Inhibition of tartrate-resistant acid phosphatase 5 can prevent cardiac fibrosis after myocardial infarction.

BACKGROUND: Myocardial infarction (MI) leads to enhanced activity of cardiac fibroblasts (CFs) and abnormal deposition of extracellular matrix proteins, resulting in cardiac fibrosis. Tartrate-resistant acid phosphatase 5 (ACP5) has been shown to promote cell proliferation and phenotypic transition. However, it remains unclear whether ACP5 is involved in the development of cardiac fibrosis after MI. The present study aimed to investigate the role of ACP5 in post-MI fibrosis and its potential underlying mechanisms. METHODS: Clinical blood samples were collected to detect ACP5 concentration. Myocardial fibrosis was induced by ligation of the left anterior descending coronary artery. The ACP5 inhibitor, AubipyOMe, was administered by intraperitoneal injection. Cardiac function and morphological changes were observed on Day 28 after injury. Cardiac CFs from neonatal mice were extracted to elucidate the underlying mechanism in vitro. The expression of ACP5 was silenced by small interfering RNA (siRNA) and overexpressed by adeno-associated viruses to evaluate its effect on CF activation. RESULTS: The expression of ACP5 was increased in patients with MI, mice with MI, and mice with Ang II-induced fibrosis in vitro. AubipyOMe inhibited cardiac fibrosis and improved cardiac function in mice after MI. ACP5 inhibition reduced cell proliferation, migration, and phenotypic changes in CFs in vitro, while adenovirus-mediated ACP5 overexpression had the opposite effect. Mechanistically, the classical profibrotic pathway of glycogen synthase kinase-3ß (GSK3ß)/ß-catenin was changed with ACP5 modulation, which indicated that ACP5 had a positive regulatory effect. Furthermore, the inhibitory effect of ACP5 deficiency on the GSK3ß/ß-catenin pathway was counteracted by an ERK activator, which indicated that ACP5 regulated GSK3ß activity through ERK-mediated phosphorylation, thereby affecting ß-catenin degradation. CONCLUSION: ACP5 may influence the proliferation, migration, and phenotypic transition of CFs, leading to the development of myocardial fibrosis after MI through modulating the ERK/GSK3ß/ß-catenin signaling pathway.

Meteorin-like (METRNL) attenuates hypertensive induced cardiac hypertrophy by inhibiting autophagy via activating BRCA2.

Hypertension, a prevalent cardiovascular ailment globally, can precipitate numerous complications, notably hypertensive cardiomyopathy. Meteorin-like (METRNL) is demonstrated to possess potential protective properties on cardiovascular diseases. However, its specific role and underlying mechanism in hypertensive myocardial hypertrophy remain elusive. Spontaneously hypertensive rats (SHRs) served as hypertensive models to explore the effects of METRNL on hypertension and its induced myocardial hypertrophy. The research results indicate that, in contrast to Wistar-Kyoto (WKY) rats, SHRs exhibit significant symptoms of hypertension and myocardial hypertrophy, but cardiac-specific overexpression (OE) of METRNL can partially ameliorate these symptoms. In H9c2 cardiomyocytes, METRNL suppresses Ang II-induced autophagy by controlling the BRCA2/Akt/mTOR signaling pathway. But when BRCA2 expression is knocked down, this effect will be suppressed. Collectively, METRNL emerges as a potential therapeutic target for hypertensive cardiomyopathy.

Resting heart rate causally affects the brain cortical structure: Mendelian randomization study.

Resting heart rate (RHR) has been linked to impaired cortical structure in observational studies. However, the extent to which this association is potentially causal has not been determined. Using genetic data, this study aimed to reveal the causal effect of RHR on brain cortical structure. A Two-Sample Mendelian randomization (MR) analysis was conducted. Sensitivity analyses, weighted median, MR Pleiotropy residual sum and outlier, and MR-Egger regression were conducted to evaluate heterogeneity and pleiotropy. A causal relationship between RHR and cortical structures was identified by MR analysis. On the global scale, elevated RHR was found to decrease global surface area (SA; P < 0.0125). On a regional scale, the elevated RHR significantly decreased the SA of pars triangularis without global weighted (P = 1.58 × 10-4) and the thickness (TH) of the paracentral with global weighted (P = 3.56 × 10-5), whereas it increased the TH of banks of the superior temporal sulcus in the presence of global weighted (P = 1.04 × 10-4). MR study provided evidence that RHR might be causally linked to brain cortical structure, which offers a different way to understand the heart-brain axis theory.

Elabela inhibits TRAF1/NF-κB induced oxidative DNA damage to promote diabetic foot ulcer wound healing.

Diabetic foot ulcer (DFU) is a serious complication of diabetes. Elabela (ELA), a ligand of apelin receptor (APJ), was shown to promote angiogenesis and suppress inflammation. This study aimed to illustrate the role of ELA in DFU wound healing. A whole-skin defect model was constructed using db/m and db/db mice to observe the effects of ELA on wound healing. The function of ELA in endothelial cells cultured in high glucose medium was investigated. Administration of ELA in peri-wound area of db/db mice accelerated wound closure and reduced inflammatory infiltration. Indicators of DNA damage, elevated reactive oxygen species (ROS) levels and tail DNA amounts, were downregulated by ELA but compromised after TRAF1 overexpression. ELA-mediated inhibition of NF-κB phosphorylation improved cell migration and angiogenesis, which were blocked by APJ silencing. The findings imply that ELA suppresses TRAF1-mediated NF-κB signal activation, reducing ROS-related oxidative DNA damage and improving protection of endothelial function.

The role of CTRP9 on Inhibition the High-glucose-induced Apoptosis of Myocardial Cells via Wnt/ß-catenin Signal Pathway.

This study aimed to investigate the effect of CTRP9 regulating the Wnt/ß-catenin signal pathway on the high-glucose-induced apoptosis of myocardial cells. For this purpose, high glucose was used to establish the myocardial cell apoptosis models on H9c2 cells which were later divided into 11 groups, with different treatments: NG group, NG+C group, NG+SKL group, NG+SKL+C group, NG+C59 group, HG group, HG+C group, HG+SKL group, HG+SKL+C group, HG+C59 group and HG+4h C group. Following the treatment, a TUNEL assay was applied to determine the apoptotic rate of cells, and RT-PCR and Western blot were carried out to determine the expression of targeted proteins or genes and the activity of the Wnt/ß-catenin signal pathway. In comparison with the cells in the NG group, cells following the 48 hours of treatment with 25 mmol/L high glucose experienced an acute increase in the apoptotic rate, with upregulation of Caspase-3 and Bax and downregulation of Bcl-2. In addition, CTRP9 treatment for the high-glucose-treated myocardial cells partially reversed the effect of single treatment by high glucose, with manifestations of decreased apoptotic rate, downregulation of caspase-3 and Bax, upregulation of Bcl-2 and inhibition of Wnt/ß-catenin signal pathway. Furthermore, SKL2001, the agonist of the Wnt/ß-catenin signal pathway, was added into the high-glucose-treated cells and increased the apoptotic rate, with the activation of the Wnt/ß-catenin signal pathway, which, however, was reversed by the treatment of CTRP9. In general, CTRP9, by inhibiting the activity of the Wnt/ß-catenin signal pathway, can alleviate the high-glucose-induced apoptosis of myocardial cells.

Achieving Band Gap Reduction and Carrier Lifetime Enhancement in Metal Halide Perovskites via Mechanical Stretching.

Strain engineering has become an efficient way to tune the optical and electronic behaviors of metal halide perovskites as a result of their unique structure-dependent optoelectronic characteristics. In this work, we show that the band gap can be reduced and, meanwhile, the carrier lifetime is increased by simply stretching the MAPbI3-xClx perovskite thin films. The narrowed band gap and prolonged carrier lifetime are beneficial for the photovoltaic actions, indicating that mechanical stretching can be a simple and efficient way to achieve photovoltaic property optimization of stretchable perovskite-based devices. Furthermore, Raman spectra show that the Pb-I bond length is shortened with mechanical stretching, which increases the valence band maximum (VBM) through orbital coupling, leading to a narrower band gap. Consequently, the trap states near VBM can be radiative as the trap energy levels become closer to the VBM, resulting in a prolonged carrier lifetime. This work brings huge opportunities to control the optoelectronic properties of metal halide perovskites through mechanical stress toward optoelectronic applications.

External Field-Tunable Internal Orbit-Orbit Interaction in Flexible Perovskites.

In hybrid metal halide perovskites, electrons carry both orbital and spin momenta through s-p wave function hybridization. This leads to a hypothesis that the orbit-orbit interaction between excitons can occur through orbital magnetic dipoles forming short-range interaction or through orbital polarizations forming long-range interaction to influence optoelectronic properties. This Letter reports an interesting phenomenon: the orbit-orbit interaction can be electrically switched between orbital magnetic dipoles and orbital polarizations in a flexible perovskite (MAPbI3-xClx) solar cell by scanning an external voltage between forward and reverse biases (0.2 and -0.2 V). Essentially, this phenomenon presents an external mechanism for electrically controlling the internal orbit-orbit interaction in hybrid perovskites. It was further observed that this bias-switchable orbit-orbit interaction is sensitive to temperature, becoming negligible when the temperature is decreased from 300 to 250 K. This observation indicates that the mobile ions driven by an external electrical field provide an intrinsic mechanism for electrically switching the orbit-orbit interaction through polarization and spin parameters while applying an external voltage between forward and reverse biases. These results provide a comprehensive understanding of tuning the orbit-orbit interaction in flexible perovskites toward developing orbitronic actions.

Glutamine supported early enteral therapy for severe acute pancreatitis: A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: Several studies have shown that glutamine (Gln) may play an important role in energy metabolism, inflammatory reactions, and immune processes in patients with severe acute pancreatitis (SAP). Nevertheless, the results of individual randomized controlled trials (RCTs) on Gln nutrition support for SAP are contradictory. This systematic review and meta-analysis evaluated the clinical benefit of Gln-supported early enteral nutrition (G+EEN) in patients with SAP. METHODS AND STUDY DESIGN: Cochrane Library, PubMed, Embase, CNKI, Wan Fang, and Chinese Biomedical Literature Database were searched for relevant studies published before December 2018. RCTs of G+EEN versus standard early enteral nutrition (EEN) for SAP were selected, with both started within 48 h of admission. RESULTS: Seven clinical RCTs including a total of 433 patients (EEN group: 218 patients; G+EEN group: 215 patients) were included. Compared with EEN, G+EEN increased serum albumin (standard mean difference [SMD]=0.74; 95% confidence interval [CI], 0.33-1.15; p<0.01), reduced serum hypersensitive C-reactive protein (SMD=-1.62; 95% CI, -1.98 to -1.26; p<0.01) and risks of mortality risk (risk ratio= 0.38; 95% CI, 0.16-0.90; p=0.03) and multiple organ dysfunction syndrome (MODS)(risk ratio=0.37; 95% CI, 0.15-0.94; p<0.01), and shortened length of hospital stay (SMD=-1.19; 95% CI, -1.88 to 0.49; p<0.01); moreover, it did not significantly increase the incidence of infection-related complications, operative interventions, or APACHE II scores. CONCLUSIONS: G+EEN is beneficial in SAP management.

Enteral nutrition provided within 48 hours after admission in severe acute pancreatitis: A systematic review and meta-analysis.

BACKGROUND: Whether to conduct enteral nutrition in patients with severe acute pancreatitis (SAP) during the active phase of intestinal stress or to feed during remission remains controversial. This study was aimed to evaluate the efficacy and safety of enteral nutrition within 48 hours after admission in the patients with SAP or predicted severe acute pancreatitis (pSAP). METHODS: We searched PubMed, EMBASE, Web of Science, and the Cochrane Library before December 2017. Randomized controlled trials of early enteral nutrition (starting within 48 hours after admission) versus late enteral nutrition or total parental nutrition in severe acute pancreatitis or predicted severe acute pancreatitis were selected. RESULTS: Ten randomized controlled trials containing 1051 patients were included. Comparing early enteral nutrition to late enteral nutrition or total parental nutrition in SAP or pSAP, the pooled risk ratios were 0.53 (95% confidence interval [CI] 0.35-0.81, P = .003) for mortality, 0.58 (95% CI 0.43-0.77, P = .0002) for multiple organ failure (MOF), 0.50 (95% CI 0.33-0.75, P = .0008) for operative intervention, 0.75 (95% CI 0.61-0.93, P = .009) for systemic infection, 0.42 (95% CI 0.26-0.69, P = .0005) for local septic complications, 0.84 (95% CI 0.74-0.96, P = .01) for gastrointestinal symptoms. 0.87 (95% CI 0.74-1.02, P = .08) for systemic inflammatory response syndrome (SIRS), and 1.24 (95% CI 0.66-2.31, P = .50) for other local complications. CONCLUSIONS: Enteral nutrition within 48 hours after admission is efficient and safe for the patients with SAP or pSAP.

Labor factor barriers to seeking medical services among metropolitan workers: a cross-sectional analysis by sex using the J-SHINE study.

OBJECTIVES: There is limited evidence on the relationship between labor factors and the decision to refrain from seeking medical services. This study aimed to examine how labor factors are related to medical service access among male and female workers in Tokyo and surrounding areas. METHODS: We used data from 4,385 respondents to the survey in the Japanese Study on Stratification, Health, Income, and Neighborhood (J-SHINE), an ongoing epidemiologic household panel study. Surveys from 2010 to 2011 were analyzed. The outcome variable was whether or not an individual refrained from seeking medical services. Labor factors included employment type (permanent, temporary, or self-employed), company size (<100, 100-1,000, or >1,000 employees) and occupation type (white-collar, blue-collar). RESULTS: We included a total of 2,013 people after excluding those with missing data (analysis utilization: 45.9%). After adjusting covariates, we found that men working in small companies were more likely to refrain from seeking medical services than were those in medium or large companies (adjusted prevalence ratio [PR]: 1.19, 95% confidence interval [CI]: 1.04-1.37). Among women, however, those in self-employment (PR: 1.38, 95% CI: 1.08-1.77) and blue-collar employment (PR: 1.24, 95% CI: 1.04-1.47) were more likely to refrain than were those classified as permanent or white-collar workers. CONCLUSIONS: The relationship between labor factors and refraining from seeking medical services differed among men by company size, and among women by employment type and occupation type.

[Nitrogen Removal Effect and Conversion Characteristics of Nitrous Oxide in Single-stage and Multi-stage A/O Processes].

The single-stage A/O and multi-stage A/O processes were simulated by sequencing batch reactors (SBRs) with alternate stirring and aeration. The removal efficiency of nitrogen and the release mechanism of N2O were studied under the identical conditions of influent quality, hydraulic retention time (HRT), sludge retention time(SRT), temperature and anoxic/oxic (A/O) retention time ratio. Experimental results showed that COD or ammonia-nitrogen removal had no significant difference between the single-stage and the multi-stage A/O processes for the influent quality equivalent to municipal wastewater. However, TN removal efficiency of the former was better than the later with 72.1% and 52.2%, respectively. In the conversion of total nitrogen, during the typical cycle in the single-stage A/O and multi-stage A/O processes, the yields of N2O were 16.95 mg and 3.95 mg, respectively. The conversion rate, which is the ratio of N2O yield and TN removal, was respectively 11.47% and 4.11%. N2O production and emission occurred mainly in aerobic (nitrification) phase while there was little N2O emission in anoxic (denitrification) phase. Although the dominant species of AOB was both Nitrosomonas in the single-stage A/O and the multi-stage A/O processes under the same operating conditions, it was more conducive to the growth of nitrifying bacteria (AOB, NOB) in the single-stage A/O process with the greater abundance of Nitrosomonas. Meanwhile, the type and abundance of NOB in the single-stage A/O process were significantly more than in the multi-stage A/O process too. Therefore, it is more competitive to deal with the high-strengthening ammonia-nitrogen wastewater in the single-stage A/O process. In the actual operation of wastewater treatment, using appropriate partitions of A/O or oxygen-supplying modes can not only result in better nitrogen removal but also decrease the secondary pollution caused by N2O to the atmosphere.

Nutrient release, recovery and removal from waste sludge of a biological nutrient removal system.

The uncontrolled release of nutrients from waste sludge results in nitrogen and phosphorus overloading in wastewater treatment plants when supernatant is returned to the inlet. A controlled release, recovery and removal of nutrient from the waste sludge of a Biological Nutrient Removal system (BNR) are investigated. Results showed that the supernatant was of high mineral salt, high electrical conductivity and poor biodegradability, in addition to high nitrogen and phosphorus concentrations after the waste sludge was hydrolysed through sodium dodecyl sulphate addition. Subsequently, over 91.8% of phosphorus and 10.5% of nitrogen in the supernatants were extracted by the crystallization method under the conditions of 9.5 pH and 400 rpm. The precipitate was mainly struvite according to X-ray diffraction and morphological examination. A multistage anoxic-oxic Moving Bed Biofilm Reactor (MBBR) was then adopted to remove the residual carbon, nitrogen and phosphorus in the supernatant. The MBBR exhibited good performance in simultaneously removing carbon, nitrogen and phosphorus under a short aeration time, which accounted for 31.25% of a cycle. Fluorescence in situ hybridization analysis demonstrated that nitrifiers presented mainly in floc, although higher extracellular polymeric substance content, especially DNA, appeared in the biofilm. Thus, a combination of hydrolysis and precipitation, followed by the MBBR, can complete the nutrient release from the waste sludge of a BNR system, recovers nutrients from the hydrolysed liquor and removes nutrients from leftovers effectively.

A new classification paradigm of extracellular polymeric substances (EPS) in activated sludge: separation and characterization of exopolymers between floc level and microcolony level.

Extracellular polymeric substances (EPS) play a crucial role in the formation of activated sludge flocs. However, until now, the EPS are rather classified by the method used for extraction than by a theoretical consideration of their function and composition. In this paper, a new classification paradigm of EPS was proposed, which offered a novel approach to identify the role of EPS in the formation of activated sludge flocs. The current study gave an exploration to distinguish the EPS in the floc level (extra-microcolony polymers, EMPS) and in the microcolony level (extra-cellular polymers, ECPS). It was found that cation exchange resin treatment is efficient to disintegrate the flocs for EMPS extraction, however, inefficient to disaggregate the microcolonies for ECPS harvesting. A two-steps extraction strategy (cation exchange resin treatment followed by ultrasonication-high speed centrifugation treatment) was suggested to separate these two types of EPS in activated sludge flocs and the physicochemical characteristics of EMPS and ECPS were compared. The protein/polysaccharide ratio of ECPS was higher than that of EMPS and the molecular weight of proteins in EMPS and ECPS were found to be different. The ECPS contained higher molecular weight proteins and more hydrophobic substances than the EMPS contained. The result of excitation-emission matrix fluorescence spectroscopy analysis also showed that the EMPS and the ECPS have different fluorescent expressions and the components of EMPS were more diverse than that of ECPS. All results reported herein demonstrated that two different types of exopolymers exist in the activated sludge flocs and the inter-particle forces for aggregation of activated sludge flocs are not identical between the floc level and the microcolony level. It suggested that cation bridging interactions are more crucial in floc level flocculation, while the entanglement and hydrophobic interactions are more important in microcolony level cohesion.

The important implications of particulate substrate in determining the physicochemical characteristics of extracellular polymeric substances (EPS) in activated sludge.

Since the notable amount of particulate substrate in wastewater, the implications of particulate substrate on treatment efficiency have been a topic of major interest in the field of biological wastewater treatment. The particulate substrate has to be hydrolyzed by the extracellular enzymes, which are mainly embedded in extracellular polymeric substances (EPS) matrix of microbial aggregates, prior to consumption. Therefore, the important relevance between the particulate substrate and the characteristics of EPS can be expected. In this study, two lab-scale sequencing batch reactors were performed in parallel to investigate the effects of particulate and soluble substrate on the physicochemical characteristics of EPS in activated sludge. The results showed that the particulate substrate in the influent could significantly change the properties of activated sludge and the characteristics of EPS. More open and fluffy flocs with poorer settleability and dewaterability were formed with particulate substrate. More protein and humic compounds were introduced into the EPS matrix due to the deep involvement of protein and humic compounds in hydrolysis process of particulate substrate. The increments of protein and humic compounds then caused the slight higher molecular weight, higher hydrophobicity and lower zeta potential of EPS in particulate substrate system. The results in this study permitted for obtaining answers to understand the significant implications of particulate substrate in determining the physicochemical characteristics of EPS in biological wastewater treatment systems.

Hydrogen utilization rate: A crucial indicator for anaerobic digestion process evaluation and monitoring.

Hydrogenotrophic methanogens had been considered as key species for the anaerobic digestion (AD) of industrial wastewater and municipal sludge. However, how to evaluate the activity of the hydrogenotrophic methanogens was less studied. In this study, a volumetric device and a test procedure were developed for measuring the specific hydrogen utilization rate (HUR) of anaerobic sludge. Results showed that HUR values were highly influenced by sludge concentrations because of limitation on H2 mass transfer. The critical value of sludge concentration in the test bottle should not be higher than 1 gVSS/L. Under such condition, the kinetics of HUR would not be limited by H2 mass transfer and the maximal value of HUR could be obtained. Field survey confirmed that HUR exhibits a good relationship with specific methanogenic activity (SMA) and reactor performance. An anaerobic system with a relatively high HUR was found to be beneficial for maintaining H2 partial pressure in an appropriately low level. Moreover, such system was thermodynamically favourable for the syntrophic degradation of volatile fatty acids. As a crucial parameter of the anaerobic process, HUR could be used as a key indicator for evaluating and monitoring AD processes.

Extended filaments of bulking sludge sink in the floc layer with particulate substrate.

Recent studies have showed that particulate substrate has a positive effect on sludge settleability. This study was driven by the question of how the extended filaments disappeared when soluble substrate was switched to particulate substrate. A lab-scale aerobic completely stirred tank reactor was performed and evaluated for a period of two months. The results showed that extended filaments were quickly induced with soluble substrate. Total extended filament length of activated sludge decreased and sludge settleability was significantly improved after the soluble substrate was switch to particulate substrate. Due to the lack of hydrolysis products in the bulk liquid when particulate substrate was fed, extended filaments were forced to grow towards the inside of the flocs and finally sink in the floc layer. A physical model was proposed to explain the evolution of extended filaments caused by soluble substrate and cured by particulate substrate.

[Evaluation of the association between cognitive impairment and the vitamin D levels among community-dwelling Japanese pre-frail elderly individuals].

AIM: Cognitive impairment is the second leading cause of long-term care, and the number of cognitively impaired elderly individuals is increasing. Cognitive impairment has been reported to be associated with a low vitamin D level. However, many elderly individuals are deficient in vitamin D due to undernutrition and a house-bound status. It is unknown whether cognitive impairment is independently associated with the vitamin D level. The aim of this study was to examine the association between cognitive impairment and the levels of vitamin D among community-dwelling Japanese pre-frail elderly individuals. METHODS: A cross-sectional survey was conducted in two towns (latitude: 36 degrees north) from June 2006 to January 2011. The subjects included 316 community-dwelling pre-frail elderly individuals 65 years of age or older (mean±SD: 77.0±5.7 yr) who attended a program for nursing care prevention. A questionnaire-based interview was conducted regarding activities of daily living. The serum levels of intact parathyroid hormone (iPTH), 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D) were measured. Age and gender were recorded, as well as the presence of cognitive impairment determined according to the Mini Mental State Examination (MMSE). The factors associated with an MMSE score of ≤23 were examined using a multiple logistic regression analysis. RESULTS: Of the subjects, 21.2% were men and 30.6% had an MMSE score of ≤23. The mean MMSE score was 25.3±3.7. The prevalence of severe deficiency of 25(OH)D was 1.7%, and only 14.0% of the participants had a sufficient vitamin D level. The multiple logistic regression analysis suggested that an MMSE score of less than 23 was significantly associated with the levels of iPTH and 25(OH)D among the pre-frail men, but not the women. CONCLUSIONS: Our data suggest that the vitamin D level is significantly associated with cognitive impairment in pre-frail elderly men.

Investigation of the influencing factors on severe acute respiratory syndrome among health care workers.

OBJECTIVE: To investigate the protective factors and risk factors of nosocomial infection of severe acute respiratory syndrome (SARS) among health care workers (HCWs), and thus provide the scientific basis for prevention and control of nosocomial infection. METHODS: With the case-control study, a standardized questionnaire was used for data collection in three general hospitals where nosocomial infection had occurred. Univariate analysis was done at first. All concerned factors about SARS infection were scanned by using Chi-square test and Fisher's exact test one by one, and determined as to whether they were risk factors or protective factors according to odd ratio (OR) score. Then, multivariate unconditional logistic regression analysis was used to re-analyze the picked-out factors for finding out which factors played independent roles. RESULTS: Twenty-two factors (nineteen protective factors and three risk factors), among the total fifty-six factors, were significantly associated with SARS infection. Multivariate unconditional logistic regression revealed that factors such as double exposure suits (OR=0.053), education (OR=0.072), gloves (OR=0.102), hands sterilized by iodine (OR=0.231), room air ventilation (OR=0.32), were significantly protective; conversely, tracheal intubation (OR=30.793) was a significant risk factor. CONCLUSION: Strict defense and antisepsis measures were pivotal in preventing SARS infection among high-risk medical personnel. Education about associated knowledge and effective air ventilation were also important factors.

[Clinical analysis of 45 patients with severe acute respiratory syndrome].

OBJECTIVE: To explore the clinical and radiology features of Severe Acute Respiratory Syndrome (SARS). METHODS: Analysis the clinical presentations, chest radiographs, courses of disease and the features of severe pneumonia of 45 cases with SARS diagnosed between April 5 and April 20, 2003 in our hospital. RESULTS: SARS appears to has high infectivity, and cause of the outbreak. The most common symptom is fever (in 100 percent of the patients). The count of leukocyte is normal or decrease (leukopenia). 80 percent of SARS patients became fever for 24 hours and then have abnormal chest radiographs, serial chest radiographs showed progression of pulmonary infiltrates within 48 hours in 71.1 percent of patients. The percent of severe pneumonia (24.4%) is higher than typical pneumonia. CONCLUSION: SARS is a disease with high infectivity, and has its own clinical and radiology features. Early recognition, prompt isolation, and appropriate therapy are the key in combating this infection.

[Comparison of severe acute respiratory syndrome with community-acquired pneumonia].

OBJECTIVE: To study the features of severe acute respiratory syndrome (SARS) and community acquired pneumonia (CAP). METHODS: The clinical presentation, chest radiographs, white blood cell count and outcome of 45 SARS patients from April 5 to 20 2003 were compared, with those of 80 CAP patients from October 1 2002 to April 1 2003 in our hospital, and the clinical features of SARS were summarized. RESULTS: (1) Fever above 38.5 centigrade, dry cough, short of breath, headache, myalgia, diarrhea in SARS were more common in SARS patients than those in CAP (P<0.01). (2) Leucopenia was more common and leukocytosis was less common in SARS than those in CAP (P<0.01). (3) 22.2 percent of SARS patients were found abnormal chest radiographs within 24 hours after onset, 71.1 percent of SARS patients were showed progressive pulmonary infiltration via serial chest radiographs, while all CAP patients had abnormal chest radiographs when they were seen first time, and no patient showed progressive pulmonary infiltration, the difference was significant between the two groups (P<0.01). (4) Patients with SARS were lack of a response to the initial antimicrobial therapy, all patients with CAP had an adequate clinical response within three days, the difference was significant between the two groups(P<0.01 ). (5) The ratio of severe pneumonia and mortality in SARS was much higher than in CAP (both P<0.01). CONCLUSION: The clinical presentation, chest radiographs, white blood cell count, response to initial antimicrobial therapy, and outcome in SARS is much different from CAP, differentiate them will be helpful to early recognition, prompt isolation, and prevention of its spread.