Search Results (423)

Background: Neonatal jaundice is a common condition with potentially severe complications such as bilirubin-induced neurological dysfunction and kernicterus. While serum bilirubin (SBR) remains the standard laboratory measurement, point-of-care methods, such as transcutaneous bilirubinometry (TcB) and blood gas analysers (BGAs), offer rapid, less invasive alternatives. Direct comparisons of their diagnostic accuracy remain limited. Objective: The aim of this study was to assess and compare diagnostic accuracy and clinical utility of TcB and BGA against SBR in neonatal hyperbilirubinaemia screening. Methods: This retrospective study included neonates (n = 221) with concurrent SBR, BGA, and TcB measurements (n = 333). Assessment was via Passing–Bablok regression, Bland–Altman analysis, and Spearman correlation. Diagnostic performance was evaluated against jaundice thresholds in phototherapy charts (≥95th percentile threshold). Subgroup analyses considered phototherapy status, haemoglobin concentration, and Fitzpatrick skin type. Results: BGA showed stronger agreement with SBR (R² = 0.88) than TcB (R² = 0.43). BGA remained accurate regardless of phototherapy or haemoglobin levels. TcB accuracy declined post-phototherapy with reduced predictive value in darker-skinned neonates (Fitzpatrick III–VI) and increased false discovery rates. Both methods demonstrated low sensitivity (45.8%) but high specificity (>95%) and negative predictive value (~91%) for clinically significant hyperbilirubinaemia. BGA had a higher diagnostic odds ratio (47.5) than TcB (19.3). When individual patient sequential SBR and BGA measurements were compared for jaundice tracking (n = 175), there was high correlation, (r = 0.971) with no statistical differences, and 50% of measurements achieving agreement within 10 μmol/L. Conclusions: BGA is a more reliable alternative to SBR than TcB, particularly in time-critical or resource-limited settings. While TcB remains a non-invasive screening tool, limited accuracy post-phototherapy and with darker skinned neonates indicate confirmatory SBR testing. These findings support the selective and context-aware use of BGA and TcB to optimise neonatal hyperbilirubinaemia management and reduce interventions. Full article

Background/Objectives: Considering the excretion pathways and administered gadolinium dose, our institution has developed a tailored gadolinium-based contrast agents (GBCAs) administration protocol for patients with renal impairment to facilitate more rapid elimination and minimal retention of gadolinium. This study aims to evaluate the 8-year clinical outcomes and safety of this institutional protocol. Methods: This single-center retrospective study included patients with renal impairment who underwent GBCA-enhanced MRI between January 2015 and December 2022. The protocol recommended specific GBCAs and adjusted doses based on chronic kidney disease (CKD) stage and serum bilirubin levels: gadoxetate disodium was used for normal serum bilirubin level due to its dual excretion pathway, while macrocyclic agents were used for those with elevated serum bilirubin levels. During the follow-up period, occurrence of nephrogenic systemic fibrosis (NSF) and evidence of gadolinium deposition in brain tissues were evaluated. Results: A total of 288 patients (age, 64.6 ± 11.7 years; male, 64.9%) underwent 716 GBCA-enhanced MRI examinations in accordance with the institutional protocol. The cohort included 62 patients with CKD stage 4 and 131 patients with CKD stage 5 or undergoing hemodialysis. In patients with CKD stage 4 and 5 and those undergoing hemodialysis, 597 examinations were performed using gadoxetate disodium, and 119 used macrocyclic agents. No cases of NSF or gadolinium deposition in brain tissues were identified over mean follow-up intervals of 27.5 and 27.8 months, respectively. Conclusions: The tailored GBCA administration protocol, considering the excretion pathways and administered gadolinium dose, appears to be safe with respect to NSF for patients with renal impairment, and no evidence of brain gadolinium deposition was observed in the evaluated subset of patients. Full article

Acute liver failure (ALF) is a rapidly progressive and life-threatening condition with limited pharmacological interventions. Poria cocos, a medicinal fungus widely used in traditional Chinese medicine, has been reported to exhibit anti-inflammatory and hepatoprotective activities; however, its potential involvement in ALF remains incompletely understood. In this study, an integrative exploratory strategy combining network pharmacology, molecular docking, and in vivo experiments was employed to investigate the protective effects of Poria cocos against lipopolysaccharide/D-galactosamine (LPS/D-GalN)-induced ALF in rats. Rats were pretreated with Poria cocos extract (50 or 200 mg/kg), and hepatoprotective effects were assessed by survival analysis, serum biochemical indicators(alanine aminotransferase [ALT], aspartate aminotransferase [AST], total bilirubin [TBil], and international normalized ratio [INR]), histopathology, and expression of inflammation- and PI3K/AKT-related markers. Network pharmacology analysis identified fifteen putative bioactive components of Poria cocos and 178 ALF-related overlapping targets, with enrichment analyses highlighting multiple inflammation-, apoptosis-, and PI3K/AKT-related signaling pathways. Molecular docking suggested potential interactions between major components and predicted core targets. In vivo, Poria cocos pretreatment was associated with improved survival, alleviated liver injury, and reduced the expression of inflammatory and apoptosis-associated markers, including PI3K, AKT1, NF-κB, TNF-α, MAPK14(p38), Caspase-3, and MMP2. Taken together, network pharmacology analysis identified PI3K/AKT-associated signaling as a candidate pathway, and the in vivo findings were generally consistent with this prediction, suggesting that the hepatoprotective effects of Poria cocos may involve multi-target regulation of inflammation- and apoptosis-related pathways. Full article

Introduction: Pre-eclampsia (PE) is a pregnancy-related hypertensive condition defined by the onset of hypertension after 20 weeks of gestation that is associated with proteinuria and maternal organ damage or uteroplacental dysfunction. It continues to be a leading cause of maternal and perinatal morbidity and mortality globally. PE is linked to systemic inflammation, endothelial dysfunction, and oxidative stress, which may compromise hepatic function. Aim: This meta-analysis assesses the impact of PE on maternal liver function by evaluating hepatic biomarkers, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and total serum bilirubin. Methods: This meta-analysis of observational studies in Epidemiology (MOOSE) involved a search of PubMed and Scopus and manual screening of studies published between 2000 and 2025. Eligible studies included cross-sectional, case–control, and cohort designs. The quality of the studies was evaluated using the Newcastle–Ottawa Scale. Statistical analysis was conducted using the online meta-analysis, Jamovi version 2.6.44, and IBM SPSS Statistics version 30, and effect estimates were reported as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Results: Forty-five studies, comprising 257,929 women 9420 with PE; 248,509 normotensive, were included. Women with PE had elevated AST, MD = 1.81 (95% CI: 1.51 to 2.10; p < 0.0001) and ALT, SMD = 1.73 (95% CI: 1.38 to 2.07; p < 0.0001); ALP, SMD = 1.43 (95% CI: 0.97 to 1.88; p < 0.0001); and total serum bilirubin (TSB), SMD = 0.62 (95% CI: 0.36 to 0.88; p < 0.0001) in comparison to normotensive controls. In the meta-regression, maternal age and quality were significant moderators, with older age and high-quality studies associated with smaller and larger effect sizes, respectively, for ALP (β = −0.720 and β = 1.444) and TSB (β = −0.304 and β = 0.761). For every 1-unit increase in body mass index, there was a significant 0.406-unit decrease in ALT effect size. Conclusions: PE is significantly associated with elevated maternal hepatic enzyme levels, indicating hepatocellular damage and impaired liver function. These findings emphasise the necessity for routine liver function monitoring in pregnant women with hypertensive disorders. Full article

Cadmium (Cd) is a ubiquitous environmental pollutant that enters the circulation from the lungs and gastrointestinal tract. For most people, staple foods form the main route of Cd exposure. Current evidence suggests that Cd may increase the prevalence of iron deficiency and anemia in environmentally exposed people. Concerningly, intravenous iron administration to treat iron deficiency anemia has resulted in adverse bone outcomes at a higher-than-expected frequency, for which reasons remain unclear. The bone-derived hormone fibroblast growth factor 23 (FGF23), the regulator of vitamin D and phosphate homeostasis, has been speculated to be implicated, given that anemia, iron deficiency and inflammatory conditions are all known to increase FGF23 expression levels in osteoblasts. Additionally, early studies have demonstrated that Cd increases FGF23 expression by osteoblast-like cells and suppresses FGF23 cleavage, leading to an abrupt rise in serum FGF23, which, in turn, mediates an effect of Cd on tubular phosphate reabsorption. In this review, experimental breakthrough studies showing Cd-induced iron deficiency and a reduction in iron absorption by Cd are summarized, together with intestinal absorption of Cd and an increment in Cd uptake and Cd body burden in those with low body iron stores. Potential contributions of Cd, anemia and iron deficiency in the context of hypophosphatemic osteomalacia development after intravenous iron supplementation are discussed. The molecular basis of Cd-induced ferroptosis in pathogenesis of osteoporosis, emphasizing heme oxygenase-1 (HO-1)/bilirubin axis and zinc deficiency, is presented. Full article

Background/Objectives: Branched-chain fatty acids (BCFAs) exhibit a range of biological activities; however, their limited natural abundance and high cost have constrained in vivo research. Lanolin represents a promising source for enriching BCFAs. Nevertheless, the in vivo application, safety, and dose-effect relationship of BCFAs derived from lanolin (BCFAs-DFL) remain unassessed. Methods: In this study, the acute toxicity in C57BL/6J mice was first evaluated for 7 days by a single oral administration of 5000 mg/kg BW of BCFAs-DFL. Subsequently, 40 mice were divided into four groups (control group, low dose of 100 mg/kg BW, medium dose of 300 mg/kg BW, and high dose of 600 mg/kg BW) and were continuously administered by gavage for 28 days to study the effects of BCFAs-DFL on the growth, blood biochemistry, intestinal morphology, and intestinal flora of the mice. Results: In the acute toxicity test, BCFAs-DFL exhibited no lethality or abnormalities in mice, indicating its non-toxic nature. Throughout the 28-day trial, mice in the medium- and high-dose groups experienced a notable decrease in average daily feed intake (p < 0.05), yet their weight gain remained unaffected (p > 0.05). Hemoglobin and hematocrit levels declined in the high-dose group (p < 0.05). Conversely, serum aspartate aminotransferase and total bilirubin levels escalated in the medium- and high-dose groups, while triglycerides and urea nitrogen levels decreased (p < 0.05). The serum’s total antioxidant capacity and immunoglobulin levels (IgA, IgG) rose in proportion to the dosage (p < 0.05). BCFAs-DFL notably enhanced the villus height of the jejunum and ileum in mice (p < 0.05). Gut microbiota analysis indicated no significant impact on overall α and β diversity. Conclusions: The 28-day intervention revealed that BCFAs-DFL can modulate feeding behavior, TG, T-AOC, and immunoglobulin levels in mice. Additionally, it promotes the development of intestinal villi. Based on various indicators, a dosage of 100 mg/kg BW effectively induces beneficial metabolic regulation, such as the reduction of triglycerides, without causing a burden on liver metabolism. This dosage may represent a more suitable application for potential use. Full article

This study was focused on the assessment of fungal occurrence, mycotoxin dynamics, aflatoxin carry-over, and associated biochemical responses in dairy cattle. Moisture emerged as the dominant factor for fungal communities, promoting the co-proliferation of fungal genera adapted to high water activity conditions (a_w > 0.90) and antagonism against xerotolerant and xerophilic species. Aspergillus spp. dominated dry substrates (a_w < 0.75), Fusarium spp. showed strong positive associations with high-moisture matrices (a_w > 0.90), and Penicillium spp. exhibited intermediate, substrate-dependent behavior. Mycotoxin levels fluctuated non-linearly, independently of fungal counts: ochratoxin A (OTA) concentrations in corn silage increased from approximately 12 μg/kg at the onset of the ensiling period to >240 μg/kg at silo opening, indicating dynamic mycotoxin accumulation during storage, while zearalenone (ZEA) oscillated from 40 to 170 µg/kg. Despite the variation in total aflatoxins (AFLA-T) across feed matrices, aflatoxin M1 (AFM1) in milk remained low (0.0020–0.0093 μg/kg), confirming limited carry-over. Serum biochemical parameters—alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), total bilirubin (BIL-T), total protein (PROT-T)—remained within physiological limits, yet multivariate analyses revealed metabolic modulation linked to aflatoxin exposure. AFM1 explained >7% of the variance in serum biochemical profiles according to PERMANOVA (p = 0.002), showed significant MANOVA effect (Pillai = 0.198), and displayed a significant canonical association (p < 10⁻¹³). Linear discriminant analysis further separated Normal vs. Borderline hepatic profiles, indicating subclinical physiological adaptation to chronic low-dose exposure. Full article

Background/Objectives: Endoscopic biliary stenting is the standard palliative intervention for malignant biliary obstruction, aimed at restoring ductal patency. Radiofrequency ablation (RFA) has been introduced as an adjunct technique to improve stent durability and patient outcomes. However, the literature remains inconclusive regarding which patients are most likely to benefit from the combination of RFA and stenting. Methods: We retrospectively described clinical outcomes of 24 patients undergoing endobiliary RFA combined with biliary stenting for malignant biliary obstruction. Post-procedural and 6-month outcomes were assessed using technical success and changes in serum bilirubin; procedure-related adverse events were extracted from available medical records. Results: Nineteen females and five males were included in the study. The most prevalent diagnoses were metastatic adenocarcinoma (n = 8) and cholangiocarcinoma (n = 6). 25% of patients did not complete the 6-month follow-up due to malignancy progression. 16 out of 18 maintained the patency of biliary stents. Repeat endoscopic intervention for suspected stent dysfunction was documented in one patient. When analyzed in an intention-to-treat manner (counting deaths before 6 months as failures), the corresponding 6-month patency/clinical success rate was 16/24 (66.7%). Conclusions: In this retrospective single-center experience, RFA combined with biliary stenting was feasible and was associated with maintained biliary drainage in a majority of patients who survived to the 6-month assessment. Full article

Objectives: Emerging evidence suggests that bilirubin, beyond being a metabolic byproduct, may exert protective effects against metabolic and cardiovascular diseases due to its antioxidant properties. However, its relationship with hyperlipidemia remains unclear. This study investigated the relationship between hyperbilirubinemia and hyperlipidemia in a large, community-based cohort. Methods: Data from 8464 participants in the Jidong Community Cohort were analyzed using a cross-sectional design. Hyperbilirubinemia was defined as serum total bilirubin (STB) ≥ 17.1 μmol/L, whereas hyperlipidemia was determined based on a prior diagnosis or elevated lipid profile. Results: Of all participants, 31.6% had hyperbilirubinemia and 51.8% had hyperlipidemia. Multivariable logistic regression revealed a significant inverse association between hyperbilirubinemia and hyperlipidemia [odds ratio (OR) = 0.764, 95% confidence interval (CI) = 0.686–0.851]. This association was significant in participants aged <65 years (OR = 0.762, p < 0.0001) but not in those aged ≥65 years. Stratified analysis by smoking status further revealed a 29% reduced risk of hyperlipidemia among never-smokers (OR = 0.708, p < 0.001), but not among current (OR = 0.831, p = 0.087) or former smokers (OR = 0.685, p = 0.175). Hyperbilirubinemia was also negatively associated with TC (p < 0.0001), TGs (p < 0.0001), LDL-C (p = 0.0061), very LDL-C (VLDL-C; p = 0.0043), and apolipoprotein B (ApoB; p < 0.0001) levels, as well as the ApoB/apolipoprotein A1 (ApoA1) ratio (p = 0.0003). Restricted cubic spline analysis revealed an inverse relationship of high STB levels with the TC, TG, LDL-C, VLDL-C, and ApoB levels, as well as the ApoB/ApoA1 ratio. Moreover, elevated STB levels were inversely linked to obesity (OR = 0.747, p < 0.0001), arterial stenosis (OR = 0.806, p = 0.0462), and metabolic syndrome (OR = 0.784, p = 0.0008). Conclusions: hyperbilirubinemia may be an independent factor protective against hyperlipidemia and related lipid abnormalities; these results provide insights for the prevention and management of lipid-related diseases. Full article

Background and Objectives: Pancreatoduodenectomy (PD) is the primary treatment for patients with resectable, non-metastatic pancreatic adenocarcinoma and periampullary tumors. Although surgical methods and perioperative management have improved, the procedure still carries a high risk of complications, with postoperative pancreatic fistula (POPF) being the most significant. This study focuses on identifying current risk factors for POPF after PD in a single HPB center. Materials and Methods: We retrospectively analyzed prospectively collected data from patients undergoing PD in our department between October 2018 and April 2024. Data included demographics, comorbidities, lifestyle factors, preoperative tests (bilirubin, CA19-9, HbA1c), intraoperative variables (pancreatic texture, duct diameter), and postoperative outcomes. POPF was classified using the International Study Group of Pancreatic Surgery (ISGPS) criteria. Univariate and multivariate logistic regression analyses were performed. Results: A total of 118 patients underwent PD (82 males, 36 females; mean age 67 (45–85) years; mean body mass index (BMI) 26.6 kg/m²). POPF occurred in 37 patients (31%), with 27 Grade B (23%) and 10 Grade C (9%). The 30- and 90-day mortality rates were 5% and 12.7%, respectively. Univariate analysis showed associations between POPF and soft pancreas (p = 0.018), c-reactive protein (CRP) on postoperative day (POD) 5 (p = 0.004), and serum amylase on POD 0 (p = 0.008). Diabetes mellitus was associated with a lower incidence of POPF (p = 0.014). Multivariate analysis confirmed CRP on POD 5 (OR 1.007, p = 0.025) and DM (OR 0.254, p = 0.015), as independent factors. ROC analysis identified POD 0 amylase >113.5 U/L (AUC 0.717) and POD 5 CRP >125.3 mg/dL (AUC 0.669) as predictive values. Conclusions: POPF remains an important complication after PD. CRP > 126 mg/dL on POD 5 was associated with POPF and may serve as an adjunctive signal to guide further assessment, including imaging. The observed inverse association with diabetes mellitus is hypothesis-generating and should be interpreted cautiously, considering potential confounding and the influence of center volume, surgeon heterogeneity, and institutional protocols. Full article

Background/Objectives: Nickel exposure is a significant environmental and occupational risk factor associated with the onset and progression of chronic liver diseases due to its capacity to induce persistent oxidative stress, inflammation, and hepatocellular injury. This study aimed to evaluate the enhanced hepatoprotective and antioxidant/anti-inflammatory effects of naringin-loaded nanoliposomes (NRG-NLPs), a novel nanoformulation designed to improve the bioavailability of naringin, a citrus-derived flavonoid phytochemical, against nickel sulfate (NiSO₄)-induced hepatotoxicity in male Wistar rats. Methods: Ninety rats were allocated into six groups (n = 15 each): control, NRG, NRG-NLPs, NiSO₄, NiSO₄ + NRG, and NiSO₄ + NRG-NLPs. Treatments consisted of oral administration of NRG or NRG-NLPs (80 mg/kg/day) and intraperitoneal injections of NiSO₄ (20 mg/kg/day) for three weeks. Endpoints included assessment of growth performance, serum biochemistry, hepatic antioxidant status, inflammatory mediators, apoptotic gene expression, nickel tissue accumulation, and histopathological and ultrastructural liver changes. Results: NiSO₄ exposure induced marked hepatic injury, evidenced by reduced body weight, adverse serum biochemical profiles, increased hepatic enzymes and bilirubin, elevated oxidative damage markers (MDA, protein carbonyls), increased proinflammatory cytokines, and upregulation of HMGB1, PI3K, mTOR, JAK/STAT, and proapoptotic genes, accompanied by aberrant nickel accumulation and severe histopathological alterations. Co-treatment with NRG-NLPs significantly ameliorated biochemical and histological disturbances, restored antioxidant defense systems (SOD, CAT, GPx, GSH, Nrf2, HO-1), and modulated key pathways of inflammation (NF-κB, TNF-α, IL-6), fibrosis (TGF-β), cell survival, and apoptosis more effectively than crude naringin. NRG-NLPs also substantially reduced hepatic nickel deposition and preserved near-normal liver architecture. Conclusions: These findings demonstrate that nanoformulated naringin confers superior hepatoprotective benefits against nickel-induced liver injury through enhanced bioavailability and multi-pathway modulation, supporting its translational potential as a citrus-derived medicinal phytochemical and dietary bioactive for the prevention and therapeutic intervention of oxidative and inflammatory chronic liver disease. Full article

Background and Objectives: Chemical androgen deprivation and estrogenization are essential components of clinical treatment for advanced prostate cancer and male-to-female sex transition. The aim of this study was to determine the effects of these therapies on anthropometric parameters, liver histology, and biochemical parameters, with the goal of establishing experimental models that accurately represent current clinical practice. Materials and Methods: Young adult Wistar rats were divided into nine groups: intact control (IC), control vehicle (CV), cyproterone acetate-treated (CA), flutamide-treated (F), control sesame oil (CO), estradiol valerate-treated (E), combined control (CC), flutamide + estradiol valerate (F + E), and cyproterone acetate + estradiol valerate (CA + E)-treated groups. Treatments were administered by subcutaneous injection for four weeks. Results: The administration of estradiol valerate, alone or combined with antiandrogens, reduced final body mass and white adipose tissue mass. Notable changes were observed in absolute and relative pituitary, liver, prostate, and testis mass in the E, F + E and CA + E groups. There were no significant changes in liver histology or glycogen deposition; however, the combined treatment groups showed an increased volume density of binucleated hepatocytes and fibrotic tissue. Regarding biochemical parameters, androgen deprivation and/or estrogenization caused marked changes in serum triglyceride, LDL (low-density lipoproteins), ALP (alkaline phosphatase), AST (aspartate aminotransferase), ALT (alanine aminotransferase), Bil-T (bilirubin), creatinine, and urea levels. Conclusions: Given the importance of these therapies in clinical practice, providing a model based on the evaluated parameters offers a solid platform for future research. Full article

Introduction: Metabolomics-based phylogenetic profiling of prostate cancer (PCa) patients before and after stereotactic body radiation therapy (SBRT) can provide insight into the way in which treatment outcomes relate to the underlying physiology and physiological responses of individual patients. It also offers the potential for helping identify precision biomarkers. Methods: In this study, we used integrated mass spectrometry to obtain untargeted serum metabolomics data from PCa patients (n = 55), which we then analyzed using a parsimony phylogenetic systems biology approach before correlating the results with the patients’ clinical parameters before and after treatment. Results: Radiotherapy (RT) generated five phylogenetic subgroups with distinct metabolomic profiles that did not correspond to hormonal treatment, risk assessment, metastasis, or PSA levels. PSA was neither a factor influencing clade membership nor an indicator of risk assessment or metastasis. Moreover, the hormone-treated patients did not form their own clade but were rather spread among the five clades. The same absence of correlation applied to risk assessment and metastasis. The 88 significantly altered pre-RT and 29 post-RT features showed aberrations in the metabolic pathways of purines, porphyrin, glycerophospholipids, and 2-methylglutaric acid, among others. Discussion: Significantly altered metabolites in a majority of patients who developed metastasis included D-tryptophan, carbamate, 5′-Benzoylphosphoadenosine, Phosphatidylcholine (PC), bilirubin, and hypoxanthine. In general, the cladogram offers a new perspective on evaluating the clinical variables that represent significant indicators of PCa progression, metastasis, and treatment response in individuals. Conclusions: Metabolic profiles and associated clinical phenotypes provided by this precision phylometabolomics approach may offer a deeper understanding of the metabolic factors and pathways implicated in cancer progression and metastasis and should contribute to the development of targeted treatments and more precise monitoring of cancer and cancer therapies. Full article

Exposure to nickel (Ni) and chromium (Cr) in environmental and occupational settings appears to be inevitable and significantly affects the liver, the principal organ responsible for their metabolic processes. This research aimed to assess the functional integrity of the liver and the molecular mechanisms underlying hepatic damage in employees exposed to Ni and Cr at work. A cross-sectional investigation was implemented with 86 non-smoking male employees working in a metallurgical factory. Serum Cr, Ni, liver function tests, oxidative and inflammatory indicators, and Keap-1, Nrf2, and miR-223 expression were assessed. In electroplating workers, serum Cr (2.47 ± 2 µg/L), Ni (1.39 ± 0.79 µg/L), liver transaminases, total bilirubin, and NF-κB were all statistically significantly greater than in the referent group. Electroplaters’ serum albumin levels were significantly lower than those of controls. Furthermore, oxidative stress was observed in electroplaters, characterized by lower levels of superoxide dismutase (SOD) and glutathione peroxidase (GPx) and greater levels of malondialdehyde (MDA) with respect to controls (p < 0.05). Additionally, compared to controls, gene expressions in electroplaters showed that Keap-1 was upregulated, while Nrf2/Ho-1 and miR-223 were downregulated. In conclusion, occupational exposure to Ni and Cr was associated with hepatic impairment through downregulation of the antioxidant Nrf2 pathway, oxidative stress, and inflammation. Full article

Vancomycin remains a cornerstone for severe Gram-positive infections in the ICU, yet creatinine elevation—a sensitive marker of early renal stress—occurs frequently and complicates therapy. We developed a machine learning model to predict vancomycin-associated creatinine elevation using routinely available clinical data, enabling preemptive risk stratification. In this retrospective MIMIC-IV cohort study ($n=10,288$ ICU adults aged 18–80 receiving vancomycin), the primary outcome was creatinine elevation per KDIGO criteria (≥0.3 mg/dL within 48 h or ≥50% within 7 d). A two-stage feature selection (SelectKBest + Random Forest) identified 15 predictors from 30 candidates. Six algorithms were compared via 5-fold cross-validation. CatBoost was selected for final modeling; interpretability was assessed using SHAP values and Accumulated Local Effects (ALE) plots. Creatinine elevation occurred in 2903 patients (28.2%). CatBoost achieved AUROC 0.818 (95% CI: 0.801–0.834), sensitivity 0.800, specificity 0.681, and NPV 0.900. Top predictors were serum phosphate, total bilirubin, magnesium, Charlson Comorbidity Index, and APSIII score. SHAP analysis confirmed hyperphosphatemia as the strongest driver; ALE plots revealed non-linear, clinically plausible thresholds (e.g., phosphate >4.5 mg/dL sharply increased risk). This interpretable model accurately predicts vancomycin-associated creatinine elevation using standard ICU monitoring data. With high negative predictive value, it supports early exclusion of low-risk patients and targeted interventions (e.g., intensified TDM, nephrotoxin avoidance) in high-risk cases—facilitating precision antimicrobial stewardship in critical care. Full article