An early scoring system to predict mechanical ventilation for botulism: a single-center-based study.

BACKGROUND: Early identification of patients requiring ventilator support will be beneficial for the outcomes of botulism. The present study aimed to establish a new scoring system to predict mechanical ventilation (MV) for botulism patients. METHODS: A single-center retrospective study was conducted to identify risk factors associated with MV in botulism patients from 2007 to 2022. Univariate analysis and multivariate logistic regression analysis were used to screen out risk factors for constructing a prognostic scoring system. The area under the receiver operating characteristic (ROC) curve was calculated. RESULTS: A total of 153 patients with botulism (66 males and 87 females, with an average age of 43 years) were included. Of these, 49 patients (32.0%) required MV, including 21 (13.7%) with invasive ventilation and 28 (18.3%) with non-invasive ventilation. Multivariate analysis revealed that botulinum toxin type, pneumonia, incubation period, degree of hypoxia, and severity of muscle involvement were independent risk factors for MV. These risk factors were incorporated into a multivariate logistic regression analysis to establish a prognostic scoring system. Each risk factor was scored by allocating a weight based on its regression coefficient and rounded to whole numbers for practical utilization ([botulinum toxin type A: 1], [pneumonia: 2], [incubation period ≤1 day: 2], [hypoxia <90%: 2], [severity of muscle involvement: grade II, 3; grade III, 7; grade IV, 11]). The scoring system achieved an area under the ROC curve of 0.82 (95% CI 0.75-0.89, P<0.001). At the optimal threshold of 9, the scoring system achieved a sensitivity of 83.7% and a specificity of 70.2%. CONCLUSION: Our study identified botulinum toxin type, pneumonia, incubation period, degree of hypoxia, and severity of muscle involvement as independent risk factors for MV in botulism patients. A score ≥9 in our scoring system is associated with a higher likelihood of requiring MV in botulism patients. This scoring system needs to be validated externally before it can be applied in clinical settings.

Identification and validation of lipid metabolism-related key genes as novel biomarkers in acute myocardial infarction and pan-cancer analysis.

BACKGROUND: Acute myocardial infarction (AMI) is associated with high morbidity and mortality, and is associated with abnormal lipid metabolism. We identified lipid metabolism related genes as biomarkers of AMI, and explored their mechanisms of action. METHODS: Microarray datasets were downloaded from the GEO database and lipid metabolism related genes were obtained from Molecular Signatures Database. WGCNA was performed to identify key genes. We evaluated differential expression and performed ROC and ELISA analyses. We also explored the mechanism of AMI mediated by key genes using gene enrichment analysis. Finally, immune infiltration and pan-cancer analyses were performed for the identified key genes. RESULTS: TRL2, S100A9, and HCK were identified as key genes related to lipid metabolism in AMI. Internal and external validation (including ELISA) showed that these were good biomarkers of AMI. In addition, the results of gene enrichment analysis showed that the key genes were enriched in inflammatory response, immune system process, and tumor-related pathways. Finally, the results of immune infiltration showed that key genes were concentrated in neutrophils and macrophages, and pan-cancer analysis showed that the key genes were highly expressed in most tumors and were associated with poor prognosis. CONCLUSIONS: TLR2, S100A9, and HCK were identified as lipid metabolism related novel diagnostic biomarkers of AMI. In addition, AMI and tumors may be related through the inflammatory immune response.

Effect of dynamic stratified potassium supplementation in elderly patients with chronic heart failure and moderate to severe hypokalaemia-a randomised, controlled trial.

OBJECTIVE: To compare the effectiveness of dynamic stratified potassium supplementation at high concentrations with enteral potassium supplementation in older patients with chronic heart failure and moderate to severe hypokalaemia. METHODS: We performed a single-centre, short-term, randomised, controlled, open-labelled, clinical trial, and patients were randomly allocated to the control or intervention group. The intervention group received intermittent infusions of 30 mmol/100 mL potassium chloride. In the control group, 10% potassium chloride was administered orally in a bolus dose. Short-term efficacy and adverse events were compared. RESULTS: The intervention group received less potassium than that in the control group. T-wave normalisation and U-wave disappearance occurred sooner in the intervention group than in the control group after potassium supplementation. The rate of increase in potassium concentrations gradually became similar in both groups. The initial blood potassium concentration, method of potassium supplementation, potassium supplement dose, and 24-hour urinary potassium excretion significantly affected the rate of increase in blood potassium concentrations after supplementation. CONCLUSIONS: The efficacy of enteral potassium supplementation is equivalent to that of supplementation with high intravenous potassium concentrations in elderly patients with chronic heart failure and moderate to severe hypokalaemia. High intravenous potassium concentrations may lead to a superior potassium recovery rate.

[Early reperfusion strategy selection and prognosis analysis in patients with acute ST segment elevation myocardial infarction: based on the data of 49 hospitals in Hebei Province].

OBJECTIVE: To explore the selection of strategies for early reperfusion therapy and its impact on prognosis in patients with acute ST segment elevation myocardial infarction (STEMI). METHODS: The treatment data and 3-year follow-up results of acute myocardial infarction (AMI) patients in 49 hospitals in Hebei Province from January to December 2016 were collected. Patients with STEMI who received either intravenous thrombolytic therapy (ITT) or primary percutaneous coronary intervention (PPCI) within 12 hours of onset were enrolled. Baseline data, the time from the first diagnosis to the start of reperfusion (FMC2N for ITT patients and FMC2B for PPCI patients), vascular recanalization rate, in-hospital mortality, 1-year mortality, and 3-year mortality were compared between ITT and PPCI groups. The efficacy and prognosis of ITT and PPCI at different starting time of reperfusion (FMC2N ≤ 30 minutes, FMC2N > 30 minutes, FMC2B ≤ 120 minutes, FMC2B > 120 minutes) were analyzed. RESULTS: A total of 1 371 STEMI patients treated with ITT or PPCI were selected, including 300 patients in the ITT group and 1 071 patients in the PPCI group. 1 055 patients were actually followed up (205 patients in the ITT group and 850 patients in the PPCI group), with a rate of 79.4%. There were no significant differences in age, gender, and previous history between the two groups. The time from the first diagnosis to the start of reperfusion in the ITT group was shorter than that in the PPCI group [minutes: 63 (38, 95) vs. 95 (60, 150), U = -9.286, P = 0.000], but was significantly longer than the guideline standard. Compared with the ITT group, the vascular recanalization rate in the PPCI group was higher [95.5% (1 023/1 071) vs. 88.3% (265/300), P < 0.01], and in-hospital mortality was lower [2.1% (22/1 071) vs. 6.7% (20/300), P < 0.01], but there were no significant differences in the 1-year mortality and 3-year mortality [5.3% (45/850) vs. 4.4% (9/205), 9.5% (81/850) vs. 9.3% (19/205), both P > 0.05]. Between ITT group and PPCI group with different reperfusion starting time, the FMC2N > 30 minutes group had the lowest vascular recanalization rate and the highest in-hospital mortality. Pairwise comparison showed that the vascular recanalization rate of the FMC2B ≤ 120 minutes group and the FMC2B > 120 minutes group were significantly higher than those of the FMC2N > 30 minutes group [95.5% (654/685), 95.6% (369/386) vs. 88.0% (220/250), both P < 0.008], the in-hospital mortality was significantly lower than that of the FMC2N > 30 minutes group [2.0% (14/685), 2.1% (8/386) vs. 7.6% (19/250), both P < 0.008]. There was no significant difference in 1-year mortality (χ2 = 2.507, P = 0.443) and 3-year mortality (χ2 = 2.204, P = 0.522) among the four groups. CONCLUSIONS: For STEMI patients within 12 hours of onset, reperfusion therapy should be performed as soon as possible. PPCI showed higher infarct related artery opening rate and lower in-hospital mortality compared with ITT, and had no effect on 1-year and 3-year mortality.

[Efficacy of hemoperfusion combined with continuous veno-venous hemofiltration on the treatment of paraquat poisoning: a Meta-analysis].

OBJECTIVE: To evaluate the efficacy of hemoperfusion (HP) combined with continuous veno-venous hemofiltration (CVVH) on the treatment of acute paraquat (PQ) poisoning. METHODS: Prospective randomized controlled trials and retrospective studies on the efficacy of HP combined CVVH in patients with oral PQ poisoning (poisoning time ≤ 24 hours) were found by searching from PubMed, Embase, Cochrane Library, Web of Science, SinoMed, CNKI and Wanfang databases before November 1st, 2019. The experimental group was treated with HP+CVVH, and the control group was treated with HP. Data included the general information of the literature, mortality, survival time, the incidence of respiratory failure and circulatory failure. The bias risk and the data were analyzed using the RevMan 5.3 software. RESULTS: A total of 1 041 literatures were retrieved, and 7 literatures were finally enrolled, including 1 199 patients, with 735 patients in the control group and 464 patients in experimental group. Meta-analysis showed that compared with HP alone, HP+CVVH could significantly reduce the short-term mortality [4-day mortality: hazard ratio (HR) = 0.52, 95% confidence interval (95%CI) was 0.38-0.71, P < 0.000 1], but no significant improvement in long-term mortality was found (28-day or 30-day mortality: HR = 0.68, 95%CI was 0.39-1.21, P = 0.19; 90-day mortality: HR = 1.13, 95%CI was 0.61-2.10, P = 0.07; total mortality: HR = 0.96, 95%CI was 0.72-1.29, P = 0.78). The survival time of patients treated with HP+CVVH was significantly longer than that of HP patients [mean difference (MD) = 2.02, 95%CI was 0.81-3.22, P = 0.001], but the heterogeneity between studies was large. According to the type of literature, a subgroup analysis showed that the survival time of patients treated with HP+CVVH in prospective randomized controlled trials and retrospective studies were significantly longer than that of HP patients (prospective studies: MD = 1.53, 95%CI was 0.94-2.12, P < 0.000 01; retrospective studies: MD = 2.40, 95%CI was 0.08-4.73, P = 0.04). Compared with HP group, HP+CVVH could significantly reduce the incidence of circulatory failure [relative risk (RR) = 0.40, 95%CI was 0.30-0.52, P < 0.00 01], but the incidence of respiratory failure significantly increased (RR = 2.75, 95%CI was 2.18-3.48, P < 0.000 01). CONCLUSIONS: HP combined with CVVH can reduce the short-term mortality and the incidence of circulatory failure, prolong the survival time, and save time for further rescue, but it can't improve the long-term prognosis of patients.

Cardiogenic shock as the initial manifestation of systemic lupus erythematosus.

Cardiogenic shock as the initial manifestation of systemic lupus erythematosus (SLE) is an uncommon but catastrophic complication. Because of the lack of typical clinical features, the diagnosis of the disease is challenging. This case report describes a 47-year-old female admitted to the emergency room in refractory cardiogenic shock with dilative cardiomyopathy and a left ventricular ejection fraction (LVEF) of 25.6% of unknown origin. The patient responded poorly to the initial tries of stabilization, and the clinical status continued to deteriorate. Venous-arterial extracorporeal membrane oxygenation (V-A ECMO) was applied to maintain hemodynamic stability. Coronary angiography revealed no obvious stenosis of the coronary artery. Evidence of virus infection was negative. After requestioning about medical history in detail, Reynaud's phenomenon was shown. SLE was suspected. A complete autoimmune laboratory workup was completed and found the positive result of antinuclear antibodies, anti-double-stranded DNA antibodies, anti-phospholipid antibodies, and low C3 and C4. The patient also presented with pericardial effusion and the PLTs <100 000/mm3 . SLE was confirmed according to the 2019 EULAR/ACR criteria. When the diagnosis was established, the immunotherapy was initiated. As a result, the patient underwent a quick recovery and achieved good outcomes. In conclusion, early diagnosis and timely application of immunotherapy is the key to treatment lupus myocarditis. Advanced mechanical support may play a necessary role when patient is in critical situation. For middle-aged female patients presenting with unexplained cardiogenic shock, lupus myocarditis should be considered in the differential diagnosis. In addition, the 2019 EULAR/ACR criteria provide a new, fitting tool for the diagnosis, which is conducive to the earlier and more accurate diagnosis of SLE.

The effects of ω-3 fish oil emulsion-based parenteral nutrition plus combination treatment for acute paraquat poisoning.

OBJECTIVE: To investigate the effects of parenteral nutrition (PN) including ω-3 fish-oil emulsion on nutritional state, inflammatory response, and prognosis in patients with acute paraquat poisoning. METHODS: Patients randomized to receive medium chain triglycerides (MCT)/long chain triglycerides (LCT)-based PN (control group) or MCT/LCT-based PN containing ω-3 fish-oil emulsion (intervention group) were compared for 90-day survival and short-term treatment efficacy. RESULTS: Tumour necrosis factor-α levels were significantly lower in the intervention group ( n = 101) versus controls ( n = 73) on treatment days 4 and 7. Intervention group C-reactive protein (CRP) levels were significantly increased on day 4, decreased to baseline (day 1) levels on day 7, and were significantly lower than baseline on day 10. Control group CRP levels were significantly increased on days 4 and 7 versus baseline, and returned to baseline levels on day 10. On day 7, retinol binding protein had recovered to baseline levels in the intervention group only. Intervention group mortality rate (36.6%) was significantly lower than controls (57.5%). ω-3 fish-oil PN was associated with reduced risk of death (hazard ratio 0.52; 95% confidence interval 0.33, 0.82). CONCLUSION: In patients with acute paraquat poisoning, MCT/LCT with ω-3 fish-oil emulsion PN plus combination treatment advantageously attenuated the inflammatory response, modified the nutritional state, and was associated with significantly improved 90-day survival versus treatment without ω-3 fish oil.

Levels of interleukin-6, superoxide dismutase and malondialdehyde in the lung tissue of a rat model of hypoxia-induced acute pulmonary edema.

The present study aimed to investigate the levels of malondialdehyde (MDA), superoxide dismutase (SOD) and interleukin (IL)-6 in the lung tissue of a rat model of acute pulmonary edema induced by acute hypoxia, and its pathophysiological significance. A total of 48 adult Wistar rats were randomly divided into group A, a normal group; group B, a model of acute pulmonary edema induced by hypoxia for 24 h; group C, a model of acute pulmonary edema induced by hypoxia for 48 h; and group D, a model of acute pulmonary edema induced by hypoxia for 72 h. The rats in groups B-D were intraperitoneally injected with 6% ammonium chloride to establish the model of acute pulmonary edema, and were subsequently sacrificed following successful modeling for 24, 48 and 72 h. The plasma of rats was isolated and the lungs of the rats were removed. Subsequently, a 10% lung homogenate was prepared and the contents and the activities of MDA, SOD and IL-6 in the lung tissue and IL-6 in the plasma were detected by enzyme-linked immunosorbent assay. MDA and IL-6 expression levels increased and SOD activity decreased in the lung tissue in group B as compared with group A; however the difference did not reach significance (P>0.05). MDA, IL-6 and SOD levels in the lung tissue of rats were significantly altered following the increased duration of pulmonary edema in groups C and D, as compared group A (P<0.05). The plasma IL-6 levels of the rats in groups B-D significantly increased, as compared with those in group A (P<0.05). In conclusion, the results of the present study demonstrated that the incidence of acute pulmonary edema may be associated with oxidative stress. Furthermore, decreased antioxidant capacity and increased free radical levels may be associated with pulmonary edema, as in the present study the levels of IL-6, SOD and MDA in the lung tissue were observed to be associated with the pathological changes of the disease.

Plate fixation versus intramedullary fixation for midshaft clavicle fractures: Meta-analysis of complications and functional outcomes.

OBJECTIVE: This analysis critically compares publications discussing complications and functional outcomes of plate fixation (PF) versus intramedullary fixation (IF) for midshaft clavicle fractures. METHODS: Relevant studies published between January 1990 and October 2014, without language restrictions, were identified in database searches of PubMed®, Medline®, Embase and the Chinese National Knowledge Infrastructure (CNKI). Studies that compared postoperative complications and functional outcomes between PF and IF for midshaft clavicle fractures, and provided sufficient data for analysis, were included in this meta-analysis. RESULTS: After strict evaluation, 12 studies were included in this meta-analysis. Studies encompassed 462 participants in the PF group and 440 in the IF group. Study participants were followed up for ≥1 year. Outcomes were superior with IF compared with PF in terms of shoulder constant score at 6-month follow-up, fewer symptomatic hardware complications, lower rate of refracture after hardware removal and less hypertrophic scarring. In other aspects, such as functional recovery at 12-months and 24-months, Disability of Arm, Shoulder and Hand (DASH) questionnaire results at 12-month follow-up, shoulder motion range, rates of superficial infection, temporary brachial plexus lesion, nonunion, malunion, delayed union, implant failure and need for major revision, both techniques were similar. CONCLUSIONS: Findings of this meta-analysis suggest that, in many respects, IF was superior to PF for the management of midshaft clavicle fractures. This finding could aid surgeons in making decisions on the optimum internal fixation pattern for midshaft clavicular fractures.