Objective. To identify the clinical correlations between plasma growth differentiation factor‐15 (GDF‐15), skeletal muscle function, and acute muscle wasting in ICU patients with mechanical ventilation. In addition, to investigate its diagnostic value for ICU‐acquired weakness (ICU‐AW) and its predictive value for 90‐day survival in mechanically ventilated patients. Methods. 95 patients with acute respiratory failure, who required mechanical ventilation therapy, were randomly selected among hospitalized patients from June 2017 to January 2019. The plasma GDF‐15 level was detected by ELISA, the rectus femoris cross‐sectional area (RFcsa) was measured by ultrasound, and the patient’s muscle strength was assessed using the British Medical Research Council (MRC) muscle strength score on day 1, day 4, and day 7. Patients were divided into an ICU‐AW group and a non‐ICU‐AW group according to their MRC‐score on the 7th day. The differences in plasma GDF‐15 level, MRC‐score, and RFcsa between the two groups were compared on the 1st, 4th, and 7th day after being admitted to the ICU. Then, the correlations between plasma GDF‐15 level, RFcsa loss, and MRC‐score on day 7 were investigated. The receiver operating characteristic curve (ROC) was used to analyze the plasma GDF‐15 level, RFcsa loss, and % decrease in RFcsa on the 7th day to the diagnosis of ICU‐AW in mechanically ventilated patients. Moreover, the predictive value of GDF‐15 on the 90‐day survival status of patients was assessed using patient survival curves. Results. Based on whether the 7th day MRC‐score was <48, 50 cases were included in the ICU‐AW group and 45 cases in the non‐ICU‐AW group. The length of mechanical ventilation, ICU length of stay, and hospital length of stay were significantly longer in the ICU‐AW group than in the non‐ICU‐AW group (all P < 0.05), while the other baseline indicators were not statistically significant between the two groups. As the treatment time increased, the plasma GDF‐15 level was significantly increased, the ICU‐AW group demonstrated a significant decreasing trend in the MRC‐score and RFcsa, while no significant changes were found in the non‐ICU‐AW group. In the ICU‐AW group, the plasma GDF‐15 level was significantly higher than that in the non‐ICU‐AW group, while the RFcsa and the MRC‐score were significantly lower than those in the non‐ICU‐AW group (GDF‐15 (pg/ml): 2542.44 ± 629.38 vs. 1542.86 ± 502.86; RFcsa (cm²): 2.04 ± 0.64 vs. 2.34 ± 0.61; MRC‐score: 41.22 ± 3.42 vs. 51.42 ± 2.72, all P < 0.001). The plasma GDF‐15 level was significantly negatively correlated with the MRC‐score (r = −0.60), while it was significantly positively correlated with the RFcsa loss (r = 0.18) and the % decrease in RFcsa (r = 0.16). Moreover, the RFcsa loss was significantly negatively correlated with the MRC‐score (r = −0.27) (all P < 0.001). The ROC curve analysis showed that plasma GDF‐15 level, RFcsa loss, and % decrease in RFcsa on day 7 had predictive value for ICU‐AW diagnosis in mechanically ventilated patients. More specifically, the area under the ROC curve (AUC) of GDF‐15 was 0.904, the AUC of RFcsa loss was 0.873, and the AUC of % decrease in RFcsa was 0.886 (all P < 0.001). The 90‐day survival curve demonstrated that the survival rate of the high plasma GDF‐15 level group was 54.00%, while that of the low plasma GDF‐15 level group was 75.56%. The difference between the two groups was statistically significant (P < 0.05). Conclusion. The plasma GDF‐15 concentration level was significantly associated with skeletal muscle function and muscle wasting on day 7 in ICU patients with mechanical ventilation. Therefore, it can be concluded that the plasma GDF‐15 level on the 7th day has a high diagnostic yield for ICU‐acquired muscle weakness, and it can predict the 90‐day survival status of ICU mechanically ventilated patients.

Background: To identify the clinical correlations between mechanical power and transforming growth factor-β1 (TGF-β1) and connective tissue growth factor (CTGF) in acute respiratory distress syndrome (ARDS) patients, their clinical significance in pulmonary structural remodeling in ARDS patients was investigated. Methods: Ninety-five patients with moderate or severe ARDS, who required mechanical ventilation therapy, were randomly selected among hospitalized patients from January 2017 to February 2019. Their mechanical power was monitored and recorded, the TGF-β1 and CTGF levels were detected by enzyme-linked immunosorbent assay (ELISA), their relevance was analyzed, and the relationship between mechanical power and 28-day survival rate was investigated. According to the high-resolution computed tomography (HRCT) examination, the patients were divided into an ARDS group and an ARDS pulmonary fibrosis (ARDS-PF) group. The differences in mechanical power, TGF-β1, and CTGF between the 2 groups were compared, and the significance of TGF-β1 and CTGF in the diagnosis of ARDS pulmonary interstitial fibrosis were evaluated. Results: A significant positive correlation between mechanical power and serum TGF-β1 and CTGF in patients with ARDS was found and the correlation coefficients were 0.424 and 0.581, respectively. The difference between mechanical power and 28-day survival rate was statistically significant (P < .05), while the area under the receiver operating characteristic curves of TGF-β1 and CTGF for the diagnosis of ARDS pulmonary fibrosis was 0.838 and 0.884, respectively (P < .05). Conclusion: A significant correlation between mechanical power and serum fibrosis biomarkers TGF-β1 and CTGF in ARDS patients was found, and its level was related to the survival prognosis of patients. Mechanical power, TGF-β1, and CTGF were clinically evaluated for the assessment of lung structural remodeling, such as ARDS pulmonary fibrosis. This study has particular significance to the early prevention of ventilator-induced lung injury and pulmonary fibrosis in patients with ARDS receiving mechanical ventilation.

The relationship between urinary collecting system invasion (UCSI) and oncological outcomes in renal cell carcinoma (RCC) patients has attracted extensive attention recent years. However, the reports were inconsistent and remain controversial. Thus, we performed a systematic literature search of PubMed, Embase, Web of Science and The Cochrane Library databases to identify relevant studies up to June 2015 and conducted a standard meta-analysis of survival outcomes. 17 studies containing 9012 RCC patients satisfied the inclusion criteria. Pooled HRs for overall survival (OS) and recurrence-free survival (RFS) were 1.45 (95% CI, 1.26–1.66, P < 0.001) and 2.27 (95% CI, 1.54–3.34, P < 0.001), respectively. Further subgroup analysis suggested that UCSI was significant associated with poor cancer-specific survival (CSS) in stage T1–T2 RCC (HR = 2.05, 95% CI: 1.43–2.96, P < 0.001) but not in stage T3–T4 tumors (HR = 1.08, 95% CI: 0.63–1.85, P = 0.771). Current evidence revealed that UCSI has a significant negative impact on OS and RFS in RCC patients and could be used to predict CSS especially in localized RCC. Thus, RCC patients with UCSI should be paid more attention by clinician and pathologist and require close follow up for their poor prognosis.

Background: To investigate the values of erector spinae muscle cross-sectional area (ESMcsa) loss for diagnosing intensive care unit-acquired weakness (ICU-AW) and predicting the 60-day survival status in patients with mechanical ventilation. Methods: Patients who were admitted into the intensive care unit (ICU) and received invasive mechanical ventilation therapy from June 2018 to June 2020 were selected. And they were divided into an ICU-AW group and a non-ICU-AW group, which were compared based on the ESMcsa and The British Medical Research Council muscle strength score (MRC-score) on the 1st and 7th day of ICU admission. The receiver operating characteristic curve was employed to measure the values of the ESMcsa Loss and ESMcsa Loss Ratio on the 7th day in order to diagnose ICU-AW in patients with mechanical ventilation. The survival curves of the patients were plotted to analyze the ESMcsa Loss Ratio values for predicting the 60-day survival status. Results: A total of 104 patients were enrolled, they were divided into the ICU-AW group (n = 56) and the non-ICU-AW group (n = 48). The mechanical ventilation time, ICU stay time, and hospital stay time of the ICU-AW group were all significantly higher than those of the non-ICU-AW group. On the 1st day, no significant difference in the ESMcsa or MRC-score between the 2 groups of patients was observed. On the 7th day, the ESMcsa and MRC-score of the ICU-AW group were significantly lower than those of the non-ICU-AW group. The ESMcsa Loss and ESMcsa Loss Ratio were both significantly negatively correlated with the MRC-score. The ESMcsa Loss and ESMcsa Loss Ratio on the 7th day were both valuable for the prediction of ICU-AW in patients with mechanical ventilation (areas under the receiver operating characteristic curve = 0.904, 0.835, and 0.889, P < .001). The survival rate of the patients in the high- and low-ESMcsa Loss Ratio groups were 60.0% and 80.0% (P < .05). Conclusions: As suggested by the ESMcsa Loss Ratios of the patients with mechanical ventilation on the 7th day of ICU admission, it offers a desirable objective indicator for the diagnosis of ICU-AW, and provides certain values for predicting the 60-day survival status of patients with mechanical ventilation in the ICU.

Background and Objective. During mechanical ventilation, the energy delivered by a ventilator to the respiratory system in one minute is defined as mechanical power (MP). It describes the combined effects of several mechanical factors, including tidal volume, driving pressure, transpulmonary pressure, flow rate, positive end‐expiratory pressure, and respiratory rate on lung ventilation. As such, MP may be useful for evaluating the severity and prognosis of acute respiratory distress syndrome (ARDS), as improvements in pulmonary ventilation directly affect a patient’s prognosis. Recent advances in lung ultrasound technology make it possible to evaluate lung ventilation at the bedside. In this study, MP was monitored in ARDS patients, and its correlation with lung ultrasound scores (LUS) was evaluated. Further analysis also explored the value of MP in evaluating the severity and prognosis of ARDS. Methods. A total of 121 patients with moderate to severe ARDS admitted to the intensive care unit (ICU) from June 2017 to April 2020 and treated with invasive mechanical ventilation were sequentially included in this study. Their general information was collected, and MP was recorded at 0 h, 24 h, 48 h, and 72 h after admission to the ICU. Professionally trained researchers performed the LUS assessments. Patients were divided into the death and survival groups according to their 28‐day prognosis. The trend of MP and LUS at the four time points was analyzed. A receiver operating characteristic curve (ROC) was used to analyze the predictive value of MP and LUS scores at 0 h and 72 h for the prognosis (28‐day mortality rate) of patients with moderate to severe ARDS. Results. 121 patients were included in the analysis, of which 73 were male and 48 were female. When patients entered the ICU, their oxygenation index (t: 30885, P < 0.01), APACHE II score (t: 2.105, P < 0.05), and SOFA score (t: 4.134, P < 0.001) were higher in the death group than the survival group. The death group had significantly higher MP and LUS at each time point (0 h, 24 h, 48 h, and 72 h) compared to the survival group (all P < 0.05). There was a significant upward trend over time in the MP and LUS of the death group, contrasting to a significant downward trend in the survival group (all P < 0.05). The Pearson correlation analysis showed that MP and LUS were significantly positively correlated at each time point (r values: 0 h: 0.3027; 24 h: 0.3705; 48 h: 0.3902; 72 h: 0.5916; all P < 0.01). The ROC curves showed that MP and LUS at 72 h were of significant value in predicting the prognosis of ARDS patients, with areas under the curve of 0.866 ± 0.032 and 0.839 ± 0.037, respectively. Conclusion. There was a significant correlation between the MP and LUS of ARDS patients at four time points from 0 to 72 h, which has a clinical value in evaluating severity and prognosis.

Acute respiratory distress syndrome (ARDS) is a devastating condition of acute inflammatory lung injury and causes high morbidity and mortality. Therefore, investigations on the effective biomarkers will be significant for the understanding of ARDS. In our research, the gene expression profiles of 27 samples from ARDS patients (n = 18) and healthy controls (n = 9) were analyzed and eight gene co-expression modules were identified by constructing weighted gene co-expression network. The correlation analysis of modules with phenotypes showed that genes in the yellow and black modules, which were significantly enriched in the ARDS-related pathways, such as TNF signaling pathway, Toll-like receptor signaling pathway, and NF-kappa B signaling pathway, were associated with the phenotype “time postinfection.” Genes DDX58 and CXCL10, which were highly expressed after infection and significantly enriched in ARDS-related pathways, presented high score in protein–protein interaction analysis, indicating that they may be associated with ARDS and providing novel biomarkers for its diagnosis, treatment, and surveillance.