Objective To understand the epidemic status of Kala azar in Gannan of Gansu Province and to provide a scientific basis for making effective control measures.Methods The epidemic monitoring data of Gannan Kala azar from the infectious disease network direct reporting system and the Gannan County Center for Disease Prevention and Control was collected, descriptive epidemiological method was used to analyze the distribution of Kala azar.Results From 2005 to 2014, a total of 285 Kala azar cases were reported, the incidence rate was 4.21/one hundred thousand (285/6 764 645).The incidence rate in 2005 was the lowest (1.97/one hundred thousand, 13/658 961), in 2011 was the highest (6.39/one hundred thousand, 44/689 104).The cases mainly distributed in the Bailongjiang Valley in Zhouqu County (14.97/one hundred thousand, 200/1 336 150) and Diebu County (14.29/one hundred thousand, 76/531 915).Gannan had reported the cases of Kala azar all year round, and the cases were sporadically distributed.The time of the disease mainly occurred from May to August.The incidence rate in male (58.60％, 167/285), children under 5 years old (43.86％, 125/285) and farmers and herdsmen (25.26％,72/285) accounted for the major parts.In addition to Luqu County and Xiahe County, other counties had cases of imported Kala azar.Conclusion Kala azar in Gannan is happened sporadically year round.Long-term mechanism need to be established;investment funding should be ensured;the monitoring of the epidemic should be strengthened;the epidemic situation of Kala azar should be timely reported in order to effectively prevent and control the epidemic of Kala azar in Gansu.

Objective To investigate the possible roles of hemodynamics, circulating hormones, cell cation transport and cyclic nucleotides in left ventricular hypertrophy (LVH) of essential hypertension (EH) in vivo. Methods Blood pressure, total peripheral resistance (TPR) and plasma norepinephrine (NE), endothelin (ET), angiotensin Ⅱ (AngⅡ), endogenous digitalis like substances (EDLS) and atrial natriuretic peptide (ANP) were determined, along with the measurements of lymphocytic membrane ion pumps, cations and cyclic nucleotides in 45 EH patients with LVH (12 concentric hypertrophy, 33 eccentric hypertrophy), 30 normal subjects and 45 EH patients without LVH (as double concurrent controls). Multiple stepwise regression analysis was computed using left ventricular mass index (LVMI) as dependent variable and 22 parameters as independent variables. Results (1) In EH patients with LVH, increases were seen in systolic blood pressure, mean arterial pressure (MAP) and NE, ET, AngⅡ, EDLS and ANP as well as lymphocytic Na +, Ca 2+ , cAMP and cAMP/cGMP ratio, while Na + K + ATPase and Ca 2+ ATPase activities, K + and Mg 2+ decreased. (2) Five hormones were related respectively to ion pumps, Na +, Ca 2+ and cyclic nucleotides. (3) LVMI were correlated with NE, ET, AngⅡ and EDLS, Ca 2+ ATPase, Na +, cAMP and cAMP/cGMP ratio. (4) The regression equation revealed that NE, ET, Ca 2+ ATPase, Mg 2+ and cAMP were the independent factors affecting LVH. (5) TPR and AngⅡ were higher, K + was lower in concentric LVH than those in eccentric LVH. Conclusion The changes of hemodynamics, circulating hormones, cell cation transport and cyclic nucleotides, or their interaction may be involved in the pathogenesis of LVH in EH. NE, ET. Ca 2+ ATPase, Mg 2+ and cAMP seem to play more important parts in LVH . TPR , whereas AngⅡ and K + may relate to cocentric LVH.

OBJECTIVETo study the excision repair capacity of human 8-oxoguanine DNA N-glycosylase 1 (hOGG1) for 8-OH-dG and the oxidative DNA damage among workers exposed to nickel in stainless steel production environment.

METHODSA total of 231 workers exposed to nickel in a stainless steel production enterprise were recruited as nickel exposure group, and another 75 water pump workers in that enterprise were recruited as control group. The workplace occupational hazard factors were determined. Double-antigen sandwich ELISA was used to determine urinary 8-OH-dG level; RT-PCR was used to determine hOGG1 mRNA level. Pearson correlation was used to analyze the correlation between urinary 8-OH-dG level and hOGG1 mRNA level.

RESULTSLevel of 8-OH-dG was compared between different types of nickel-exposed workers and control workers; rolling mill workers showed no significant difference from the control group (P > 0.05), while steel making workers and steel slag disposing workers showed significant differences from the control group (P < 0.05). Level of 8-OH-dG was also compared between nickel-exposed workers with different working years and control workers; nickel-exposed workers with 0∼5 and 6∼10 working years showed no significant differences from the control group (P > 0.05), while other exposed workers showed significant differences from the control group (P < 0.05). Different types of nickel-exposed workers all showed significant differences from the control group in hOGG1 mRNA level (P < 0.05). Nickel-exposed workers with 0∼5 working years showed no significant difference from the control group in hOGG1 mRNA level (P > 0.05), while other exposed workers showed significant differences from the control group (P < 0.05). Pearson correlation analysis showed that urinary 8-OH-dG level was positively correlated with hOGG1 mRNA level (r = 0.993) in different types of nickel-exposed workers, and the correlation was significant at α = 0.01 (P < 0.05); urinary 8-OH-dG level also showed a positive correlation with hOGG1 mRNA level in nickel-exposed workers with different working years (r = 0.968), and the correlation was significant at α = 0.01 (P < 0.05).

CONCLUSIONExposure to nickel increases oxidative DNA damage among steel workers, and hOGG1 shows active excision repair capacity for 8-OH-dG.

Adult ; DNA Damage ; DNA Glycosylases ; metabolism ; DNA Repair ; Humans ; Male ; Metallurgy ; Middle Aged ; Nickel ; adverse effects ; Occupational Exposure ; adverse effects ; Stainless Steel ; Young Adult

Objective:To investigate the clinical value of nutritional indexes including body mass index (BMI), albumin (ALB), nutrition risk screening 2002 (NRS 2002) and the nutrition risk in critically ill score (NUTRIC) in 28-day prognosis of patients with sepsis related acute kidney injury (AKI).Methods:A prospective cohort study was conducted. Patients with sepsis treated in the emergency intensive care unit (EICU) of China Rehabilitation Research Center from December 1, 2018 to December 1, 2020 were observed for 7 days. Patients with sepsis related AKI were enrolled in this study. The gender, age, BMI, basic diseases, shock, number of affected organs, length of hospital stay, ALB, mechanical ventilation (MV) and vasoactive drug use, sequential organ failure score (SOFA), rapid sequential organ failure score (qSOFA) and acute physiology and chronic health evaluationⅡ(APACHEⅡ) were recorded. The NRS 2002 score and NUTRIC score were calculated. Cox regression model was used to analyze the risk factors of 28-day mortality in patients with sepsis related AKI. The receiver operator characteristic curves (ROC curves) were drawn and the areas under the ROC curves (AUC) were calculated, and the value of BMI, ALB, NRS 2002 score and NUTRIC score was analyzed to predict 28-day mortality in patients with sepsis related AKI. Kaplan Meier survival curves were used to analyze the effects of NRS 2002 score and NUTRIC score stratification on the 28 day prognosis of patients with sepsis related AKI.Results:A total of 140 patients with sepsis related AKI were enrolled, including 73 survival patients and 67 died patients within 28 days. The 28-day mortality was 47.9% (67/140). BMI in the survival group was significantly higher than that in the death group [kg/m 2: 22.0 (19.5, 25.6) vs. 20.7 (17.3, 23.9), P < 0.05], and NRS 2002 score and NUTRIC score were significantly lower than those in the death group [NRS 2002 score: 5 (4, 6) vs. 7 (6, 7), NUTRIC score: 6 (5, 7) vs. 7 (6, 9), both P < 0.05]. The ALB of the survival group was slightly higher than that of the death group, but the difference was not statistically significant. Cox regression analysis showed that NRS 2002 score and NUTRIC score were independent risk factors for 28-day death in patients with sepsis related AKI. ROC curve analysis showed that NUTRIC score had the strongest predictive ability for 28-day death [AUC = 0.785, 95% confidence interval (95% CI) was 0.708-0.850], followed by NRS 2002 score (AUC = 0.728, 95% CI was 0.647-0.800), but there was no significant difference between them. Compared with NRS 2002 score, the predictive ability of BMI and ALB was poor. Kaplan-Meier curve analysis showed that the prognosis of patients with NRS 2002 score≥5 was significantly worse than that of patients with NRS 2002 score < 5 (28-day cumulative survival rate: 42.1% vs. 75.6%, Log-Rank test: 2 = 11.884, P = 0.001), and the prognosis of patients with NUTRIC score≥6 was significantly worse than that of patients with NUTRIC score < 6 (28-day cumulative survival rate: 40.4% vs. 86.1%, Log-Rank test: 2 = 19.026, P = 0.000). Conclusions:Patients with sepsis related AKI have high nutritional risk. Both NRS 2002 score and NUTRIC score have good predictive value for the prognosis of patients with sepsis related AKI, while BMI and ALB have low predictive value. Due to the complex calculation of NUTRIC score, NRS 2002 score may be more suitable for emergency department.

Objective:To investigate the predictive value of mid-regional proadrenomedullin (MR-proADM) on poor prognosis of low-risk patients with sepsis.Methods:This was a prospective cohort study. Patients with sepsis admitted to the Emergency Intensive Care Unit of China Rehabilitation Research Center from December 2018 to December 2020 were included in this study. The patients were divided into the low-risk group (SOFA≤7) and medium-high-risk group (SOFA>7) according to the sequential organ failure assessment (SOFA) score, and the clinical characteristics of the two groups were compared. Proportional hazards regression model (COX regression model) was used to investigate the risk factors of 28-day mortality in the low-risk and medium-high-risk group. The predictive ability of MR-proADM, C-reactive protein (CRP), lactic acid (Lac), interleukin-6 (IL-6), SOFA score, and acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) score for the prognosis in each group was evaluated by receiver operating characteristic (ROC) curve. The outcomes of patients with different concentration of MR-proADM in the low-risk group were compared.Results:Totally 205 patients with sepsis were included, and the 28-day mortality was 41.0% (84/205). There were significant differences in the number of organ dysfunction, acute kidney injury, use of vasoactive drugs, Lac, IL-6, SOFA score and APACHEⅡ score between the two groups ( P<0.05). Cox regression model showed that age, MR-proADM, mechanical ventilation, IL-6 and APACHEⅡ score were the risk factors of 28-day death in the low-risk group, while MR-proADM, Lac, SOFA score and APACHEⅡ score were the risk factors of 28-day mortality in the medium-high-risk group. In each group, MR-proADM had a good predictive ability for the prognosis of patients with sepsis ( P<0.001). Especially in low-risk patients with sepsis, the predictive ability of MR-proADM was better than other indicators. Kaplan-Meier survival curve suggested that the patients with MR-proADM >2.53 nmol/L had worse prognosis than those with MR-proADM ≤2.53 nmol/L, and the difference was statistically significant ( P<0.001). In the low-risk group, the mortality of patients increased from 7.8% to 58.2% if MR-proADM >2.53 nmol/L. Conclusions:MR-proADM is a risk factor for 28-day mortality in patients with sepsis, and MR-proADM can early identify the poor prognosis of low-risk patients with sepsis.

Objective:To establish a clinical diagnostic scoring system for septic cardiomyopathy (SCM) and evaluate its diagnostic efficacy.Methods:A prospective cohort study was performed. Patients with sepsis and septic shock admitted to the department of emergency of China Rehabilitation Research Center were enrolled from January 2019 to December 2020. The baseline information, medical history, heart rate (HR), mean arterial pressure (MAP), body temperature and respiratory rate (RR) on admission were recorded. Laboratory indexes such as white blood cell count (WBC), hypersensitivity C-reactive protein (hs-CRP), N-terminal pro-brain natriuretic peptide (NT-proBNP), and blood lactic acid (Lac) were measured. Transthoracic echocardiography was conducted within 24 hours and on the 7th after admission. Sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluationⅡ(APACHEⅡ), and nutritional risk screening 2002 scale (NRS2002) were also assessed. The patients were divided into two groups according to whether SCM occurred or not. The risk factors of SCM were screened by univariate and multivariate Logistic regression. The cut-off value of continuous index was determined by receiver operator characteristic curve (ROC curve) and discretized concerning clinical data. The regression coefficient β was used to establish the corresponding score, and the clinical diagnostic score system of SCM was established. The diagnostic value of the model was evaluated by ROC curve.Results:In total, 147 patients were enrolled in the study and the incidence of SCM was 28.6% (42/147). Univariate Logistic regression analysis showed the risk factors of SCM included: ① continuous indicators: age, NT-proBNP, RR, MAP, Lac, NRS2002, SOFA, APACHEⅡ; ② discrete indicators: shock, use of vasoactive drugs, history of coronary heart disease, acute kidney injury (AKI). Multivariate Logistic regression analysis after discretization of above continuous index showed that age≥87 years old, NT-proBNP≥3 000 ng/L, RR≥30 times/min, Lac≥3 mmol/L and SOFA≥10 points were independent risk factors for SCM [age ≥87 years: odds ratio ( OR) = 3.491, 95% confidence interval (95% CI) was 1.371-8.893, P = 0.009; NT-proBNP≥3 000 ng/L: OR = 2.708, 95% CI was 1.093-6.711, P = 0.031; RR≥30 times/min: OR = 3.404, 95% CI was 1.356-8.541, P = 0.009; Lac≥3 mmol/L: OR = 3.572, 95% CI was 1.460-8.739, P = 0.005; SOFA≥10 points: OR = 8.693, 95% CI was 2.541-29.742, P = 0.001]. The clinical diagnostic score system of SCM was established successfully, which was composed of age≥87 years old (1 point), NT-proBNP ≥ 3 000 ng/L(1 point), RR≥30 times/min (1 point), Lac≥3.0 mmol/L (1 point), SOFA≥10 points (2 points), and the total score was 6 points. ROC curve analysis showed the cut-off value of the scoring system for diagnosing SCM was 3 points, the area under ROC curve (AUC) was 0.833, 95% CI was 0.755-0.910, P < 0.001, with the sensitivity of 71.4%, and specificity of 86.7%. Conclusion:The clinical diagnostic scoring system has good diagnostic efficacy for SCM and contributes to early identification of SCM for clinicians.

Objective:To observe the changes of serum histone H4 level and its predictive value in patients with septic cardiomyopathy.Methods:A prospective study was conducted. A total of 147 patients with sepsis and septic shock were collected in emergency department. The general data were recorded. Transthoracic echocardiography and plasma histone H4 were conducted within 24 hours and 7 days after admission.The scores of sequential organ failure assessment(SOFA), acute physiology and chronic health evaluationⅡ(APACHEⅡ), and nutritional risk screening 2002 (NRS2002) were evaluated within 24 hours. According to whether septic cardiomyopathy occurred, the patients were divided into two groups, and dynamic changes of histone H4 on the first and seventh day of the two groups were observed. The factors influencing the occurrence of septic cardiomyopathy were analyzed by multivariate logistic regression. The prediction ability of serum histone H4 on septic cardiomyopathy was evaluated by receiver operating curve (ROC).Results:The incidence of septic cardiomyopathy was 28.6% (42 / 147). The level of histone H4 in septic cardiomyopathy group was higher than that in non septic cardiomyopathy group ( Z = 4.449, P < 0.001), and dynamic detection showed that the level of histone H4 on the seventh day was lower than that on admission ( Z=3.057, P=0.002). Multivariate logistic regression showed that the high serum histone H4 level [Odd Ratio( OR)=1.337, 95% confidence interval (95% CI) was 1.173-1.522, P < 0.001], SOFA ( OR= 1.474, 95% CI 1.227-1.769, P < 0.001), older age ( OR = 1.074, 95% CI 1.019-1.132, P = 0.008) were independent risk factors for septic cardiomyopathy. The area of ROC curve for serum histone H4 to predict septic cardiomyopathy was 0.729 ( P < 0.001), the predictive cut-off value was 10.81 ng/ml, which yielded a sensitivity 0.524 and a specificity of 0.914. Conclusions:The level of histone H4 showed dynamic change in septic cardiomyopathy, and high serum histone H4 level has a good predictive value for the occurrence of septic cardiomyopathy.

Objective:To investigate the correlation between the level of serum 25-hydroxyvitamin D [25(OH)D] and infarction volume in patients with acute ischemic stroke (AIS) with internal carotid artery system (anterior circulation).Methods:A prospective cohort study was conducted. Patients with AIS admitted to the department of emergency of Beijing Boai Hospital from October 2017 to September 2019 were enrolled. Nutritional risk screening 2002 (NRS 2002) were assessed in all cases within 24 hours after enrollment. Fasting venous blood was collected for biochemical analysis, including albumin (ALB), homocysteine (HCY), uric acid (UA), hypersensitive C-reactive protein (hs-CRP), etc. Serum 25(OH)D level was detected by electrochemiluminescence immunoassay. Magnetic resonance imaging (MRI) was performed to calculate the volume of cerebral infarction. According to the volume of cerebral infarction, the patients were divided into small volume (≤ 1 cm 3) group, medium volume (1 cm 3 < infarct volume < 20 cm 3) group and large volume (≥20 cm 3) group. The differences of serum 25(OH)D and other indicators in each group were compared; the influencing factors of infarct volume were analyzed by Logistic regression; and the goodness of fit of regression model was tested by Hosmer-Lemeshow (HL). Results:A total of 224 patients with AIS were enrolled, 92 in small volume group, 90 in medium volume group and 42 in large volume group, and there was no significant difference in serum 25(OH)D level among small, medium and large volume groups [μg/L: 13.21 (7.47, 19.33), 11.20 (7.00, 15.07), 9.19 (6.30, 17.10), H = 4.994, P = 0.082]. There were 124 patients with AIS in anterior circulation, 45, 56 and 23 patients in the small, medium and large volume groups, respectively, with the increase of the cerebral infarction volume, the serum 25(OH)D level in small, medium and large volume groups decreased gradually, and the difference was statistically significant [μg/L: 13.22 (9.00, 19.65), 10.41 (6.72, 14.92), 8.30 (4.70, 11.30), H = 11.068, P = 0.004]. In addition, with the increase of the cerebral infarction volume, the older the patients with AIS in anterior circulation [years old: 63.0 (54.0, 75.5), 76.0 (63.0, 84.0), 82.0 (67.5, 85.0), H = 14.981, P = 0.001], the higher the nutritional risk ratio (35.6%, 53.6%, 73.9%, χ2 = 9.271, P = 0.010), the higher the serum hs-CRP level [mg/L: 1.91 (0.92, 3.40), 4.10 (1.73, 22.42), 19.74 (4.02, 68.81), H = 21.477, P < 0.001], and the lower the ALB level (g/L: 42.30±12, 38.11±5.06, 35.14±5.49, F = 19.347, P < 0.001). After adjusting for age, gender, atrial fibrillation, nutritional risk, hs-CRP and other confounding factors, serum 25(OH)D was an independent protective factor for the infarct volume of AIS in anterior circulation [odds ratio ( OR) = 0.962, P = 0.040], For every 10 μg/L decrease of 25(OH)D, the risk of one grade increase in infarction volume was increased by 47.7% respectively (goodness of fit: χ2 = 5.357, P = 0.719). Conclusion:The low serum 25(OH)D level was associated with the increase of infarct volume in the anterior circulation cerebral infarction, and early detection of serum 25(OH)D level can help risk stratification of AIS patients.

Objective:To explore the association of Vitamin D (Vit D) nutritional status and prognosis in elderly patients in emergency care settings.Methods:The clinical data of 317 elderly patients admitted in the Emergency Care Unit and Emergency Observation Ward of Beijing Bo'Ai hospital from January 2021 to September 2021 were collected continuously. Blood routine, biochemical indicators, serum interleukin-6 (IL-6), thyroid-stimulating hornone (TSH), cortisol (COR) and 25-hydroxyvitamin D [25(OH)D] levels were detected within 24 hours after enrollment. Patients were divided into severe vitamin D deficiency group and non-severe vitamin D deficiency group according to the level of serum 25(OH)D. Patients were followed up for the treatment with machinery ventilation during hospitalization and 28-day all-cause mortality. Multivariable logistic regression model was used to analyze the association between the Vit D nutritional status and machinery ventilation. In order to evaluate the predictive ability of serum 25(OH)D for the requirement of machinery ventilation, the receiver operating characteristic (ROC) curve was applied and the area under the ROC curve (95% confidence interval) [AUC (95% CI)] was calculated. Cox proportional hazards regression model was used to analyze the association between Vit D nutritional status and 28-day all-cause mortality. Results:Serum 25(OH) level in the machinery ventilation group was significantly lower than that in the non-mechanical ventilation group ( Z = 5.150, P < 0.001). Multivariable logistic regression analysis showed that severe Vit D deficiency ( OR = 7.223, 95% CI: 1.546-33.742, P = 0.012) was independently associated with machinery ventilation. The AUC (95% CI) of serum 25(OH)D for predicting machinery ventilation was 0.825 (0.770-0.871) ( P < 0.001), the predictive cut-off point was 11.0 μg/L, and the Youden index was 0.580, yielding a sensitivity of 0.903 and a specificity of 0.677. Cox regression analysis showed that severe Vit D deficiency ( HR = 2.403, 95% CI: 1.133-5.096, P = 0.022) was an independent predictor of 28-day all-cause mortality in elderly emergency patients. Conclusions:Serum 25(OH)D can be used as an independent predictor of short-term prognosis in elderly emergency patients.

Objective:To explore the association of frailty and serum C-terminal agrin fragment(CAF)with the prognosis of elderly patients with acute coronary syndrome(ACS).Methods:In this prospective cohort study, clinical data of 207 older patients with ACS between January 2020 and May 2022 were collected.Serum samples were obtained within 24 hours after enrollment to detect CAF levels.Meanwhile, the thrombolysis in myocardial infarction(TIMI)and frailty screening questionnaire(FSQ)scores were assessed on admission.Patients were followed up for major adverse cardiovascular and cerebrovascular events(MACCE)for 90 days.Multivariate logistic regression was used to analyze the influencing factors of MACCE.The receiver operating characteristic(ROC)curve was performed to evaluate the predictive ability of the FSQ score, serum CAF and their combination for MACCE.According to 90-day mortality, patients were divided into a survival group(n=176)and a death group(n=31). The Cox proportional hazards regression model was used for survival analysis.Results:The FSQ score( Z=4.412, P<0.001)and serum CAF( Z=6.702, P<0.001)in the MACCE group were higher than those in the non-MACCE group.Logistic regression analysis showed that after adjusting for age, sex, TIMI score and complete revascularization, frailty defined by FSQ( OR=1.714; 95% CI: 1.059-2.775; P=0.028)and high serum CAF( OR=1.230; 95% CI: 1.122-1.350; P<0.05)were independent risk factors for MACCE.The area under the ROC curve(AUC)of the FSQ score for predicting MACCE was 0.797(95% CI: 0.735-0.850; P<0.001), the predictive cut-off point was an FSQ score >2, and the Youden index(YI)was 0.419, yielding a sensitivity of 0.708 and a specificity of 0.711.In addition, the AUC of serum CAF for predicting MACCE was 0.766(95% CI: 0.701-0.822; P<0.001), the predictive cut-off point was >6.01 μg/L, and YI was 0.460, yielding a sensitivity of 0.750 and a specificity of 0.710.The predictive ability of FSQ combined with CAF for MACCE was higher than FSQ( Z=2.294, P=0.022)or CAF( Z=2.545, P=0.011)alone.Cox regression analysis showed that frailty defined by FSQ( HR=3.487; 95% CI: 1.329-9.153; P=0.011)was independently associated with all-cause mortality within 90 days after ACS. Conclusions:Frailty assessment and serum CAF detection can improve the risk stratification of elderly patients with ACS.