney U tests, t-tests, chi-square tests, and fisher's exact tests were performed between-group comparisons. Logistic and lasso regressions were applied to screen independent risk factors for concomitant bowel perforation, and R software (RMS package) was used to formulate the nomogram prediction model. In addition, the receiver operating curve (ROC) and the calibration curve were drawn to verify the predictive power, while decision curve analysis (DCA) was constructed to evaluate the clinical applicability of the nomogram model. Results 180 neonates with NEC were included, of which 48 had intestinal perforations, and 132 did not; the overall incidence of intestinal perforation was 26.67% (48/180). Bloody stool (OR = 5.60), APTT ≥ 50s (OR = 3.22), thrombocytopenia (OR = 4.74), and hypoalbuminemia (OR = 5.56) were identified as independent risk variables for NEC intestinal perforation (P < 0.05) through multivariate logistic regression analysis. These factors were then applied to develop a nomogram prediction model (C-index = 0.838) by using the R software. The area under the curve (AUC) for the nomogram in the training and validation cohorts were 0.838 (95% Cl: 0.768, 0.908) and 0.802 (95% CI: 0.659, 0.944), respectively. The calibration curve shown that the nomogram has a good predictive ability for predicting the risk of intestinal perforation occurrence. And the decision curve and clinical impact curve analyses demonstrated good clinical utility of the nomogram model. Conclusion We found that Bloody stool, APTT ≥ 50s, Thrombocytopenia, and hypoalbuminemia could be used as independent risk factors for predicting intestinal perforation in neonates with NEC. The nomogram model based on these variables had high predictive values to identify NEC patients with intestinal perforation.
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