Neoastilbin ameliorates sepsis-induced liver and kidney injury by blocking the TLR4/NF-κB pathway.

Sepsis frequently causes systemic inflammatory response syndrome and multiple organ failure in patients. Neoastilbin (NAS) is a flavonoid that plays vital functions in inflammation. This work aims to investigate the protective effects of NAS against sepsis-induced liver and kidney injury and elucidate its underlying mechanisms. The mouse model was established using cecal ligation puncture (CLP) induction. NAS was given to mice by gavage for 7 consecutive days before surgery. Liver and kidney function, oxidative stress, and inflammatory factors in serum or tissues were examined by ELISA or related kits. The expression of relevant proteins was assessed by Western blot. Hematoxylin and eosin and/or periodic acid-Schiff staining revealed that NAS ameliorated the pathological damage in liver and kidney tissues of CLP-induced mice. NAS improved liver and kidney functions, as evidenced by elevated levels of blood urea nitrogen, Creatinine, ALT, and AST in the serum of septic mice. TUNEL assay and the expression of Bcl-2 and Bax showed that NAS dramatically reduced apoptosis in liver and renal tissues. NAS treatment lowered the levels of myeloperoxidase and malondialdehyde, while elevated the superoxide dismutase content in liver and kidney tissues of CLP-induced mice. The levels of inflammatory cytokines (IL-6, TNF-α, and IL-1ß) in the serum and both tissues of CLP-injured mice were markedly decreased by NAS. Mechanically, NAS downregulated TLR4 expression and inhibited NF-κB activation, and overexpression of TLR4 reversed the protective effects of NAS against liver and kidney injury. Collectively, NAS attenuated CLP-induced apoptosis, oxidative stress, inflammation, and dysfunction in the liver and kidney by restraining the TLR4/NF-κB pathway.

HAND2-AS1 associates with outcomes of acute coronary syndrome and regulates cell viability of vascular endothelial cells.

OBJECTIVE: Acute coronary syndrome (ACS) is an emergency and severe disorder of the cardiovascular system. This paper assessed the expression of plasma HAND2-AS1 in patients with ACS, researched its diagnostic and prognostic significance, and studied its possible mechanism for participating in ACS. METHODS: The concentration of HAND2-AS1 of 101 included patients with ACS was certified by qRT-PCR and its possible diagnostic function was revealed by the receiver operating characteristic (ROC) curve. All patients were followed up for 6 months after percutaneous coronary intervention (PCI) therapy and Kaplan-Meier (K-M) curve and COX regression analysis was performed to estimate the short-term prognostic value of HAND2-AS1 in ACS. The interrelationship between HAND2-AS1 and Gensini score and endothelial injury was identified via Pearson correlation. The function of HAND2-AS1 on the viability, migration, and apoptosis of human umbilical vein endothelial cells (HUVECs) was estimated by the Cell Counting Kit-8 (CCK-8), Transwell chamber, and flow cytometry. RESULTS: In ACS patients, the expression of serum HAND2-AS1 was prominently decreased and closely correlated with the Gensini score. The decreased HAND2-AS1 expression was of diagnostic significance. Declined plasma HAND2-AS1 was observed in patients with the major adverse cardio-cerebrovascular event (MACCE) and was an independent risk for the poor prognosis of ACS patients. In the cell model, upregulation of HAND2-AS1 improved cell viability and migration and inhibited cell apoptosis. CONCLUSION: HAND2-AS1 was an independent biomarker for the diagnosis and prognosis of ACS. HAND2-AS1 might be involved in ACS development by regulating endothelial damage.

The Distribution Characteristics of Vegetation in the Subrange of the Altai Mountains, Xinjiang.

The Altai Mountains are an important center of biodiversity and are a major habitat for threatened and endemic species in Asia. Moreover, the Altai Mountains are a valuable site for the study of the evolution of central Asian vegetation. The Xinjiang Altai subrange represents the largest part of the southern Altai Mountains and has many unique plant communities. After conducting a thorough literature review and field investigation, we utilized the Chinese vegetation categorization system to identify the dominant plant communities in the Xinjiang Altai subrange and report their composition and distribution characteristics. Our results show that (1) the natural plant communities present in the Xinjiang Altai subrange can be divided into eight vegetation types, eighteen vegetation subtypes, and 50 communities. Among these, two communities-Form. Calligonum rubicundum and Form. Seriphidium borotalense-Festuca valesiaca-are present only in the Xinjiang Altai subrange. (2) The Xinjiang Altai subrange is located at the junction of three major biomes containing unique vegetation types (coniferous forest, temperate broadleaf forest, and desert). Thus, the Xinjiang Altai subrange is distinct in its staggered transition from mountainous boreal taiga to temperate desert. This research provides textual data to contextualize the cultural heritage of the Xinjiang Altai subrange and also provides a scientific basis for the protection and sustainable management of natural resources found in the Xinjiang Altai.

Mechanism of DYRK1a in myocardial ischemia-reperfusion injury by regulating ferroptosis of cardiomyocytes.

This study aimed to explore the role and mechanism of DYRK1a regulating ferroptosis of cardiomyocytes during myocardial ischemia-reperfusion injury (MIRI). H9c2 cells treated with oxygen-glucose deprivation/reoxygenation (OGD/R) were used as MIRI cell models and transfected with sh-DYRK1a or/and erastin. Cell viability, apoptosis, and DYRK1a mRNA/protein expression were measured accordingly. The levels of reactive oxygen species (ROS), iron, malondialdehyde (MDA), and glutathione (GSH) were determined. The expression of ferroptosis-related proteins (GPX4, SLC7A11, ACSL4, and TFR1) was detected using western blotting. The MIRI rat model was established to explore the possible role of DYRK1a suppression in cell injury and ferroptosis. OGD/R cells showed elevated mRNA and protein expression for DYRK1a. OGD/R cells transfected with sh-DYRK1a showed elevated cell viability, GSH content, increased GPX4 and SLC7A11 expression, suppressed iron content, MDA, ROS, ACSL4, and TFR1 expression, and reduced apoptosis rate, whereas co-transfection of sh-DYRK1a with erastin reversed the attenuation of sh-DYRK1a on MIRI. The suppressive effect of sh-DYRK1a on MI/R injury was confirmed in an MIRI rat model. DYRK1a mediates ferroptosis of cardiomyocytes to deteriorate MIRI progression.

The complete chloroplast genome sequence of Tamarix arceuthoides Bunge and Tamarix ramosissima Ledeb. (Tamaricaceae).

Tamarix L. is of great ecological and economic significance in arid desert ecosystems. This study reports the complete chloroplast (cp) genomic sequences of T. arceuthoides Bunge and T. ramosissima Ledeb., which are currently unknown, by high-throughput sequencing. The cp genomes of T. arceuthoides 1852 and T. ramosissima 1829 were 156,198 and 156,172 bp in length, respectively, and contained a small single-copy region (SSC: 18,247 bp), a large single-copy region (LSC: 84,795 and 84,890 bp, respectively), and a pair of inverted repeat regions (IRs: 26,565 and 26,470 bp, respectively). The two cp genomes possessed 123 genes arranged in the same order, including 79 protein-coding, 36 tRNA, and eight rRNA genes. Of these, 11 protein-coding genes and seven tRNA genes contained at least one intron. The present study found that Tamarix and Myricaria are sister groups with the closest genetic relationship. The obtained knowledge could provide useful information for future phylogenetic, taxonomic, and evolutionary studies on Tamaricaceae.

Sigmoido-vesical fistula secondary to sigmoid colon cancer presenting as urinary tract infection with Lactococcus lactis: A case report.

A colovesical fistula is a pathological communication between the colon and bladder. The symptoms include pneumaturia, fecaluria, and a lower urinary tract infection. The diagnosis is based on clinical symptoms, but the symptoms are not specific. Therefore, confirming the diagnosis is challenging. Urine cultures performed in patients with colovesical fistulas usually show growth of Escherichia coli or mixed growth of bowel organisms. Urinary tract infections caused by Lactococcus lactis are very rare, as it is rarely considered pathogenic in humans. We report the case of a 70-year-old woman who presented with symptoms of a recurrent urinary tract infection. Urine cultures were positive for L. lactis. Abdominopelvic computed tomography (CT) revealed focal thickening of the bladder wall and gas in the bladder. Cystoscopic examination and colonoscopy revealed sigmoid colon cancer and a sigmoido-vesical fistula. Laparoscopic surgical treatment was done. The patient recovered and was discharged 3 weeks later without chemoradiotherapy. On follow-up after 6 months, the patient was asymptomatic and stable. To our knowledge, this is the second reported case of L. lactis infection of the urinary tract and the first reported case in adults. L. lactis infection usually indicates the presence of serious underlying diseases such as malignancies, uncontrolled diabetes, and organ failure.

Phytotoxic, insecticidal, and antimicrobial activities of Ajania tibetica essential oil.

The chemical profile of Ajania tibetica essential oil (EO) and its phytotoxic, insecticidal, and antimicrobial activities were assessed. Monoterpenes (79.05%) and sesquiterpenes (10.33%) were dominant in the EO, with camphor, (+/-)-lavandulol and eucalyptol being the major constituents, representing 55.06% of the total EO. The EO possessed potent phytotoxicity against Poa annua and Medicago sativa starting from 0.5 mg/mL, and when the concentration rose to 5 mg/mL, seed germination of both tested species was 100% suppressed. Ajania tibetica EO displayed significant pesticidal activity against Aphis gossypii with an LC50 value of 17.41 µg/mL; meanwhile, the EO also showed antimicrobial activity against Escherichia coli, Bacillus subtilis, Verticillium dahlia and Aspergillus niger using broth microdilution and disc diffusion methods. For the tested bacterial and fungal strains, the EO exhibited a repressing effect, with minimum inhibitory concentrations (MICs) ranging from 0.3125 to 1.25 mg/mL for bacteria and from 1.25 to 2.5 mg/mL for fungi, whereas the minimum microbicidal concentrations (MMCs) were 5 mg/mL for bacteria and 2.5 mg/mL for fungi. Our study is the first report on the chemical profile as well as the phytotoxicity, insecticidal and antimicrobic activity of A. tibetica EO, indicating its potential value as an alternative synthetic pesticide.

[Inhibitory effect and mechanism of bone marrow mesenchymal stem cells on inflammation in rats with multiple organ dysfunction syndrome].

Objective To observe the anti-inflammatory effect and mechanism of bone marrow mesenchymal stem cell (BMSC) on multiple organ dysfunction syndrome (MODS) rats. Methods SD rats were randomly divided into control group, model group and BMSC group, with 10 rats in each group. Rats in model group and BMSC group were intraperitoneally injected with 7 mg/kg lipopolysaccharide (LPS) to establish MODS models. Rat BMSCs were cultured in vitro, and the fourth generation cells were used for experiments. The rats in BMSC group were injected with 1×106 BMSCs through the tail vein, and the rats in control group and model group were injected with the same amount of normal saline through the tail vein. 72 hours after MODS model was established, blood oxygen partial pressure (PaO2) and arterial carbon dioxide partial pressure (PaCO2) were detected by blood gas analyzer. ELISA were used to detect the bilirubin (TB), albumin (ALB), serum creatinine (Scr), blood urea nitrogen (BUN), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and cyclic adenosine monophosphate (cAMP). HE staining was performed to observe pathological changes in lung, liver and kidney tissues. Western blot analysis was used to detect the protein expression of protein kinase A (PKA) and nuclear factor kappa-B p65 (NF-κB p65) in tissues of lung, liver and kidney. Results Compared with control group, PaO2 in model group and BMSC group significantly decreased, while the PaCO2 significantly increased. TB, Cr, BUN, TNF-α and IL-6 levels was found increased, and ALB and cAMP levels was found decreased, along with the decreased PKA protein expression levels in lung, liver and kidney tissues, and increased NF-κB p65 protein expression levels. Compared with model group, PaO2 in BMSC group increased significantly, while its PaCO2 decreased markedly. It's also detected decreased TB, Cr, BUN, TNF-α and IL-6 levels, increased ALB and cAMP levels, as well as increased PKA protein expression levels in lung, liver and kidney tissues, and decreased NF-κB p65 protein expression levels. Conclusion BMSCs can reduce the damaged organ function and inhibit the release of inflammatory factors in MODS rats. The mechanism may be related to the change of cAMP/PKA/NF-κB signaling pathway.

Shp2 in Alveolar Macrophages Regulates Macrophage I Phenotype in Acute Lung Injury.

Macrophage play important role in acute lung injury (ALI). This study aims to explore the possible role of Shp2 in regulating macrophage 1 (M1) in ALI progression. ALI was induced in rats by intravenous injection of lipopolysacharide (LPS). Lentivirus was used to knock down Shp2 expression. Lungs from LPS-induced ALI rats were evaluated by H&E staining and wet/dry lung weight ratio (W/D ratio) measurement. The expression of inflammatory cytokines IL-1ß, TNF-α and IL-6 in bronchoalveolar lavage fluid were detected by ELISA. The expressions of M1 biomarker (iNOS) and macrophage 2 (M2) biomarker (Arg-1) in lung tissues and macrophages were measured by immunofluorescence and western blot. The ratio of M2/M1 was detected by flow cytometry. Inflammatory cytokines were highly expressed in ALI rat models, in which elevated expression of iNOS and decreased Arg-1 expression were detected. Shp2 was found to be highly expressed in lung tissues of ALI rat models. LPS treatment in NR8383 cells lead to increased M1 phenotype and elevated expression of Shp2. Suppression on Shp2 expression can counteract the LPS-induced effect and further attenuate ALI progression. Evidence collected from ALI rat and cell models showed that suppression Shp2 expression in macrophages can inhibit M1 phenotype to attenuate ALI progression.

Work Content of General Practitioners in Beijing, China: A Multi-method Study.

Background: Despite the dramatic growth of primary care in China, little evidence showed what general practitioner (GP) do and how GP provided medical service in Beijing. Objective: This study aimed to explore the work content of GPs in primary care in Beijing. Methods: A multi-method study was conducted in five community health service institutions using non-participant observation and critical incident technique interview. Eleven GPs was recruited by purpose sampling, with each GP recording details of 100 patient encounters. Health problems of patients and activities of GPs were observed in consultations. Then, critical incident technique interviews were conducted focusing on GPs' works out of clinics and challenge. Results: A total of 1, 100 patients encounters and 1,897 reasons for encounter (RFEs) were recorded from 11 GPs. There were 1897 RFEs (1.72 per encounter) and 2,762 health problems (2.51 per encounter) from 1,100 encounters during our observation. GPs' work related to consultation was focus on disease diagnoses and treatment. Physical examination and investigations were performed in only 15.5 and 17.1% consultations, respectively. Procedures for chronic disease management were infrequently provided to patients (0.4-26.6%). Time spent in each work process in consultations ranged from 0.68 ± 0.27 min for reservation to 4.00 ± 2.45 min for surgical treatment. In addition to clinical work, there were tasks about health files, contracted family doctor services, health education, teaching students, and scientific research. Conclusion: This study illustrated the complexity of GPs' work and heavy workload in Beijing, China. More attention and effort are needed to develop GPs performance and release GPs' work workload in primary care.

Predictive Model of Cerebral Vasospasm in Subarachnoid Hemorrhage Based on Regression Equation.

In order to explore the regression equation for the prediction model of subarachnoid hemorrhage and cerebral vasospasm, the nomogram prediction model of SCVS occurrence was established. This study is a retrospective analysis of 125 cases of aSAH admitted to a hospital; the patients were divided into SCVS group and non-SCVS group. Select SIRI as a simple and reliable marker of inflammation, analyze its correlation with SCVS and its predictive value, and analyze the predictive value of SIRI to SCVS through ROC curve. Based on the SIRI inflammation level and other related risk factors, a nomogram prediction model for the occurrence of SCVS was built. The experimental results show that the SIRI level of patients in the SCVS group was significantly higher than that of the non-SCVS group, and logistic regression analysis found that SIRI is an independent risk factor for SCVS. SIRI = 3.63 × 109/L is the best cutoff value for diagnosing the occurrence of SCVS. When TC = 2.24 mmol/L and SIRI = 3.63 × 10%/L, its Youden Index is the largest (0.312, 0.296) and is the best cutoff value for predicting the occurrence of SCVS; at the same time, its prediction accuracy (area under the ROC curve (AUC)), sensitivity, specificity, the positive predictive value, and negative predictive value are 0.743, 72.70%, 80.10%, 77.53%, and 94.24% and 0.725, 70.60%, 76.90%, 73.49%, and 93.59%. Nomogram prediction model establishment and evaluation combined with the results of multifactor analysis are used to build an individual nomogram prediction model. The model has good prediction consistency (C-index = 0.685, P < 0.01). ROC analysis results showed that the model that combined SIRI and other standard variables (AUC = 0.896, 95% CI was 0.803-0.929, P < 0.001) was better than the model that did not combine SIRI (AUC = 0.859, 95% CI was 0.759-0.912, P < 0.001) and the model based only on SIRI (AUC = 0.725, 95% CI was 0.586-0.793, P = 0.001) has better predictive value for SCVS. Joint SIRI will optimize the prediction performance of the nomogram model and improve the early recognition and screening capabilities of SCVS.

Long non-coding RNA XIST alleviates sepsis-induced acute kidney injury through inhibiting inflammation and cell apoptosis via regulating miR-155-5p/WWC1 axis.

Sepsis is characterized by a severe inflammatory response throughout the whole body and can induce acute kidney injury (AKI). This research aimed to investigate the regulatory mechanisms underlying miR-155-5p in sepsis-induced AKI. CLP-treated mice were used as an in vivo model of sepsis-induced AKI, and LPS-treated HK-2 and TCMK-1 cells were used as in vitro models. Bioinformatics analyses and mechanistic assays were utilized to reveal the relationships between molecules. H&E staining was used to reveal morphological changes in kidney tissues. ELISAs were conducted to detect the concentrations of proinflammatory cytokines. We discovered that miR-155-5p was prominently upregulated in sepsis-induced AKI in vivo and in vitro. MiR-155-5p inhibition alleviated kidney injury in mice. Moreover, WWC1 served as a direct target of miR-155-5p and was negatively regulated by miR-155-5p. WWC1 upregulation inhibited the productions of inflammatory cytokines and suppressed apoptosis in vivo and in vitro. In addition, rescue assays demonstrated that WWC1 knockdown counteracted the inhibitory effect of anti-miR-155-5p on inflammation and apoptosis. Moreover, miR-155-5p could bind to XIST. XIST expression was downregulated in LPS-stimulated HK-2 and TCMK-1 cells. XIST could negatively regulate miR-155-5p expression and positively regulate WWC1 expression. Rescue assays revealed that miR-155-5p overexpression significantly reversed the suppressive effects of XIST upregulation on inflammation and apoptosis. In conclusion, our study revealed that the XIST/miR-155-5p/WWC1 axis modulated sepsis-induced AKI progression, providing promising insight into therapeutic targets for sepsis-induced AKI.

A prediction model for the 5-year, 10-year and 20-year mortality of medullary thyroid carcinoma patients based on lymph node ratio and other predictors.

Aim: To explore the predictive value of lymph node ratio (LNR) for the prognosis of medullary thyroid carcinoma (MTC) patients, and constructed prediction models for the 5-year, 10-year and 20-year mortality of MTC patients based on LNR and other predictors. Methods: This cohort study extracted the data of 2,093 MTC patients aged ≥18 years undergoing total thyroidectomy and neck lymph nodes dissection. Kaplan-Meier curves and log-rank tests were performed to compare survival curves between LNR < 15% group and LNR ≥ 15% group. All data was divided into the training set (n = 1,465) and the testing set (n = 628). The random survival forest model was constructed in the training set and validated in the testing set. The area under the curve (AUC) was employed for evaluating the predictive ability of the model. Results: The 5-year, 10-year and 20-year overall survival (OS) and cause-specific survival (CSS) of MTC patients with LNR <15% were higher than those with LNR ≥15%. The OS was 46% and the CSS was 75% after 20 years' follow-up. The AUC of the model for the 5-year, 10-year, and 20-year OS in MTC patients was 0.878 (95%CI: 0.856-0.900), 0.859 (95%CI: 0.838-0.879) and 0.843 (95%CI: 0.823-0.862) in the training set and 0.845 (95%CI: 0.807-0.883), 0.841 (95%CI: 0.807-0.875) and 0.841 (95%CI: 0.811-0.872) in the testing set. In the training set, the AUCs were 0.869 (95%CI: 0.845-0.892), 0.843 (95%CI: 0.821-0.865), 0.819 (95%CI: 0.798-0.840) for the 5-year, 10-year and 20-year CCS in MTC patients, respectively. In the testing set, the AUCs were 0.857 (95%CI: 0.822-0.892), 0.839 (95%CI: 0.805-0.873) and 0.826 (95%CI: 0.794-0.857) for the 5-year CCS, 10-year CCS and 20-year CCS in MTC patients, respectively. Conclusion: The models displayed good predictive performance, which might help identify MTC patients might have poor outcomes and appropriate interventions should be applied in these patients.

Is Plant Life-History of Biseasonal Germination Consistent in Response to Extreme Precipitation?

Future climate is projected to increase in the intensity and frequency of extreme precipitation events, and the resulting ecological consequences are often more serious than those of normal precipitation events. In particular, in desert ecosystems, due to the low frequency and strong fluctuation of extreme precipitation, the destructive consequences for desert plants caused by extreme precipitation have not received enough attention for some time. Based on statistics of extreme precipitation events (1965-2018) in the Gurbantunggut Desert, we investigated the effects of extreme precipitation (+0%, CK; +50%, W1; +100%, W2; +200%, W3; maintenance of field capacity, W4) on the plant life-history of the spring-germinated (SG) and autumn-germinated (AG) ephemeral plant Erodium oxyrhynchum by monitoring seedling emergence, survival, phenology, organ size, biomass accumulation, and allocation. The results showed that extreme precipitation caused about 2.5% seedling emergence of E. oxyrhynchum in autumn 2018 and 3.0% seedling emergence in early spring 2019, which means that most seeds may be stored in the soil or have died. Meanwhile, extreme precipitation significantly improved the survival, organ size, and biomass accumulation of SG and AG plants, and W3 was close to the precipitation threshold of SG (326.70 mm) and AG (560.10 mm) plants corresponding to the maximum individual biomass; thus, AG plants with a longer life cycle need more water for growth. Conversely, W4 caused AG plants to enter the leaf stage in advance and led to death in winter, which indicates that extreme precipitation may not be good for AG plants. Root and reproduction biomass allocation of SG and AG plants showed a significantly opposite trend under extreme precipitation treatments, which might be related to their different life-history strategies. Therefore, when only taking into account the changing trend of extreme precipitation from the Coupled Model Intercomparison Project 6 (CMIP6) climate projections data, we speculate that extreme precipitation may promote the growth of SG and AG plants from the beginning to the middle of this century, but extreme precipitation in autumn exceeding a certain threshold may adversely affect the survival of AG plants at the end of the century.

MicroRNA-144-3p enhances LPS induced septic acute lung injury in mice through downregulating Caveolin-2.

OBJECTIVE: The emphasis of this study focused on the possible implication and the mechanism of miR-144-3p in septic acute lung injury (ALI) condition. METHODS: Mice were pre-injected with miR-144-3p agomir, miR-144-3p antagomir, sh-Caveolin-2 or PBS before 10 mg/kg LPS induced sepsis model establishment. The ratio of wet weight of lung tissues and body weight (W/W) was calculated. The pathological changes on lung tissues were observed by H&E staining. Secretions of inflammatory cytokines (TNF-α, IL-1ß and IL-6) in both mouse serum and lung tissues were determined by ELISA. Cell apoptosis and cell morphology were measured by TUNEL staining and H&E staining. The expressions of miR-144-3p, Caveolin-2, apoptotic related proteins and JAK/STAT pathway related proteins were measured by qRT-PCR or/and Western blot. Dual luciferase reporter assay was applied to detect the binding of miR-144-3p with Caveolin-2. RESULTS: LPS resulted in increased W/W, disrupted lung tissue, enhanced inflammatory response and cell apoptosis. miR-144-3p was upregulated while Caveolin-2 was downregulated in response to LPS treatment. Inflammation and cell apoptosis induced by LPS can be alleviated by miR-144-3p antagomir injection, but enhanced by miR-144-3p agomir or sh-Caveolin-2 treatment. miR-144-3p can negatively target Caveolin-2. miR-144-3p can activate the JAK/STAT signal pathway through Caveolin-2 in septic ALI mouse. CONCLUSION: miR-144-3 can promote LPS induced septic ALI through downregulating Caveolin-2 to activate the JAK/STAT signal pathway.

The prognostic value of routine coagulation tests for patients with heat stroke.

OBJECTIVE: To evaluate the prognostic value of routine coagulation tests for patients with heat stroke. METHODS: This was a multi-center retrospective study. Patients who arrived at the hospital <24 h after the onset of Heat Stroke (HS) were included. The routine coagulation variables were detected within 24 h after the onset, including the lowest platelet count (PLC). RESULTS: 60-day mortality rate was 20.9%. The median Prothrombin Time-International Normalized Ratio (PT-INR) of the non-surviving patients was significantly higher than that of the survivors (P < 0.01). The median Activated Partial Thromboplastin Time (APTT) in non-surviving patients was significantly higher than in the surviving patients (P < 0.01). A Cox regression analysis revealed that 60-day mortality was associated with PT-INR (P = 0.032) and APTT (P = 0.004). The optimal PT-INR point for predicting 60-day mortality rate was 1.7. The optimal APTT point for predicting 60-day mortality was 51.45. Patients with increased PT-INR (≥1.7) levels had, overall, a significantly reduced survival time (P < 0.01). Patients with elevated APTT (≥51.45) also had a decrease in survival time (P < 0.01). The prognostic scoring, with increased PT-INR (≥1.7) and prolonged APTT (≥51.45) at one point each, was also demonstrated to be useful in predicting 60-day mortality. Patients whose temperature fell to 38.9 °C within 30 min had significantly lower levels of PT-INR and APTT within 24 h than those who took longer to cool down. CONCLUSIONS: A prolonged APTT and elevated PT-INR within 24 h are independent prognostic factors of 60-day mortality in HS.

ABO blood group influences risk of venous thromboembolism and myocardial infarction.

ABO blood group has been associated with various disease phenotypes. However, ABO blood group to influence patients in risk of venous thromboembolic events (VTEs) and arterial thromboembolic events (ATEs) remains controversial after evaluation in several reports. To fully assess effects of ABO blood group on VTEs and ATEs, we conducted a cross-sectional study and investigated the interaction between blood group and age, and between blood group and sex on the prevalence of VTEs and ATEs. In addition, the effect of blood group on ATEs in patients with atrial fibrillation (AF) was observed. Detailed information of 7830 patients was collected. Multivariate logistic regression analyses were used to evaluate the association between blood group and VTEs, pulmonary embolism (PE) and myocardial infarction (MI). In those 7830 patients, the respective risk of VTEs and PE was higher for patients with blood group A compared with blood group O individually. In those 6713 patients with rheumatic heart disease, cardiomyopathy, myocarditis, constrictive pericarditis, or valvular heart disease excluded, blood group A was associated with the risk of MI. For VTEs, PE, and MI, blood group also exhibited significant interactions with sex and age, although there was no evidence of interaction between blood group and age for VTEs. In addition, interactions among blood group, age, and AF for the ATEs were observed. Similar to prior population studies an association of ABO blood group with susceptibility to VTEs and MI was found. Age and sex may modulate the association between ABO blood group and these thromboembolic diseases.

Sex differences in risk factors for stroke in patients with hypertension and hyperhomocysteinemia.

Data on the sex-specific differences in risk of stroke among patients with H-type hypertension are limited. We aimed to analyze interactions between sex and other risk factors on stroke, including the sex-methylenetetrahydrofolate reductase (MTHFR) interaction. A retrospective analysis of baseline data from 2040 patients with hypertension and hyperhomocysteinemia (HHcy) included demographic characteristics, biomarkers, history of chronic diseases and lifestyle factors. Polymerase chain reaction-restriction fragment length polymorphism method was used to investigate the C677T polymorphism of MTHFR gene. We examined independent effects and interactions between sex and stratified factors on the risk of stroke by logistic regression model. A total of 1412 patients suffered stroke, and the prevalence of stroke was 70.65% in men and 66.53% in women. Both men and women had independent risk factors for stroke, including diabetes mellitus, atrial fibrillation, smoking, increased level of systolic blood pressure (SBP) and plasma total homocysteine (tHcy), as well as the decreased level of high-density lipoprotein cholesterol. Diastolic blood pressure (DBP) -specific risk of stroke was unique to men. Interactions between sex and other risk factors on stroke risk were statistically significant: age, fasting plasma glucose (FPG), SBP, DBP, triglycerides (TG) and tHcy. Furthermore, tHcy interacted with age, SBP and DBP in men, and age, SBP, DBP, FPG, and TG in women to modulate the risk of stroke. Although TT genotype did not have an independent effect on stroke, it could interact with sex and FPG, TG and SBP to increase stroke. In conclusion, sex-specific differences are useful to stratify the risk of stroke and assist clinicians in the decision to select a reasonable therapeutic option for high-risk patients.

Pathogens distribution and drug resistance in patients with acute cerebral infarction complicated with diabetes and nosocomial pulmonary infection.

BACKGROUND: This study aims to investigate the pathogen distribution and drug resistance in patients with acute cerebral infarction complicated with diabetes mellitus and nosocomial pulmonary infection. METHODS: From August 2015 to December 2017, 172 pathogenic bacterial strains from patients with acute cerebral infarction complicated with diabetes mellitus and nosocomial pulmonary infection in our hospital were identified, and the drug sensitivity was analyzed. RESULTS: Among these 172 strains of pathogenic bacteria, gram negative bacteria was the main cause of pulmonary infection in hospitalized patients with acute cerebral infarction, accounting for 75.6% of all pathogens. Furthermore, 80% of diabetic patients with cerebral infarction had lung infection induced by gram negative bacteria, which was significantly higher than that in non-diabetic patients (72.2%). Moreover, the drug resistance rate in the diabetic group (68.3%) was significantly higher than that in the non-diabetic group (54.3%). Gram positive bacteria accounted for 19.1% of all pathogenic bacteria. The infection rate of gram-positive bacteria in diabetic patients with cerebral infarction was 14.7%, which was lower than that in the non-diabetic group (22.6%). The drug-resistance rate was higher in the diabetic group (45.5%) than in the non-diabetic group (28.2%). Furthermore, the fungal infection rate in patients with lung infection in these two groups was 5.3 and 5.2%, respectively, and fungi presented with high sensitivity to commonly used antifungal agents. CONCLUSION: In patients with acute cerebral infarction complicated with diabetes mellitus and nosocomial pulmonary infection, the majority of pathogens are multidrug-resistant gram negative bacilli. Pathogen culture should be conducted as soon as possible before using antibiotics, and antimicrobial agents should be reasonably used according to drug sensitivity test results.

[Accuracy of sequential organ failure assessment score in emergency department physicians in Beijing: a multicenter investigation study].

OBJECTIVE: To investigate the accuracy of sequential organ failure assessment (SOFA) scoring in emergency physicians in Beijing. METHODS: Emergency physicians from 8 hospitals in Beijing in January 2018 were demanded to complete a SOFA questionnaire which was developed on "wenjuanxing" website and submit via cell phone. All participants were divided into urban center group (UC group) and no-urban center group (NUC group) based on the hospital's location. The accuracy rate of components and total score of SOFA along with the mistakes were evaluated, and the results of the two groups were compared. RESULTS: (1) The questionnaire was sent to 217 emergency physicians of the 8 hospitals, and 197 qualified questionnaires were received with 109 of NUC group and 88 of UC group, respectively, the total response rate was 90.8%. Compared with those from NUC group, UC physicians had older ages [years: 37 (32, 42) vs. 34 (29, 40), Z = -2.554, P = 0.011] and higher education level [postgraduate degree 76.1% (67/88) vs. 40.4% (44/109), χ2 = 25.327, P < 0.001], and more of them experienced SOFA scoring [62.5% (55/88) vs. 45.9% (50/109), χ2 = 5.409, P = 0.020]. Other baseline characteristics such as gender, working years, professional title and training experience were not different between the two groups. (2) The accuracy rate of total SOFA score was 62.4% (123/197) in the whole cohort, and UC group was lower than that of NUC group, but the difference was not significant [56.8% (50/88) vs. 67.0% (73/109), χ2 = 2.141, P = 0.143]. While comparing the accuracy of individual variable/system of SOFA, the accuracy rate of norepinephrine of UC group was much higher than NUC group [80.7% (71/88) vs. 66.1% (72/109), χ2 = 5.235, P = 0.022], but the accuracy of Glasgow coma scale (GCS) was much lower in NUC group [38.6% (27/70) vs. 81.6% (71/87), χ2 = 30.629, P < 0.001]. Other variables of SOFA were not different between the two groups. Based upon the results of all submitted questionnaires, 566 mistakes were identified. It was indicated that the mistakes per capital was 2.9 in the whole cohort and in the two groups. The first type mistakes which caused by carelessness (including calculating error, filling error, choosing error) were 233 times. The calculating error in norepinephrine from NUC physicians was higher than the UC group [33.9% (37/109) vs. 19.3% (17/88), χ2 = 5.235, P = 0.022], there was no significant difference in any other first type mistakes between the two groups. The total second type mistakes caused by misunderstanding of SOFA (including using wrong variables, not using the worst value within 24 hours, and incorrect GCS score) were 333 times in the whole cohort. GCS error [61.8% (42/88) vs. 16.9% (14/109), χ2 = 32.292, P < 0.001], and using urine output per hour instead of urine output per 24 hours [15.9% (14/88) vs. 4.6% (5/109), χ2 = 7.162, P = 0.007] were much higher in UC group than NUC group. CONCLUSIONS: The total accuracy of SOFA scoring in the investigated emergency physicians of 8 hospitals in Beijing was not good. Mistakes causing by carelessness or misunderstanding of score rules were similar. It is necessary to apply strict training in SOFA scoring.