Risk Factor Analysis and Nomogram for Predicting In-Hospital Mortality in ICU Patients with Heat Stroke: A National Multicenter Study.

Objective: The aim of this nationwide multicenter study was to ascertain the risk factors associated with in-hospital mortality in patients with heat stroke admitted to intensive care units (ICUs) and to develop a nomogram for prognostic prediction. Methods: A retrospective analysis was conducted on clinical data collected from ICU patients diagnosed with heat stroke across multiple centers nationwide. Univariate and multivariate logistic regression analyses were performed to identify significant risk factors for in-hospital mortality. Based on the results of the multivariate analysis, a nomogram was constructed to estimate the individualized probability of mortality. Internal validation of the nomogram was performed, and its performance was assessed using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). Results: A total of 292 ICU patients with heat stroke were included in this study. Three risk factors, namely Cr (creatinine), AST (aspartate aminotransferase), and SBP (systolic blood pressure), were found to be significantly associated with in-hospital mortality. These risk factors were incorporated into the nomogram, which exhibited good discriminative ability (area under the ROC curve of the training and validation cohorts were 0.763 and 0.739, respectively) and calibration. Internal validation and decision curve analysis confirmed the stability and reliability of the nomogram. Conclusion: This nationwide multicenter study identified key risk factors for in-hospital mortality in ICU patients with heat stroke. The developed nomogram provides an individualized prediction of mortality risk and can serve as a valuable tool for clinicians in the assessment and management of ICU patients with heat stroke.

"One-can" strategy for the synthesis of hydrothermal biochar modified with phosphate groups and efficient removal of uranium(VI).

Significant selectivity, reasonable surface modification and increased structural porosity were three key factors to improve the competitiveness of biochar in the adsorption field. In this study, a hydrothermal bamboo-derived biochar modified with phosphate groups (HPBC) was synthesized using "one-can" strategy. BET showed that this method could effectively increase the specific surface area (137.32 m2 g-1) and simulation of wastewater experiments indicated HPBC had an excellent selectivity for U(VI) (70.35%), which was conducive to removal of U(VI) in real and complex environments. The accurate matchings of pseudo-second-order kinetic model, thermodynamic model and Langmuir isotherm showed that at 298 K, pH = 4.0, the adsorption process dominated by chemical complexation and monolayer adsorption was spontaneous, endothermic and disordered. Saturated adsorption capacity of HPBC could reach 781.02 mg g-1 within 2 h. The introduction of phosphoric acid and citric acid by "one-can" method not only provided abundant -PO4 to assist adsorption, but also activated oxygen-containing groups on the surface of the bamboo matrix. Results showed that adsorption mechanism of U(VI) by HPBC included electrostatic action and chemical complexation involving P-O, PO and ample oxygen-containing functional groups. Therefore, HPBC with high phosphorus content, outstanding adsorption performance, excellent regeneration, remarkable selectivity and green value provided a novel solution for the field of radioactive wastewater treatment.

Lipoxin A4 attenuates MSU-crystal-induced NLRP3 inflammasome activation through suppressing Nrf2 thereby increasing TXNRD2.

Gout is a common inflammatory disease. The activation of NLRP3 inflammasome induced by monosodium urate (MSU) crystals has a critical role in gout, and its prevention is beneficial for patients. Lipoxin A4 (LXA4) is an endogenous lipoxygenase-derived eicosanoid mediator with powerful anti-inflammatory properties. However, whether LXA4 can suppress NLRP3 inflammasome activation induced by MSU crystals remains unclear. This study aimed to investigate the protective effect of LXA4 on MSU-crystal-induced NLRP3 inflammasome activation and its underlying molecular mechanisms. We found that LXA4 inhibited MSU-crystal-induced NLRP3 inflammasome activation, interleukin (IL)-1ß maturation, and pyroptosis. More specifically, LXA4 suppressed the assembly of the NLRP3 inflammasome, including oligomerization and speck formation of ASC, and ASC-NLRP3 interaction. Furthermore, LXA4 suppressed oxidative stress, the upstream events for NLRP3 inflammasome activation, as evidenced by the fact that LXA4 eliminated total reactive oxygen species (ROS) generation and alleviated nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activation and mitochondrial dysfunction. However, LXA4 also depressed the Nrf2 activation, a critical molecule in the antioxidant pathway, and then exerted an inhibitory impact on Klf9 expression and promotional impact on TXNRD2 expression, two molecules located downstream of Nrf2 in sequence. Knockdown of TXNRD2 reversed the LXA4-induced depression of ROS and NLRP3 inflammasome. Moreover, LXA4 alleviated joint inflammation and decreased the production of cleaved caspase-1 and matured IL-1ß in gouty arthritis rats. Taken together, our findings demonstrate that LXA4 can attenuate MSU-crystal-induced NLRP3 inflammasome activation, probably through suppressing Nrf2 activation to increase TXNRD2 expression. The present study highlights the potential of LXA4 as an attractive new gout treatment candidate.

Static Model of Athlete's Upper Limb Posture Rehabilitation Training Indexes.

With the gradual expansion of the development of sports, the level of sports has been rapidly improved. Athletes have to carry out high-intensity and systemic technical movements in training and competition. Some sports have the greatest burden on the shoulder joint. From the observation and investigation of the injured parts of athletes, it is found that the shoulder joint is the most common sports injury, which is the most typical sports injury. Based on the problem of insufficient strength and endurance reserve after rehabilitation of shoulder external rotator injury, it will cause muscle tension and poor extensibility. To prove the improvement effect of functional training and posture index calibration on the poor posture of the shoulder, considering the measurement of global passive torque, this paper uses a limited set of joint angles and corresponding passive torque data in the upper arm lifting trajectory to train the neural network and uses the trained network to predict the passive torque in other upper arm trajectories. The kinematics model of the shoulder joint is established, and the human-computer interaction experiment is designed on the platform of the gesture index manipulator. The passive and active torque components of the shoulder joint in the human-computer interaction process are calculated by measuring the man-machine interaction force of the subjects in the motion state, which is used as the basis for evaluating the active motion intention of the subjects. Surface electromyography (SEMG) was used to calibrate and verify the attitude index of shoulder active torque. The method proposed in this paper is helpful to achieve more efficient on-demand assisted rehabilitation training exercises, which is of great significance to improve the level of rehabilitation training.

Development and internal validation of a Wasp Sting Severity Score to assess severity and indicate blood purification in persons with Asian wasp stings.

BACKGROUND: In recent years, the incidence of wasp sting has increased annually in China. Organ damage and high mortality due to mass wasp envenomation remain major challenges. Timely and appropriate medical intervention can improve survival. However, there are currently no normalized tools for early assessment of severity. METHODS: The clinical data of wasp sting patients hospitalized from 2011 to 2019 were used as a training set. Logistic regression was used to explore major risk factors for the development of a severe case of wasp sting (SC). The Wasp Sting Severity Score (WSS) was determined considering these risk factors to identify SCs and was tested in a validation dataset that was prospectively collected in 2020. RESULTS: The data of 1131 wasp sting patients from 2011 to 2019 were included in the training set. Logistic regression analysis showed that tea-colored urine, number of stings, and lactate dehydrogenase and total bilirubin levels were risk factors for developing an SC. The WSS was developed considering these four risk factors, and the total possible WSS was 20 points. The WSS was tested using the validation dataset, comprising the data of 153 patients, in 2020, and we found that a WSS ≥3 points was an important indication for blood purification, with a sensitivity of 71.9%, specificity of 92.6% and an area under the curve of 0.918 (95% confidence interval 0.873-0.962). Among patients with more than 30 stings, mortality in those who underwent plasma exchange (PE) within 24 h after admission was significantly lower than that in those who did not receive PE treatment (14.3% versus 46.9%, P = 0.003). However, continuous venovenous hemofiltration (CVVH) (P = 0.317) and hemoperfusion (HP) (P = 0.869) did not significantly reduce mortality. CONCLUSIONS: Patients with WSS scores ≥3 should be considered for blood purification as early as possible in addition to routine treatment. In addition, PE is better than CVVH and HP at reducing mortality in patients suffering from severe wasp stings.

Ward renovation and PPE use procedures to protect medical staff from COVID-19 infection.

In the early stages of the coronavirus disease 2019 (COVID-19) outbreak in Wuhan, many cross-infections occurred due to the limited number of wards and insufficient medical staff, which could not cope with the large number of patients visiting the hospital. A series of new infection control measures were implemented in our institution and a Wuhan hospital supported by our medical team, mainly including temporarily transforming the general ward into a passage for the staff to enter the infectious ward and standardizing the procedure for the wearing and removal of personal protection equipment (PPE). These measures significantly improved the situation, and no member of our medical staff was infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the middle and late stages of the disease epidemic. We hope that these experiences can provide references for medical institutions that may face an outbreak of COVID-19, especially those in underdeveloped countries and regions.

Taurolidine lock solutions for the prevention of catheter-related bloodstream infections: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Catheter-related bloodstream infections (CRBSIs) are a significant cause of morbidity and mortality in critically ill patients, contributing to prolonged hospital stays and increased costs. Whether taurolidine lock solutions (TLS) are beneficial for the prevention of CRBSIs remains controversial. In this meta-analysis, we aim to assess the efficacy of TLS for preventing CRBSIs. METHODS: We conducted a systematic search of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. Eligible studies included randomized controlled trials that reported on the effects of TLS for preventing CRBSIs. The primary outcome in these studies was catheter-related bloodstream infections, with microbial distribution of CRBSI and catheter-associated thrombosis as secondary outcomes. Data were combined using random-effects models owing to significant clinical heterogeneity. RESULTS: Six randomized controlled trials (RCTs) conducted from 2004 through 2013 involving 431 patients and 86,078 catheter-days were included in the review. TLS were significantly associated with a lower incidence of CRBSIs when compared to heparin lock solutions (Risk Ratio [RR], 0.34; 95% Confidence Interval [CI], 0.21-0.55). Use of TLS significantly decreased the incidence of CRBSIs from gram-negative (G-) bacteria (P = 0.004; RR, 0.27; CI, 0.11-0.65), and was associated with a non-significant decrease in gram-positive (G+) bacterial infections (P = 0.07; RR, 0.41; CI, 0.15-1.09). No significant association was observed with TLS and catheter-associated thrombosis (RR, 1.99; CI, 0.75-5.28). CONCLUSIONS: The use of TLS reduced the incidence of CRBSIs without obvious adverse effects or bacterial resistance. However, the susceptibility of G+ and G- bacteria to taurolidine and the risk for catheter-associated thrombosis of TLS are indeterminate due to limited data. The results should be treated with caution due to the limited sample sizes and methodological deficiencies of included studies. Therefore, additional well-designed and adequately powered RCTs are needed to confirm these findings.