Musculoskeletal disorders (MSDs) represent an important threat to public health in both developed and developing countries, and are present in many occupational sectors including education. Regular practice of physical activity (PA) is known elicit preventive effects on the occurrence of MSDs.This study aimed at determining the prevalence of MSDs and the preventive impact of PA on their occurrence among secondary school teachers.A cross-sectional study was conducted among 179 teachers in five government secondary schools in Douala, Cameroon. The Nordic and Ricci-Gagnon questionnaires were used to determine MSDs and to assess the level of PA, respectively.p = 0.04). The risk of MSDs during the last seven days was higher in teachers aged 30-40 years  and 40-50 years  than those under 30 years. This risk was tripled in inactive teachers , compared to their active counterparts.The 12-month and 7-day prevalence of MSD (PMSD-12m and PMSD-7d) were 84.3% and 69.3%, respectively. The most affected body regions by MSDs were neck , lower back , and shoulders . Compared to female, males were protected against MSDs during the last 12 months (OR = 0.37; 95% CI 0.16–0.93; MSDs are prevalent among secondary school teachers and associated with aging, gender, and lower level of PA Musculoskeletal disorders (MSDs) is a generic term encompassing a set of periarticular disorders that affect the musculoskeletal system, and mainly result in daily pain and functional discomfort . These aMSDs are a cause of public health concern in developed countries such as United States of America (USA), Canada, Finland, France, Sweden, and The United Kingdom. Indeed, MSDs are a major cause of absenteeism and inability to work , 6. MSDsGiven the challenges related to economic growth, African countries are facing increasingly important prevalence and deleterious effects of MSDs in workers of several occupational sectors, especially in education sector. In Africa, work conditions of teachers are rude and non-ergonomic , and expose them to MSDs , 9. PrevPhysical activitiy (PA) is defined as any energy-requiring body movement produced by skeletal muscles . The WorThe extensive researches on MSDs in developed countries contrasts with the lack of reports in their developing counterparts, especially in African countries, where there is a paucity of data on the prevalence and associated factors of MSDs in teachers. The effect of PA on MSD-related burden is also an important missing link in African context. In this regard, the present study aimed at determining the prevalence of MSDs and associated factors as well as the impact of PA among secondary school teachers of Douala city, Cameroon.This cross-sectional and analytical study was carried out at five Government secondary schools in the city of Douala, the economic capital of Cameroon. Teachers willing to participate in the study, with professional experience of at least one year, and having signed an informed consent form were included. Teachers with trauma history and on MSDs related medication were excluded.N = p (1-p) z2/d2, where N is the minimum sample size; p is the prevalence of MSDs (96%) reported previously by El Gendy and Korish (z is the statistic for the desired confidence level (z = 1.96 for confidence at 95%), and d is the accepted margin of error (d = 0.05). Thus, the minimal sample size found was N = 59 participants.The minimum sample size required for the study was computed using the Lorentz's formula: d Korish ; z is thThe study objectives and data collection methods were first explained to administration staff of the government schools, and after issuing administrative authorization, they were explained to teachers. An informed consent form was given to each teacher who accepted to participate in the study. Anthropometric parameters were measured and questionnaire forms were given to each participant. The teachers were asked to returned filled questionnaire within seven days upon reception. Teachers were assisted by research team members if questions were not well understood. Identification codes were assigned to each questionnaire to process and analyze it anonymously. Incomplete and poorly completed questionnaires were excluded from the final analysis. A total of 300 questionnaires were distributed, and 179 (60%) teachers returned correctly filled questionnaires .A structured questionnaire was administered to each participant and consisted of three parts. (i) socio-demographic and anthropometric characteristics , (ii) socio-professional information ; (iii) level of PA and prevalence of MSDs during the last six months or last seven days.−2) = Weight (kg) / height2 (m2). Based on BMI values, participants were categorized as normal (18.5 < BMI < 25), overweight (25 ≤ BMI < 30), and Obese (BMI ≥ 30).Height was measured using a rod graduated to the nearest centimeter. Weight was measured using an electronic scale Tanita BC-532 . The body mass index was determined using Quetelet's formula: BMI (kg.mMSD-12m) and the last seven days (PMSD−7d) were determined.The Nordic questionnaire  was usedThe Ricci and Gagnon questionnaire was used to determine the level of PA of each participant . This qu2 test was used to compare proportions of unpaired samples. Logistic regression analysis was used to determine factors associated with MSD among teachers. The association between the dependent variable (presence of MSDs) and independent variables  was quantified in logistic regression analysis by computing odds ratios (OR), their confidence interval at 95%, and p-value. The level significance was set for a value of p < 0.05.Qualitative variables were presented as percentages (%). Statistical analyses were conducted using the Statistical Package for Social Science v21.0 . The normality of quantitative was checked using the Kolmogorov-Smirnov test. Pearson independence ChiMost of the participants were females (66.5%) and aged 30–40 years (54.2%). Based on BMI analysis, 30.7% and 28.2% of teachers were overweight and obese, respectively .MSD-12m value was significantly higher in females compared to males . MSD-12m and MSD-7d were most frequently reported at neck (54.2% and 33.5%), lower back (43% and 33%), and shoulders (35.2% and 22.9%).The prevalence of MSDs by body regions and gender is depicted on MSD-12m = 19.0% and PMSD−7d = 19.0%) and three body regions (PMSD-12m = 18.4% and PMSD−7d = 11.7%) (The teachers reported MSDs at one to nine body regions . The pre= 11.7%) .p = 0.02), and by over four times in those aged 40–50 years , compared to those aged below 30 years old. It was also noticed positive effect of PA on the risk of MSD-7d. Teachers classified as “inactive” were three times at risk of MSDs , compared with those classified as “active”. In contrast, the risk of MSD-12 m was decreased by 63% in males   .The purpose of this study was to assess the prevalence and determinants of MSDs as well as the impact of PA on MSDs risk, among secondary school teachers of Douala, Cameroon.MSD-12m of 84.3% was in this study, thereby indicating that MSDs were very frequent among secondary teachers. This prevalence is consistent with that reported in different settings including Botswana (83.3%), Nigeria (70.2%), Saudi Arabia (68.50-79.17%), and Philippines (79.17%) (MSD-12m estimates were reported in Chile (90.81%) (A P(79.17%) , 29, 30.(90.81%)  and Egyp(90.81%) .MSD−7d estimate reported here  of teachers suffered from MSDs during the last seven days, and this is in line with that reported in Bolivia (63.4%) by Solis-Soto et al. . Facing ted here , 9. Seve.3% of teted here –36. A hited here , 38.Consisting with previous studies , 39, MSDMSD-12m was significantly higher in women compared to men. Similar observations were done elsewhere on an increased risk of MSD-12m at various body parts  in female gender in the educational sector (Pl sector , 29, 42.l sector , this prThis study confirms the protective role of PA against MSDs, and this finding was also reported in diverse studies on education sector , 44, 45,Causes of MSDs being multifactorial, some of them constitute the limits of this study. Therefore, crucial determinants such as psychosocial factors, job/salary satisfaction, quality of life, exposure to workplace violence, and ergonomic factors were not captured, and this represents an important limitation to this study. Also, medical confirmation of MSDs diagnostic was not done. Thus, MSDs prevalence estimates based on the Nordic questionnaire could not reflect the real burden of MSDs among teachers.This study found a high prevalence of MSDs among Cameroonian secondary school teachers, with a predominance of MSDs at neck, lower back, and shoulders. The study also outlined protective effect of PA in reducing risk of MSDs. It is critical to implement primary MSDs prevention measures to preserve wellbeing of teachers through improvement of work conditions and promotion of PA and sport. All taken together could be very helpful to prevent and control efficiently education sector-related MSDs.


To evaluate the effectiveness of enhanced check to the duration of the central venous catheters associated bloodstream infections (CABSIs), and the impact on infection rates.A before-after, real-world study in six adult intensive care units was conducted. All adult patients who had only one central venous catheter were included during two consecutive periods. The intervention period, added cross-check that all patients with central venous catheter (CVC) need to be performed, and included nurses' checks for insertion practices and doctors' checks for maintenance practices. Propensity scores matching were used to account for potential confounding, and restricted cubic spline was served as visualizing the CABSI risk.P < 0.001), and the acute period of rapid increase in CABSI risk was shortened, 6.5 to 5 days for femoral-vein catheterization and 7 to 5.5 days for subclavian-vein catheterization. For jugular-vein catheterization, the acute onset period disappeared.A total of 2906 patients with 26,157 CVC-days were analyzed. After intervention, the density incidence of CABSI decreased from 10.24 to 6.33/1,000 CVC-days (Enhanced check during the first 7 calendar days after CVC insertion shortens the duration of the CABSI acute phase and tends to decrease CABSI rate.The online version contains supplementary material available at 10.1186/s13756-022-01190-z. Central venous catheters (CVCs) are indispensable in the modern-day intensive care of critically ill patients . HoweverThe duration of catheterization was also considered to be clearly associated with the risk of CABSI , 8. At pWe did a prospective, before–after, real-world study in the six adult ICUs  of Sichuan Academy of Medical Sciences, Sichuan People's Hospital, School of Medicine, University of Electronic Science and Technology of China, a 4200-bed tertiary care teaching hospital in Chengdu in the region of Sichuan (Western China). All adult (≥ 18 years) patients with only one CVC insertion admitted during January 2019 to December 2021 were included, avoiding the possible biases caused by the interaction between different catheter insertion states, such as insertion time and insertion sites. Patients hospitalized ≤ 2 days and/or catheterized ≤ 2 days were excluded. After matching screening, the remaining participants were included in the final comparative analysis. The informed consent was waived by the local ethics committee as it was an observational study.Two consecutive periods  were set. Period 1, the control period, included a basic combination of prevention bundle for CVC insertion based on the published best practices, and a insertion checklist  were used in all patients. Catheters were inserted using the Seldinger technique and full aseptic technique by a physician who had been granted the insertion qualification by the medical department. I.V. transparent film dressing with border  was placed over the exit site at the time of insertion.https://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf:)  , diabetePropensity score matching (PSM), a method of post-randomization, was performed between intervention and control groups using specific R Package Matching version 4.9–2 to optimize inter group comparability. To minimize the impact of potential bias, we performed the following analysis: 1. Standardized mean differences (SMD) were determined the baseline characteristics that lead to incompatibility between groups. And the SMD of less than 0.1 was considered as an indicator of good balance . 2. A loA multivariable logistic model with restricted cubic splines (RCS) was built using specific R Package Regression Modeling Strategies (RMS) version 6.2–0 to evaluate the impact of CVC-insertion in different sites on CABSI. RCS has been widely described as a valid strategy to realize the correlation analysis between continuous exposure and outcomes –22. The The Kaplan–Meier survival functions were used to estimate the cumulative hazard of CABSI. Log rank (Mantel-Cox) test was used for time-to-event analysis. For infection-free survival analysis, survival endpoints in this study were 30 days from insertion until CABSI.2 test / Fischer’ exact test for categorical variables, data were compared between the two periods. Using specific R Package VIOPLOT version 0.3.7, Violin plots were used to visualize the incidence densities of CABSI between the two periods. All tests were 2-sided with an R software (v3.6.1) under RStudio (v1.2.5001) was utilized for data analyses. Data are presented as number (corresponding percentage) for categorical variables, and as median  for non-normally continuous variables and as mean ± standard deviation for normally continuous variables. Using Wilcoxon rank sum test/one-way ANOVA for continuous variables and the χP = 0.007), less community infection , less ABT , less mechanical ventilation , less tracheotomy  and less COPD  than patients with subclavian (SC)-vein or jugular-vein catheterization. The density incidence of CABSI was statistically higher for femoral than for jugular  and subclavian  access.During the study period, a total of 2906 patients with 26,157 CVC-days fulfilled the selection criteria  between Periods 1 and 2. As noted in Table 2 = 83.981, P < 0.001), CVC insertion sites , ABT , UCI  and principal diagnosis . PSM improved the balance on the baseline characteristics with all SMD decreasing to 0.1 between groups  and from 10.24 to 6.33/1,000 CVC-days (P < 0.001) between Periods 1 and 2, respectively. Figure 2 = 7.276, P = 0.007, Fig. 2 = 29.272, P < 0.001, Fig. After PSM, the final analyzed data consisted of 952 patients with 8792 CVC-days in Period 1 and 952 patients with 8537 CVC-days in Period 2  different baseline clinical characteristics, including Allogeneic Blood Transfusion, Urinary Catheter Insertion, ICU Department, and Principal Diagnosis, were the main reason for poor comparability between groups; and (2) the choice of insertion site significantly influence the incidence of CABSI. Randomized studies have demonstrated excess risk of CABSI associated with the femoral venous catheterization compared wlith the subclavian catheterization or the internal jugular catheterization in ICU patients –34. MostThe CABSI prospective whistle-blower system, which had been already certified by the National Copyright Administration of the People's Republic of China (Additional file A number of limitations of this study should be considered. First, we evaluated interventions in an academic medical center with a relatively high incidence of CABSI, and as a result, it was difficult to judge whether our interventions equally effective in the case of low CABSI rate or not. Rather, we might still underestimate our CABSI rate because participants with only one catheter were included in this study, potentially limiting the ability to generalize. Nevertheless, our interventions were significantly effective and were cost-effective and, therefore, can be widely used.Second, the before-after study design have not accounted for other confounding factors that may have led to imbalance between groups over time. For example, standardized measures of patient severity of illness, which generally include Acute Physiology and Chronic Health Evaluation, Sequential Organ Failure Assessment, Charlson Comorbidity Index and Glasgow Coma Scale, were not applied due to the data blackout caused by different management styles during the study period, as mentioned by our team member Huang and coworkers in November 2019 . NeverthIn summary, the implementation of enhanced check during the first 7 calendar days after CVC insertion shortens the duration of the CABSI acute phase and tends to decrease CABSI rate.Additional file 1. Necessary accessory materials: Checklist for CVC insertion and maintenance, Certificate issued by the National Copyright Administration of the People's Republic of China, and Baseline characteristics according to catheter site.


The objective of the study was to identify the causes of smear-positive-culture-negative (S+/C–) outcomes of patients with tuberculosis during the treatment course.A laboratory-based retrospective study was performed at the Beijing Chest Hospital in China. Within the study period, all patients with pulmonary tuberculosis (PTB) who undertook anti-TB treatments and yielded smear positive outcomes with simultaneous culture outcomes on sputa were considered. Patients were classified into three groups: (I) performed LJ medium culture only; (II) performed BACTEC MGIT960 liquid culture only; and (III) performed both LJ culture and MGIT960 culture. The S+/C– rates of each group were analyzed. The clinical medical records regarding patient category, follow-up bacteriologic examination data, and treatment response were investigated.p < 0.001, χ2 = 102.64). Among the 102 S+/C– patients who had follow-up cultures performed, 35 (34.3%) had positive culture outcomes. Whereas among the 67 patients with follow-up information for more than 3 months but without supportive bacteriological evidence, 45  had unfavorable prognosis (including relapse and unimproved conditions), and only 22  patients had improved conditions. Compared with new cases, retreated cases produced S+/C– outcomes more frequently and had more chances to be cultivated bacilli successfully afterward.In total, 1,200 eligible patients were enrolled, and the overall S+/C– rate was 17.5% . Group I had obviously higher S+/C– rate (37%) than group II (18.5%) and group III (9.5%). When solid and liquid cultures were considered independently, the S+/C– outcome was observed more frequently in the solid culture group than in the liquid culture group (30.4%, 345/1,135 vs. 11.5%, 100/873; Among our patients, the sporadic smear positive and culture negative outcomes for sputa are more likely associated with the technical failures of culture than with dead bacilli, and this is especially noteworthy for LJ medium culture. In addition to symptomatic and radiographic improvement, the absence of acid-fast bacilli (AFB) from sputum smears and negative culture outcome are used to assess the response to therapy for patients with tuberculosis (TB) , 2. DireIdentifying whether or not the dead bacilli cause the S+/C outcome is a very serious question. As dead bacilli mean that the treatment regimen is effective and should be continued, whereas if the suboptimal sensitivity of culture is the reason, smear positive could mean ill treatment response, leading to regimen adjustment, as well as public health action, such as elongated isolation of the patient and an expanded contact investigation. In this study, we sought to test whether laboratory technical failure is an important cause of S+/C– outcomes, which can help clinicians to better interpret the outcomes and then take appropriate action.This study was approved by the Medical Ethics Committee of Beijing Chest Hospital. The written consent was waived due to the retrospective design of the study.A laboratory-based retrospective study was performed in the Beijing Chest Hospital, a designated hospital for TB patient care in Beijing, China. All smear positive outcomes from sputa of patients with PTB, undertaking anti-TB treatments, were considered from January 2015 to July 2016. The eligibility criteria for patient recruitment in this study were as follows: (I) The sputum smear test was positive, (II) Lowenstein-Jensen (LJ) medium culture and/or BACTEC MGIT 960 liquid culture were performed with the same specimen that produced positive smear test, or with specimen collected in the same day with the smear testing, and (III) negative outcome was obtained from the culturing. For patients with multiple S+/C– outcomes during the study period, the analysis was based on the time point of the first S+/C– outcome. The clinical medical records regarding patient category, follow-up bacteriologic examination data, and treatment outcomes were investigated.Patients were classified into three groups based on the culturing methods used when recruited for this study: (I) performed LJ medium culture only; (II) performed BACTEC MGIT960 medium culture only; and (III) performed both LJ medium and MGIT960 medium culture.Each sputum sample should contain 5–10 ml of sputum. Direct smear, prepared with sputum, was stained using auramine and then examined by light-emitting diode (LED) microscopy . The solid culture with LJ medium was performed following the guidelines from the Chinese anti-TB Association  and the 2 test, with a p-value of <0.05 indicating significance, using SPSS version 13.0 software.The statistical analysis was carried out using the χ2 = 33.01, p < 0.001).A total of 1,200 patients undertaking anti-TB treatments yielded S+ outcomes during the study period. In total, 990 (82.5%) had culture positive outcomes by any of the culture methods . Smear-pp < 0.001, χ2 = 102.64).In the group that performed LJ medium culture only, S+/C– outcome was observed in 121 of the 327 patients (37.0%); in the group that performed BACTEC MGIT960 medium culture only, S+/C–occurred in 12 of the 65 patients (18.5%); in the group performed both LJ and BACTEC MGIT960 medium culture, the S+/C–was observed in 77 of the 808 patients (9.5%), but 147 patients had MGIT960+/LJ– outcomes, while only 11 patients had LJ +/ MGIT960– outcomes. When solid and liquid cultures were independently considered, the S+/C– was observed more frequently among solid than liquid cultures  patients had positive culture outcomes by any kind of culture method. Patients of all groups I, II, and III all had good chances to yield cultivatable bacilli during follow-up terms [45.5% (25/55), 25% (2/8), and 20.5% (8/39); Among the 182 patients who had traceable medical records, 147 either had negative culture outcomes in the follow-up bacterial examinations or were not cultured afterward. In total, 80 out of these 147 patients were excluded because they had follow-up terms shorter than 3 months after obtaining the S+/C– outcome, which would be too short to evaluate the treatment response objectively. Therefore, 67 patients were eligible for treatment response evaluation by referring to the microbiological, radiological, and symptomatic data . The folA study in Tanzania observed 17.8% of their patients with newly diagnosed pulmonary tuberculosis produced S+/C– outcomes, and about 30% of these S+/C– patients were confirmed TB cases by repeated culture and/or molecular test . Since nWe obtained a little bit higher S+/C– rate (37.0%) for group I patients than other reposts, and we attribute this increase to the involvement of retreated patients in the study. All the other studies evaluated the S+/C– phenomenon among the small number of new cases, which may have different bacteriological conversion patterns than the retreated patients. Retreated patients often have more tough bacilli than new cases, for example, higher levels of drug resistance and long-term drug exposure may alleviate the vitality of the cells .Totally, 102 patients performed culture at least once during the follow-up term and 35 (34.3%) patients had positive culture outcomes by any kind of culture method . AlthougWhether non-tuberculosis mycobacteria (NTM) was a cause of S+/C– outcome was evaluated. Species identification was performed on the recovered isolates after the S+/C– outcome of the enrolled patients, of which seven were identified as NTM. In total, seven patients were diagnosed with NTM infections, while five of them had positive cultures again after the S+/C– presented. Various studies have reported that NTM is a risk factor for S+/C– outcome; here, the proportion of NTM infection among the 210 cases was a little bit higher than the routine NTM isolation rate in the same laboratory (3.3 vs. 2.6%) , but theFor the patient who either had negative culture outcomes in the follow-up bacterial examinations or no culture was performed afterward, the treatment response was followed up. According to our data, 67.2% (45/67) of the eligible cases had unfavorable prognoses within the follow-up term (including relapse and unimproved conditions). The prognostic evaluation outcomes did not support a good relationship between S+/C– and dead bacilli either.According to our suggestion, a sporadic S+/C– outcome in clinical practice should first be taken as positive bacteriological evidence instead of assuming dead bacilli as a cause. However, since dead bacilli are an underlying reason for the S+/C– outcome, therefore, a comprehensive evaluation of clinical manifestations and chest radiographic findings and lateral bacteriological evidence are needed to interpret the outcomes appropriately. Some studies found that late smear positivity usually has no clinical significance and requires no specific action , 19, wheOur study has some limitations. As a national level referral hospital, a lot of patients only accepted periodical treatments here, which resulted in insufficient follow-up data for patient evaluation. This may lead to bias on less symptomatic and well-response patients, for whom the dead bacilli and S+/C– outcomes may be more related. Furthermore, the constitutions of the recruited patients  may also cause bias in the conclusion and prompt further analysis to verify our inferential opinions.In our studied set of patients, the sporadic smear positive and culture negative outcomes for sputa are more likely to be associated with low sensitivity of culture than with dead bacilli, especially when only LJ medium culture is used. In contrast to new cases, retreated cases easily produced S+/C– outcomes and had a higher change to cultivate live bacilli afterward. Despite our findings, further downstream work should be done to seek the underlying reason for S+/C– outcomes for patients with TB.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.This study was approved by Medical Ethics Committee of Beijing Chest Hospital. The written consent was waived due to the retrospective design of the study.HH contributed to the study's conception and design. JL, XY, LD, FH, QL, YM, and YS were performed by material preparation, data collection, and analysis. HH and JL wrote the first draft of the manuscript. All authors commented on the previous versions of the manuscript, contributed to the article, and approved the submitted version.


The inhibitory effect of tempol was absent in PO and lard and attenuated in OO. Vascular insulin sensitivity was decreased in all HFD groups. This decreased sensitivity of insulin was more important with PO and lard when compared to OO diet. In conclusion, the results of this study clearly show that high consumption of palm olein, olive oil, and lard can compromise glucose tolerance and thus insulin sensitivity. Furthermore, palm olein and lard have a more deleterious effect than olive oil on the contractile function of the aorta. Excessive consumption of saturated or unsaturated fatty acids is harmful to health, regardless of their vegetable or animal origin.Palm olein (PO) and lard are considered harmful to health because of their highly saturated fatty acid content. On the contrary, olive oil (OO) with its high level of polyunsaturated fatty acids is considered healthier. This study aims to evaluate the effects of high consumption of these oils on carbohydrate metabolism and vascular function. Male Wistar rats were fed ad libitum for 12 weeks with different high fat diets (HFD) containing 30% of each oil. Systemic glycemia, insulinemia, and lipidemia were assessed by routine methods or by ELISA. GLUT4 muscular expression and hepatic and muscular Akt phosphorylation were analyzed by western blot. Vascular function was evaluated, ex vivo, on aortic rings and on the variations of isometric tensions. The results show that fasting blood glucose was increased with PO and OO diets and decreased with lard. Compared to control diet, this increase was significant only with PO diet. The area under the curve of IPGTT was increased in all HFD groups. Compared to control diet, this increase was significant only with PO. In contrast, stimulation of the pathway with insulin showed a significant decrease in Akt phosphorylation in all HFD compared to control diet. KCl and phenylephrine induced strong, dose-dependent vasoconstriction of rat aortas in all groups, but KCl EC A high-fat diet (HFD) over time promotes metabolic syndrome. The metabolic syndrome consists of many health problems, such as glucose intolerance, obesity, dyslipidemia, insulin resistance, and high blood pressure –4. All tCardiovascular diseases are caused by numerous changes in the arterial vasculature such as arterial stiffening , arteriaPalm olein (PO) and lard are rich in saturated fatty acids with similar compositions. Palm olein is composed of 50% SFA, 40% MUFA, and 10% PUFA, . Lard isThe aim of the present study was to evaluate the effects of long-term consumption of a hypercaloric diet high in saturated fatty acids versus unsaturated fatty acids on carbohydrate metabolism and arterial vessels' function. Thus, we compared the effects of HFD rich either in palm olein, lard, or olive oil on insulin resistance and vascular reactivity in rats.th edition, 2011), and all procedures were approved by the local ethical committee . Thirty-two young male Wistar rats aged 6 weeks coming from the Animal facilities of Charles River Laboratories, France, were used. The animals were housed under conditions of constant temperature (20–22°C), humidity (45–50%), and a standard dark cycle (20.00-08.00 h) with free access to food and water. Rats were randomly assigned to four groups of eight animals and fed for 12 weeks either a standard rat chow diet (control) or one of the three HFD. In the control diet, 11% of the energy was given by fat (5% soybean oil), whereas in enriched diets, 56% of the energy was provided by fat intake /22.5.The plasma contents of glucose, total cholesterol, HDL cholesterol, and triglycerides, were determined using standard methods on a COBAS automated analyzer . Plasma insulin level was quantified by an immunoassay kit (Mercodia Rat Insulin ELISA). The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated using the follow equation: HOMA-IR = [fasting blood glucose level  of antiprotease cocktail . Proteins were resolved by SDS-PAGE and then transferred to nitrocellulose membranes at 20 V overnight using refrigerated Tris-glycine transfer buffer. The membranes were blocked in 5% nonfat milk in PBS (without Tween) for 1 h at room temperature. Then, membranes were incubated overnight with primary antibody of protein kinase B (Akt), phospho-protein kinase B (p-Akt) ; glucose transporter Glut 4 (GLUT 4) ; tubulin  in blocking buffer. After washes in PBS/Tween under gentle agitation, the membranes were incubated for 45 min in the dark with the fluorescent-labeled secondary antibodies and finally quantified using the Odyssey infrared imaging system .Protein isolation and western blot analysis were performed as previously described . Whole-cex vivo the responses to agonists and antagonists of arterial contraction as previously described [2, 0.5 KH2PO4, 0.5 Na2HPO4, 2.5 CaCl2, 10 HEPES, and 10 glucose. Aortic tissue was cleaned of fat and connective tissue and cut into 2-3 mm wide rings. Aortic rings were mounted in standard organ bath chambers  maintained at 37°C and continuously bubbled with O2. Then, the changes in isometric tension were recorded according to Fort et al. [µM phenylephrine (Phe), and the presence of endothelium was confirmed by the vasorelaxation induced by application of acetylcholine . After several washouts and a 20–30 min period of stabilization, dose responses were performed by cumulative increases in the concentration of the agonist Phe (0.01–100 µM range) or the depolarizing agent KCl (1–80 mM). Endothelial function was assessed by studying the relaxing effects of cumulative increases of Ach between 1 nM and 10 µM on arteries contracted with a submaximally active concentration of Phe (10 µM). The effects of the nitric oxide (NO) synthase inhibitor nitro-L-arginine methyl ester  and the reactive oxygen species scavenger tempol (100 µM) were evaluated on the contractile response to Phe and the relaxing effect of Ach. Inhibitors were added for a 15 min period of incubation before Phe addition. Endothelium-independent relaxations to sodium nitroprusside  were studied in endothelium-denuded rings previously contracted with Phe (10 µM). Each protocol was performed in triplicate for each aorta. All chemical compounds were purchased from Sigma-Aldrich .The thoracic aorta was used to study escribed . Immediat et al. . Each arn = 7-8 animals per group. Statistical analysis was based on one-way ANOVA followed by a Tukey Kramer multiple comparisons test. When statistical variances were unequal, a Welch test was performed. Dose-response data were analyzed and compared by nonlinear regression methods using the PRISM software . Differences between dose–response curves were investigated by the half maximum effective concentration or sensitivity (EC50) and maximum effect (Emax). The limit of statistical significance was set at p < 0.05. The group mean values with different letters  are significantly different. Statistical analyses were performed using the Stat-View program .Values were expressed as mean ± SD, p=0.0083) by HFD (+15%) whatever the type of fat and with no difference between diets and type of fat. No increase in plasma total cholesterol and triglyceride levels was observed. Even in OO and lard groups, plasma levels of total cholesterol (p=0.0301) and HDL cholesterol (p=0.0106) were decreased. Compared to control diet, plasma HDL cholesterol was decreased with OO (−10.54%) and lard (−28.88%) diets and slightly increased with PO diet (+4.49%). Only lard significantly decreased HDL cholesterol compared to control diet. Blood SOD activity was decreased with PO and lard diets when compared to control and OO diets (As shown in OO diets .p=0.009) but not OO diet. With lard diet, glycemia was unchanged. Although no diet significantly changed fasting insulin levels and HOMA-IR, all HFD increased the value of these two parameters compared to control diet. HOMA-IR index was, however, higher with PO diet (Fasting blood glucose was increased with PO (+13%) and OO (+8%) diets and decreased with lard (−5.43%). When compared to control diet, this increase was significant with PO ( PO diet .p=0.0223) and T60 minutes (p=0.0189) was significantly higher (p=0.0263), and no difference was observed between the different HFD  . No signy higher . The arerent HFD . These rp=0.0057) in Akt phosphorylation in all HFD compared to control diet. However, no differences between HFD themselves were found . Both agonists induced strong, dose-dependent vasoconstriction of rat aortas in all groups (p=0.03) with lard diet compared to control diet  were increased in the aortas of rats fed with PO and lard, while no difference was observed in the OO group compared to the control group (The contractile responses to Phe (0.01–100 ol group . EC50 vaol group .p=0.021) and especially with OO diet when compared to control group  (µM)   or SNP-iµM) (µM) . No signdetected .In the presence of L-NAME, Ach-induced relaxation was strongly inhibited  in all gµM insulin  and its nature (saturated or unsaturated) induced weight gain is, disrupted lipidemic status and carbohydrate metabolism and decreased insulin sensitivity. However, only diets enriched with saturated fatty acids (PO and lard) increased arterial procontractile tone involving reduced NO bioavailability and increased oxidative stress.The disruption of carbohydrate metabolism, highlighted by many authors –33, was Many studies have shown that high fat diets contribute to vascular dysfunction. In animal models, abnormalities in vascular reactivity consist primarily of increased contractility and reduced vasodilation associated to endothelial dysfunction . Endothe, and early endothelial dysfunction may be masked by compensatory mechanisms. Interestingly, it has been shown in some models that insulin-induced vasodilation, which is also endothelium-dependent, is impaired earlier than dilation to acetylcholine [On the other hand, whether endothelial dysfunction is a common feature of HFD-induced vascular alterations, numerous studies report no difference in Ach-induced endothelium-dependent relaxation of arteries , and earlcholine . In our lcholine .2−) could be increased leading to increased peroxynitrite production and hypercontractility. Consistent with this hypothesis and with a previous study [2− is not the main ROS involved in vascular tone.The endothelium constitutively produces NO and hyperpolarizing factors, which participate in baseline tone through anticontractile activity . NO signus study , on the 2− dismutation.Taken together, our results demonstrated that all HFD altered vascular function and NO availability rather than NO production. With PO and lard diets, a vascular procontractile dysfunction associated to increased oxidative stress and NO oxidation is observed, while, in comparison with OO diet, NO oxidation is reduced in favor OIn conclusion, the results of this study clearly show that high consumption of PO, OO, and lard can compromise glucose tolerance and thus insulin sensitivity. Furthermore, PO and lard have a more deleterious effect than OO on the contractile function of the aorta. Excessive consumption of saturated or unsaturated fatty acids is harmful to health, regardless of their vegetable or animal origin. As these results are not necessarily transposable to usual fat consumption, it would be interesting to study the effects of increasing doses of PO, OO, or lard to determine the adequate dose that does not compromise insulin sensitivity and aortic contractility. Further studies are needed to assess the effect of long-term consumption of OO, PO or lard in nonobesogenic diets in human.


After 70 days of feeding, sheep were slaughtered and the ruminal fluids were collected and analyzed to determine fermentation parameters. Microbiota was determined using metagenomics sequencing. Notably, the microbial cell protein (MCP) and butyric acid concentrations were significantly high in the HE group. Metagenomic sequencing revealed that ACE and Chao indexes of the HE group were significantly decreased. Four genera among the major classified taxa across all the kingdoms differed in relative abundance in the three dietary energy levels. The relative abundances of Prevotella_brevis, Succiniclasticum_ruminis, Prevotellace-ae_bacterium, and Lachnospiraceae_bacterium were significantly correlated with rumen fermentation. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis further revealed that a high-energy diet increased lipid metabolism of microbiota. The Carbohydrate Active enzymes (CAZy) gene, which participates in energy metabolism, was upregulated, while genes regulating plant cell wall degradation were downregulated in the HE group. These results suggest that a high-energy diet had minimal influence on the rumen fermentation pattern but altered the composition of the rumen microbiota, enhancing microbial lipid metabolism and limiting crude fiber metabolism. The findings of this study provide scientific evidence of the effect of dietary energy on ruminant fermentation and fattening sheep production.Higher dietary energy is often used to achieve better animal performance in mutton sheep production. Notably, changing the diet formula affects rumen fermentation and the microbiota of ruminants. In this study, we investigated the effect of dietary energy on rumen fermentation and ruminal microbiota in fattening sheep. Fifteen 2-month-old white-headed Suffolk sheep (♂) × Hu sheep (♀) crossbred lambs were randomly divided into three treatments based on the dietary energy of the feeds fed: 8.67 MJ/kg (Low energy (LE); The online version contains supplementary material available at 10.1186/s12917-023-03592-6. The rumen harbors numerous microorganisms, which form a highly interconnected complex ecosystem . The micIn the modern intensive farming mode, concentrated rations are used to increase production by providing high energy to the animal. An increase in dietary energy levels displayed promising results in the performance of lambs, with average daily weight gains increased with metabolic energy elevating . A high-In this study, the effects of dietary energy levels on rumen fermentation and microbiota in sheep were assessed across the different fattening stages. The interactions between microbes and sheep energy absorption were also analyzed to understand the role of microorganisms in host energy metabolism. The findings of this study provide solid scientific evidence for the best mutton production practice.The protocol for this study was approved by the Animal Care and Use Committee of the Northwest Agriculture & Forestry University, China .The sheep were reared at Gansu Charming Sheep Breeder Co., Ltd.  for 78 days between July 24, 2020, and October 10, 2020, and comprised 8 days of pretest and 70 days of testing. Thirty-six 2-month-old white-headed Suffolk sheep (♂) × Hu sheep (♀) crossbred lambs with an average body weight of 20.58 ± 1.47 kg were selected from 2000 lambs born at the same time (sex ratio of the lambs was 1:1). The lambs were randomly divided into the low energy (LE), standard (CON), and high energy (HE) groups based on diet. Every group had four replicates, each with three sheep. The sheep feeds were prepared based on the mutton sheep feeding standard of the China Agricultural Industry Standard (NY/T816-2004). The weight gain of the 20.0 kg sheep was 200 g/d. The digestible energy (DE) and crude protein in the CON diet were 10.38 MJ/kg and 14.36%, respectively. The LE diet contained an 85% energy level compared to that of the standard group, and its DE was 8.67 MJ/kg. The energy in HE feeds was 15% higher than that of the CON diet and had a DE value of 12.31 MJ/kg. Notably, the dietary protein was equal in all groups. The lambs were adequately fed on a mixed ration of dried pellets twice a day at 08:00 and 17:00 and had enough water. Table One sheep was randomly selected from each replicate, and one of the eight remaining sheep in each group was selected, totaling five sheep per group, for slaughter and sampling on the morning of the 70th day of the trial. The sheep were slaughtered after 12 h of fasting. Rumen fluid was collected and immediately filtered through four layers of sterile gauze. The rumen fluid pH was measured using a portable pH probe . Each rumen fluid sample was divided into four parts: one part was mixed with 0.2 mol/L hydrochloric acids and stored at − 20 °C before determining the ammonia nitrogen content, while the rest were stored at − 80 °C awaiting the microbial cell protein (MCP) test, volatile fatty acid (VFA) test, and metagenomics sequencing.The concentration of ammonia nitrogen was determined using the indophenol method after thawing and centrifuging the rumen fluid at 11000×g for 10 min at 4 °C . The MCPTotal genomic DNA from rumen fluid samples was extracted using the MP-soil E.Z.N.A.® Soil DNA Kit  following the manufacturer’s instructions. The sequencing was performed on an Illumina NovaSeq/Hiseq Xten platform  at Majorbio Bio-Pharm Technology Co., Ltd. . The generated sequence data were deposited in the NCBI Short Read Archive database (Accession Number: PRJNA826547).http://www.diamondsearch.org/index.php, version 0.8.35) based on data in the KEGG database . The cutoff e-value was set at 1e-5. Carbohydrate-active enzymes (CAZy) annotation was conducted using hmm can (http://hmmer.janelia.org/search/hmmscan) against the CAZy database (http://www.cazy.org/) with an e-value cutoff of 1e-5. The detailed method is shown in the supplementary material After sequence quality control and genome assembly, gene prediction, taxonomy, and functional annotation were conducted. Kyoto Encyclopedia of Genes and Genomes (KEGG) annotation was performed using the Diamond tool  . The alpha diversity of bacteria was analyzed using the Mothur tool (Version 1.30.2) and visualized using the R Software (Version 2.15.3). ANOSIM of rumen microbial community composition was analyzed using abund_jaccard. Correlation network analysis was performed using Python (Version 3.5) Networkx package. CAZy and KEGG enrichment data were analyzed using the nonparametric Wilcoxon rank-sum test. The significance threshold was set at p < 0.05, and the highly significant threshold at p < 0.01.Fermentation data were tested for normality using the Shapiro-Wilk test. The data was then analyzed using one-way ANOVA with an LSD post-hoc test, performed using SPSS version 24.0. software . Metagenomics data were presented as box-and-whiskers plots constructed after a two-tailed Wilcoxon rank-sum test. An FDR correction of the 3-N concentration and the pH of rumen fluid among the three groups. Notably, MCP concentration in the rumen fluid of the CON and LE groups was highly significantly lower than that in the HE group (p < 0.01). However, there was no significant difference in MCP concentration in the rumen fluid between the CON and LE groups.The rumen fermentation indexes are outlined in Table p < 0.05). The propionic acid concentration was significantly higher in the CON than in the HE group (p < 0.05). However, there was no significant difference in propionic acid concentration between the HE and LE groups. Butyric acid concentration was highly significantly lower in the CON and LE groups than in the HE group (p < 0.01). The concentration of valeric acid was significantly higher in the CON group than in the LE group (p < 0.05). The concentration of Isobutyric and Isovaleric acids was significantly higher in the CON and LE groups than in the HE group (p < 0.01). The Acetic/Propionic ratio was significantly lower in the CON group than in the HE group (p < 0.05). Of note, there was no significant difference in the total VFA concentration among the three groups.The dietary energy level altered VFA concentration in the rumen fluid. There was no significant difference in acetic acid concentration between the CON and HE groups. However, acetic acid concentration was significantly higher in the LE group than in the HE group .p < 0.01). ANOSIM analysis revealed a significant difference in the microbial community composition  in the HE group.Figure Prevotella, unclassified Lachnospiraceae, unclassified Bacteroidales, unclassified Clostridiales, unclassified Prevotellaceae, unclassified Rikenellaceae, Bacteroides, unclassified Ruminococcaceae, Clostridium, and Olsenella. The relative abundance of unclassified Lachnospiraceae was significantly lower (p < 0.05) in the LE group than in the HE group, while those of unclassified Bacteroidales and Bacteroides in the CON and LE groups were significantly higher than in the HE group . The relative abundance of unclassified Rikenellaceae was significantly higher in the CON group than in the HE group (p < 0.05) , while that of Lachnospiraceae_bacterium was significantly higher in the HE group than in the LE group (p < 0.05). Moreover, the relative abundance of Bacteroidales_bacterium was significantly lower in the HE group than in the CON (p < 0.05) and LE (p < 0.01) groups . However, the relative abundance of Prevotella_brevis, Prevotellaceae_bacterium, and Succiniclasticum_ruminis were significantly higher in the CON and LE groups than in the HE group (p < 0.05).The relationship between rumen microbiota and fermentation was analyzed based on the Spearman correlation coefficient. Only ammonia nitrogen, acetic acid, propionic acid, isobutyric acid, isovaleric acid, and valeric acid levels were associated with the abundance of the rumen microbes Fig. . Ammoniark Table . The relp < 0.05) with an increase in diet energy level. In contrast, the phosphotransferase system (PTS), primary bile acid biosynthesis, secondary bile acid biosynthesis, and geraniol degradation were significantly higher in the HE group (p < 0.05)  Fig. .Fig. 4Mup < 0.05) . These genes encoded energy metabolism genes, such as 4-α-glucanotransferase (EC 2.4.1.25), acetyl xylan esterase (EC 3.1.1.72), 1,2-diacylglycerol, and 3-β-glucosyltransferase (EC 2.4.1.157). The expression of GH31, GH92, GH9, GH146, and CE15 decreased with an increase in the dietary energy level (p < 0.05)  the mRNA expression of fat deposition-related genes in subcutaneous fat (HSL), tail fat (FASN), and longissimus dorsi (FABP4) [Dietary energy is an important factor that affects nutrient intake, digestion, metabolic efficiency, and production performance. Herein, high dietary energy levels increased the final weight, live weight, average daily gain, and feed rewards in lambs. The increase of dietary energy significantly increased ( (FABP4) . The inf3-N, and MCP are the critical indices of the rumen fermentation pattern. In ruminants, feeds first undergo microbial fermentation in the rumen. Ruminal microbiota breaks down carbohydrates into VFA, the main metabolite of microbial fermentation [VFA, NHentation . Microbeentation . ATP forRumen fermentation patterns usually change under different nutritional conditions. VFA concentration increases with an increase in the energy level or a high concentrate diet. High ME also significantly increases the proportions of butyrate and valerate . MoreoveBacteria are the most abundant and diverse microbiota in the rumen, a phenomenon attributable to diet . The micunidentified Prevotellaceae, Fibrobacter, unidentified Lachnospiraceae, Saccharofermentans, and Succinivibrio [Lentisphaera, Prevotella, unclassified Lachnospiraceae, unclassified Bacteroidales, unclassified Clostridiales, and unclassified Prevotellaceae.Despite the complexity of the rumen ecosystem, the composition and abundance of rumen microbiota are relatively stable at the phylum level. Firmicutes, Bacteroidetes, Fibrobacteres, and Proteobacteria are the four most abundant phyla in the sheep rumen, whereas the dominant genera include nivibrio . In thisButyrivibrio, Fibrobacter, Olsenella, and Prevotella are critical in degrading cellulose [Bacteroidetes utilize crude fiber in the form of glycans (oligomeric and polymeric glycans); the abundance of this bacteria is influenced by the dietary intake of these indigestible carbohydrates [Bacteroides in the HE group was relatively low (feed of sheep in the HE group contained little crude fiber). Furthermore, the relative abundance of Rikenellaceae_bacterium and Bacteroidales_bacterium decreased with an increase in the dietary energy level. Rikenellaceae is one of the main producers of VFA. Previous studies postulate that a high-fat diet significantly decreases the Rikenellaceae composition in the rumen [Relevant studies continue to reveal the functions of ruminal microbiota in ruminants. For instance, Bacteroidetes degrade carbohydrates and polysaccharides more efficiently than Proteobacteria . At the ellulose . Generalellulose –37. A prhydrates . In thishe rumen . SimilarLachnospiraceae family are among the main producers of short-chain fatty acids [Bacteroidetes produce enzymes that degrade plant cell wall compounds  to release VFA  [Succiniclasticum degrades starch into acetic and succinic acids and further converts succinic acid into propionic acid [Prevotellaceae UCG-003 is positively correlated with the rumen VFA content [Lachnospiraceae_bacterium, Prevotella_brevis, Prevotellaceae_bacterium, and Succiniclasticum_ruminis was significantly different among the groups. Prevotella_brevis promotes acetic acid synthesis, Succiniclasticum_ruminis promotes synthesis, Prevotellaceae_bacterium promotes propionic acid, isobutyric acid, and isovaleric acid synthesis, whereas Lachnospiraceae_bacterium inhibits ammonia nitrogen and propionic acid synthesis.The rumen microbiota produces numerous metabolites, including VFA and polyamines, through anaerobic fermentation. Notably, 10% of metabolites in mammalian blood are derived from microbes or microbial activities . The bloty acids . Bacteroutyrate) . The phyutyrate) . Succininic acid . The abu content . In thisChanges in the KEGG pathway reflect an alteration in the rumen microbial function under specific conditions. Changes in enzyme function also modify microbial function. Rumen microbial functions changes with dietary energy concentration. Zhang et al.  investigKEGG and CAZy enrichment data further revealed that a high-energy diet improved lipid metabolism in sheep by promoting the expression of genes associated with lipid metabolism. In contrast, low-energy diets enhanced glycan biosynthesis and metabolism by promoting the expression of enzymes involved in plant cell wall degradation to meet the animals’ energy needs.Although we observed improvements in production performance caused by higher dietary energy in our previous study and obtained microbial-related data in this current study, we could not directly correlate microbial-related data with host metabolism. This limitation was occasioned by preliminary sample collection issues, which made it difficult to facilitate such correlations. Future studies should focus on this aspect to have holistic results.A high dietary energy diet had limited influence on the rumen fermentation pattern but increased MCP synthesis. Notably, changes in dietary energy altered the rumen microbial composition and microbial energy metabolism pattern. In particular, a high dietary energy diet reduced crude fiber metabolism but strengthened the energy metabolism pathway of microorganisms. This study recommends a fattening dietary energy level of 12.31 MJ/kg for 2-month-old lambs.Additional file 1: Metagenomics of the rumen microorganisms.


To study the efficacy of interval debulking surgery (IDS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) compared to IDS alone for the treatment of ovarian cancer after neoadjuvant chemotherapy (NACT).N = 20) or without (N = 42) HIPEC were included. HIPEC was administered after surgery and was combined with 1–2 courses of intraperitoneal hyperthermic perfusion with normal saline only. We analyzed clinical information and outcomes for the two groups.We conducted a retrospective study of patients with stage IIIC/IV high-grade serous ovarian carcinoma who underwent surgery at our center from January 2018 to December 2019. Patients who underwent IDS after NACT with (P = 0.597). The median overall survival (OS) was not reached. After adjustment for age between the two groups, the differences in PFS and OS remained nonsignificant. The change ratio of postoperative CA-125 to preoperative CA-125 was 0.66 in the IDS plus HIPEC group and 0.53 in the IDS group (P = 0.341). The difference in human epididymis protein 4 (HE-4) change ratio between the two groups was nonsignificant (P = 0.225). No significant difference was observed in the occurrence of grade 3 and 4 adverse events between the two groups (P = 0.201).The median progression-free survival (PFS) was 14.05 months in the IDS plus HIPEC group and 12.97 months in the IDS group (After NACT, IDS plus HIPEC did not show significant PFS and tumor index change ratio benefits over IDS alone in patients with primary ovarian cancer. Further investigations are needed to assess the role of HIPEC in the treatment of ovarian cancer. Based on incidence and mortality, ovarian cancer is among the top ten cancer types in females . A largevia multiple mechanisms. The combination of high temperature and chemotherapy can also function via multiple mechanisms, including increased local drug concentrations, cytotoxic effects of chemotherapeutic drugs on cancer cells, and penetration of the drug into tumor tissue  or diameter for residual tumor ≤1 cm (R1) . HIPEC wThe NACT and adjuvant chemotherapy regimen for all patients was platinum- and taxane-based, which is the classic first-line regimen for ovarian cancer. The number of cycles was 6–8 for most patients unless new progression occurred.HIPEC using chemotherapy drugs was administered after surgery and was combined with 1–2 courses of intraperitoneal hyperthermic perfusion with normal saline only. Different perfusion courses were conducted on separate days. The intraperitoneal chemotherapy drugs used for HIPEC in our center include cisplatin, lobaplatin, and paclitaxel, either alone or in combination. Intraperitoneal perfusion tubes including two inflow and two outflow catheters were inserted into the abdominal cavity during the operation, and HIPEC with chemotherapy was administered within one week after the operation. Chemotherapy drugs were mixed with normal saline and administered intraperitoneally at a temperature of 43 °C for one hour. The additional intraperitoneal hyperthermic perfusion with only normal saline was also administered at a temperature of 43 °C for one hour. Intravenous chemotherapy drugs were administered intravenously on the same day as HIPEC.For all patients, CA-125 and HE-4 serum levels were regularly tested before surgery and are referred to as preoperative CA-125 and preoperative HE-4, respectively. The tumor index was tested three weeks after the first cycle of postoperative chemotherapy, either intravenous or HIPEC, and before the second course of postoperative chemotherapy and is referred to as postoperative CA-125 and postoperative HE-4.Postoperative complications were defined as complications that occurred within one month after the operation and were graded according to the Common Terminology Criteria for Adverse Events Version 5.0.P value <0.05 was considered significant. All statistical calculations were performed using SPSS software (version 23.0).PFS was defined as the time between surgery and the first progression of the disease. Progression was defined as the date of imaging or biochemical progression occurrence according to RECIST 1.1 criteria and CA-125 criteria . OS was From January 2018 to December 2019, there were 20 patients with stage IIIC/IV ovarian carcinoma with a histologic subtype of high-grade serous ovarian cancer and satisfactory cytoreduction surgery (R0 or R1) after NACT at our center who underwent HIPEC. They were included in the IDS plus HIPEC group. There were 42 patients who underwent IDS alone, were treated by the same physicians during the same period as the IDS plus HIPEC group, and were included in the IDS group.P = 0.036). The majority of the patients (approximately 90%) in both groups were diagnosed with FIGO IIIC ovarian cancer, and the remaining patients had stage IV disease. The majority of the patients received ≤3 cycles of adjuvant chemotherapy.The clinical characteristics of the study population are shown in 2 combined with intravenous paclitaxel (approximately 175 mg/m2). Three patients underwent HIPEC with paclitaxel (approximately 175 mg/m2) combined with intravenous carboplatin (AUC5-6). One patient underwent HIPEC with lobaplatin (approximately 30 mg/m2) combined with intravenous paclitaxel (approximately 175 mg/m2). Four patients underwent HIPEC with cisplatin (75 mg/m2) and low-dose paclitaxel (approximately 60 mg/m2) combined with intravenous paclitaxel chemotherapy (approximately 175 mg/m2). One patient underwent HIPEC with lobaplatin (approximately 30 mg/m2) and low-dose paclitaxel (approximately 60 mg/m2) combined with intravenous paclitaxel (approximately 135 mg/m2). HIPEC with two different chemotherapy drugs was performed on two separate days.For women who underwent IDS plus HIPEC, HIPEC with chemotherapeutic drugs was mostly administered within one week after surgery. Intravenous chemotherapy was administered primarily on the same day as HIPEC. Eleven patients underwent HIPEC with cisplatin at a dose of approximately 75 mg/mP = 0.597). At the cutoff, 5 of the 20 patients in the IDS plus HIPEC group and 12 of the 42 patients in the IDS group had died. The median OS was not reached.The median follow-up time after surgery was 30.35 months. Of the 20 patients in the IDS plus HIPEC group, 12 had experienced disease progression at the follow-up cutoff, and the median PFS was 14.05 months . Of the 42 patients in the IDS group, 32 had experienced disease progression at the follow-up cutoff, and the median PFS was 12.97 months . There was no significant difference between the two groups (P = 0.570) (P = 0.744)   and OS (= 0.744)  remainedP = 0.319). The average change ratio of postoperative CA-125 to preoperative CA-125 was 0.66 in the IDS plus HIPEC group and 0.53 in the IDS group, which also showed no significant difference (P = 0.341)    .P = 0.387). There was no significant difference in the postoperative HE-4 and HE-4 change ratios between the two groups  (The average preoperative HE-4 was 146.14 pmol/L in the IDS plus HIPEC group and 198.97 pmol/L in the IDS group. There was no significant difference in the preoperative HE-4 between the two groups (ctively)   .P = 0.201)  .As ovarian cancer typically spreads intraperitoneally, intraperitoneal chemotherapy has been proposed as a therapy for advanced ovarian cancer for years. Clinical trials, such as GOG172, a randomized, phase 3 trial, demonstrated that intraperitoneal chemotherapy improves survival in patients with optimally debulked stage III ovarian cancer compared with intravenous chemotherapy . HoweverThere are few randomized clinical trials on HIPEC in the primary treatment of ovarian cancer. Based on the results of trials, the role of HIPEC in ovarian cancer remains debatable. Van Driel et al.  conducteRetrospective studies also reached different conclusions on the role of HIPEC in primary ovarian cancer. One retrospective study  conducteHIPEC is controversial not only in primary treated ovarian cancer but also in recurrent ovarian cancer. A prospective study  conducteP = 0.597). There was no significant difference between the change ratio of postoperative CA-125 to preoperative CA-125 or the ratio of postoperative HE-4 to preoperative HE-4 between the two groups. Even after adjusting for the age differences between groups, the differences in PFS and OS continued to lack statistical significance . In our study, neither the survival analysis nor the change in tumor index showed the advantage of HIPEC in patients who underwent IDS after NACT.The results of our study showed a median PFS of 14.05 months in the IDS plus HIPEC group and 12.97 months in the IDS group (In our study, HIPEC was administered using chemotherapy drugs, with additional intraperitoneal hyperthermic perfusion using only normal saline. Intraperitoneal hyperthermic perfusion with normal saline has been proven to improve survival outcomes in pancreatic cancer without increasing the risk of complications , 31. ThuHIPEC is often administered immediately after cytoreduction surgery , but somChemotherapy drugs used in HIPEC in published studies differed and contained multiple types, including cisplatin, paclitaxel, and doxorubicin , 33. CisThere are some limitations of our study. Most importantly, this is a retrospective study with a small sample size, which may make the results inaccurate. The time of HIPEC administration and the technique and drugs used for HIPEC in our study were not identical to those in previously reported studies. These differences may affect the clinical results.To date, HIPEC remains a controversial treatment for ovarian cancer. Large clinical randomized trials are needed to address this topic and assess the true role and benefit of HIPEC in the treatment of ovarian cancer.


Abdominal obesity has been linked to risk of mortality, but whether and how trajectory of waist circumstance (WC) underpins this association remains unclear. The study aimed to identify long-term WC change trajectories and examine their association and joint effect with body mass index (BMI) on mortality among Chinese older adults.This present study included participants 60 years of age or older from China Health and Nutrition Survey (CHNS) from 1991 to 2015. The duration of follow-up was defined as period from the first to latest visit date attended with information on mortality, end of follow-up, or loss to follow-up (censoring). Latent class trajectory analysis (LCTA) was used to assess the changes of WC trajectories overtime. Cox proportional hazard models were used to assess hazard ratios (HRs) and corresponding 95% confidence internal (CIs) for mortality.A total of 2601 participants with 8700 visits were included, and 562 mortality (21.6%) occurred during a median follow-up of 8.7 years. Using a group-based modeling approach, four distinct trajectories of WC change among Chinese older adults were identified as loss (13.5%), stable (46.8%), moderate gain (31.2%) and substantial gain (8.5%). With WC stable group as reference, the multivariable adjusted HRs for mortality were 1.34(95%CI:1.01-1.78) in loss group, 1.13(0.91-1.41) in moderate gain and 1.54(1.12-2.12) in substantial gain group. Compared with participants with normal BMI at baseline and maintained WC stable, the risk of mortality generally increased for all WC change group in initial overweight/obesity individuals, and the highest risk were observed for WC loss and stable pattern ).In older Chinese, both long-term WC loss and substantial gain conferred excess risk for mortality. The baseline BMI might modify the effect as overweight individuals had a greater risk imposed by WC loss than those in normal weight. Maintaining stable WC and normal weight might be necessary to reduce the risk of mortality.The online version contains supplementary material available at 10.1186/s13690-022-00861-y. The prevalence of obesity and overweight is high and increasing dramatically in all age groups , 2. In CThe association between WC and all-cause mortality has been a topic of debate. It is well-known that potential causal association between higher WC and all-cause and cardiovascular mortality was supported by prospective observational studies . And evewww.cpc.unc.edu/projects/china). A multistage random cluster process was used to draw a sample of about 7,200 households with over 30,000 individuals in 15 provinces. The first round of CHNS was conducted in 1989 and was subsequently conducted in 1991, 1993, 1997, 2000, 2004, 2006, 2009, 2011 and 2015. A detailed description of study design and procedures has been reported elsewhere [Data used in current study was from China Health and Nutrition Survey (CHNS), which was an ongoing open-cohort, collaborative study to examine the effect of social and economic transformation of Chinese society on nutrition and health status in this population. The open database, study materials and acknowledgement is available at the website  statement of cohort studies. The first survey wave was set as 1993 when complete WC information was collected. In brief, the data used were based on 8 waves of CHNS performed from 1993 to 2015. The flow diagram of participants was summarized in Supplemental Fig. Individuals included in current analysis were followed prospectively from their first visit in the CHNS. The study was an open cohort, as participants might enter and leave in any wave, and those lost to follow-up in one wave were still likely to enter the survey in other waves. Therefore, the duration of follow-up duration was defined as period from the first to latest visit attended with information on mortality, end of follow-up, or loss to follow-up (censoring).All-cause mortality was ascertained based on the report of household members in each survey year . If a de2; normal weight, BMI was from 18.5 to 23.9 kg/m2; overweight, BMI was from 24.0 to 27.9 kg/m2; obesity, BMI ≥ 28 kg/m2 [Weight, height, and WC were measured by trained health care workers following standardized protocols as recommended by the WHO at each wave . Weight 28 kg/m2 . WC was 28 kg/m2 . And theWe used latent class trajectory analysis (LCTA) implemented by SAS Proc Traj procedure, a group based modeling approach to identify subgroup sharing similar underlying trajectory of change , 23.We mEvidence from large-scale cohort studies suggested that mortality risk and weight change might be confounded by demographics variables, lifestyle factor and physical measurement (BMI and blood pressure) , 26, 27.Information on socio-economic status and lifestyle factors were collected through standardized interview questionnaire. Income was measured in RMB and derived from total household. Smoker were assigned if they answer “yes” to the question “Have you ever smoked cigarettes (hand-rolled or device-rolled)”. Similarly, drinkers were defined if they consumed alcohol including beer, wine or other alcoholic beverage during the past year. Physical activity level was measured by a semi-quantitative question, including items of occupational, domestic, travel, and leisure time in this study. The intensity score, indicated by metabolic equivalent (MET) score, was calculated by multiplying frequency and duration of the activity converted to per day . Dietary2 = 7.910, P = 0.005). Likelihood ratio test comparing with and without this variable conforms this result with significance. Thus, we stratify the sample by baseline BMI status to better understand this relationship. We repeated Cox proportional hazard regression, with WC stable trajectory and normal weight at baseline as reference. Furthermore, we conducted subgroup analysis to explore the possible heterogeneity of association, according to the baseline characteristics as gender, BMI status, urbanization, smoking status, drinking status, physical activity and dietary energy intake. For each of these variables, we tested for potential effect modification using likelihood ratio tests. Due to the potential for type I error caused by multiple comparisons, the interpretation of subgroup analyses should be treated as exploratory [We calculated the follow-up person years from the date of returning the individuals first enrolled to the date of mortality or the end of cohort, whichever came first. Baseline demographic and health-related variable were summarized across different WC change trajectories, with number and percentage for categorical variables and mean and S.D. for continuous ones. Chi-square test and ANOVA were used to compare baseline characteristic differences. Cox proportional hazard regression was used to assess the WC-mortality link, with WC stable trajectory as reference. We elevated the proportional hazards assumption by creating interaction term of follow-up time and main variables including WC change trajectories. Results of likelihood-ratio test indicated no significant, consistent with visual inspection of log–log plots. Hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were adjusted for covariates including age (continuous), urbanization , gender, education  and income level (continuous), enrollment year (continuous), initial BMI  and WC (continuous), initial SBP/DBP (continuous), smoking status , drinking status , physical activity  and dietary energy intake . Consistent with previous studies , we comploratory .P < 0.05 was considered statistically significant.We also conducted several sensitivity analyses to evaluate the robustness of the findings. First, we excluded participants with 3 times or less to test applicability of favorable models and its association with mortality. Second, we used subsample of individuals without a history of chronic diseases , to accommodate potential residual confounding from pre-existing disease. Third, we completed multiple imputation using the chained equations models. The predictors in multivariate models included WC change trajectories, hypertension and other demographics, anthropometry and health behavior variables. We used linear regression models for continuous variables and discriminant functions for categorical variables to impute values. A total of 20 datasets were generated, as the total missing across these variables was lower than 15%. We repeated the analysis in each augmented dataset, and calculated parameter estimates the 20 sets and their SEs by the Rubin method. Finally, to assess the effect of baseline WC on the association between WC change trajectories and mortality, we estimated HRs of mortality according to baseline WC , with WC stable trajectory and normal WC at baseline as reference. All analyses were conducted with SAS 9.4 . Two-sided tests were used and 2. More detailed baseline characteristic of the study participants was presented in Supplementary Table A total of 2601 individuals  were included in the analysis. Mean follow-up time was 8.7 years, during which 562 deaths occurred. Smoker and drinker accounted for 31.4% and 30.9%. The average WC and BMI were 82.5 ± 10.7 cm and 23.1 ± 3.7 kg/mResults of group-based trajectory modeling analysis indicated that the model with four trajectories had a better fit (lowest Bayesian Information Criteria) than that with other number of trajectories. The four potential trajectories were identified and characterized as WC loss , stable (change within 1 cm), moderate gain (increase of nearly 10 cm) and substantial gain (increase of nearly 20 cm).The group membership probability across 4 groups were  13.5%, 46.8%, 31.2%, and 8.5%. The average posterior probability assignment ranged from 78.6 to 86.2%, and indicating a good discrimination of trajectory.  of participants with a rapidly total average gain of nearly 20 cm. The only decrease group  had an average decrease of 8–12 cm during follow-up period.The extracted four WC trajectories could be interpretable in context of the conventional WC categories Fig. . Startinp < 0.001). Relatively younger participants had higher odds of WC stable relative to other change group. However, their physical activity level, smoking and drinking status, dietary energy intake and duration of follow-up were similar. Additionally, participants in WC loss group tended to have a higher prevalence of chronic disease.The distribution of demographics and lifestyle characteristics across WC change trajectories was showed in Table p = 0.512).During the mean of 8.7 years of follow-up, a total of 562 death (21.6%) were reported. Among these participants, 80 were in WC loss group (22.8%), 232 in “stable” group (19.1%), 184 in “moderate gain group” (22.7%) and 66 in “substantial gain” group (29.7%). Cumulative hazard of mortality across the four trajectory patterns is shown in Fig. p = 0.113). The risk of mortality generally increased for all WC change group among baseline overweight individuals, and those in WC loss group were at higher risk . The HRs for WC stable pattern, moderate gain and substantial gain were 1.67 (1.07–2.60), 1.58 (0.95–2.63) and 1.36 (0.60–3.09) respectively.We further assessed the joint association of WC change trajectories and initial BMI with mortality Table . Individp = 0.082). Detailed results was presented in Supplementary Table No significant interaction was observed between prespecified subgroup and mortality . Furthermore, the increased risk was more striking for those in WC loss and overweight group at baseline, compared with WC stable and normal BMI. Our study suggested avoiding excessive WC gain or loss and maintaining reasonable weight might be helpful to reduce risk of mortality. However, the results should be interpreted with caution due to the small sample size and complexity of WC change in the older. Further study was warranted to confirm our findings and clear the possible reasons.We extracted four distinct and mutually exclusive WC change pattern using LCTA method and assessed the possible contributors of baseline characteristic or behaviors to their trajectory profiles. This helps to conceptualize the change trajectory of WC and probe into the individuals’ heterogeneity in the susceptibility of change over time, which is helpful for public health policy and further research. During the 8.7-year period, over a third of participants gained WC significantly and transited up into higher level over time. It might be likely that these numbers would be higher for today’s adults, as abdominal obesity is highly prevalent among Chinese adults, compounded by the ageing of the population , 32. OurOur data suggested that the bulk of adverse changes in mortality among older Chinese might be attributable to excessive rapid WC gain, irrespective of main confounders including age, initial BMI and health-related behavior factors. The adverse effect persisted across subgroup and sensitivity analysis. This finding was in accordance with previous cohort studies in other countries , 23, 36.The positive association between WC loss trajectory and all-cause mortality was consistent with previous cohort studies in different cultural and socioeconomic population , 26. ResN = 43). Additionally, initially overweight and stable WC also contributed to higher risk of mortality. Similar moderating effect was also observed between baseline WC and WC change patterns in sensitivity analysis. Taken together, the joint analysis indicated that individuals with normal weight and maintaining stable or moderate WC change had lower mortality risk than other groups. Given the small sample of each group, further examination of whether and how baseline BMI/WC modifies the association between WC change and mortality in older adults was essential.Of note, the current study suggested that the effect of WC change stratified by initial BMI, and the striking increased risk was observed for WC loss and stable in overweight participants, providing evidence that baseline BMI might be an effect modifier. Similar joint association between BMI and WC was previously reported , 23. TheSeveral strengths and limitations should be addressed when interpreting the our findings. The longitude analysis of WC change patterns and their interaction with BMI at baseline might be of great significance to promote prevention adiposity issue among Chinese older adults. The LCTA trajectory method had the unique ability to extract the developmental course of WC and categorize individuals into distinct, mutually exclusive groups. All physical measurements were conducted by research staff, which reduced cognitive biases because of self-administered measurements. However, the sample size might limit the results robustness for estimating mortality risk, although the main results were consistent with previous studies across Asian and western countries , 36. SecOur study suggested that majority of participants suffered WC change during follow-up in older Chinese. Both long-term WC loss and substantial gain was associated with increased risk of mortality, with some evidence that overweight individuals might have a greater risk imposed by WC loss than those in normal BMI, although the mechanism was not well understood. Taken together, our study suggested avoiding excessive weight gain and maintaining stable WC might be beneficial for mortality. Due to that there were relatively few end events in each subgroup, the interpretation of results should be cautious. Further studies were required to unravel the mechanism underlying the association between WC change and mortality and to confirm our findings.Additional file1.


This retrospective study aimed to determine the incidence, risk factors, and outcomes of acute kidney injury (AKI) in neonates following the arterial switch operation (ASO) for transposition of great arteries (TGA).Retrospective review of medical data of children who underwent ASO in 2019–2020 in the Ukrainian Children’s Cardiac Center.p = 0.02). 76 min of cross-clamp time were defined as a threshold value for increased severe AKI risk, OR 4.4 . Higher lactate levels during cardiopulmonary bypass (CPB) increased severe AKI development risk, OR 1.5 . Children with severe AKI had prolonged mechanical ventilation, longer time to negative fluid balance, and higher postoperative day 3 (POD3) Inotropic Score (IS). Only one patient required peritoneal dialysis.76 consecutive neonatal patients were included, 48 developed AKI after ASO (51.7%), and 24 – had severe AKI (25.8%). Severe AKI development was associated with longer cross-clamp time: 82 (61–127) versus 73.5 (53–136) in the non-severe AKI group (In our study, 51.7% of patients developed AKI after ASO, 25.8%–severe AKI. Prolonged cross-clamp time and higher lactate levels during cardiopulmonary bypass increased the risk for severe AKI development. The development of AKI was associated with prolonged mechanical ventilation, longer time to negative fluid balance, higher POD 3 Inotropic Score. Acute kidney injury (AKI) is common in children after cardiac surgery. It occurs in 15–64% of patients after congenital heart surgery . AKI hasPatients with transposition of great arteries (TGA) are a special interest group in studying kidney function. They are newborns with cyanosis who require complex cardiac surgery with long CPB. It greatly increases the risk of developing AKI .There are a few studies describing the incidence of AKI among patients after total repair of TGA – arterial switch operation (ASO). However, the characteristics and complexity of patients included in these studies are heterogeneous. According to this data, AKI develops in 20–50.7% of cases .The Ukrainian children’s cardiac center is a leading Ukrainian hospital in the treatment of congenital heart diseases. We perform surgical treatment of nearly 1000 infants younger than 3-years-old yearly; 200 of them are newborns. Children with TGA are admitted to the Center in the first minutes after delivery, and ASO is performed in the first hours of the neonate’s life. Nearly 50 neonates underwent ASO in the first days or hours of life yearly. This approach allows us to exclude preoperative factors’ impact  .Our aim was to determine the incidence of AKI among neonates following ASO in our Center, identify potential risk factors for the development of this complication, and assess the impact of AKI on the postoperative course.A retrospective cohort study of consecutive patients who underwent ASO surgery in the 2019–2020 years in the Ukrainian children’s cardiac center was performed. Patients with TGA ) and Tausig-Bing anomaly were included. We collected and analyzed medical data during pre-, intra-, and postoperative treatment stages, from admission to ICU until the patient’s ICU discharge/death.The study was approved by the Institutional Review Board (IRB) of the Ukrainian Children’s Cardiac Center .Information, collected before ASO, included: age at the time of surgery, serum creatinine, total serum protein level, and usage of prostaglandins and inotropes. Anatomical variants, included in the analysis: TGA with and without VSD, Tausig-Bing anomaly, and patients with and without aortic arch pathology.We analyzed the duration of CPB and aortic cross-clamp time, amount of red blood cells (RBC) transfused, highest arterial blood lactate level during CPB, and fluid balance data.Values of postoperative course were analyzed, including intensive care unit length of stay (ICU LOS), duration of ventilation, fluid balance in the first three postoperative days (POD) (day of surgery counted as day 0), need in peritoneal dialysis (PD) catheter placement. As a measure of inotropic support, we used the Inotrope score (IS), calculated by Wernovsky et al. AKI 0 – creatinine level after surgery <150% compared to baseline.AKI 1 – creatinine level after surgery 150–200% compared to baseline.AKI 2 – creatinine level after surgery 200–300% compared to baseline.AKI 3 – creatinine level after surgery >300 compared to baseline, or need in kidney replacement therapy .AKI 2 and AKI 3 were considered severe AKI in the risk factors analysis.Kidney function was evaluated using the pRIFLE scale . This scU-test depending on the distribution. Univariate and multivariate logistic regression were performed to identify risk factors for developing severe AKI. To find a cut-point that maximizes the variable’s ability to differentiate the non-severe AKI from the severe AKI endpoint the ROC curve analysis was performed and the Youden index (J) was computed. A p-value of less than 0.05 (two-sided) was considered statistically significant.Statistical analysis for this data was conducted using Microsoft Excel, StatSoft, Inc. (2014) STATISTICA, version 12. Continuous variables were described as medians with ranges. Categorical variables were presented as frequencies and percentages. Baseline comparisons between patients from the non-severe AKI and the severe AKI groups were performed using the chi-square or Mann–Whitney During 2019–2020 93 ASO procedures were performed for neonates and infants with TGA and Tausig-Bing anomaly. A total of 65 AKI cases were diagnosed. In 17 patients with AKI developed before surgery, they were excluded from the final analysis. In 48 (51.7%) patients AKI first developed after ASO. 24 patients (50%) were classified as AKI 1, 15 patients (31.3%) as AKI 2, and 9 patients (18.7%) as AKI 3. Severe AKI (stages 2 and 3) developed in 25.8% of patients. Two groups of patients were formed: the non-severe AKI group − 52 patients (28 with no AKI and 24 with AKI 1) and the severe AKI group − 24 children .Patients’ data before ASO is presented in p = 0.03).There were no significant preoperative differences between the two groups, except for creatinine values. Lowest preoperative creatinine was significantly lower in the severe AKI group: 59.2 (22.6 − 78.7) versus 64.7 (14.7 − 121.1) in the non-severe AKI group  versus 73.5 (53–136) in the non-severe AKI group (p = 0.02). Maximal lactate level during CPB was significantly higher in the severe AKI group: 4.7 (2–10) versus 3.3 (0.9–8.5) in the non-severe AKI group. Cardiopulmonary bypass duration, red blood cells transfusion volume, intraoperative Inotrope Score, and fluid balance were not different in the two groups.Information about the postoperative course of the patient is presented in p = 0.01). Only one patient in the severe AKI group required peritoneal dialysis. Significantly more patients in the severe AKI group had an open sternum after surgery: 4 (16.7%) in the AKI group versus 0 in the non-AKI group (p = 0.01). Fluid balance tended to be less restrictive in the first 2 days in the severe AKI group. In the next 2 days, this difference was not significant. Inotrope score (IS) was significantly higher at POD 3 in the severe AKI group: 5 (0 − 7.5) versus 3 (0 − 7.5) in the non-severe AKI group (p = 0.03).Patients in the severe AKI had a longer duration of mechanical ventilation: 129 h (43–1090) versus 70d (12–1554) in the non-severe AKI group . When Youden indexes were calculated, a threshold value of 76 min of cross-clamp time was found to discriminate the risk of severe AKI development , with OR 4.4 . An association between the highest lactate level during CPB and increased risk for severe AKI development was found, OR 1.5 . Increased IS POD3 was associated with severe AKI development, OR 1.4 .Prolonged cross-clamp time was associated with an increased risk for severe AKI, OR 1.03 . Highest lactate during CPB was also found to be a significant independent risk factor for severe AKI development, OR 1.5 (95% CI:1.0 − 2.0).To our knowledge information about the prevalence of AKI after ASO in developing countries is limited. We present our experience from a main Ukrainian pediatric cardiosurgical center. In our institution usual practice is to perform ASO in the first days and hours of life (median age of surgery 1 day in our cohort) ,11. ThisThere is a big discrepancy between CPB and cross-clamp time impact in articles, dedicated to post-cardiac surgery AKI. The deleterious effect of CPB and cross-clamp on renal function is multifactorial and well-known and they are regarded as potentially modifiable risk factors ,14. CPB Duration of cross-clamp may be increased in case of complex heart surgery, including ASO with VSD closure or aortic arch repair. However, in previous studies, any association between these anatomical variants and increased AKI risk was not shown, as well as in our paper ,3,4. On Serum creatinine and creatinine clearance remain to be most precise and widespread AKI diagnostic tools in children. Zappitelli showed, that even a small rise in creatinine after cardiac surgery can predict AKI development . He alsoThe positive fluid balance increases ICU LOS . UsuallyIn our study, severe AKI group patients needed relatively higher inotropic support (measured using an Inotropic score). Inotropic and vasoactive drugs are usually used in the early postoperative treatment of neonates after complex cardiac surgery, and associations between their doses and AKI have been studied. In Schoenmaker’s research paper patients with severe AKI had higher vasoactive-inotropic scores 24 and 48 h after surgery . DavidsoOur study was conducted only in one center, which limits its results. We have no data on a patient’s kidney function later in life. Further research is needed to evaluate the impact of neonatal surgery on the risk of chronic kidney disease later. In many cases, ASO was performed in the first hours of a patient’s life due to our Center's surgical policy . In suchIn our retrospective single-center study, AKI incidence among neonates after ASO was 51.7%, and the severe AKI incidence (AKI 2 and 3)−25.8%. We have not found any predictors of AKI before surgery, which may be related to the relative homogeneity of the group (in terms of age) and minimal time between childbirth and ASO performed (only a few hours in some cases). Patients with severe AKI had longer cross-clamp times and higher lactate levels during CPB. Cross-clamp time and higher lactate levels during CPB were found as significant risk factors for severe AKI development. Development of AKI was associated with longer ventilation time and time to negative fluid balance, higher IS POD3. Only one patient in the severe AKI group required dialysis. Further studies are needed to search for possible predictors, early AKI diagnostic tools, and maternal creatinine impact on diagnosis accuracy.