BackgroundCurrent guidelines have unsatisfied performance in predicting severe outcomes after Clostridium difficile infection (CDI). Our objectives were to develop a risk prediction model for 30-day mortality and to examine its performance among inpatients with CDI.MethodsThis retrospective cohort study was conducted at China Medical University Hospital, a 2111-bed tertiary medical center in central Taiwan. We included adult inpatients who had a first positive C. difficile culture or toxin assay and had diarrhea as the study population. The main exposure of interest was the biochemical profiles of white blood cell count, serum creatinine (SCr), estimated glomerular filtration rate, blood urea nitrogen (BUN), serum albumin, and glucose. The primary outcome was the 30-day all-cause mortality and the secondary outcome was the length of stay in the intensive care units (ICU) following CDI. A multivariable Cox model and a logistic regression model were developed using clinically relevant and statistically significant variables for 30-day mortality and for length of ICU stay, respectively. A risk scoring system was established by standardizing the coefficients. We compared the performance of our models and the guidelines.ResultsOf 401 patients, 23.4% died within 30 days. In the multivariable model, malignancy (hazard ratio [HR] = 1.95), ≥ 1.5-fold rise in SCr (HR = 2.27), BUN-to-SCr ratio > 20 (HR = 2.04), and increased glucose (≥ 193 vs < 142 mg/dL, HR = 2.18) were significant predictors of 30-day mortality. For patients who survived the first 30 days of CDI, BUN-to-SCr ratio > 20 (Odds ratio [OR] = 4.01) was the only significant predictor for prolonged (> 9 days) length of ICU stay following CDI. The Harrell’s c statistic of our Cox model for 30-day mortality (0.727) was significantly superior to those of SHEA-IDSA 2010 (0.645), SHEA-IDSA 2018 (0.591), and ECSMID (0.650). Similarly, the conventional c statistic of our logistic regression model for prolonged ICU stay (0.737) was significantly superior to that of the guidelines (SHEA-IDSA 2010, c = 0.600; SHEA-IDSA 2018, c = 0.634; ESCMID, c = 0.645). Our risk prediction scoring system for 30-day mortality correctly reclassified 20.7, 32.1, and 47.9% of patients, respectively.ConclusionsOur model that included novel biomarkers of BUN-to-SCr ratio and glucose have a higher predictive performance of 30-day mortality and prolonged ICU stay following CDI than do the guidelines.
BackgroundCastration‐resistant prostate cancer (CRPC) is refractory to hormone treatment and the therapeutic options are continuously advancing. This study aims to discover the anti‐CRPC effects and underlying mechanisms of small‐molecule compounds targeting topoisomerase (TOP) II and cellular components of DNA damage repair.MethodsCell proliferation was determined in CRPC PC‐3 and DU‐145 cells using anchorage‐dependent colony formation, sulforhodamine B assay and flow cytometric analysis of CFSE staining. Flow cytometric analyses of propidium iodide staining and JC‐1 staining were used to examine the population of cell‐cycle phases and mitochondrial membrane potential, respectively. Nuclear extraction was performed to detect the nuclear localization of cellular components in DNA repair pathways. Protein expressions were determined using Western blot analysis.ResultsA series of azathioxanthone‐based derivatives were synthesized and examined for bioactivities in which WC‐A13, WC‐A14, WC‐A15, and WC‐A16 displayed potent anti‐CRPC activities in both PC‐3 and DU‐145 cell models. These WC‐A compounds selectively downregulated both TOP IIα and TOP IIβ but not TOP I protein expression. WC‐A13, WC‐A14, and WC‐A15 were more potent than WC‐A16 on TOP II inhibition, mitochondrial dysfunction, and induction of caspase cascades indicating the key role of amine‐containing side chain of the compounds in determining anti‐CRPC activities. Furthermore, WC‐A compounds induced an increase of γH2AX and activated ATR‐Chk1 and ATM‐Chk2 signaling pathways. P21 protein expression was also upregulated by WC‐A compounds in which WC‐A16 showed the least activity. Notably, WC‐A compounds exhibited different regulation on Rad51, a major protein in homologous recombination of DNA in double‐stranded break repair. WC‐A13, WC‐A14, and WC‐A15 inhibited, whereas WC‐A16 induced, the nuclear translocation of Rad51.ConclusionThe data suggest that WC‐A compounds exhibit anti‐CRPC effects through the inhibition of TOP II activities, leading to mitochondrial stress‐involved caspase activation and apoptosis. Moreover, WC‐A13, WC‐A14, and WC‐A15 but not WC‐A16 display inhibitory activities of Rad51‐mediated DNA repair pathway which may increase apoptotic effect of CRPC cells.
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