Objective:To investigate the association between exposure to major air pollutants (including PM 2.5, PM 10, NO 2, SO 2, O 3 and CO) and 28-day all-cause mortality in patients admitted to the intensive care unit (ICU). Methods:The electronic medical records of critically ill patients admitted to the ICU in Hubei Province General Hospital and Jingzhou Central Hospital were collected from August 2018 to August 2019 and from May 2021 to May 2022. Patients' exposure to air pollutants was assessed based on the average concentrations at their place of residence during the previous two months. A generalized linear regression model was used to estimate the association between air pollutant exposure and 28-day all-cause mortality in critically ill patients. Subgroup analysis was then conducted to examine the impact of individual air pollutant exposure on 28-day mortality, which served as the primary outcome in this study. The effect size and confidence interval were adjusted for patient characteristics including age, gender, smoking or drinking habits, length of hospital stay, and SOFA score. Additionally, mediation analysis was conducted using the mediation package (Bruce R) in R software. The direct effect represented the association between exposure to air pollutants and risk of mortality, while the indirect effect aimed to assess whether neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and monocyte- lymphocyte ratio (MLR) served as mediating variables in the correlation between exposure to air pollutants and mortality risk.Results:The study included a total of 3 772 critically ill patients admitted to the ICU, with a 28-day all-cause mortality rate of 40.0% (1 509/3 772). A significant positive correlation was observed between an incremental increase of 1 μg/m 3 in air pollutants (specifically PM 2.5, NO 2 and CO) and an elevated risk of mortality within 28 days among critically ill patients. Conversely, there is an inverse relationship between O 3 levels and mortality risk. Additionally, male gender and SOFA rating >3 scores were identified as independent risk factors for all-cause mortality in ICU patients exposed to NO 2 or CO. The Neutrophil/lymphocyte ratio (NLR) played a mediating role in the correlation between PM 2.5 or CO exposure and mortality risk, accounting for 9.09% or 4.71% of the correlations, respectively. Conclusions:The exposure to air pollutants (PM 2.5, NO 2, CO) significantly associate with a high risk of 28-day all-cause mortality in ICU patients. Even at low levels of air pollution, NO 2, CO remains positively correlate with the mortality risk in critically ill patients, who belong to a vulnerable population.

Bacteremia induced by periodontal infection is an important factor for periodontitis to threaten general health. P. gingivalis DNA/virulence factors have been found in the brain tissues from patients with Alzheimer's disease (AD). The blood-brain barrier (BBB) is essential for keeping toxic substances from entering brain tissues. However, the effect of P. gingivalis bacteremia on BBB permeability and its underlying mechanism remains unclear. In the present study, rats were injected by tail vein with P. gingivalis three times a week for eight weeks to induce bacteremia. An in vitro BBB model infected with P. gingivalis was also established. We found that the infiltration of Evans blue dye and Albumin protein deposition in the rat brain tissues were increased in the rat brain tissues with P. gingivalis bacteremia and P. gingivalis could pass through the in vitro BBB model. Caveolae were detected after P. gingivalis infection in BMECs both in vivo and in vitro. Caveolin-1 (Cav-1) expression was enhanced after P. gingivalis infection. Downregulation of Cav-1 rescued P. gingivalis-enhanced BMECs permeability. We further found P. gingivalis-gingipain could be colocalized with Cav-1 and the strong hydrogen bonding between Cav-1 and arg-specific-gingipain (RgpA) were detected. Moreover, P. gingivalis significantly inhibited the major facilitator superfamily domain containing 2a (Mfsd2a) expression. Mfsd2a overexpression reversed P. gingivalis-increased BMECs permeability and Cav-1 expression. These results revealed that Mfsd2a/Cav-1 mediated transcytosis is a key pathway governing BBB BMECs permeability induced by P. gingivalis, which may contribute to P. gingivalis/virulence factors entrance and the subsequent neurological impairments.
Animals ; Rats ; Bacteremia/metabolism* ; Blood-Brain Barrier/microbiology* ; Caveolin 1/metabolism* ; Gingipain Cysteine Endopeptidases/metabolism* ; Permeability ; Porphyromonas gingivalis/pathogenicity* ; Transcytosis ; Virulence Factors/metabolism*

Infant, Newborn ; Humans ; Infant, Premature ; Infant, Low Birth Weight ; Blood Transfusion ; Infant, Premature, Diseases

BACKGROUND: Intensive phototherapy (IPT) and exchange transfusion (ET) are the main treatments for extreme hyperbilirubinemia. However, there is no reliable evidence on determining the thresholds for these treatments. This multicenter study compared the effectiveness and complications of IPT and ET in the treatment of extreme hyperbilirubinemia. METHODS: This retrospective cohort study was conducted in seven centers from January 2015 to January 2018. Patients with extreme hyperbilirubinemia that met the criteria of ET were included. Patients were divided into three subgroups (low-, medium-, and high- risk) according to gestational week and risk factors. Propensity score matching (PSM) was performed to balance the data before treatment. Study outcomes included the development of bilirubin encephalopathy, duration of hospitalization, expenses, and complications. Mortality, auditory complications, seizures, enamel dysplasia, ocular motility disorders, athetosis, motor, and language development were evaluated during follow-up at age of 3 years. RESULTS: A total of 1164 patients were included in this study. After PSM, 296 patients in the IPT only group and 296 patients in the IPT plus ET group were further divided into the low-, medium-, and high-risk subgroups with 188, 364, and 40 matched patients, respectively. No significant differences were found between the IPT only and IPT plus ET groups in terms of morbidity, complications, and sequelae. Hospitalization duration and expenses were lower in the low- and medium-risk subgroups in the IPT only group. CONCLUSIONS In this study, our results suggest that IPT is a safe and effective treatment for extreme hyperbilirubinemia. The indication of ET for patients with hyperbilirubinemia could be stricter. However, it is necessary to have a contingency plan for emergency ET as soon as IPT is commenced especially for infants with risk factors. If IPT can be guaranteed and proved to be therapeutic, ET should be avoided as much as possible.
Child, Preschool ; Exchange Transfusion, Whole Blood/adverse effects* ; Humans ; Hyperbilirubinemia, Neonatal/therapy* ; Infant ; Infant, Newborn ; Kernicterus/therapy* ; Phototherapy/methods* ; Retrospective Studies

Objective:To evaluate any effect of transcranial pulsed current stimulation (tPCS) on the motor functioning of rats modelling stroke using the Catwalk gait analysis system.Methods:A stroke model was induced in 24 rats using middle cerebral artery embolization. They were then randomly divided into a sham operation group, a model group and a tPCS group, each of 8. Neurological deficit scores were assigned 1 day after the modeling. Beginning two days after the modeling the tPCS group was given 20 minutes of tPCS daily with an intensity of 0.2mA at 10Hz for 7 days. Gait data were collected using the Catwalk gait system 1 day before, as well as 1 and 9 days after the modeling.Results:Nine days after the modeling the average Bederson neuroethology score of the tPCS group was significantly lower than one day after the modelling and significantly lower than the model group′s average. One day after the modelling significant differences were observed in the model and tPCS groups in the average contact area of the affected limb′s paw prints, limb swing speed, stride length, limb speed, swing time, average running speed and standing time compared with before the operation. After nine days the average standing time on the affected fore and hind limbs, as well as the paw contact areas were significantly better in the tPCS group than in the model group.Conclusion:tPCS can promote improvements in gait after ischemia and reperfusion, at least in rats.

? Objective? To explore the application of tsusanli warming moxibustion in early rehabilitation in patients with cerebral infarction. Methods? Totally 120 patients with cerebral infarction and stable vital signs treated in the Department of Neurology of the First People's Hospital of Huzhou from January 2018 to March 2019 were selected using convenient sampling and divided into control (n=60) and observation (n=60) groups according to the random number table. Patients in the control group received routine drug therapy and rehabilitation care, while patients in the observation group received warming moxibustion, routine drug therapy and rehabilitation care. Bathel Index (BI), National Institute of Health Stroke Scale (NIHSS) and myodynamia were used to compare the effects of intervention. Results? The total effective rate in the observation group was 91.3%, higher than 66.7% in the control group, and there was statistically significant difference between the two groups (P＜0.05). The number of patients with a BI ≥ 75 in the observation group were more than that in the control group 2 and 3 months after treatment, and there was statistically significant difference between the two groups (P＜0.05). The NIHSS score of the observation group was lower than that of the control group 2 and 3 months after treatment, and there was statistically significant difference between the two groups (P＜0.05). Conclusions? Tsusanli warming moxibustion combined with integrated Chinese and Western medical methods in routine rehabilitation care show an obvious effect on the neurological function in patients with cerebral stroke during early rehabilitation, which can also improve their activities of daily living.

With the increasing number of immunocompromised hosts, the epidemiological characteristics of fungal infections have undergone enormous changes worldwide, including in China. In this paper, we reviewed the existing data on mycosis across China to summarize available epidemiological profiles. We found that the general incidence of superficial fungal infections in China has been stable, but the incidence of tinea capitis has decreased and the transmission route has changed. By contrast, the overall incidence of invasive fungal infections has continued to rise. The occurrence of candidemia caused by Candida species other than C. albicans and including some uncommon Candida species has increased recently in China. Infections caused by Aspergillus have also propagated in recent years, particularly with the emergence of azole-resistant Aspergillus fumigatus. An increasing trend of cryptococcosis has been noted in China, with Cryptococcus neoformans var. grubii ST 5 genotype isolates as the predominant pathogen. Retrospective studies have suggested that the epidemiological characteristics of Pneumocystis pneumonia in China may be similar to those in other developing countries. Endemic fungal infections, such as sporotrichosis in Northeastern China, must arouse research, diagnostic, and treatment vigilance. Currently, the epidemiological data on mycosis in China are variable and fragmentary. Thus, a nationwide epidemiological research on fungal infections in China is an important need for improving the country's health.
Animals ; China ; epidemiology ; Fungi ; genetics ; pathogenicity ; Genotype ; Humans ; Incidence ; Mycoses ; epidemiology ; transmission

Objective Observed the characteristics and influence factors of blood pressure circadian rhythm in continuous ambulatory peritoneal dialysis patients.To investigate the effect of residual renal function and cardiac function.Methods Prospectively collected 120 cases of continuous ambulatory peritoneal dialysis from June 2016 to March 2017 in Tangshan renal medicine dialysis centers,who combined with hypertension were treated with peritoneal dialysis for more than 3 months.According to the dynamic monitoring blood pressure circadian rhythm of blood pressure,120 cases were divided into the normal rhythm of blood pressure and the abnormal blood pressure rhythm group.Collected medical history;Tested related test index respectively;Cardiac ultrasound.According to the formula to calculate residual renal function,left ventricular mass index,Eingabe/Ausgabe,Ejection Fraction.Univariate and multivariate unconditional logistic regression analysis was used to analyze the risk factors of circadian rhythm of blood pressure.Stepwise multiple linear regression analysis was used to analyze the risk factors of residual renal function and cardiac function.Results CAPD patients with normal blood pressure rhythm in 14 cases(11.7％),abnormal blood pressure rhythm in 106 cases(88.3％),Among them,non dipper blood pressure accounted for 75 cases(62.5％).Single factor and multiple factors unconditioned logistic regression analysis revealed that after the comparison of gender and age,Risk factors for abnormal circadian rhythm of blood pressure were:UA(OR=1.197,95％CI:1.099-1.441),CRP(OR=1.170,95％CI:1.061-1.331),RRF(OR=1.389,95％CI:1.160-1.779).Using stepwise multiple linear regression analysis of dangerous factors affecting residual renal function and cardiac function,we found:Residual renal function negatively correlated with left ventricular myocardial mass index,systolic blood pressure drops at night rate,and ultrafiltration volume;LVMI (cardiac function) Positively correlated with 24 h average systolic blood pressure,and negatively correlated with systolic blood pressure drop ratio and residual renal function at night.Abnormal circadian rhythm of blood pressure may lead to the decline of residual renal function and cardiac function.Conclusions UA,CRP and RRF may affect the CAPD patients blood pressure circadian rhythm.At the same time,abnormal circadian rhythm of blood pressure may lead to the decline of residual renal function and cardiac function.Therefore,pay attention to the monitoring and control of ABPM,can better protect the residual renal function and improve cardiac function,so as to prolong and improve the survival time and quality of life of patients with CAPD.

Objective To establish a prediction model for 3-years recurrence after initial ischemic stroke by Cox proportional hazards regression and individual prognostic Index(PI)equation, and to evaluate its application value and external reality. Methods The inpatients with cerebral ischemic stroke hospitalized in Neurology Department in North China University of Science and Technology Affiliated Hospital were finally internalized between January 2013 and December 2013.Follow-up study on recurrence was carried out between January 2016 and December 2016.The recurrence prediction model was constructed by the Cox proportional hazards regression model.During January 2016 and December 2016,data of patients with ischemic stroke were prospectively continuously collected.And PI equation was used to verify its external reality in ischemic stroke patients. Results A total of 184 cases had stroke recurrence during the follow-up period.The Cox proportional hazards regression model analysis showed that age(RR=1.303,95% CI:1.019-1.666),history of heart disease(RR=1.788,95% CI:1.127-2.836),hypertension(RR=1.897,95% CI:1.097-3.280),diabetes(RR= 1.674,95% CI:1.015-2.760)and total cholesterol(RR= 2.136,95% CI:1.396-3.266)were the independent risk factors for stroke recurrence.The established recurrence model was correlated with individual PI equation,which was PI = 0.265X1+ 0.581X2+ 0.640X3+ 0.515X4+0.759X5.By the validation study of PI equation to predict stroke recurrence among patients admitted later, the sensitivity was 0.719,specificity was 0.769,and accuracy was 0.800. Conclusions Age,history of heart disease,hypertension,diabetes,and total cholesterol are independent risk factors for recurrence of ischemic stroke.And the PI for predicting stroke recurrence within 3 years after initial stroke is successfully established,which is good and helpful for predicting ischemic stroke recurrence.

Objective To explore the value of modified early warning score (MEWS) in clinical status assessment and outcome prediction of heat stroke patients.Methods The clinical data of 46 heat stroke patients were collected.According to the severity,the subjects were divided into mild group and severe group;and alternatively,according to the treatment outcomes,the subjects were also divided into survival group and death group.The MEWS at admission was employed for comparison of the differences in severity and outcome of heat stroke between groups.Receiver operating characteristic curve (ROC curve) was used to evaluate the accuracy of MEWS used at admission in assessing severity and predicting outcome of heat stroke patients.Results The results of MEWS calculated at admission in mild and severe heat stroke patients showed significant difference between them (3.00 ± 1.70 vs.6.85 ± 3.03,P =0.004).The area under the ROC curve (AUC) of MEWS got at admission for the diagnosis of severe heat stroke was 0.864 ± 0.056.The results of MEWS obtained at admission in survived and died heat stroke patients were 5.13 ± 2.96 and 9.25 ± 2.05,respectively (P =0.037).The AUC of MEWS used at admission for predicting the death of heat stroke patients was 0.867 ± 0.061.Conclusions The initial MEWS is useful to accurately assess and predict the outcome of heat stroke patients.Heat stroke patients with higher level of MEWS used at admission than 4.5 could be diagnosed as severe heat stroke,and whereas the value of MEWS got at admission higher than 7.5 could be the indicator of the poor prognosis.