Sites and Causes of Infection in Patients with Sepsis-Associated Liver Dysfunction: A Population Study from the Medical Information Mart for Intensive Care III.

BACKGROUND Little is known about the relationship between the site of infection, type of pathogen, and the occurrence of sepsis-associated liver dysfunction (SALD). This population study aimed to identify the sites and types of infection in SALD patients. MATERIAL AND METHODS We conducted a retrospective observational study using the Medical Information Mart for Intensive Care III. Patients with sepsis were divided into a SALD group and a control group. We evaluated the effect of the location of culture-positive specimens and the distribution of pathogens on the occurrence of SALD and then compared the clinical outcomes. RESULTS A total of 14 596 admissions were included, and the incidence of SALD was 11.96%. Positive bile culture (odds ratio [OR] 7.450, P<0.001), peritoneal fluid culture (OR 3.616, P<0.001), and blood culture (OR 1.957, P<0.001) were correlated with the occurrence of SALD. Infection with Enterococcus faecium (OR 3.065, P<0.001), Bacteroides fragilis (OR 2.061, P<0.001), Klebsiella oxytoca (OR 2.066, P<0.001), Enterobacter aerogenes (OR 1.92, P=0.001), and Aspergillus fumigatus (OR 2.144, P=0.001) were correlated with the occurrence of SALD. The Intensive Care Unit mortality and hospital mortality were higher in the SALD group than in the control group (24.7% vs 9.0%, P<0.001; 34.2% vs 13.8%, P<0.001, respectively). CONCLUSIONS SALD should be considered for patients with sepsis whose infection site is the biliary system, abdominal cavity, or blood and the pathogen is Enterococcus faecium, B. fragilis, K. oxytoca, Enterobacter aerogenes, or A. fumigatus. When SALD occurs in patients with sepsis, the above infection sites and pathogens should be considered first.

Immediate or delayed loading protocols for two-implant mandibular overdentures: A systematic review and meta-analysis of randomized controlled trials.

STATEMENT OF PROBLEM: The immediate loading protocol for 2-implant mandibular overdentures has been widely reported. Nevertheless, the clinical effects reported in different articles are quite different. PURPOSE: The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to compare the clinical effects of immediate and delayed loading of 2-implant mandibular overdentures. MATERIAL AND METHODS: The review followed the guidelines of Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). PubMed, Cochrane Library, Web of Science, Embase, Scopus, ScienceDirect, CBM, CNKI, and Wan Fang databases were searched electronically for RCTs published before March 25, 2020. Two authors independently conducted literature screening, quality assessment, and data extraction. The outcomes of interest were implant failure rate, marginal bone loss (MBL), implant stability quotient (ISQ), periotest value (PTV), and patient satisfaction. RESULTS: A total of 2498 unduplicated records were identified. After full-text analysis, 7 eligible RCTs were included. All studies were followed for at least 12 months, and the meta-analysis was based on this. The meta-analysis showed that the implant failure rate in the immediate group was higher than that in the delayed group, but there was no statistically significant difference (I2=0%; n=7; risk difference [RD]=0.03; 95% confidence interval [CI]=-0.01 to 0.08). The difference of MBL between immediate and delayed loading was not significant (I2=88%; n=6; mean difference [MD]=-0.04; 95% CI=-0.16 to 0.24). Because of the limited articles reporting on ISQ, PTV, and patient satisfaction, no quantitative analysis was conducted for these outcomes. CONCLUSIONS: Although the implant failure rate was more likely to favor the delayed group, available evidence indicates no statistical difference in implant failure and marginal bone loss between immediate and delayed loading protocols.

A Rule of Thumb for Evaluating Surface Areas of Chronic Wounds.

BACKGROUND: Rapid estimation of the area of chronic wounds is clinically important. A simple method using the thumb was investigated for universal physical measurement, particularly of small and multiple wounds; the thumb surface area (TSA) was then compared with the total body surface area (TBSA). METHODS: A cross-sectional observational study and random sampling were used to obtain the characteristics of 343 participants. Data related to handprint surface area of the thumb and palm were collected using a scanner and laptop and assessed using image software. The TSA as a percentage of TBSA was confirmed based on the traditional rule that regards palmar surface area as 1% of TBSA. Information on factors potentially influencing measurement was gathered with questionnaires to analyze correlations. RESULTS: The left and right TSAs were on average 4.27% and 4.28%, respectively, of the palmar surface area for all participants. Multiple linear regression analysis found that male and older participants had higher TSA:TBSA proportions (sex, P = .0020; age, P < .0001). The TSA:TBSA proportion increased by age for both males (by age group, 0.0418%, 0.0426%, 0.0432%, and 0.0460%, respectively) and females (0.0400%, 0.0409%, 0.0427%, and 0.0430%, respectively). CONCLUSIONS: Thumb size is relatively stable in relation to TBSA, lending itself to a universal method for estimating the size of chronic wounds as a percentage of TBSA. It therefore represents a convenient physical measurement for assessing the area of burns and other wounds.

A comprehensive review on asphalt fume suppression and energy saving technologies in asphalt pavement industry.

Based on the environmental issues of high energy consumption and high emissions of asphalt fumes that are associated with hot mixing asphalt pavement construction, especially with modified asphalt mixtures such as waste rubber modified asphalt (WRMA) mixtures, significant environmentally-friendly new technologies have been successfully applied in the field of asphalt pavement materials. These include fume purification equipment, fume suppression or flame-retarding asphalt mixture, and warm mixing or cold mixing asphalt mixture. This paper provides a comprehensive review of the latest technology in this area regarding both asphalt fume suppression and energy conservation within the last six years. Firstly, asphalt fume suppression technologies in production, laying, and combustion scenarios of an asphalt mixture are identified, and asphalt fume purification equipment utilized in the production process is thoroughly examined. The impacts and mechanisms of various fume suppressants and flame retardants of asphalt fumes regarding their influence on the performance of asphalt pavement are discussed. Secondly, from the perspective of reducing asphalt mixture temperature, different mixing techniques such as cold mixing asphalt (CMA), warm mixing asphalt (WMA), and warm mixing based retarding viscosity asphalt (WM-RVA) are introduced and evaluated utilizing energy consumption and carbon emission evaluation models. These results show that the combination of advanced oxidation and traditional purification methods is critical for promoting the green production of asphalt mixtures. In-depth research on nanomaterials and composite-type asphalt fume suppression materials, WM-RVA, and effective combinations of high-performance modification, recycled materials, fume suppression functional materials, and WMA or CMA hold great promise for future development in this field.

Evaluating Positional Obstructive Sleep Apnea in Children: Prevalence, Characteristics, and Risk Factors.

Purpose: This study investigates the prevalence, risk factors, and clinical characteristics of positional obstructive sleep apnea (POSA) among pediatric patients diagnosed with obstructive sleep apnea (OSA). Patients and Methods: A total of 1,236 children aged 0 to 17 years who underwent nocturnal polysomnography (PSG) and completed the Sleep Questionnaire were included. After excluding those with an AHI <1, neurological or muscular disorders, or insufficient sleep time in specific positions, 908 patients remained: 158 with POSA and 750 with non-positional OSA (NPOSA). Propensity score matching (PSM) was applied at a 1:2 ratio, resulting in a final sample of 153 POSA and 306 NPOSA patients. Data analyses were performed using R software (version 4.2.3). Results: The prevalence of POSA was 12.8%. After PSM, patients with POSA had a lower overall AHI (8.66 vs 10.30), REM-AHI (14.30 vs 17.40), and NREM-AHI (7.43 vs 8.77) compared to those with NPOSA. POSA patients also had a shorter total sleep time (411 vs 427 minutes), spent less time in the supine position (168 vs 225 minutes), and more time in non-supine positions (241 vs 202 minutes) than NPOSA patients. Additionally, while the supine AHI was higher in POSA patients (15.60 vs 10.30), the non-supine AHI was lower (5.00 vs 11.00) compared to NPOSA patients. The minimum oxygen saturation was slightly higher in POSA patients (0.88 vs 0.87). All differences were statistically significant (P < 0.05). Risk factors for POSA included mild OSA, allergic rhinitis, non-allergic rhinitis, and obesity. Conclusion: The prevalence of POSA in children is lower than in adults, and its severity is less than that of NPOSA. Compared to NPOSA patients, POSA patients had significantly higher AHI during supine sleep and lower AHI during non-supine sleep. POSA patients also spent more time in non-supine positions, suggesting that avoiding supine sleep may help reduce apnea events. These findings highlight the importance of monitoring and managing sleep posture in POSA patients.

Corona-Poled Porous Electrospun Films of Gram-Scale Y-Doped ZnO and PVDF Composites for Piezoelectric Nanogenerators.

For digging out eco-friendly and well-performed energy harvesters, piezoelectric nanogenerators are preferred owing to their effortless assembly. Corona-poling promotes output performance of either aligned or porous PVDF electrospun films and higher piezoelectric output was achieved by corona-poled porous PVDF electrospun films due to more poled electret dipoles in pores. Increasing the duration of electrospinning rendered more electret dipoles in PVDF porous electrospun films, resulting in higher piezoelectric output. Moreover, corona-poled PVDF/Y-ZnO porous electrospun films performed better than corona-poled PVDF/ZnO porous electrospun films because of the larger polar crystal face of Y-ZnO. Flexible piezoelectric polymer PVDF and high-piezoelectric Y-ZnO complement each other in electrospun films. With 15 wt% of Y-ZnO, corona-poled PVDF/Y-ZnO porous electrospun films generated maximum power density of 3.6 µW/cm2, which is 18 times that of PVDF/BiCl3 electrospun films.

[Risk factors for citrate accumulation in patients with liver failure undergoing continuous renal replacement therapy with regional citrate anticoagulation].

OBJECTIVE: To investigate the risk factors of citrate accumulation in patients with liver failure treated with regional citrate anticoagulated continuous renal replacement therapy (RCA-CRRT). METHODS: The clinical data of liver failure patients with RCA-CRRT admitted to department of intensive care unit (ICU) of Nantong Third People's Hospital from January 2017 to June 2020 were retrospectively analyzed. The selected patients were divided into citrate accumulation group and control group according to whether there was citrate accumulation (serum total calcium/free calcium ratio ≥ 2.4) during CRRT. The age, acute physiology and chronic health evaluation II (APACHE II), mean arterial pressure (MAP), norepinephrine (NE) dose, blood lactic acid (Lac) concentration, liver function status, citrate dose, filter time and prognosis of the patients were compared between the two groups. Unconditional Logistic regression was used to analyze the risk factors for citrate accumulation. RESULTS: Among 48 patients with RCA-CRRT and liver failure, 20 patients had citrate accumulation (accumulation group), and a total of 96 CRRTs were performed; the remaining 28 patients did not have citrate accumulation (control group), a total of 106 CRRTs were performed. There were no significant differences in age and APACHE II score between the two groups. Compared with the control group, the MAP in the accumulation group was lower [mmHg (1 mmHg = 0.133 kPa): 66.9±13.6 vs. 86.4±8.3, P = 0.032], and the dosage of NE (µg/min: 16.3±8.4 vs. 5.9±2.8, P = 0.015) and lactic acid level (mmol/L: 4.89±1.45 vs. 2.98±0.87, P = 0.004) were higher, the damage of liver function was more serious [total bilirubin (TBil, µmol/L): 220.4±45.2 vs. 163.4±43.8, P = 0.012; Child-Pugh score: 12.0±2.5 vs. 8.8±1.4, P = 0.029; model for end-stage liver disease (MELD) score: 31.30±8.22 vs. 21.78±6.40, P = 0.041], hourly citric acid dosage (mmol/h: 27.4±6.9 vs. 19.3±4.9, P = 0.032) and total citric acid dosage (mmol: 3 393±809 vs. 1 819±502, P = 0.039) were higher. Although there were no significant differences in the length of ICU stay, total length of hospitalization stay and cost of hospitalization between the two groups, the 28-day mortality of the accumulation group was higher than that of the control group (60.0% vs. 28.6%, P = 0.039). Unconditional Logistic regression analysis showed that MAP [odds ratio (OR) = 2.901, 95% confidence interval (95%CI) was 0.921-19.493, P = 0.019], NE dosage (OR = 2.098, 95%CI was 1.923-12.342, P = 0.002), Lac level (OR = 5.201, 95%CI was 3.211-9.433, P = 0.012), Child-Pugh score (OR = 1.843, 95%CI was 0.437-7.420, P = 0.018), MELD score (OR = 3.012, 95%CI was 0.384-12.843, P = 0.031), hourly citric acid dosage (OR = 4.254, 95%CI was 1.734-11.839, P = 0.011) and total citric acid dosage (OR = 4.109, 95%CI was 1.283-18.343, P = 0.001) were risk factors for citrate accumulation. CONCLUSIONS: In patients with tissue hypoperfusion and severe liver function damage, citrate anticoagulation should be avoided or the dosage of citric acid should be reduced, in order to avoid citrate accumulation.

[Value of radiographic assessment of lung edema score in evaluating the severity and prognosis of patients with acute respiratory distress syndrome].

OBJECTIVE: To explore the value of radiographic assessment of lung edema (RALE) score in evaluating the severity and prognosis of patients with acute respiratory distress syndrome (ARDS). METHODS: A retrospective study was conducted. Patients with ARDS admitted to the department of intensive care unit (ICU) of Affiliated Nantong Third Hospital of Nantong University from January 2016 to November 2020 were enrolled. Clinical data of those patients were collected, and two senior radiologists who did not know the outcome of the patients independently scored each chest radiograph, the mean value of which was taken as the RALE score. The patients were divided into death group and survival group according to the 28-day prognosis. The differences of the basic data, PaO2/FiO2, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score and RALE score between groups were analyzed. ARDS patients were classified according to the Berlin standard and RALE scores were compared between groups. Then, the correlations between RALE score and PaO2/FiO2, SOFA score, APACHE II score were analyzed. The prognostic capacity of RALE score for 28-day prognosis of ARDS patients were analyzed by Kaplan-Meier survival curve. RESULTS: Of the 98 ARDS patients, 62 were included in the final analysis, 39 patients survived and 23 patients died. The 28-day mortality was 37.1%. Compared with the survival group, patients in the death group were older (years old: 72.83±12.21 vs. 64.44±14.68), had lower PaO2/FiO2 [mmHg (1 mmHg = 0.133 kPa): 122.66±48.32 vs. 150.26±50.40], and higher SOFA score and greater difference of RALE score between the third day and the first day after admission (D3-D1 RALE score) (SOFA score: 11.26±3.91 vs. 9.04±3.72, D3-D1 RALE score: 1.35±6.42 vs. -2.74±7.35), with statistically significant differences (all P < 0.05). However, there were no significant differences in gender, cause of ARDS, APACHE II score, and RALE scores on the first and the third day of admission (D1 RALE, D3 RALE) between the two groups. Among the 62 patients, there were 11 mild cases (17.7%), 36 moderate cases (58.1%), and 15 severe cases (24.2%). The D1 RALE score of patients with mild and moderate ARDS were lower than those of patients with severe ARDS (19.09±3.65, 22.58±6.79 vs. 27.07±5.23, both P < 0.05). Correlation analysis showed that D1 RALE score was negatively correlated with PaO2/FiO2 (r = -0.385, P = 0.002), and positively correlated with SOFA score and APACHE II score (r1 = 0.433, r2 = 0.442, both P < 0.001). Kaplan-Meier survival curve analysis showed that the 28-day survival rate of ARDS patients in D3-D1 RALE score ≥ -1 group was significantly higher than that in D3-D1 RALE score < -1 group (73.08% vs. 55.56%; log-rank test: χ2 = 3.979, P = 0.046). CONCLUSIONS: The RALE score is a simple and reliable non-invasive evaluation index, which can be used to evaluate the severity of ARDS patients. The difference of RALE score in early stage is helpful to identify ARDS patients with poor prognosis.

Effects of p38 MAPK signaling pathway on cognitive function and recovery of neuronal function after hypoxic-ischemic brain injury in newborn rats.

To explore the effects of p38 MAPK signaling pathway on cognitive function and recovery of neuronal function after hypoxic-ischemic brain injury (HIBI) in newborn rats. Seventy-two healthy SPF grade SD newborn rats were randomly and equally divided into Normal group (healthy rats) and Sham group (rats underwent sham operation), Model group (HIBI model rats), p38 MAPK Inhibitor group (HIBI model rats treated with p38 MAPK inhibitor) and p38 MAPK Activator group (HIBI model rats treated with p38 MAPK activator). On postnatal day 28, Morris water maze, tail suspension test and inclined plane test were conducted on rats in each group. Twenty-four hours after modeling, the expression of p-p38 MAPK protein and apoptosis related genes in rat hippocampal tissues was detected by TUNEL staining, qRT-PCR and Western blot. Compared with Normal group, escape latency and inclined plane test time were prolonged, the number of passing through the platform and tail suspension time were reduced (all P < 0.05); Bax and Caspase-3 mRNA and protein expression levels and p-p38 MAPK protein level were increased, Bcl-2 mRNA level was decreased, and neuronal apoptosis proportion was increased in Model group (all P < 0.05). Compared with Model group, the above indicators showed reversed and enhanced trends in p38 MAPK Inhibitor and p38 MAPK Activator groups, respectively (all P < 0.05). Inhibition of p38 MAPK signaling pathway can effectively improve the learning and memory ability and motor function of newborn rats with HIBI, and reduce neuronal apoptosis in the hippocampal tissues, thereby promoting neuronal recovery.

Thrombosis in the portal venous system caused by hypereosinophilic syndrome: A case report.

RATIONALE: Extensive thrombosis in the portal venous system caused by hypereosinophilic syndrome (HES) is rare, and there is no consensus on anticoagulant and thrombolytic treatments for arteriovenous thrombosis caused by HES. PATIENT CONCERNS: The clinical data of a patient with extensive thrombosis in his portal venous system (superior mesenteric, splenic, hepatic, and portal veins), renal artery thrombosis, and mesenteric thrombosis caused by HES with secondary gastrointestinal bleeding and intestinal necrosis were retrospectively analyzed. Before admission, his eosinophil count increased to 7.47 × 10/L, and HES had been confirmed via bone marrow cytology. The patient experienced fever, cough, abdominal pain, massive hematemesis, and hematochezia that developed in succession. Abdominal computed tomography showed portal vein and superior mesenteric vein thromboses. DIAGNOSIS: Hypereosinophilic syndrome; extensive thrombosis in the portal venous system; acute eosinophil-associated pneumonia; gastrointestinal bleeding; intestinal necrosis. INTERVENTIONS: The patient was first treated with methylprednisolone, plasma exchange/hemofiltration, and single or combined use of unfractionated heparin and argatroban for anticoagulation. He was also administered alteplase and urokinase, successively, for thrombolytic treatment. Once the thromboses finally disappeared, the patient underwent surgery to excise a necrotic intestinal canal. OUTCOMES: The thromboses disappeared with these treatments, and the patient recovered after the necrotic intestinal canal was excised. LESSONS: The clinical manifestations of HES are complex and varied, and this condition can cause severe and extensive arteriovenous thrombosis. Anticoagulation therapy and thrombolysis are necessary interventions, and appear to be safe and effective.