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Objective: To explore how non-surgical esophageal cancer patients can identify high-risk factors for radiation-induced pneumonitis after receiving radiotherapy., Methods: We retrospectively included 228 esophageal cancer patients who were unable to undergo surgical treatment but received radiotherapy for the first time. By retrospective analysis and identifying potential risk factors for symptomatic radiation-induced pneumonitis (ie ≥grade 2), as well as delineating the affected lung as an area of interest on localized CT and extracting radiomics features, along with extracting dosimetric parameters from the affected lung area. After feature screening, patients were randomly divided into training and testing sets in a 7-to-3 ratio, and a prediction model was established using machine learning algorithms. Finally, the receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were used to validate the predictive performance of the model., Results: A total of 54 cases of symptomatic radiation pneumonitis occurred in this study, with a total incidence rate of 23.68%. The results of multivariate analysis showed that the occurrence of symptomatic radiation pneumonitis was significantly correlated with the mean lung dose (MLD), esophageal PTVD90, esophageal PTVV50, V5, V10, V15, and V20 in patients. The machine learning prediction model constructed based on candidate prediction variables has a prediction performance interval between 0.751 (95% CI: 0.700-0.802) and 0.891 (95% CI: 0.840-0.942) in the training and validation sets, respectively. Among them, the RFM algorithm has the best prediction performance for radiation-induced pneumonitis, with 0.891 (95% CI: 0.840-0.942) and 0.887 (95% CI: 0.836-0.938) in the training and validation sets, respectively., Conclusion: The combination of localization CT radiomics features and diseased lung dosimetry parameters has good predictive value for radiation-induced pneumonitis in esophageal cancer patients after radiotherapy. Especially, the radiation-induced pneumonitis prediction model constructed using RF algorithm can be more effectively used to guide clinical decision-making in esophageal cancer patients., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Hu et al.)

Abstract: Background: Sepsis-induced acute kidney injury (SI-AKI) is a kind of kidney dysfunction, which brings a lot of suffering. This study aimed to figure out the role of the miR-218-5p/PGC-1α axis in SI-AKI. Methods: AKI mouse model was established through cecal ligation and puncture. PGC-1α expression was activated using an activator ZLN005 before the serum and tissue samples were collected. Next, pathological structure and apoptosis of kidney tissues were observed. Levels of blood urea nitrogen, serum creatinine, and indicators of inflammation and oxidative stress were assessed. Moreover, reactive oxygen species and mitochondrial membrane potential levels, adenosine 5'-triphosphate content, and mitochondrial ultrastructure of kidney tissues were observed. HK2 cells were treated by lipopolysaccharide (LPS) to mimic sepsis in vitro , followed by evaluation of cell survival and apoptosis, inflammation, and oxidative stress. Subsequently, the binding relation between PGC-1α and miR-218-5p was predicted and validated. Then expression of PGC-1α and miR-218-5p was detected. PGC-1α and miR-218-5p expression were intervened to detect their influences in mitochondrial biogenesis. At last, miR-218-5p was overexpressed in ZLN005 (PGC-1α activating agent) pretreated SI-AKI mice to validate the mechanism. Results: PGC-1α is poorly expressed in SI-AKI, but overexpression of PGC-1α using ZLN005 alleviated SI-AKI injury and promoted mitochondrial biogenesis in AKI mice, and relieved LPS-induced cell injury. PGC-1α is a target of miR-218-5p. Downregulation of miR-218-5p expression in HK2 cells attenuated mitochondrial biogenesis disorder. Inhibition of PGC-1α annulled the role of miR-218-5p silencing in cells. In vivo , miR-218-5p overexpression partly reversed the protective role of ZLN005 in SI-AKI mice. Conclusion: miR-218-5p targeted PGC-1α to disrupt mitochondrial biogenesis, thereby exacerbating SI-AKI., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by the Shock Society.)

Objective: To investigate the effect of pulmonary vascular dysfunction in the prognosis of patients with acute lung injury (ALI)., Methods: Patients with ALI who underwent pulmonary artery catheterization in the department of critical care medicine of Wuhan NO.1 Hospital from June 2017 to June 2019 were enrolled. The general information, clinical and hemodynamic indexes [central venous pressure (CVP), pulmonary artery wedge pressure (PAWP), pulmonary artery systolic pressure (sPAP), pulmonary artery diastolic pressure (dPAP), mean pulmonary artery pressure (mPAP), cardiac index (CI)], acute physiology and chronic health evaluation II (APACHE II) score, arterial blood gas parameters [pH, partial pressure of oxygen (PO 2 ), partial pressure of carbon dioxide (PCO 2 ), oxygenation index (PaO 2 /FiO 2 )], whether there was shock or not; ventilator parameters [platform pressure (Plat), positive end-expiratory pressure (PEEP)], etc. were recorded. Pulmonary artery oxygen saturation, pulmonary vascular function indexes [transpulmonary potential gradient (TPG) and pulmonary vascular resistance index (PVRi)] were calculated. The relationship between TPG, PVRi and mechanical ventilation time, the length of intensive care unit (ICU) stay, cardiovascular days and 60-day mortality were analyzed in patients with different prognosis of 60-day and whether the TPG increased (≥ 12 mmHg was defined as elevated TPG, 1 mmHg = 0.133 kPa)., Results: A total of 65 patients were included in the study, including 30 males and 35 females; aged (48.9±15.2) years old. Forty-eight cases survived in 60-days, 17 died, and the 60-day mortality was 26.2%. At the baseline, there were no significant differences in cardiopulmonary function measurements, such as CVP, sPAP, dPAP, PAWP, CI, etc. between the two groups of patients with different prognosis. The APACHE II score, shock ratio, TPG and PVRi of the death group were significant higher than those of the survival group [APACHE II: 34±9 vs. 28±11, shock: 52.9% vs. 25.0%, TPG (mmHg): 16.2±1.9 vs. 14.6±2.1, PVRi (kPa×s×L -1 ): 31.8±4.2 vs. 29.7±3.5, all P < 0.05]. The 60-day mortality of 47 patients with TPG ≥ 12 mmHg was significantly higher than that of 18 patients with TPG < 12 mmHg (34.0% vs. 5.6%), and the mechanical ventilation time and the length of ICU stay were also significantly longer (days: 17±9 vs. 11±8, 16±5 vs. 12±5), and the cardiovascular days also increased significantly (days: 23±7 vs. 18±6), and the differences were statistically significant (all P < 0.05). Pearson correlation analysis showed that PVRi was significantly correlated with mechanical ventilation time, the length of ICU stay and cardiovascular days (r 1 = 0.317, P 1 = 0.030; r 2 = 0.277, P 2 = 0.005; r 3 = 0.285, P 3 = 0.002). In the individual multivariate Logistic regression model, the highest PVRi was an independent risk factor for the 60-day mortality [odds ratio (OR) = 30.5, 95% confidence interval was 20.4-43.1, P = 0.023]., Conclusions: Pulmonary vascular dysfunction is common in ALI patients and is independently associated with adverse outcomes.