Prognostic value of red blood cell distribution width for severe acute pancreatitis

BACKGROUND Severe acute pancreatitis(SAP)is a common condition in the intensive care unit(ICU)and has a high mortality.Early evaluation of the severity and prognosis is very important for SAP therapy.Recently,red blood cell distribution(RDW)was associated with mortality of sepsis patients and could be used as a predictor of prognosis.Similarly,RDW may be associated with the prognosis of SAP patients and be used as a prognostic indicator for SAP patients.AIM To investigate the prognostic value of RDW for SAP patients.METHODS We retrospectively enrolled SAP patients admitted to the ICU of the First Affiliated Hospital of China Medical University from June 2015 to June 2017.According to the prognosis at 90 d,SAP patients were divided into a survival group and a non-survival group.RDW was extracted from a routine blood test.Demographic parameters and RDW were recorded and compared between the two groups.The receiver operator characteristic(ROC)curve was constructed and Cox regression analysis was performed to investigate the prognostic value of RDW for SAP patients.RESULTS In this retrospective cohort study,42 SAP patients were enrolled,of whom 22 survived(survival group)and 20 died(non-survival group).The baseline parameters were comparable between the two groups.The coefficient of variation of RDW(RDW-CV),standard deviation of RDW(RDW-SD),Acute Physiology and Chronic Health Evaluation II(APACHE II)score,and Sequential Organ Failure Assessment(SOFA)score were significantly higher in the non-survival group than in the survival group(P<0.05).The RDW-CV and RDW-SD were significantly correlated with the APACHE II score and SOFA score,respectively.The areas under the ROC curves(AUCs)of RDW-CV and RDW-SD were all greater than those of the APACHE II score and SOFA score,among which,the AUC of RDW-SD was the greatest.The results demonstrated that RDW had better prognostic value for predicting the mortality of SAP patients.When the RDW-SD was greater than 45.5,the sensitivity for predicting prognosis was 77.8%and the specificity was 70.8%.Both RDW-CV and RDW-SD could be used as independent risk factors to predict the mortality of SAP patients in multivariate logistic regression analysis and univariate Cox proportional hazards regression analysis,similar to the APACHE II and SOFA scores.CONCLUSION The RDW is greater in the non-surviving SAP patients than in the surviving patients.RDW is significantly correlated with the APACHE II and SOFA scores.RDW has better prognostic value for SAP patients than the APACHE II and SOFA scores and could easily be used by clinicians for the treatment of SAP patients.

Corrosion behavior of Mg−Li alloys:A review

It has been known that the lack of excellent corrosion resistance is the key problem restricting the wide application of Mg−Li alloys.Based on a quantity of literature about corrosion behavior of Mg−Li alloys,this review elaborates the factors affecting the corrosion behavior of Mg−Li alloys and the processing methods for improving corrosion resistance.The corrosion characteristics of Mg−Li alloys are described firstly.Then,it is explained that the grain size,orientation,second phase,and surface film strongly influence corrosion performance,which can be tailored by alloying,plastic deformation,and heat treatment.Further in-depth discussion about the corrosion mechanisms for Mg−Li alloys was also presented.Finally,important points of improving corrosion resistance are suggested.

Osa-miR1873 fine-tunes rice immunity against Magnaporthe oryzae and yield traits

MicroRNAs(miRNAs)are known to fine-tune growth,development,and stress-induced responses.Osa-miR1873 is a rice-specific miRNA targeting LOC_Os05g01790.Here,we show that Osa-miR1873 fine-tunes rice immunity against Magnaporthe oryzae and yield traits via LOC_Os05g01790.Osa-miR1873 was significantly upregulated in a susceptible accession but downregulated in a resistance accession at 24 h post-inoculation(hpi)of M.oryzae.Overexpressing Osa-miR1873 enhanced susceptibility to M.oryzae and compromised induction of defense responses.In contrast,blocking Osa-miR1873 through target mimicry compromised susceptibility to M.oryzae and enhanced induction of defense responses.Altered expression of Osa-miR1873 also resulted in some defects in yield traits,including grain numbers and seed setting rate.Moreover,overexpression of the target gene LOC_Os05g01790 increased rice blast disease resistance but severely penalized growth and yield.Taken together,we demonstrate that Osa-miR1873 fine-tunes the rice immunity-growth trade-off via LOC_Os05g01790,and blocking Osa-miR1873 could improve blast disease resistance without significant yield penalty.Thus,the Osa-miR1873-LOC_Os05g01790 regulatory module is valuable in balancing yield traits and blast resistance.

High salt-induced weakness of anti-oxidative function of natriuretic peptide receptor-C and podocyte damage in the kidneys of Dahl rats

Background:Atrial natriuretic peptide(ANP)and its natriuretic peptide receptors A(NPR-A)and C(NPR-C)are involved in the regulation of physiological and pathophysiological process of blood pressure.The present study aimed to determine the role of NPR-C in the development of salt-sensitive hypertension.Methods::The Dahl salt-sensitive(DS)and salt-resistant(DR)rats were used in this study.Animals were matched according to their age and weight,and then placed on either a high-salt(HS,8%)or a normal-salt(NS,0.4%)diet for 6 weeks randomly using random number table.The systolic blood pressure(SBP),plasmatic sodium concentration(PL Na),urinary sodium excretion(UV Na),and serum creatinine concentration(Scr)were measured.The concentration of ANP in blood and tissues(heart and kidney)was detected by enzyme-linked immunosorbent assay.The expression of ANP,NPR-A,and NPR-C in kidney was evaluated with western blot analysis.Regarding renal redox state,the concentration changes in malondialdehyde(MDA),lipofuscin,nicotinamide adenine dinucleotide phosphate(NADPH)oxidase(Nox),and nitric oxide synthase(NOS)in kidney were detected by a spectrophotometric method.The kidney damage was evaluated using pathological techniques and the succinodehydrogenase(SDHase)examination.Furthermore,after an intra-peritoneal injection of C-atrial natriuretic peptide(ANP)4-23(C-ANP 4-23),an NPR-C receptor agonist,the SBP,biochemical values in blood and urine,and renal redox state were evaluated.The paired Student’s t test and analysis of variance followed by the Bonferroni test were performed for statistical analyses of the comparisons between two groups and multiple groups,respectively.Results::The baseline SBP in all groups was within the normal range.At the end of the 6-week experiment,HS diet significantly increased the SBP in DS rats from 116.63±2.90 mmHg to 162.25±2.15 mmHg(t=-10.213,P<0.001).The changes of SBP were not significant in DS rats on an NS diet and DR rats on an NS diet or on an HS diet(all P>0.05).The significant increase of PL Na,UV Na,and Scr related to an HS diet was found in both DS and DR rats(all P<0.05).However,significant changes in the concentration(t=-21.915,P<0.001)and expression of renal ANP(t=-3.566,P=0.016)and the expression of renal NPR-C(t=5.864,P=0.002)were only observed in DS hypertensive rats.The significantly higher desmin immunochemical staining score(t=-5.715,P=0.005)and mitochondrial injury score(t=-6.325,P=0.003)accompanied by the lower SDHase concentration(t=3.972,P=0.017)revealed mitochondrial pathologic abnormalities in podocytes in DS rats with an HS diet.The distinct increases of MDA(t=-4.685,P=0.009),lipofuscin(t=-8.195,P=0.001),and Nox(t=-12.733,P<0.001)but not NOS(t=-0.328,P=0.764)in kidneys were also found in DS hypertensive rats.C-ANP 4-23 treatment significantly decreased the SBP induced by HS in DS rats(P<0.05),which was still higher than NS groups with the vehicle or C-ANP 4-23 treatment(P<0.05).Moreover,the HS-induced increase of MDA,lipofuscin,Nox concentrations,and Nox4 expression in DS rats was significantly attenuated by C-ANP 4-23 treatment as compared with those with HS diet and vehicle injection(all P<0.05).Conclusions::The results indicated that the renal NPR-C might be involved in the salt-sensitive hypertension through the damage of mitochondria in podocytes and the reduction of the anti-oxidative function.Hence,C-ANP 4-23 might serve as a therapeutic agent in treating salt-sensitive hypertension.

Evolutions of Microstructure and Mechanical Properties in Mg-5Li-1Zn-0.5Ag-0.5Zr-xGd Alloy

The evolution of the microstructure and mechanical properties of alloy system with nominally composition Mg-5Li-1Zn-0.5Ag-0.5Zr-xGd(x=0,1.2,2.4,3.6,4.8,6)is evaluated based on computational phase diagram and corresponding experimental studies.The results show that grains are significantly refined with the increase of Gd content.The main phases of as-cast alloys areα-Mg,β-Li,AgLi_(2)Mg,and Mg_(3)Gd.With the increase of Gd content,the amounts of Mg_(3)Gd phase andβ-Li phase have been increased.When the Gd content exceeds 3.6 wt%,Mg_(3)Gd phase precipitates in a form of the network at the grain boundaries.The precipitation ofβ-Li can be attributed to the competitive dissolution of Zn,Gd,and Li in Mg.Meanwhile,γ″is formed after the addition of Gd,which grows and transforms intoγ′with the increase of Gd content.In solidification process,stacking faults are formed by solid transformation of partialα-Mg and Mg_(3)Gd.Eventually,with the synergistic effect of Mg_(3)Gd,β-Li,andγ″(orγ′),as the Gd content increasing,the tensile strength of the alloy first increases,then decreases,and the elongation decreases.When the content of Gd is 4.8 wt%,the ultimate tensile strength and yield strength reach the maximum values of 227 MPa and 139 MPa,and the elongation is 18.1%,respectively.

Epidemiological Study of Sepsis in China： Protocol of a Cross-sectional Survey

Background： Sepsis is the leading cause of death among critically ill patients. Herein, we conducted a national survey to provide data on epidemiology and treatment of sepsis in the clinical practice in China, which has no detailed epidemiological data available on sepsis. Methods： This was a prospective cross-sectional survey from December 1, 2015 to January 31, 2016 in all provinces/municipalities of the mainland of China. The primary outcome of this study was the incidence of sepsis, and the secondary outcome was its etiology in China. Patients with sepsis admitted to the Intensive Care Units were included in this study. The demographic, physiological, bacteriological, and therapeutic data of these patients were recorded. The incidence of sepsis was estimated using the data from the sixth census in China, reported by the Chinese National Health and Family Planning Commission and the National Bureau of Statistics as the standard population. The independent risk factors for increased mortality from sepsis were calculated. Conclusions： This study indicated the incidence and outcome of sepsis in China. It also showed the most common etiology of different sites and types of infection, which could guide empiric antibiotic therapy. Moreover, it provided information on the independent risk factors for increased mortality due to sepsis. The findings provide evidence to guide clinical management and may help improve the outcome in septic patients.

Value of Kidney Disease Improving Global Outcomes Urine Output Criteria in Critically III Patients： A Secondary Analysis of a Multicenter Prospective Cohort Study

Background： Urine output （UO） is an essential criterion of the Kidney Disease Improving Global Outcomes （KD1GO） definition and classification system tbr acute kidney injury （AKI）, of which the diagnostic value has not been extensively studied. We aimed to determine whether AKI based on KDIGO UO criteria （KDtGOLro） could improve the diagnostic and prognostic accuracy, compared with KDIGO serum creatinine criteria （KDIGOscr）.Methods： We conducted a secondary analysis of the database of a previous study conducted by China Critical Care Clinical Trial Group （CCCCTG）, which was a 2-month prospective cohort study （July 1,2009 to August 31,2009） involving 3063 patients in 22 tertiary Intensive Care Units in Mainland of China. AKI was diagnosed and classified separately based on KDIGOt,o and KDlGOsc,. Hospital mortality of patients with more severe AKI classification based on KDIGOvo was compared with other patients by univariate and multivariate regression analyses. Results： The prevalence of AKl increased from 52.4% based on KDIGOscr to 55.4% based on KD1GOsc~ combined with KDIGOuo. KDIGOv~~ also restllted in an upgrade of AKI classification in 7.3% of patients, representing those with more severe AK1 classification based on KDIGOvo. Compared with non-AKI patients or those with maximum AKI classification by KDIGOscr, those with maximum AKI classification by KDIGOuo had a significantly higher hospital mortality of 58.4% （odds ratio [OR]： 7.580, 95% confidence interval [CI]： 4.141-13.873, P 〈 0.001）. In a multivariate logistic regression analysis, AKI based on KDIGOuo （OR： 2.891, 95% CI： 1.964-4.254, P 〈 0.001）, but not based on KDIGOscr （OR： 1.322, 95% CI： 0.902-1.939, P = 0.152）, was an independent risk factor for hospital mortality. Conclusion： UO was a criterion with additional value beyond creatinine criterion for AKI diagnosis and classification, which can help identify a group of patients with high risk of death.

Unfractionated heparin attenuates endothelial barrier dysfunction via the phosphatidylinositol-3 kinase/serine/threonine kinase/nuclear factor kappa-B pathway

Background::Vascular endothelial dysfunction is considered a key pathophysiologic process for the development of acute lung injury.In this study,we aimed at investigating the effects of unfractionated heparin(UFH)on the lipopolysaccharide(LPS)-induced changes of vascular endothelial-cadherin(VE-cadherin)and the potential underlying mechanisms.Methods::Male C57BL/6 J mice were randomized into three groups:vehicle,LPS,and LPS+UFH groups.Intraperitoneal injection of 30 mg/kg LPS was used to induce sepsis.Mice in the LPS+UFH group received subcutaneous injection of 8 U UFH 0.5 h before LPS injection.The lung tissue of the mice was collected for assessing lung injury by measuring the lung wet/dry(W/D)weight ratio and observing histological changes.Human pulmonary microvascular endothelial cells(HPMECs)were cultured and used to analyze the effects of UFH on LPS-or tumor necrosis factor-alpha(TNF-α)-induced vascular hyperpermeability,membrane expression of VE-cadherin,p120-catenin,and phosphorylated myosin light chain(p-MLC),and F-actin remodeling,and on the LPS-induced activation of the phosphatidylinositol-3 kinase(PI3K)/serine/threonine kinase(Akt)/nuclear factor kappa-B(NF-κB)signaling pathway.Results::In vivo,UFH pretreatment significantly attenuated LPS-induced pulmonary histopathological changes(neutrophil infiltration and erythrocyte effusion,alveolus pulmonis collapse,and thicker septum),decreased the lung W/D,and increased protein concentration(LPS vs.LPS+UFH:0.57±0.04 vs.0.32±0.04 mg/mL,P=0.0092),total cell count(LPS vs.LPS+UFH:9.57±1.23 vs.3.65±0.78×105/mL,P=0.0155),polymorphonuclear neutrophil percentage(LPS vs.LPS+UFH:88.05%±2.88%vs.22.20%±3.92%,P=0.0002),and TNF-α(460.33±23.48 vs.189.33±14.19 pg/mL,P=0.0006)in the bronchoalveolar lavage fluid.In vitro,UFH pre-treatment prevented the LPS-induced decrease in the membrane expression of VE-cadherin(LPS vs.LPS+UFH:0.368±0.044 vs.0.716±0.064,P=0.0114)and p120-catenin(LPS vs.LPS+UFH:0.208±0.018 vs.0.924±0.092,P=0.0016),and the LPS-induced increase in the expression of p-MLC(LPS vs.LPS+UFH:0.972±0.092 vs.0.293±0.025,P=0.0021).Furthermore,UFH attenuated LPS-and TNF-α-induced hyperpermeability of HPMECs(LPS vs.LPS+UFH:8.90±0.66 vs.15.84±1.09Ω·cm 2,P=0.0056;TNF-αvs.TNF-α+UFH:11.28±0.64 vs.18.15±0.98Ω·cm 2,P=0.0042)and F-actin remodeling(LPS vs.LPS+UFH:56.25±1.51 vs.39.70±1.98,P=0.0027;TNF-αvs.TNF-α+UFH:55.42±1.42 vs.36.51±1.20,P=0.0005)in vitro.Additionally,UFH decreased the phosphorylation of Akt(LPS vs.LPS+UFH:0.977±0.081 vs.0.466±0.035,P=0.0045)and I kappa B Kinase(IKK)(LPS vs.LPS+UFH:1.023±0.070 vs.0.578±0.044,P=0.0060),and the nuclear translocation of NF-κB(LPS vs.LPS+UFH:1.003±0.077 vs.0.503±0.065,P=0.0078)in HPMECs,which was similar to the effect of the PI3K inhibitor,wortmannin.Conclusions::The protective effect of UFH against LPS-induced pulmonary endothelial barrier dysfunction involves VE-cadherin stabilization and PI3K/Akt/NF-κB signaling.