Association between albumin-corrected anion gap level and the risk of acute kidney injury in intensive care unit.

PURPOSE: This study was to investigate the association between albumin-corrected anion gap (AG) (ACAG) levels and the risk of acute kidney injury (AKI) in intensive care unit (ICU) patients. METHODS: The ICU patients of this retrospective cohort study were collected from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database between 2008 and 2019. ACAG = AG + {4.4 - [albumin (g/dl)]} × 2.5. The incidence of AKI was determined using the Kidney Disease: Improving Global Outcomes (KDIGO) definition. The logistic regression model was used to evaluate the association between ACAG levels and the risk of AKI. Subgroup analyses were applied based on age, gender, mechanical ventilation, vasopressors, the Charlson comorbidity index (CCI), and the Simplified Acute Physiology Score II (SAPS II). RESULTS: Totally, 5586 patients were enrolled, of which 1929 patients (34.53%) occurred AKI. The higher levels of ACAG were associated with the risk of AKI in ICU patients, with the odds ratio (OR) value being 1.23 [95% confidence interval (CI): 1.22-1.24, P = 0.005] in ACAG level between 16.5 and 19.5, and OR value being 1.20 (95% CI 1.16-1.24, P = 0.016) in ACAG level > 19.5. A higher ACAG level was associated with a higher risk of AKI in ICU patients aged < 65 years, in ICU patients of female gender, in ICU patients who used mechanical ventilation, in ICU patients who did not use vasopressors, in patients without cardiogenic shock, and in ICU patients with CCI ≥ 2, and SAPS II > 31 (all P < 0.05). CONCLUSION: There is an association between ACAG level and the risk of AKI in ICU patients. A higher ACAG value in ICU patients should therefore receive more attention.

Pretreatment of 3-hydroxyacetophenone in pharmaceutical wastewater using combined salting-out crystallization+ Fenton system and subsequent impact analysis of effluent water.

Selecting a suitable pretreatment process for pharmaceutical wastewater that is difficult to treat biochemically so that it can enter the subsequent biochemical treatment. In this study, pharmaceutical wastewater consisting of 45 g/L sodium bisulfate, 9 g/L 3-hydroxyacetophenone (3-HAP), and 36.75 g/L sulfuric acids,which is a kind of typical pharmaceutical wastewater, was used for the pretreatment case study, and the process was screened by technology. A salting-out crystallization+Fenton system(SC-F) was developed for the treatment of this wastewater. The salting-out agent is formed by the pH adjustment process without additional additions and the salting-out crystallization effect is significant for the precipitation of 3-HAP from the wastewater. Subsequently, the optimal operating conditions for SC-F were derived from experiments as H2O2 of 0.4692 mol/L, n(H2O2):n(Fe2+)=30:1, pH=3. Under optimal conditions, the reaction time of 2 h achieved a COD removal rate of 90% and a BOD/COD value of 0.56, confirming the effectiveness of the technology in treating this wastewater. Additionally, it was discovered that the Fenton treatment was not significantly impacted by the inorganic components of the effluent. Analysis of effluent properties and possible effects on subsequent treatment by LC-MS and toxicity analysis. The results show that the biodegradability are enhanced by the pretreatment technology. However, the effluent still suffers from high acidity and high salt content, and this study proposes a solution to this problem. Furthermore, research on the treatment of 3-HAP wastewater has not been reported and this study provides a new case study in the field of wastewater treatment.

Ceftazidime/avibactam combined with colistin: a novel attempt to treat carbapenem-resistant Gram-negative bacilli infection.

BACKGROUND: The rapid global emergence and spread of carbapenem-resistant Gram-negative bacilli (CR-GNB) is recognized as a major public health concern, and there are currently few effective treatments for CR-GNB infection. The aim of this study was to investigate the clinical characteristics and outcomes of patients with CR-GNB infections treated with ceftazidime/avibactam (CAZ/AVI) combined with colistin from October 2019 to February 2023 in China. METHODS: A total of 31 patients with CR-GNB infections were retrospectively identified using the electronic medical record system of Zhejiang Provincial People's Hospital. RESULTS: Thirty-one patients were treated with CAZ/AVI combined with colistin. Respiratory tract infections (87%) were most common. The common drug-resistant bacteria encompass Klebsiella pneumonia (54.8%), Acinetobacter baumannii (29.0%), and Pseudomonas aeruginosa (16.1%). The 30-day mortality rate was 29.0%, and the 7-day microbial clearance rate was 64.5%. The inflammatory marker CRP changes, but not PCT and WBC, were statistically significant on days 7 and 14 after combination therapy. There were seven patients developing acute renal injury (AKI) after combination therapy and treating with continuous renal replacement therapy (CRRT). Two patients developed diarrhea. CONCLUSION: The combination of CAZ/AVI and colistin has potential efficacy in patients with CR-GNB infection, but more studies are needed to determine whether it can reduce 30-day mortality rates and increase 7-day microbial clearance. At the same time, the adverse reactions of combination therapy should not be ignored.

Current status and prospects of basic research and clinical application of mesenchymal stem cells in acute respiratory distress syndrome.

Acute respiratory distress syndrome (ARDS) is a common and clinically devastating disease that causes respiratory failure. Morbidity and mortality of patients in intensive care units are stubbornly high, and various complications severely affect the quality of life of survivors. The pathophysiology of ARDS includes increased alveolar-capillary membrane permeability, an influx of protein-rich pulmonary edema fluid, and surfactant dysfunction leading to severe hypoxemia. At present, the main treatment for ARDS is mechanical treatment combined with diuretics to reduce pulmonary edema, which primarily improves symptoms, but the prognosis of patients with ARDS is still very poor. Mesenchymal stem cells (MSCs) are stromal cells that possess the capacity to self-renew and also exhibit multilineage differentiation. MSCs can be isolated from a variety of tissues, such as the umbilical cord, endometrial polyps, menstrual blood, bone marrow, and adipose tissues. Studies have confirmed the critical healing and immunomodulatory properties of MSCs in the treatment of a variety of diseases. Recently, the potential of stem cells in treating ARDS has been explored via basic research and clinical trials. The efficacy of MSCs has been shown in a variety of in vivo models of ARDS, reducing bacterial pneumonia and ischemia-reperfusion injury while promoting the repair of ventilator-induced lung injury. This article reviews the current basic research findings and clinical applications of MSCs in the treatment of ARDS in order to emphasize the clinical prospects of MSCs.

Study on Degradation of 1,2,4-TrCB by Sugarcane Cellulose-TiO2 Carrier in an Intimate Coupling of Photocatalysis and Biodegradation System.

1,2,4 trichlorobenzene (1,2,4-TrCB) is a persistent organic pollutant with chemical stability, biological toxicity, and durability, which has a significant adverse impact on the ecological environment and human health. In order to solve the pollution problem, bagasse cellulose is used as the basic framework and nano TiO2 is used as the photocatalyst to prepare composite carriers with excellent performance. Based on this, an intimate coupling of photocatalysis and biodegradation (ICPB) system combining photocatalysis and microorganisms is constructed. We use the combined technology for the first time to deal with the pollution problem of 1,2,4-TrCB. The biofilm in the composite carrier can decompose the photocatalytic products so that the removal rate of 1,2,4-TrCB is 68.01%, which is 14.81% higher than those of biodegradation or photocatalysis alone, and the mineralization rate is 50.30%, which is 11.50% higher than that of photocatalysis alone. The degradation pathways and mechanisms of 1,2,4-TrCB are explored, which provide a theoretical basis and potential application for the efficient degradation of 1,2,4-TrCB and other refractory organics by the ICPB system.

Ni3S2/Ni Heterostructure Nanobelt Arrays as Bifunctional Catalysts for Urea-Rich Wastewater Degradation.

Urea electrolysis is a cost-effective method for urea-rich wastewater degradation to achieve a pollution-free environment. In this work, the Ni3S2/Ni heterostructure nanobelt arrays supported on nickel foam (Ni3S2/Ni/NF) are synthesized for accelerating the urea oxidation reaction (UOR) and hydrogen evolution reaction (HER). It only needs ultralow potentials of 1.30 V and -54 mV to achieve the current density of ±10 mA cm-2 for UOR and HER, respectively. Meanwhile, the overall urea oxidation driven by Ni3S2/Ni/NF only needs 1.36 V to achieve 10 mA cm-2, and it can remain at 100 mA cm-2 for 60 h without obvious activity attenuation. The superior performance could be attributed to the heterostructure between Ni3S2 and Ni, which can promote electron transfer and form electron-poor Ni species to optimize urea decomposition and hydrogen production. Moreover, the nanobelt self-supported structure could expose abundant active sites. This work thus provides a feasible and cost-effective strategy for urea-rich wastewater degradation and hydrogen production.

Degradation of chlorine dioxide bleaching wastewater and response of bacterial community in the intimately coupled system of visible-light photocatalysis and biodegradation.

Intimate coupling of visible-light photocatalysis and biodegradation (ICPB) offers potential for degrading chlorine dioxide bleaching wastewater. In this study, we reported a TiO2-coated sponge biofilm carrier with significant adhesion of TiO2 and the ability to accumulate biomass in its interior. Four mechanisms possibly acting in ICPB were tested separately: adsorption of chlorine dioxide bleaching wastewater to the carrier, photolysis, photocatalysis, and biodegradation by the biofilm inside the carrier. The carrier had an adsorption capacity of 17% and 16% for CODcr and AOX, respectively, in the wastewater. The photodegradation rate of wastewater was very low and could be ignored. Both biodegradation (AOX 30.1%, CODcr 33.8%, DOC 26.2%) and photocatalysis (AOX 65.1%, CODcr 71.2%, DOC 62.3%) possessed a certain degradation efficiency of wastewater. However, the removal rate of AOX, CODcr, and DOC in wastewater treatment by protocol ICPB reached 80.3%, 90.5%, and 86.7%. FT-IR and GC-MS analysis showed that the ICPB system had photocatalytic activity on the surface of the porous carrier in vitro, which could transform organic into small molecules for microbial utilization or complete mineralization. Moreover, the biofilm in the interior of the TiO2-coated sponge carrier could mineralize the photocatalytic products, which enhanced the removal of AOX, CODcr, and DOC by more than 15.2%, 20.0%, and 24.0%, respectively. The biofilm in the carrier of the ICPB system evolved, enriched in Proteobacteria, Chloroflexi, Bacteroidetes, and Actinobacteria, microorganisms known to play active roles in the biodegradation of papermaking wastewater.