An improved meteorological variables-based aerosol optical depth estimation method by combining a physical mechanism model with a two-stage model.

A two-stage model integrating a spatiotemporal linear mixed effect (STLME) and a geographic weight regression (GWR) model is proposed to improve the meteorological variables-based aerosol optical depth (AOD) retrieval method (Elterman retrieval model-ERM). The proposed model is referred to as the STG-ERM model. The STG-ERM model is applied over the Beijing-Tianjin-Hebei (BTH) region in China for the years 2019 and 2020. The results show that data coverage increased by 39.0% in 2019 and 40.5% in 2020. Cross-validation of the retrieval results versus multi-angle implementation of atmospheric correction (MAIAC) AOD shows the substantial improvement of the STG-ERM model over earlier meteorological models for AOD estimation, with a determination coefficient (R2) of daily AOD of 0.86, root mean squared prediction error (RMSE) and the relative prediction error (RPE) of 0.10 and 36.14% in 2019 and R2 of 0.86, RMSE of 0.12 and RPE of 37.86% in 2020. The fused annual mean AOD indicates strong spatial variation with high value in south plain and low value in northwestern mountainous areas of the BTH region. The overall spatial seasonal mean AOD ranges from 0.441 to 0.586, demonstrating strongly seasonal variation. The coverage of STG-ERM retrieved AOD, as determined in this exercise by leaving out part of the meteorological data, affects the accuracy of fused AOD. The coverage of the meteorological data has smaller impact on the fused AOD in the districts with low annual mean AOD of less than 0.35 than that in the districts with high annual mean AOD of greater than 0.6. If available, continuous daily meteorological data with high spatiotemporal resolution can improve the model performance and the accuracy of fused AOD. The STG-ERM model may serve as a valuable approach to provide data to fill gaps in satellite-retrieved AOD products.

Clinical Characteristics, Prognosis and Treatment of Bloodstream Infections with Enterobacter Cloacae Complex in a Chinese Tertiary Hospital: A Retrospective Study.

Objective: This research aimed to analyze the clinical characteristics, prognosis, and antimicrobial treatment of bloodstream infections (BSI) caused by Enterobacter cloacae complex (ECC). Methods: The clinical data of patients with bloodstream infections caused by Enterobacter cloacae complex from April 2017 to June 2023 were collected retrospectively. These data were then analyzed in subgroups based on the detection results of extended-spectrum ß-lactamase (ESBL), 30-day mortality, and the type of antimicrobial agent used (ß-lactam/ß-lactamase inhibitor combinations (BLICs) or carbapenems). Results: The proportion of ESBL-producing Enterobacter cloacae complex was 32.5% (37/114). Meanwhile, ICU admission, receiving surgical treatment within 3 months, and biliary tract infection were identified as risk factors for ESBL-producing ECC-BSI. Additionally, immunocompromised status and Sequential Organ Failure Assessment (SOFA) score ≥ 6.0 were identified as independent risk factors of 30-day mortality in patients with ECC-BSI (n = 108). Further analysis in BSI patients caused by non-ESBL-producing ECC revealed that patients treated with BLICs (n = 45) had lower SOFA scores and lower incidence of hypoproteinemia and sepsis compared with patients treated with carbapenems (n = 20). Moreover, in non-ESBL-producing ECC-BSI patients, the univariate Cox regression analysis indicated a significantly lower 30-day mortality rate in patients treated with BLICs compared to those treated with carbapenems (hazard ratios (HR) [95% CI] 0.190 [0.055-0.662], P = 0.009; adjusted HR [95% CI] 0.106 [0.013-0.863], P = 0.036). Conclusion: This study investigated the factors influencing the susceptibility to infection by ESBL-producing strains and risk factors for 30-day mortality in ECC-BSI patients. The results revealed that ESBL-negative ECC-BSI patients treated with BLICs exhibited significantly lower 30-day mortality compared to those treated with carbapenems. BLICs were found to be more effective in ECC-BSI patients with milder disease (ESBL-negative and SOFA ≤6.0).

GC-IMS facilitates identification of carbapenem-resistant Klebsiella pneumoniae in simulated blood cultures.

This study aimed to identify carbapenem-resistant Klebsiella pneumoniae (CRKP) based on changes in levels of its volatile organic compounds (VOCs) in simulated blood cultures (BCs) using the gas chromatography-ion mobility spectrometry (GC-IMS) technique. A comprehensive analysis of volatile metabolites produced by Klebsiella pneumoniae (K. pneumoniae) in BC bottles was conducted using GC-IMS. Subsequently, the released VOCs were analyzed to examine differences in VOC release between CRKP and carbapenem-susceptible Klebsiella pneumoniae (CSKP). A total of 54 VOCs were detected, of which 18 (6 VOCs found in both monomer and dimer forms) were successfully identified. The VOCs produced by K. pneumoniae in BC bottles (BacT/ALERT® SA) were primarily composed of organic acids, alcohols, esters, and ketones. The content of certain VOCs was significantly different between CRKP and CSKP after the addition of imipenem (IPM). Moreover, the inclusion of carbapenemase inhibitors facilitated the identification of carbapenemase-producing K. pneumoniae based on the variations in VOCs. This study demonstrates the utility of GC-IMS technology in identifying CRKP, and reveals that changes in VOCs are closely related to the growth and metabolism of K. pneumoniae, indicating that they can be leveraged to promote early identification of CRKP bacteremia. However, further in-depth studies and experiments are needed to validate our findings.

Comparison of bacteremic pneumonia caused by Escherichia coli and Klebsiella pneumoniae: A retrospective study.

OBJECTIVES: To compare the prognosis of bacteremic pneumonia caused by Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. coli) pathogens. METHODS: A retrospective analysis was carried out on the clinical data of 162 patients who were diagnosed with bacterial pneumonia caused by either K. pneumoniae or E. coli between 2016-2019. The primary outcome of the analysis was the patients' 30-day mortality rate. RESULTS: There were 82 patients in the E. coli bacteremic pneumonia (E. coli-BP) group and 80 patients in the K. pneumoniae bacteremic pneumonia (KP-BP) group. The 30-day mortality rate was 43.75% (n=35/80) in the KP-BP group and 21.95% (n=18/82) in the E. coli-BP group (p<0.001). Following the adjustment for confounding variables in 4 distinct models, the hazard ratios for the primary outcome in KP-BP were determined to be 0.70 (95% confidence interval [CI]: [0.44-1.02]) in Model 1, 0.72 (95% CI: [0.46-1.14]) in Model 2, 0.99 (95% CI: [0.57-1.73]) in Model 3, and 1.22 (95% CI: [0.69-2.18]) in Model 4. CONCLUSION: Patients diagnosed with KP-BP exhibited a similar prognosis as those diagnosed with E. coli-BP. For patients with KP-BP, the risk of mortality was significantly higher for those who were in the intensive care unit, were infected with carbapenem-resistant strains, or had a high sequential organ failure assessment score. In patients with E. coli-BP, the Pitt bacteremia score was strongly associated with the 30-day mortality rate.

Targeting STAT6 to mitigate sepsis-induced muscle atrophy and weakness: Modulation of mitochondrial dysfunction, ferroptosis, and CHI3L1-Mediated satellite cell loss.

Sepsis-induced muscle weakness is a debilitating consequence of prolonged critical illness, often associated with a poor prognosis. While recent research has shown that STAT6 functions as an inhibitor of myogenesis, its role in sepsis-induced muscle weakness remains unclear. In this study, we hypothesized that inhibiting STAT6 could attenuate sepsis-induced muscle atrophy and weakness, and we explored the underlying mechanisms. Leveraging a microarray dataset from sepsis patients, we identified significant enrichment of genes related to muscle function, ferroptosis, and the p53 signalling pathway in muscle tissue from sepsis patients. Using a murine sepsis model induced by cecum ligation and puncture (CLP), we explore the multifaceted role of STAT6 inhibition. Our findings demonstrate that STAT6 inhibition effectively attenuates muscle atrophy, enhances grip strength, preserves mitochondrial integrity, and modulates ferroptosis in septic mice. Additionally, we identify elevated levels of CHI3L1 in septic muscle tissue, which are significantly reduced by STAT6 inhibition. In-depth analysis of primary muscle satellite cells reveals that CHI3L1 overexpression is associated with increased expression of key regulators of satellite cell myogenicity, while negatively impacting cell viability. Silencing CHI3L1 expression mitigates satellite cell injury and loss, highlighting its pivotal role in sepsis-induced muscle damage. In summary, this study unveils the potential of STAT6 as a therapeutic target for mitigating sepsis-induced muscle atrophy and weakness. Our findings underscore the regulation of mitochondrial dysfunction, ferroptosis, and CHI3L1-mediated satellite cell damage by STAT6, offering promising avenues for therapeutic intervention in the management of sepsis-induced muscle weakness.

Effects of medical abortion assisted by traditional Chinese medicine: A network meta-analysis of randomized controlled trials.

BACKGROUND: To what extent traditional Chinese medicine (TCM) combined with mifepristone and misoprostol is beneficial for improving the complete abortion rate and duration of vaginal bleeding has been a subject of debate in the field of medical abortion. OBJECTIVE: To assess the evidence regarding the complete abortion rate and duration of vaginal bleeding of medical abortion assisted by different kinds of TCM. SEARCH STRATEGY: We searched electronic databases such as PubMed, Web of Science and Cochrane Library database, China National Knowledge Internet, Wan fang Database, VIP Database, and China Biology Medicine disc from 2000 to February 15, 2023. SELECTION CRITERIA: The control group was medical abortion with mifepristone and misoprostol, and the experimental group was medical abortion assisted by TCM. DATA COLLECTION AND ANALYSIS: Major data extraction included sample size, age, medicine used for abortion, outcome measures. RevMan 5.3 and Stata 15.1 software were used to assess the literature quality and perform network meta-analysis, respectively. MAIN RESULTS: A total of 73 randomized controlled trials (RCTs) with 11 683 patients and nine kinds of TCM were included in this study. Compared with mifepristone and misoprostol, eight kinds of TCM had statistical significance in improving the complete abortion rate. The effect value of Sancao decoction was 5.86 (95% confidence interval [CI] 2.53-13.58). Seven kinds of TCM shortened the duration of vaginal bleeding. The effect value of comfrey and trichosanthin decoction was -8.75 (95% CI -10.86 to -6.64). CONCLUSIONS: This network meta-analysis showed that Lenge Zhumo decoction and Sancao decoction could have a large beneficial effect on complete abortion rate in medical abortion during early pregnancy, and comfrey and trichosanthin decoction could be the best TCM for shortening the duration of vaginal bleeding.

Emerging Human Fascioliasis: A Retrospective Study of Epidemiological Findings in Dali, Yunnan Province, China (2012-2021).

BACKGROUND Human fascioliasis is an emerging zoonotic disease caused by the trematodes, or flatworms, Fasciola hepatica and Fasciola gigantica, also known as liver flukes. This retrospective study aimed to report the epidemiological findings in 95 cases of human fascioliasis in Dali, Yunnan Province, southwestern China, diagnosed between 2012 and 2021. MATERIAL AND METHODS The epidemiologic and clinical data of 95 patients diagnosed with human fascioliasis in Dali area from January 2012 to December 2021 were collected and retrospectively analyzed. The diagnosis of fascioliasis was based on the Chinese National Standard of Diagnosis of Fascioliasis (WS/T566-2017). RESULTS The mean age of patients was 38.54±15.68 years, and there were more female patients than male (61.05% vs 38.95%). The high-incidence seasons were identified as summer and autumn. The patients with human fascioliasis lived in pastoral areas or were infected F. gigantica by consuming contaminated vegetables or water containing metacercaria. Meanwhile, human fascioliasis was diagnosed by positive serologic tests (1: 640), and Fasciola eggs (144-180×73-96 µm) were detected in stool samples of 6 patients. The most common clinical features were abdominal pain (70.53%), accompanied by elevated eosinophils in 89.5% of these patients. Antiparasitic treatment with triclabendazole at 10 mg/kg/day for 2 days led to symptom relief in all patients. CONCLUSIONS The findings from this observational epidemiological study have highlighted the importance of recognizing, diagnosing, and managing fascioliasis, which is an emerging zoonosis associated with increased human proximity to plant-eating domestic and farmed animals.

[Signal transducer and activator of transcription 6 mediates skeletal muscle cell injury in septic mice by regulating ferroptosis].

OBJECTIVE: To explore the effect of signal transducer and activator of transcription 6 (STAT6) on ferroptosis in skeletal muscle cells in sepsis model and its potential mechanism. METHODS: Twenty-four 8-week-old male specific pathogen free Kunming mice were divided into normal control group, sham group, sepsis model group and STAT6 inhibitor pretreatment group according to random number table method with 6 mice in each group. A mouse sepsis model was reproduced by cecal ligation and perforation (CLP). In the sham group, the skin of mice was sutured after exposing the cecum tissue. In the STAT6 inhibitor pretreatment group, 10 mg/kg AS1517499 was injected intraperitoneally 1 hour before model reproduction. The sham group and the model group were intraperitoneally injected with the same volume of normal saline. Mice in the normal control group did not receive any operation or drug intervention. The mice were sacrificed 24 hours after model reproduction, and the muscle tissue of hind limb was obtained under sterile condition. Hematoxylin-eosin (HE) staining was used to observe the histopathology with optical microscope, and mitochondrial morphological changes were observed by transmission electron microscopy after double staining with uranium acetate lead citrate. The ferroptosis marker proteins expressions of chitinase-3-like protein 1 (CHI3L1), cyclooxygenase-2 (COX-2), acyl-CoA synthetase long-chain family member 4 (ACSL4), ferritin heavy chain 1 (FTH1), and glutathione peroxidase 4 (GPx4) were detected by Western blotting. RESULTS: Under the optical microscope, the morphology and structure of skeletal muscle tissues in the normal control and sham groups were normal. In the model group, the structure of skeletal muscle tissues was loose, the muscle fiber became smaller and atrophic, inflammatory cell infiltration and even muscle fiber loss were found. Compared with the model group, the structure of skeletal muscle tissues was tight and skeletal muscle atrophy was improved in the STAT6 inhibitor pretreatment group. The ultrastructure of skeletal muscle cell in the normal control and sham groups was normal under transmission electron microscope. The ultrastructure characteristics of skeletal muscle in the model group showed that cell membrane was broken and blister, mitochondria became smaller and membrane density increased, the mitochondrial crista decreased or disappeared, the mitochondrial outer membrane was broken, and the nucleus was normal in size but lacked chromatin condensation. Compared with the model group, the STAT6 inhibitor pretreatment group had a significant improvement in the ultrastructure of muscle cells. Compared with the normal control and sham groups, the protein expressions of CHI3L1, COX-2, ACSL4 and FTH1 in the muscle of the model group were significantly increased, while the protein expression of GPx4 was decreased significantly, indicating that the skeletal muscle cells in the mouse sepsis model showed characteristic mitochondrial injury and abnormal expression of ferroptosis markers. Compared with the model group, the protein expressions of CHI3LI, COX-2, ACSL4 and FTH1 in the STAT6 inhibitor pretreatment group were significantly decreased [CHI3L1 protein (CHI3L1/GAPDH): 0.70±0.08 vs. 0.97±0.09, COX-2 protein (COX-2/GAPDH): 0.61±0.03 vs. 0.83±0.03, ACSL4 protein (ACSL4/GAPDH): 0.75±0.04 vs. 1.02±0.16, FTH1 protein (FTH1/GAPDH): 0.49±0.06 vs. 0.76±0.13, all P < 0.05], while the protein expression of GPx4 was significantly increased (GPx4/GAPDH: 1.14±0.29 vs. 0.53±0.03, P < 0.05). CONCLUSIONS: Sepsis can induce ferroptosis in skeletal muscle cells of mice. STAT6 may mediate ferroptosis in mouse skeletal muscle cells by regulating the expressions of COX-2, ACSL4, FTH1 and GPx4, thereby inducing skeletal muscle cell injury in sepsis.

Clinical Characteristics and Prognosis of Hospital-Acquired Klebsiella pneumoniae Bacteremic Pneumonia versus Escherichia coli Bacteremic Pneumonia: A Retrospective Comparative Study.

Objective: This research aimed to investigate the variations in clinical features and prognosis of HABP caused by E. coli and K. pneumoniae. We also aimed to evaluate the risk variables related to 30-day death in the investigated groups. Methods: A single-center retrospective cohort research lasting four years was performed. A total of 117 patients with HABP were involved in this research. The primary prognosis was 30-day death. Results: Among 117 patients with HABP, 60 patients were infected with K. pneumoniae (KP-HABP), and 57 patients were infected with E. coli (E. coli-HABP). A higher proportion of males, ICU admission, undergoing tracheotomy and trachea cannulation, carbapenem-resistant strains, inappropriate empirical therapy (IET), immune compromise, diabetes mellitus, and sepsis were observed in the patients with KP-HABP (all P < 0.05). Meanwhile, the median SOFA score and Pitt score were significantly (P < 0.001) higher in the KP-HABP group compared to the E. coli-HABP group. The 30-day death was 48.33% in the KP-HABP group and 24.56% in the E. coli-HABP group (P = 0.008). After adjusting for the main covariates, the hazard ratios for 30-day mortality in KP-HABP were 1.58 (95% CI:0.80-3.12), 3.24 (95% CI:1.48-7.06), 5.67 (95% CI:2.00-16.07), and 5.99 (95% CI:2.10-17.06), respectively. Multivariate logistic regression models revealed that IET, hypoproteinaemia, cerebral vascular disease (CVD), and SOFA score ≥ 5.0 were the independent risk variables for 30-day death in KP-HABP. Simultaneously, SOFA score ≥ 4.0 and Pitt score ≥ 2.0 were independent risk factors for 30-day mortality in E. coli-HABP. Conclusion: The clinical features of HABP vary depending on whether it is caused by Escherichia coli or K. pneumoniae. KP-HABP patients have higher 30-day mortality than E. coli-HABP patients. To ensure greater validity, it is necessary to further verify this conclusion using a larger sample size.

Early Lactate/Albumin and Procalcitonin/Albumin Ratios as Predictors of 28-Day Mortality in ICU-Admitted Sepsis Patients: A Retrospective Cohort Study.

BACKGROUND Lactate/albumin (LA/ALB) and procalcitonin/albumin (PCT/ALB) ratios have been implicated in predicting mortality in sepsis patients. However, their prognostic value and relationship to sepsis severity require further investigation. This retrospective study aimed to assess the prognostic value of lactate/albumin (LA/ALB) and procalcitonin/albumin (PCT/ALB) ratios in septic patients admitted to the Intensive Care Unit (ICU). MATERIAL AND METHODS A total of 340 adult sepsis patients admitted to the ICU were included in the derivation cohort. LA/ALB and PCT/ALB ratios were calculated and analyzed in relation to sepsis severity and survival status. Additionally, a validation cohort of 75 sepsis patients from another medical center was selected. RESULTS In the derivation cohort, higher LA/ALB and PCT/ALB ratios and SOFA scores were significantly associated with increased mortality (P<0.001). The LA/ALB and PCT/ALB ratios positively correlated with SOFA score. Survival analysis revealed significantly higher 28-day mortality in sepsis patients with elevated PCT/ALB (≥0.256) and LA/ALB (≥0.079) ratios upon ICU admission. The constructed prediction model incorporating LA/ALB ratio, PCT/ALB ratio, and SOFA score yielded an AUC of 0.826, demonstrating good predictive ability. The associations between LA/ALB and PCT/ALB ratios and 28-day mortality in sepsis patients were validated in the validation cohort. CONCLUSIONS The LA/ALB and PCT/ALB ratios at ICU admission provide valuable prognostic information for predicting 28-day mortality in sepsis patients. Combining these ratios with SOFA score improves the assessment of prognosis in sepsis patients.

Assessment of Effective Antimicrobial Regimens and Mortality-Related Risk Factors for Bloodstream Infections Caused by Carbapenem-Resistant Acinetobacter baumannii.

Objective: This study aimed to determine the clinical features, risk factors, and effective antimicrobial therapy for Carbapenem-resistant Acinetobacter baumannii (CRAB) bloodstream infection (BSI). Methods: This was a retrospective analysis of data from patients with CRAB bacteremia in a Chinese tertiary hospital between January 2012 and October 2021. Risk factors, predictors of 30-day mortality, and effective antimicrobial therapy for CRAB BSI were identified using logistic and cox regression analyses. Results: Data from 276 patients with Acinetobacter baumannii (AB) BSI were included, of whom 157 (56.9%) had CRAB BSI. The risk factors that were significantly associated with CRAB BSI included previous intensive care unit (ICU) stay (P < 0.001), immunocompromised status (P < 0.001), cephalosporin use (P = 0.014), and fluoroquinolone use (P = 0.007). The 30-day mortality of the CRAB BSI group was 49.7% (78/157). ICU stay after BSI (P = 0.047), sequential organ failure assessment (SOFA) score ≥10 (P < 0.001), and multiple organ failure (MOF) (P = 0.037) were independent predictors of 30-day mortality. Among antibiotic strategies for the treatment of patients with CRAB BSI, we found that definitive regimens containing cefoperazone/sulbactam were superior to those without cefoperazone/sulbactam in reducing the 30-day mortality rate (25.4% vs 53.4%, P = 0.005). After propensity score matching, we observed a significant increase in the 30-day mortality (77.8%vs 33.3%, P = 0.036) in patients receiving tigecycline monotherapy compared to those receiving cefoperazone/sulbactam monotherapy. The mortality rate of patients receiving tigecycline with cefoperazone/sulbactam was also higher than that of patients receiving cefoperazone-sulbactam monotherapy; however, the difference was not significant (28.6%vs 19.0%, P = 0.375). Conclusion: The severity of patient conditions was significantly associated with mortality in patients with CRAB BSI. Those Patients treated with cefoperazone/sulbactam had better clinical prognoses, and tigecycline should be used with caution.

Ceftazidime/Avibactam, Polymyxin or Tigecycline as a Rescue Strategy for the Treatment of Carbapenem-Resistant Klebsiella pneumoniae in Bloodstream Infection: A Retrospective Cohort Study.

Objective: To analyze the clinical characteristics, outcomes, and risk factors of patients treated with ceftazidime/avibactam, polymyxin, or tigecycline (CPT) compared with those receiving a conventional therapy (CT) (ie, imipenem, levofloxacin, or gentamicin). Methods: A single-center retrospective cohort study included patients with carbapenem-resistant Klebsiella pneumoniae bloodstream infection (CRKP-BSI) treated at one Chinese tertiary hospital between March 2012 and November 2022 was performed. Clinical characteristics, outcomes, and risk factors of patients treated with CPT or CT were compared. Predictors of 30-day mortality of patients with CRKP-BSI were also analysed in our study. Results: Among 184 recruited patients with CRKP-BSI, 39.7% (73/184) were treated with CPT, while 60.3% (111/184) were treated with CT. Compared to patients treated with CT, patients treated with CPT had worse conditions, as evidenced by a higher rate of underlying diseases and invasive procedures; however, they also had a better prognosis and lower rates of 14-day treatment failure (p = 0.024). In addition, univariate analysis and multivariate analysis showed that SOFA score [odds ratio (OR) = 1.310, 95% confidence interval (CI) 1.157-1.483; p < 0.001] and cold weather (OR = 3.658, 95% CI 1.474-9.081; p = 0.005) were independent risk factors for 30-day mortality. Conclusion: Compared to CRKP-BSI patients treated with CT, patients treated with CPT had worse conditions but better prognoses. CRKP-BSI occurred more frequently in hot weather; however, higher 30-day mortality was associated with cold weather. A randomized trial is needed to confirm these observational results.

Observation of black carbon in Northern China in winter of 2018-2020 and its implications for black carbon mitigation.

Enhanced observations of BC in hotspot regions with a high temporal resolution are critical to refining our BC mitigation strategies, which are co-directed by air-quality and climate goals. In this work, the temporal variation and emission sources of BC in Shijiazhuang, Northern China, during the winter of 2018-2020 were investigated on the basis of multi-wavelength Aethalometer BC observations. The average BC concentrations decreased from 9.13 ± 6.63 µg/m3 in the winter of 2018 to 3.51 ± 2.48 µg/m3 in the winter of 2020. The BC source attributions derived from the Aethalometer model showed that the BC concentrations in Shijiazhuang in the winter of 2018 were mainly contributed by biomass burning (53 %). In contrast, during the winter of 2019 and 2020, fossil fuel combustion (BCff) exhibited higher contributions, and higher BC concentrations attributed to greater BCff contributions. Potential source contribution function (PSCF) analysis suggested that local emissions in Shijiazhuang and transport from highly industrialized regions like central Shanxi and southern Hebei contributed significantly to BC in Shijiazhuang. Concentration weighted trajectory (CWT) analysis revealed that the BC contributions from source regions decreased successively from the winter of 2018 to the winter of 2020. Our results also implied an air quality/climate co-benefit effect of enforcing multi-scale air-quality improvement regulations. Yet, it is still worth noting that some of the measures in favor of reducing BC emissions contradict the measures for reducing CO2. The synergies of BC to air quality and climate should be considered and addressed by policymakers with the aim of realizing a sustainable environment.

Study on ESD Protection Circuit by TCAD Simulation and TLP Experiment.

The anti-ESD characteristic of the electronic system is paid more and more attention. Moreover, the on-chip electrostatic discharge (ESD) is necessary for integrated circuits to prevent ESD failures. In this paper, the mixed TCAD model of the ESD protection circuit is built and simulated, and the negative transmission line pulse (TLP) injection damage experiment is carried out on the CD4069UBC chip. The circuit model consists of three-dimensional shallow trench isolation (STI) diode TCAD models and a three-dimensional multi-gate Complementary Metal-Oxide-Semiconductor (CMOS) inverter TCAD model. Moreover, the TCAD modeling is based on a 0.25 µm technology node. Through the transient simulation of the electrothermal coupling, the electrical signal of the input and output nodes of the circuit and the distribution of the electrothermal parameters in the device are obtained. Moreover, by analyzing the simulation results, the physical phenomena and the mechanisms of interference and damage mechanism during TLP injection are explained. The location and type of diode damage in the TLP injection simulation results of the circuit model are consistent with the TLP experiment damage results. The proposed ESD protection circuit model and analysis method are beneficial to ESD robustness prediction and ESD soft damage analysis of IC.

Clinical Value of the Serum Procalcitonin to Albumin Ratio in the Diagnosis and Prognosis of Sepsis-Associated ARDS Patients: A Retrospective Study.

OBJECTIVE: To evaluate the diagnostic and prognostic value of the Serum Procalcitonin (PCT) to Albumin (ALB) ratio in sepsis-associated ARDS patients. METHODS: We conducted a retrospective study including 349 septic patients (159 and 190 with and without ARDS, respectively). The serum PCT/ALB ratio was measured at admission, and participants' 28-day mortality and Sequential Organ Failure Assessment (SOFA) scores were compared. RESULTS: Compared to patients without sepsis-associated ARDS, sepsis-associated ARDS patients had a higher PCT/ALB ratio (P<0.001). Among sepsis-associated ARDS patients, non-survivors had a significantly higher PCT/ALB ratio than survivors (P<0.05). The AUC of the PCT/ALB ratio associated with the 28-day mortality in sepsis-associated ARDS patients on admission day was 0.62 (95% CI [0.54-0.69], P<0.001). In assessing the 28-day mortality in sepsis-associated ARDS patients, the AUC of the PCT/ALB ratio in combination with the oxygenation index and SOFA score rose from 0.62 to 0.78 (95% CI: 0.70-0.84; P<0.001). Moreover, survival analysis revealed that sepsis-associated ARDS patients with a higher PCT/ALB ratio (≥2.03 µg/g) had a significantly poorer prognosis than those with a low ratio (<2.03 µg/g). CONCLUSIONS: The PCT/ALB ratio is a potential biomarker for the diagnosis and prognosis of sepsis-associated ARDS patients.

Characterization of the Dicranostigma leptopodum chloroplast genome and comparative analysis within subfamily Papaveroideae.

BACKGROUND: Dicranostigma leptopodum (Maxim.) Fedde is a perennial herb with bright yellow flowers, well known as "Hongmao Cao" for its medicinal properties, and is an excellent early spring flower used in urban greening. However, its molecular genomic information remains largely unknown. Here, we sequenced and analyzed the chloroplast genome of D. leptopodum to discover its genome structure, organization, and phylogenomic position within the subfamily Papaveroideae. RESULTS: The chloroplast genome size of D. leptopodum was 162,942 bp, and D. leptopodum exhibited a characteristic circular quadripartite structure, with a large single-copy (LSC) region (87,565 bp), a small single-copy (SSC) region (18,759 bp) and a pair of inverted repeat (IR) regions (28,309 bp). The D. leptopodum chloroplast genome encoded 113 genes, including 79 protein-coding genes, 30 tRNA genes, and four rRNA genes. The dynamics of the genome structures, genes, IR contraction and expansion, long repeats, and single sequence repeats exhibited similarities, with slight differences observed among the eight Papaveroideae species. In addition, seven interspace regions and three coding genes displayed highly variable divergence, signifying their potential to serve as molecular markers for phylogenetic and species identification studies. Molecular evolution analyses indicated that most of the genes were undergoing purifying selection. Phylogenetic analyses revealed that D. leptopodum formed a clade with the tribe Chelidonieae. CONCLUSIONS: Our study provides detailed information on the D. leptopodum chloroplast genome, expanding the available genomic resources that may be used for future evolution and genetic diversity studies.

Mechanism Analysis and Multi-Scale Protection Design of GaN HEMT Induced by High-Power Electromagnetic Pulse.

Currently, severe electromagnetic circumstances pose a serious threat to electronic systems. In this paper, the damage effects of a high-power electromagnetic pulse (EMP) on the GaN high-electron-mobility transistor (HEMT) were investigated in detail. The mechanism is presented by analyzing the variation in the internal distribution of multiple physical quantities in the device. The results reveal that the device damage was dominated by different thermal accumulation effects such as self-heating, avalanche breakdown and hot carrier emission during the action of the high-power EMP. Furthermore, a multi-scale protection design for the GaN HEMT against high-power electromagnetic interference (EMI) is presented and verified by a simulation study. The device structure optimization results demonstrate that the symmetrical structure, with the same distance from the gate to drain (Lgd) and gate to source (Lgs), possesses a higher damage threshold compared to the asymmetrical structure, and that a proper passivation layer, which enhances the breakdown characteristics, can improve the anti-EMI capability. The circuit optimization results present the influences of external components on the damage progress. The findings show that the resistive components which are in series at the source and gate will strengthen the capability of the device to withstand high-power EMP damage. All of the above conclusions are important for device reliability design using gallium nitride materials, especially when the device operates under severe electromagnetic circumstances.

Evaluation of the diagnostic and prognostic values of serum HSP90α in sepsis patients: a retrospective study.

Background: Sepsis is a serious syndrome that is caused by immune responses dysfunction and leads to high mortality. The abilities of heat shock protein 90α (HSP90α) in assessing the diagnosis and prognosis in patients with sepsis remain ill-defined to date. We conducted a study to reveal the possible clinical applications of HSP90α as biomarker for the diagnosis and prognosis in patients with sepsis. Methods: In total, 150 patients of sepsis, 110 patients without sepsis admitted to ICU and 110 healthy subjects were involved in this study. The serum HSP90α contents, sequential organ failure assessment (SOFA) scores, procalcitonin (PCT), and short-term survival status of the participants were measured and compared. Logistic and linear regression models adjusting for potential confounders were used to examine the association of HSP90α with sepsis survival. Moreover, serum IL-1ß, IL-18, MIP-3α, and ENA-78 were also determined. Finally, Spearman correlation analysis was employed to reveal a possible mechanism that HSP90α contributed to the short-term deaths. Results: Serum HSP90α levels in sepsis patients were higher than those in ICU controls and healthy controls (P < 0.001), and even increased in patients who died within 28 days (P < 0.001). Logistic and linear regression models identified HSP90α was an independent risk factors for sepsis mortality. Receiver operating characteristic (ROC) analysis displayed that HSP90α had a considerable predictive performance for sepsis outcome, with an area under curve (AUC) value up to 0.79. Survival analysis demonstrated that the mortality of sepsis individuals at 28 days was positively associated with HSP90α levels, especially the levels of HSP90α were greater than 120 ng/mL (P < 0.001). Moreover, among sepsis patients, those who died had notably elevated cytokines, IL-1ß, IL-18, and chemokines, MIP-3α, ENA-78, relative to survivors. Further correlation analysis demonstrated that there was a nominally positive correlation between HSP90α and IL-1ß, IL-18, and MIP-3α. Conclusion: HSP90α is of favorable clinical significance in sepsis diagnosis and prognosis, laying a foundation for future clinical applications.

Study of Self-Heating and High-Power Microwave Effects for Enhancement-Mode p-Gate GaN HEMT.

The self-heating and high-power microwave (HPM) effects that can cause device heating are serious reliability issues for gallium nitride (GaN) high-electron-mobility transistors (HEMT), but the specific mechanisms are disparate. The different impacts of the two effects on enhancement-mode p-gate AlGaN/GaN HEMT are first investigated in this paper by simulation and experimental verification. The simulation models are calibrated with previously reported work in electrical characteristics. By simulation, the distributions of lattice temperature, energy band, current density, electric field strength, and carrier mobility within the device are plotted to facilitate understanding of the two distinguishing mechanisms. The results show that the upward trend in temperature, the distribution of hot spots, and the thermal mechanism are the main distinctions. The effect of HPM leads to breakdown and unrecoverable thermal damage in the source and drain areas below the gate, while self-heating can only cause heat accumulation in the drain area. This is an important reference for future research on HEMT damage location prediction technology and reliability enhancement.

The RING-domain E3 ubiquitin ligase RNF146 promotes cardiac hypertrophy by suppressing the LKB1/AMPK signaling pathway.

The RING-domain E3 ubiquitin ligase RNF146 is an enzyme that plays an important role in ubiquitin-proteasomal protein degradation and participates in various pathophysiological processes. However, its role in cardiac hypertrophy is unclear. In the present work, thoracic transverse aortic constriction (TAC) was performed in transgenic mice with RNF146 knockout mice (KO) and wild-type mice, and neonatal rat cardiomyocytes (NRCMs) were subjected to angiotensin II (Ang II) stimulation to induce cardiac hypertrophy in vitro and in vivo. RNF146 expression was significantly increased in hypertrophied murine hearts and Ang II-stimulated NRCMs. RNF146-KO mice and knockdown of RNF146 NRCMs attenuated TAC- or Ang II-stimulated cardiac hypertrophy. Conversely, enforced expression of RNF146 aggravated these changes. Mechanistically, we found that RNF146 KO or knockdown increased the activation of the AMP-activated protein kinase (AMPK) pathway. Furthermore, we found that RNF146 KO or knockdown decreased ubiquitination of Liver kinase B1 (LKB1), which promoted the activation of the AMPK pathway in a dependent manner. In conclusion, RNF146 targets LKB1 protein for ubiquitin-proteasome degradation in cardiomyocytes and subsequently promotes cardiac hypertrophy by suppressing the activation of the AMPK signaling pathway.