An ideal material for C2H6/C2H4 separation would simultaneously have the highest C2H6 uptake capacity and the highest C2H6/C2H4 selectivity. But such material is elusive. A benchmark material for ...ethane-selective C2H6/C2H4 separation is peroxo-functionalized MOF-74-Fe that exhibits the best known separation performance due to its high C2H6/C2H4 selectivity (4.4), although its C2H6 uptake capacity is moderate (74.3 cm3/g). Here, we report a family of pore-space-partitioned crystalline porous materials (CPMs) with exceptional C2H6 uptake capacity and C2H6/C2H4 separation potential (i.e., C2H4 recovered from the mixture) despite their moderate C2H6/C2H4 selectivity (up to 1.75). The ethane uptake capacity as high as 166.8 cm3/g at 1 atm and 298 K, more than twice that of peroxo-MOF-74-Fe, has been achieved even though the isosteric heat of adsorption (21.9–30.4 kJ/mol) for these CPMs is as low as about one-third of that for peroxo-MOF-74-Fe (66.8 kJ/mol). While the overall C2H6/C2H4 separation potentials have not yet surpassed peroxo-MOF-74-Fe, these robust CPMs exhibit outstanding properties including high thermal stability (up to 450 °C) and aqueous stability, low regeneration energy, and a high degree of chemical and geometrical tunability within the same isoreticular framework.
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IJS, KILJ, NUK, PNG, UL, UM
We sought to determine the associations between baseline chronic medical conditions and future risk of sepsis.
Longitudinal cohort study using the 30,239 community-dwelling participants of the ...REGARDS cohort. We determined associations between baseline chronic medical conditions and incident sepsis episodes, defined as hospitalization for an infection with the presence of infection plus two or more systemic inflammatory response syndrome criteria.
Over the mean observation time of 4.6 years (February 5, 2003 through October 14, 2011), there were 975 incident cases of sepsis. Incident sepsis episodes were associated with older age (p<0.001), white race (HR 1.39; 95% CI: 1.22-1.59), lower education (p<0.001) and income (p<0.001), tobacco use (p<0.001), and alcohol use (p = 0.02). Incident sepsis episodes were associated with baseline chronic lung disease (adjusted HR 2.43; 95% CI: 2.05-2.86), peripheral artery disease (2.16; 1.58-2.95), chronic kidney disease (1.99; 1.73-2.29), myocardial infarction 1.79 (1.49-2.15), diabetes 1.78 (1.53-2.07), stroke 1.67 (1.34-2.07), deep vein thrombosis 1.63 (1.29-2.06), coronary artery disease 1.61 (1.38-1.87), hypertension 1.49 (1.29-1.74), atrial fibrillation 1.48 (1.21-1.81) and dyslipidemia 1.16 (1.01-1.34). Sepsis risk increased with the number of chronic medical conditions (p<0.001).
Individuals with chronic medical conditions are at increased risk of future sepsis events.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
OBJECTIVES:The emergency department is an important venue for initial sepsis recognition and care. We sought to determine contemporary estimates of the epidemiology of U.S. emergency department ...visits for sepsis.
DESIGN:Analysis of data from the National Hospital Ambulatory Medical Care Survey.
SETTING:U.S. emergency department visits, 2009–2011.
PATIENTS:Adult (age, ≥ 18 yr) emergency department sepsis patients. We defined serious infection as an emergency department diagnosis of a serious infection or a triage temperature greater than 38°C or less than 36°C. We defined three emergency department sepsis classifications1) original emergency department sepsis—serious infection plus emergency department diagnosis of organ dysfunction, endotracheal intubation, or systolic blood pressure less than or equal to 90 mm Hg or explicit sepsis emergency department diagnoses; 2) quick Sequential Organ Failure Assessment emergency department sepsis—serious infection plus presence of at least two “quick” Sequential Organ Failure Assessment criteria (Glasgow Coma Scale ≤ 14, respiratory rate ≥ 22 breaths/min, or systolic blood pressure ≤ 100 mm Hg); and 3) revised emergency department sepsis—original or quick Sequential Organ Failure Assessment emergency department sepsis.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:We used survey design and weighting variables to produce national estimates of annual adult emergency department visits using updated sepsis classifications. Over 2009–2011, there were 103,257,516 annual adult emergency department visits. The estimated number of emergency department sepsis visits were as follows1) original emergency department sepsis 665,319 (0.64%; 95% CI, 0.57–0.73); 2) quick Sequential Organ Failure Assessment emergency department sepsis 318,832 (0.31%; 95% CI, 0.26–0.37); and 3) revised emergency department sepsis 847,868 (0.82%; 95% CI, 0.74–0.91).
CONCLUSIONS:Sepsis continues to present a major burden to U.S. emergency departments, affecting up to nearly 850,000 emergency department visits annually. Updated sepsis classifications may impact national estimates of emergency department sepsis epidemiology.
The objective of this study was to determine the incidence of acute kidney injury (AKI) and its relation with mortality among hospitalized patients.
Analysis of hospital discharge and laboratory data ...from an urban academic medical center over a 1-year period. We included hospitalized adult patients receiving two or more serum creatinine (sCr) measurements. We excluded prisoners, psychiatry, labor and delivery, and transferred patients, 'bedded outpatients' as well as individuals with a history of kidney transplant or chronic dialysis. We defined AKI as (a) an increase in sCr of ≥0.3 mg/dl; (b) an increase in sCr to ≥150% of baseline, or (c) the initiation of dialysis in a patient with no known history of prior dialysis. We identified factors associated with AKI as well as the relationships between AKI and in-hospital mortality.
Among the 19,249 hospitalizations included in the analysis, the incidence of AKI was 22.7%. Older persons, Blacks, and patients with reduced baseline kidney function were more likely to develop AKI (all p < 0.001). Among AKI cases, the most common primary admitting diagnosis groups were circulatory diseases (25.4%) and infection (16.4%). After adjustment for age, sex, race, admitting sCr concentration, and the severity of illness index, AKI was independently associated with in-hospital mortality (adjusted odds ratio 4.43, 95% confidence interval 3.68-5.35).
AKI occurred in over 1 of 5 hospitalizations and was associated with a more than fourfold increased likelihood of death. These observations highlight the importance of AKI recognition as well as the association of AKI with mortality in hospitalized patients.
Patient with Blurred Vision Lin, Leon; Tourkow, Benjamin; Wang, Henry E.
Annals of emergency medicine,
September 2022, 2022-09-00, 20220901, Volume:
80, Issue:
3
Journal Article
Peer reviewed
Open access
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Summary Background The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) present clinical criteria for the classification of patients with sepsis. We investigated ...incidence and long-term outcomes of patients diagnosed with these classifications, which are currently unknown. Methods We did a retrospective analysis using data from 30 239 participants from the USA who were aged at least 45 years and enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. Patients were enrolled between Jan 25, 2003, and Oct 30, 2007, and we identified hospital admissions from Feb 5, 2003, to Dec 31, 2012, and applied three classifications: infection and systemic inflammatory response syndrome (SIRS) criteria, elevated sepsis-related organ failure assessment (SOFA) score from Sepsis-3, and elevated quick SOFA (qSOFA) score from Sepsis-3. We estimated incidence during the study period, in-hospital mortality, and 1-year mortality. Findings Of 2593 first infection events, 1526 met SIRS criteria, 1080 met SOFA criteria, and 378 met qSOFA criteria. Incidence was 8·2 events (95% CI 7·8–8·7) per 1000 person-years for SIRS, 5·8 events (5·4–6·1) per 1000 person-years for SOFA, and 2·0 events (1·8–2·2) per 1000 person-years for qSOFA. In-hospital mortality was higher for patients with an elevated qSOFA score (67 23% of 295 patients died) than for those with an elevated SOFA score (125 13% of 960 patients died) or who met SIRS criteria (128 9% of 1392 patients died). Mortality at 1 year after discharge was also highest for patients with an elevated qSOFA score (29·4 deaths 95% CI 22·3–38·7 per 100 person-years) compared with those with an elevated SOFA score (22·6 deaths 19·2–26·6 per 100 person-years) or those who met SIRS criteria (14·7 deaths 12·5–17·2 per 100 person-years). Interpretation SIRS, SOFA, and qSOFA classifications identified different incidences and mortality. Our findings support the use of the SOFA and qSOFA classifications to identify patients with infection who are at elevated risk of poor outcomes. These classifications could be used in future epidemiological assessments and studies of patients with infection. Funding National Institute for Nursing Research, National Center for Research Resources, and National Institute of Neurological Disorders and Stroke.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Abstract Background Optimal out of hospital cardiac arrest (OHCA) airway management strategies remain unclear. We compared OHCA outcomes between patients receiving endotracheal intubation (ETI) ...versus supraglottic airway (SGA), and between patients receiving ETI or SGA and those receiving no advanced airway. Methods We studied adult OHCA in the Cardiac Arrest Registry to Enhance Survival (CARES). Primary exposures were ETI, SGA, or no advanced prehospital airway placed. Primary outcomes were sustained ROSC, survival to hospital admission, survival to hospital discharge, and neurologically-intact survival to hospital discharge (cerebral performance category 1–2). Propensity scores characterized the probability of receiving ETI, SGA, or no advanced airway. We adjusted for Utstein confounders. Multivariable random effects regression accounted for clustering by EMS agency. We compared outcomes between (1) ETI vs. SGA, and (2) no advanced airway vs. ETI or SGA. Results Of 10,691 OHCA, 5591 received ETI, 3110 SGA, and 1929 had no advanced airway. Unadjusted neurologically-intact survival was: ETI 5.4%, SGA 5.2%, no advanced airway 18.6%. Compared with SGA, ETI achieved higher sustained ROSC (OR 1.35; 95%CI 1.19–1.54), survival to hospital admission (1.36; 1.19–1.55), hospital survival (1.41; 1.14–1.76) and hospital discharge with good neurologic outcome (1.44; 1.10–1.88). Compared with ETI or SGA, patients receiving no advanced airway attained higher survival to hospital admission (1.31; 1.16–1.49), hospital survival (2.96; 2.50–3.51) and hospital discharge with good neurologic outcome (4.24; 3.46–5.20). Conclusion In CARES, survival was higher among OHCA receiving ETI than those receiving SGA, and for patients who received no advanced airway than those receiving ETI or SGA.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
How neuron types encode behavioral states
What is the contribution of molecularly defined cell types to neural coding of stimuli and states? Xu
et al.
aimed to evaluate neural representation of ...multiple behavioral states in the mouse paraventricular hypothalamus. To achieve this goal, they combined deep-brain two-photon imaging with post hoc validation of gene expression in the imaged cells. The behavioral states could be well predicted by the neural response of multiple neuronal clusters. Some clusters were broadly tuned and contributed strongly to the decoding of multiple behavioral states, whereas others were more specifically tuned to certain behaviors or specific time windows of a behavioral state.
Science
, this issue p.
eabb2494
An imaging method can merge molecular and systems neuroscience to reveal combinatorial cell type coding of essential survival behaviors.
INTRODUCTION
Brain function is often compared to an orchestral ensemble, where subgroups of neurons that have similar activity are analogous to different types of instruments playing a musical score. Brains are composed of specialized neuronal subtypes that can be efficiently classified by gene expression profiles measured by single-cell RNA sequencing (scRNA-seq). Are these molecularly defined cell types the “instruments” in the neural ensemble? To address this question, we examined the neural ensemble dynamics of the hypothalamic paraventricular nucleus (PVH), a small brain region that is important for behavior states such as hunger, thirst, and stress. Past work has emphasized specialized behavioral state–setting roles for different PVH cell types, but it is not clear whether the dynamics of the PVH ensemble support this view.
RATIONALE
We considered three possibilities for how PVH neurons could be involved in encoding behavioral states: (i) PVH neurons of a molecularly defined cell type may respond similarly and be specialized for a behavioral state as a “labeled-line,” (ii) molecularly defined cell types may show unrelated activity patterns and be irrelevant to behavioral state coding, and (iii) molecularly defined neurons may respond similarly within a type, but behavioral state may be encoded by combinations of cell types. To evaluate the role of molecularly defined cell types in the neural ensemble, it is important to monitor activity in many individual neurons with subsecond temporal resolution along with quantitative gene expression information about each cell. For this, we developed the CaRMA (calcium and RNA multiplexed activity) imaging platform in which deep-brain two-photon calcium imaging of neuron activity is performed in mice during multiple behavioral tasks. This is followed by ex vivo multiplexed RNA fluorescent in situ hybridization to measure gene expression information in the in vivo–imaged neurons.
RESULTS
We simultaneously imaged calcium activity in hundreds of PVH neurons from 10 cell types across 11 behavioral states. Within a molecularly defined cell type, neurons often showed similar activity patterns such that we could predict functional responses of individual neurons solely from their quantitative gene expression information. Behavioral states could be decoded with high accuracy based on combinatorial assemblies of PVH cell types, which we called “grouped-ensemble coding.” Labeled-line coding was not observed. The neuromodulatory receptor gene
neuropeptide receptor neuropeptide Y receptor type 1
(
Npy1r
) was usually the most predictive gene for neuron functional response and was expressed in multiple cell types, analogous to the “conductor” of the PVH neural ensemble.
CONCLUSION
Our results validated molecularly defined neurons as important information processing units in the PVH. We found correspondence between the gene expression hierarchies used for molecularly defined cell type classification and functional activity hierarchies involving coordination by neuromodulation. CaRMA imaging offers a solution to the problem of how to rapidly evaluate the function of the panoply of cell types being uncovered with scRNA-seq. CaRMA imaging bridges a gap between the abstract digital elements typically described in systems neuroscience with the “wetware” associated with traditional molecular neuroscience. Merging these two areas is essential to understanding the relationships of gene expression, brain function, behavior, and ultimately neurological diseases.
CaRMA imaging reveals combinatorial cell type coding of behavior states.
CaRMA imaging records calcium dynamics of PVH neurons across multiple behavioral states followed by gene expression profiling. Combinatorial assemblies of PVH cell types encoded behavioral states. The PVH neural activity ensemble was split by Npy1r expression into two main cell classes that were subdivided into cell types. Thus, neuromodulation coordinates cell types for grouped-ensemble coding to represent different survival behaviors such as eating, drinking, and stress.
Brains encode behaviors using neurons amenable to systematic classification by gene expression. The contribution of molecular identity to neural coding is not understood because of the challenges involved with measuring neural dynamics and molecular information from the same cells. We developed CaRMA (calcium and RNA multiplexed activity) imaging based on recording in vivo single-neuron calcium dynamics followed by gene expression analysis. We simultaneously monitored activity in hundreds of neurons in mouse paraventricular hypothalamus (PVH). Combinations of cell-type marker genes had predictive power for neuronal responses across 11 behavioral states. The PVH uses combinatorial assemblies of molecularly defined neuron populations for grouped-ensemble coding of survival behaviors. The neuropeptide receptor neuropeptide Y receptor type 1 (Npy1r) amalgamated multiple cell types with similar responses. Our results show that molecularly defined neurons are important processing units for brain function.
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