Background
The US Centers for Disease Control and Prevention (CDC) recently released simplified eSOFA organ dysfunction criteria of Adult Sepsis Event for sepsis surveillance in the US. Our study ...aimed to compare the prevalence, characteristics, and outcomes of sepsis patients identified by eSOFA criteria versus Sequential Organ Failure Assessment (SOFA) Score (Sepsis-3) and assess the external validity of eSOFA criteria in China.
Methods
We conducted a retrospective cohort study of adult residents of Yuetan Subdistrict, Beijing, China, who were hospitalized from July 1, 2012 to June 30, 2014. Among patients with infection, sepsis was identified if there was a concurrent rise in SOFA score by 2 or more points (Sepsis-3) or the presence of 1 or more eSOFA criteria: vasopressor initiation, mechanical ventilation initiation, doubling in creatinine, doubling in bilirubin to 2.0 mg/dL or above, 50% or greater decrease in platelet count to less than 100 cells/μL, or lactate equal to or above 2.0 mmol/L. Areas under the receiver operating characteristic curves (AUROCs) for in-hospital mortality were compared between sepsis patients detected by the two criteria, adjusting for baseline characteristics.
Results
Of 1716 hospitalized patients with infection, 935 (54.5%) met Sepsis-3 criteria, 573 (33.4%) met eSOFA criteria, while 475 (27.7%) met both criteria. Demographic and clinical characteristics of sepsis patients meeting Sepsis-3 or eSOFA criteria were similar. In-hospital mortality was higher with eSOFA criteria versus Sepsis-3 (46.6% vs. 32.0%,
p
< 0.001). eSOFA criteria had high PPV (82.9%), but low sensitivity (50.8%) for the diagnosis of Sepsis-3. Patients meeting both criteria had the highest in-hospital mortality rate (52.8%, all
p
< 0.001), while patients who only met eSOFA criteria had higher mortality rate than those meeting Sepsis-3 alone (16.3% vs. 10.4%,
p
= 0.097). The predicted probability for in-hospital mortality was higher with eSOFA criteria versus Sepsis-3 (AUROC 0.830 vs. 0.795,
p
= 0.001) adjusting for baseline characteristics.
Conclusions
The CDC Adult Sepsis Event’s eSOFA criteria identify a smaller, more severely ill cohort of sepsis patients with similar demographic and clinical characteristics as the more complex Sepsis-3 SOFA score. These results suggest similar performance of eSOFA criteria across diverse populations, with low sensitivity and high specificity for the diagnosis of Sepsis-3.
Following the recent adjustments to coronavirus disease 2019 (COVID-19) prevention and control policies, an increasing number of medical staffs, especially those in primary care facilities are ...confronted with rapid growth of COVID-19 patients. Peking Union Medical College Hospital (PUMCH) has therefore compiled this recommendation for COVID-19 primary care practices based on a patient-centered perspective and following recommendations from domestic and international guidelines as well as the latest Chinese government policies. Further, PUMCH's conception and compilation of this recommendation strictly adhere to evidence-based, concise and clinically applicable principles of practice. For the critical clinical questions with insufficient medical evidence, the recommendation offers insights on the basis of experience from PUMCH multi-disciplinary expert team and first-line medics' practices. Emphasizing on screening community residents with higher risk of severe illness, implementing early interventions includi
Recycled aggregate crumb rubber concrete (RCC) is made of recycled aggregate and rubber materials. In this paper, the particle size, composition and substitution rate of rubber material were ...considered; the physical performance, thermal performance and acoustic performance of normal concrete (NC), recycled aggregate concrete (RC) and RCC were compared and analyzed. The main indexes of different concretes were compared, including the bulk density, porosity, heat transfer coefficient, thermal resistance, sound absorption coefficient and noise reduction coefficient. The test results show that, compared with the NC, the RCC has the lower bulk density, smaller heat transfer coefficient, larger thermal resistance, larger sound absorption coefficient and noise reduction coefficient. Besides, the performances of thermal insulation and sound insulation and noise reduction of RCC have great functional advantages over that of NC.
•The recycled aggregate and recycled rubber materials could be reused reasonably in recycled aggregate crumb rubber concrete（RCC）.•Standardized experiments regarding thermal and acoustic performance of RCC are carried out.•When the rubber replacement rate is 30%, the effect of sound insulation and noise reduction is the best.•When the rubber replacement rate is 20%, the increase of thermal resistance is the most obvious.•The proposed RCC have a wide application in partition walls of green buildings.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
•SOX6 played a role in regulating melanogenesis by binding with β-catenin to regulate Cyclin D1 in alpaca melanocytes.•SOX6 can phosphorylate CDK5.•SOX6 played an important role in regulating ...melanogenesis.
Sex-determining region Y-box (SOX) proteins function as transcriptional regulators. The derivation of melanocytes from nerve crest cells has been reported to depend on SOX proteins, including SOX10 and SOX5. Whether SOX6 is expressed and has a functional role in melanocytes is unknown.
We aimed to study the effect of transcription factor SOX6 on melanogenesis in alpaca melanocytes.
We verified the role of SOX6 in melanogenesis by overexpressing and inhibiting SOX6 in melanocytes. Co-immunoprecipitation (co-IP) experiments were performed to further explore the function of SOX6 in melanogenesis and its mechanism of melanin production. We found that SOX6 interacted with cyclin-dependent kinase （CDK5）, β-catenin, and Cyclin D1.
Bioinformatics analysis suggested that SOX6 has a phosphorylation site for CDK5, which regulates melanogenesis, suggesting that SOX6 might play a role in melanogenesis. Co-IP experiments indicated that SOX6 interacted with CDK5, β-catenin, and Cyclin D1. Quantitative real-time polymerase chain reaction and western blot analyses of SOX6-overexpressing melanocytes revealed increased mRNA and protein expression of Cyclin D1, CDK5, microphthalmia transcription factor (MITF), tyrosinase (TYR), tyrosine related protein-1 (TYRP1), and dopachrome-tautomerase (DCT), whereas β-catenin levels decreased in SOX6-overexpressing melanocytes. The opposite results were observed upon SOX6 knockdown. The melanin content was significantly increased or decreased, respectively, by SOX6 overexpression or knockdown.
Our results suggest that SOX6 might enhance melanogenesis by binding with β-catenin to increase Cyclin D1 and MITF expression.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
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► V-shaped PS-b-PEO brushes on planar Au substrate were prepared. ► Surface composition of the brushes varies with chain structure and solvent. ► The morphology of the V-shaped ...brushes is responsive to solvent stimuli.
Trithiocarbonate group was introduced into the polystyrene-b-poly(ethylene oxide) (PS-b-PEO) block copolymers as the junction of the blocks through RAFT polymerization. Mixed PS and PEO brushes with a V-shape were prepared by anchoring the trithiocarbonate group on the planar gold substrate. The morphology of the V-shaped brushes was characterized by atomic force microscopy (AFM) and the surface composition responsive to solvent treatment was detected by X-ray photoelectron spectroscopy (XPS). Different morphologies were observed for the V-shaped PS-b-PEO brushes, depending on the chain structure and solvent treatment. The highly selective solvent for PEO, ethanol, can intensify or induce microphase separation of the V-shaped brushes, leading to vertical microphase separation. When the V-shaped brushes are treated with the co-solvent, THF, miscible morphology, lateral microphase separation, and vertical microphase separation are observed as the PS block length increases. After treatment with the non-selective poor solvent, cyclohexane, the V-shaped PS106-b-PEO113 brush, exhibits a laterally microphase-separated morphology, but the V-shaped PS52-b-PEO113 and PS253-b-PEO113 brushes are vertically microphase-separated.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
In order to study the lightning damage characteristics of carbon fiber composite materials (CFRP) with fasteners, three-dimensional finite element models of CFRP with fasteners and CFRP without ...fasteners were established respectively, and the lightning damage morphology of CFRP was analyzed by electro-thermal coupling simulation, and Corresponding to the lightning current damage experiment, the damage characteristics of the two CFRPs under different lightning current peaks were compared and studied. The results show that when the lightning current peak is low, the surface damage of CFRP with fasteners is lower than that of CFRP without fasteners. As the lightning current peak increases, the damage of CFRP with fasteners along the longitudinal direction of the carbon fiber gradually increases. And eventually surpassed CFRP without fasteners. In the experiment, when the CFRP without fasteners was struck by lightning, linear damage occurred in the direction perpendicular to the carbon fiber on the surface, while
Background:
Extracorporeal membrane oxygenation (ECMO) is a rapidly evolving therapy for acute lung and/or heart failure. However, the information on the application of ECMO in severe coronavirus ...disease 2019 (COVID-19) is limited, such as the initiation time. Especially in the period and regions of ECMO instrument shortage, not all the listed patients could be treated with ECMO in time. This study aimed to investigate and clarify the timing of ECMO initiation related to the outcomes of severe patients with COVID-19. The results show that ECMO should be initiated within 24 h after the criteria are met.
Methods:
In this retrospective, multicenter cohort study, we enrolled all ECMO patients with confirmed COVID-19 at the three hospitals between December 29, 2019 and April 5, 2020. Data on the demographics, clinical presentation, laboratory profile, clinical course, treatments, complications, and outcomes were collected. The primary outcomes were successful ECMO weaning rate and 60-day mortality after ECMO. Successful weaning from ECMO means that the condition of patients improved with adequate oxygenation and gas exchange, as shown by the vital signs, blood gases, and chest X-ray, and the patient was weaned from ECMO for at least 48 h.
Results:
A total of 31 patients were included in the analysis. The 60-day mortality rate after ECMO was 71%, and the ECMO weaning rate was 26%. Patients were divided into a delayed ECMO group 3 (interquartile range (IQR), 2–5) days and an early ECMO group 0.5 (IQR, 0–1) days based on the time between meeting the ECMO criteria and ECMO initiation. In this study, 14 and 17 patients were included in the early and delayed treatment groups, respectively. Early initiation of ECMO was associated with decreased 60-day mortality after ECMO (50 vs. 88%,
P
= 0.044) and an increased ECMO weaning rate (50 vs. 6%,
P
= 0.011).
Conclusions:
In ECMO-supported patients with COVID-19, delayed initiation of ECMO is a risk factor associated with a poorer outcome.
Trial Registration:
Clinical trial submission: March 19, 2020. Registry name: A medical records-based study for the clinical application of extracorporeal membrane oxygenation in the treatment of severe respiratory failure patients with novel coronavirus pneumonia (COVID-19). Chinese Clinical Trial Registry:
https://www.chictr.org.cn/showproj.aspx?proj=51267,identifier:~ChiCTR2000030947
.
Serological tests for Herpes simplex viruses (HSV)-IgM, Coxsackievirus A16-IgM, Toxoplasma-IgM, Rubella virus-IgM, Cytomegalovirus-IgM, Parvovirus B19-IgM, and Cytomegalovirus-DNA were negative. Dr. ...Li Weng, Medical Intensive Care Unit, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing 100730, ChinaE-Mail: wengli@gmail.com How to cite this article: Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.cmj.org).Medical Intensive Care Unit, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China.
Ratoon rice is resource efficient to produce economically sound and environmentally sustainable rice production. However, there is no more information on the relative impact of soil tillage practices ...on soil physical and chemical properties, microbial biomass, and enzymatic activity, and grain yield in a rice–ratoon rice cropping system remains to be tested. Systematic study of soil under ratooning rice model is a problem to be solved in the development of ratooning rice model. This study primarily investigated the long‐term (from 2014 to 2020) changes in soil bulk density (BD), soil organic carbon (SOC) concentration, total nitrogen (TN) concentration, microbial biomass, β‐glucosidase activity (BG), urease activity (UR), and yield under four treatments: no‐tillage (NT), no plowing tillage + rotatory tillage (RT), plowing tillage in winter + rotatory tillage (PTW), and plowing tillage in spring + rotatory tillage (PTS). NT increased BD by 9.65%–12.97%, and RT increased the 20–40 cm soil layer BD by 8.80% in 2020, compared with the baseline initial value (in 2014). Plowing tillage (PT) time had no significant effect on BD. All tillage methods decreased the SOC concentration in the 0–20 cm soil layer, and only RT increased the TN concentration. PT was the only treatment that increased the SOC and TN concentrations in the 20–40 cm soil layer. Both the main‐season rice yield and the ratoon season rice yield ranked PTW > PTS > NT > RT, in which the main‐season rice yield increased by 28.15% and the ratoon season rice yield increased by 25.19% in PTW. Overall, the PTW treatment had the highest microbial biomass, enzyme activity, and grain yield compared with the other tillage methods. In conclusion, plowing tillage in winter + rotatory tillage is a more suitable tillage method under the mode of ratooning rice.
A long‐term study on the effects of tillage on soil traits and yield in a rice–ratoon rice cropping system has been carried out. Plowing tillage in winter + rotatory tillage (PTW) maintains soil permeability at a depth of 0–40 cm. Independent of tillage methods and ratoon rice systems require increased SOM input to maintain C storage. PTW had the highest soil microbial biomass, soil enzyme activity, and grain yield.
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FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
Background：Biliverdin （BV） has a protective role against ischemia-reperfusion injury （IRI）.However,the protective role and potential mechanisms of BV on lung IRI （LIRI） remain to be ...elucidated.Thus,we aimed to investigate the protective role and potential mechanisms of BV on LIRI.Methods：Lungs were isolated from Sprague-Dawley rats to establish an ex vivo LIRI model.After an initial 15 min stabilization period,the isolated lungs were subjected to ischemia for 60 min,followed by 90 min ofreperfusion with or without BV treatment.Results：Lungs in the I/R group exhibited significant decrease in tidal volume （1.44 ± 0.23 ml/min in I/R group vs.2.41 ± 0.31 ml/min in sham group;P 〈 0.001）,lung compliance （0.27 ± 0.06 ml/cmH2O in I/R group vs.0.44 ± 0.09 ml/cmH2O in sham group;P 〈 0.001;1 cmH2O=0.098 kPa）,and oxygen partial pressure （PaO2） levels （64.12 ± 12 mmHg in FR group vs.114 ± 8.0 mmHg in sham group;P 〈 0.001;1 mmHg =0.133 kPa）.In contrast,these parameters in the BV group （2.27 ± 0.37 ml/min of tidal volume,0.41 ± 0.10 ml/ cmH2O of compliance,and 98.7 ± 9.7 mmHg of PaO2） were significantly higher compared with the I/R group （P =0.004,P 〈 0.001,and P 〈 0.001,respectively）.Compared to the I/R group,the contents of superoxide dismutase were significantly higher （47.07 ± 7.91 U/mg protein vs.33.84 ± 10.15 U/mg protein;P =0.005） while the wet/dry weight ratio （P 〈 0.01）,methane dicarboxylic aldehyde （1.92 ± 0.25 nmol/mg protein vs.2.67 ± 0.46 nmol/mg protein;P 〈 0.001）,and adenosine triphosphate contents （297.05 ± 47.45 nmol/mg protein vs.208.09 ± 29.11 nmol/mg protein;P =0.005） were markedly lower in BV-treated lungs.Histological analysis revealed that BV alleviated LIRI.Furthermore,the expression of inflammatory cytokines （interleukin-1 β,interleukin-6,and tumor necrosis factor-α） was downregulated and the expression of cyclooxygenase-2,inducible nitric oxide synthase,and Jun N-terminal kinase was significantly reduced in BV group （all P 〈 0.01 compared to I/R group）.Finally,the apoptosis index in the BV group was significantly decreased （P 〈 0.01 compared to I/R group）.Conclusion：BV protects lung IRI through its antioxidative,anti-inflammatory,and anti-apoptotic effects.
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