目的·分析重度烧伤患者早期血清肝素结合蛋白(heparin-binding protein,HBP)表达水平,探讨其对患者预后及脓毒症发生的预警价值。方法·回顾性分析上海交通大学医学院附属瑞金医院灼伤整形科2021年1月—2023年5月收治的52例重...目的·分析重度烧伤患者早期血清肝素结合蛋白(heparin-binding protein,HBP)表达水平,探讨其对患者预后及脓毒症发生的预警价值。方法·回顾性分析上海交通大学医学院附属瑞金医院灼伤整形科2021年1月—2023年5月收治的52例重度烧伤患者的临床资料。收集患者性别、年龄、烧伤总面积、身体质量指数(body mass index,BMI)、是否行气管插管或气管切开等一般资料。收集患者入院48 h内的HBP、血清降钙素原(procalcitonin,PCT)、血清C反应蛋白(C reactive protein,CRP)水平和白细胞计数,以及入院48 h内急性生理与慢性健康评估Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)和序贯性器官衰竭评估(sequential organ failure assessment,SOFA)的评分。根据出院时的状态,将患者分为死亡组和存活组;根据住院期间是否发生脓毒症,将患者分为脓毒症组和非脓毒症组;根据是否发生休克,将脓毒症患者分为脓毒症无休克组和脓毒症休克组。采用Logistic回归分析重度烧伤患者死亡、脓毒症及脓毒症休克的危险因素。绘制受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)评估上述指标对患者死亡、脓毒症,以及脓毒症休克的早期预警作用。结果·与存活组比较,死亡组患者年龄较大,差异有统计学意义(P=0.036);烧伤总面积及行气管插管或切开在是否发生脓毒症患者中差异有统计学意义(P=0.011,P=0.001)。与存活组相比,死亡组患者血清HBP较高,差异具有统计学意义(P=0.002);与非脓毒症组相比,脓毒症组患者血清HBP水平、APACHEⅡ评分、SOFA评分较高,差异具有统计学意义(均P<0.05),其余指标差异均无统计学意义。与脓毒症无休克组比较,脓毒症休克组患者HBP水平较高,差异有统计学意义(P=0.008)。Logistic回归分析显示,HBP是住院期间重度烧伤患者死亡的独立危险因素,同时也是重度烧伤后脓毒症患者发生脓毒症休克的独立危险因素。ROC曲线分析显示,HBP水平预测住院期间患者死亡的ROC曲线下面积(area under the curve,AUC)为0.798;当HBP≥147.03 ng/mL时,其敏感度和特异度分别为88.33%和70.00%。HBP水平预测重度烧伤后脓毒症患者出现脓毒症休克的AUC为0.789;当HBP≥147.03 ng/mL时,其敏感度和特异度分别为90.00%和63.20%。结论·入院48 h内的血清HBP水平可作为重度烧伤患者预后以及重度烧伤脓毒症患者是否发生脓毒症休克的预警指标。展开更多
目的探讨烧伤合并吸入性损伤患者行机械通气第24小时的氧合指数(OI)对患者预后的影响。方法142例烧伤合并吸入性损伤行机械通气患者,根据第24小时的OI值分为A组[OI≤200 mm Hg(1 mm Hg=0.133 kPa),36例]、B组(200 mm Hg<OI≤300 mm H...目的探讨烧伤合并吸入性损伤患者行机械通气第24小时的氧合指数(OI)对患者预后的影响。方法142例烧伤合并吸入性损伤行机械通气患者,根据第24小时的OI值分为A组[OI≤200 mm Hg(1 mm Hg=0.133 kPa),36例]、B组(200 mm Hg<OI≤300 mm Hg,46例)、C组(OI>300 mm Hg,60例)。比较三组一般资料及预后情况;依据预后情况将患者分为预后不良组(86例)与预后良好组(56例)。采用单因素和多因素Logistic回归分析烧伤合并吸入性损伤机械通气患者预后不良的危险因素。结果三组年龄、烧伤总面积(TBSA)、机械通气前氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、血氧饱和度(SaO_(2))及预后情况比较,差异具有统计学意义(P<0.05)。C组年龄(40.07±21.20)岁小于A组的(54.64±17.83)岁和B组的(51.72±17.99)岁(P<0.05);B组TBSA(60.43±29.04)%和C组TBSA(62.89±24.85)%小于A组的(74.14±21.90)%,预后不良率54.3%、48.3%低于A组的88.9%(P<0.05)。机械通气前,A组和B组PaO_(2)水平显著低于C组,PaCO_(2)高于C组(P<0.05);B和C组SaO_(2)高于A组(P<0.05)。三组机械通气开始时间、三度烧伤面积及入院延迟复苏情况比较差异无统计学意义(P>0.05)。预后不良组与预后良好组患者的年龄、TBSA、机械通气后第24小时OI比较差异具有统计学意义(P<0.05);预后不良组与预后良好组患者的机械通气开始时间、机械通气时间及机械通气前PaO_(2)、PaCO_(2)、SaO_(2)比较差异无统计学意义(P>0.05)。将筛选出P<0.05的因素纳入多元Logistic回归分析,排除混杂因素后,结果显示:机械通气后第24小时OI≤200 mm Hg、TBSA大、老年是烧伤合并吸入性损伤行机械通气患者预后不良的独立危险因素(OR=5.551、1.046、10.187,P<0.05)。结论机械通气第24小时OI≤200 mm Hg的烧伤合并吸入性损伤患者预后不良,TBSA越大,机械通气前PaO_(2)及SaO_(2)越低,通气后第24小时的OI可能越低。展开更多
Burned area mapping is an essential step in the forest fire research to investigate the relationship between forest fire and cli- mate change and the effect of forest fire on carbon budgets. This study proposed an alg...Burned area mapping is an essential step in the forest fire research to investigate the relationship between forest fire and cli- mate change and the effect of forest fire on carbon budgets. This study proposed an algorithm to map forest fire burned area using the Moderate-Resolution Imaging Spectroradiameter (MODIS) time series data in Heilongjiang Province, China. The algorithm is divided into two steps: Firstly, the 'core' pixels were extracted to represent the most possible burned pixels based on the comparison of the tem- poral change of Global Environmental Monitoring Index (GEMI), Burned Area Index (BAI) and MODIS active fire products between pre- and post-fires. Secondly, a 15-km distance was set to extract the entire burned areas near the 'core' pixels as more relaxed conditions were used to identify the fire pixels for reducing the omission error as much as possible. The algorithm comprehensively considered the thermal characteristics and the spectral change between pre- and post-fires, which are represented by the MODIS fire products and the spectral index, respectively. Tahe, Mohe and Huma counties of Heilongjiang Province, China were chosen as the study area for burned area mapping and a time series of burned maps were produced from 2000 to 2011. The results show that the algorithm can extract burned areas more accurately with the hiehest accuracy of 96.61%.展开更多
Wild-land fires are a dynamic and destructive force in natural ecosystems. In recent decades, fire disturbances have increased concerns and awareness over significant economic loss and landscape change. The focus of t...Wild-land fires are a dynamic and destructive force in natural ecosystems. In recent decades, fire disturbances have increased concerns and awareness over significant economic loss and landscape change. The focus of this research was to study two northern California wild-land fires: Butte Humboldt Complex and Butte Lightning Complex of 2008 and assessment of vegetation recovery after the fires via ground based measurements and utilization of Landsat 5 imagery and analysis software to assess landscape change. Multi-temporal and burn severity dynamics and assessment through satellite imagery were used to visually ascertain levels of landscape change, under two temporal scales. Visual interpretation indicated noticeable levels of landscape change and relevant insight into the magnitude and impact of both wild-land fires. Normalized Burn Ratio (NBR) and delta NBR (DNBR) data allowed for quantitative analysis of burn severity levels. DNBR results indicate low severity and low re-growth for Butte Humboldt Complex “burned center” subplots. In contrast, DNBR values for Butte Lightning Complex “burned center” subplots indicated low-moderate burn severity levels.展开更多
The severity of an initial burn injury is critical for determining the treatment plan and prognosis of burn patients. Here, we measured serum neutrophil gelatinase-associated lipocalin (NGAL) levels to determine wheth...The severity of an initial burn injury is critical for determining the treatment plan and prognosis of burn patients. Here, we measured serum neutrophil gelatinase-associated lipocalin (NGAL) levels to determine whether NGAL can be used as a biomarker for severity of burn injuries. A study of the demographic, clinical, and laboratory markers for various organ damage was performed at Bestian Burn Center (n = 10 healthy people, n = 31 patients). NGAL and organ damage marker levels were measured in 31 patients with severe burns within 2 - 3 days following their admission to the intensive care unit. Serum NGAL level of the expired patients was 788.5 (685.0 - 998.0) pg/mL, whereas that of the discharged patients was 421.2 (356.2 - 480.6) pg/mL, showing that the initial serum NGAL level can be used to estimate mortality. We also determined the correlation between serum NGAL level and the currently used severity markers (total body surface area burned and abbreviated burn severity index) and confirmed that serum NGAL level could be used as a severity marker. We also found that serum NGAL level was correlated with damage of organs such as the liver, kidney, heart, and respiratory organs in patients with severe burns.展开更多
Fire severity classifications determine fire damage and regeneration potential in post-fire areas for effective implementation of restoration applications.Since fire damage varies according to vegetation and fire char...Fire severity classifications determine fire damage and regeneration potential in post-fire areas for effective implementation of restoration applications.Since fire damage varies according to vegetation and fire characteristics,regional assessment of fire severity is crucial.The objectives of this study were:(1)to test the performance of different satellite imagery and spectral indices,and two field—measured severity indices,CBI(Composite Burn Index)and GeoCBI(Geometrically structured Composite Burn Index)to assess fire severity;(2)to calculate classification thresholds for spectral indices that performed best in the study areas;and(3)to generate fire severity maps that could be used to determine the ecological impact of forest fires.Five large fires in Pinus brutia(Turkish pine)and Pinus nigra subsp.pallasiana var.pallasiana(Anatolian black pine)—dominated forests during 2020 and 2021 were selected as study sites.The results show that GeoCBI provided more reliable estimates of field—measured fire severity than CBI.While Sentinel-2 and Landsat-8/OLI images performed similarly well,MODIS performed poorly.Fire severity classification thresholds were determined for Sentinel-2 based RdNBR,dNBR,dSAVI,dNDVI,and dNDMI and Landsat-8/OLI based dNBR,dNDVI,and dSAVI.Among several spectral indices,the highest accuracy for fire severity classification was found for Sentinel-2 based RdNBR(72.1%)and Landsat-8/OLI based dNBR(69.2%).The results can be used to assess and map fire severity in forest ecosystems similar to those in this study.展开更多
文摘目的·分析重度烧伤患者早期血清肝素结合蛋白(heparin-binding protein,HBP)表达水平,探讨其对患者预后及脓毒症发生的预警价值。方法·回顾性分析上海交通大学医学院附属瑞金医院灼伤整形科2021年1月—2023年5月收治的52例重度烧伤患者的临床资料。收集患者性别、年龄、烧伤总面积、身体质量指数(body mass index,BMI)、是否行气管插管或气管切开等一般资料。收集患者入院48 h内的HBP、血清降钙素原(procalcitonin,PCT)、血清C反应蛋白(C reactive protein,CRP)水平和白细胞计数,以及入院48 h内急性生理与慢性健康评估Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)和序贯性器官衰竭评估(sequential organ failure assessment,SOFA)的评分。根据出院时的状态,将患者分为死亡组和存活组;根据住院期间是否发生脓毒症,将患者分为脓毒症组和非脓毒症组;根据是否发生休克,将脓毒症患者分为脓毒症无休克组和脓毒症休克组。采用Logistic回归分析重度烧伤患者死亡、脓毒症及脓毒症休克的危险因素。绘制受试者操作特征曲线(receiver operator characteristic curve,ROC曲线)评估上述指标对患者死亡、脓毒症,以及脓毒症休克的早期预警作用。结果·与存活组比较,死亡组患者年龄较大,差异有统计学意义(P=0.036);烧伤总面积及行气管插管或切开在是否发生脓毒症患者中差异有统计学意义(P=0.011,P=0.001)。与存活组相比,死亡组患者血清HBP较高,差异具有统计学意义(P=0.002);与非脓毒症组相比,脓毒症组患者血清HBP水平、APACHEⅡ评分、SOFA评分较高,差异具有统计学意义(均P<0.05),其余指标差异均无统计学意义。与脓毒症无休克组比较,脓毒症休克组患者HBP水平较高,差异有统计学意义(P=0.008)。Logistic回归分析显示,HBP是住院期间重度烧伤患者死亡的独立危险因素,同时也是重度烧伤后脓毒症患者发生脓毒症休克的独立危险因素。ROC曲线分析显示,HBP水平预测住院期间患者死亡的ROC曲线下面积(area under the curve,AUC)为0.798;当HBP≥147.03 ng/mL时,其敏感度和特异度分别为88.33%和70.00%。HBP水平预测重度烧伤后脓毒症患者出现脓毒症休克的AUC为0.789;当HBP≥147.03 ng/mL时,其敏感度和特异度分别为90.00%和63.20%。结论·入院48 h内的血清HBP水平可作为重度烧伤患者预后以及重度烧伤脓毒症患者是否发生脓毒症休克的预警指标。
文摘目的探讨烧伤合并吸入性损伤患者行机械通气第24小时的氧合指数(OI)对患者预后的影响。方法142例烧伤合并吸入性损伤行机械通气患者,根据第24小时的OI值分为A组[OI≤200 mm Hg(1 mm Hg=0.133 kPa),36例]、B组(200 mm Hg<OI≤300 mm Hg,46例)、C组(OI>300 mm Hg,60例)。比较三组一般资料及预后情况;依据预后情况将患者分为预后不良组(86例)与预后良好组(56例)。采用单因素和多因素Logistic回归分析烧伤合并吸入性损伤机械通气患者预后不良的危险因素。结果三组年龄、烧伤总面积(TBSA)、机械通气前氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、血氧饱和度(SaO_(2))及预后情况比较,差异具有统计学意义(P<0.05)。C组年龄(40.07±21.20)岁小于A组的(54.64±17.83)岁和B组的(51.72±17.99)岁(P<0.05);B组TBSA(60.43±29.04)%和C组TBSA(62.89±24.85)%小于A组的(74.14±21.90)%,预后不良率54.3%、48.3%低于A组的88.9%(P<0.05)。机械通气前,A组和B组PaO_(2)水平显著低于C组,PaCO_(2)高于C组(P<0.05);B和C组SaO_(2)高于A组(P<0.05)。三组机械通气开始时间、三度烧伤面积及入院延迟复苏情况比较差异无统计学意义(P>0.05)。预后不良组与预后良好组患者的年龄、TBSA、机械通气后第24小时OI比较差异具有统计学意义(P<0.05);预后不良组与预后良好组患者的机械通气开始时间、机械通气时间及机械通气前PaO_(2)、PaCO_(2)、SaO_(2)比较差异无统计学意义(P>0.05)。将筛选出P<0.05的因素纳入多元Logistic回归分析,排除混杂因素后,结果显示:机械通气后第24小时OI≤200 mm Hg、TBSA大、老年是烧伤合并吸入性损伤行机械通气患者预后不良的独立危险因素(OR=5.551、1.046、10.187,P<0.05)。结论机械通气第24小时OI≤200 mm Hg的烧伤合并吸入性损伤患者预后不良,TBSA越大,机械通气前PaO_(2)及SaO_(2)越低,通气后第24小时的OI可能越低。
基金Under the auspices of Strategic Pilot Science and Technology Projects of Chinese Academic Sciences(No.XDA05090310)
文摘Burned area mapping is an essential step in the forest fire research to investigate the relationship between forest fire and cli- mate change and the effect of forest fire on carbon budgets. This study proposed an algorithm to map forest fire burned area using the Moderate-Resolution Imaging Spectroradiameter (MODIS) time series data in Heilongjiang Province, China. The algorithm is divided into two steps: Firstly, the 'core' pixels were extracted to represent the most possible burned pixels based on the comparison of the tem- poral change of Global Environmental Monitoring Index (GEMI), Burned Area Index (BAI) and MODIS active fire products between pre- and post-fires. Secondly, a 15-km distance was set to extract the entire burned areas near the 'core' pixels as more relaxed conditions were used to identify the fire pixels for reducing the omission error as much as possible. The algorithm comprehensively considered the thermal characteristics and the spectral change between pre- and post-fires, which are represented by the MODIS fire products and the spectral index, respectively. Tahe, Mohe and Huma counties of Heilongjiang Province, China were chosen as the study area for burned area mapping and a time series of burned maps were produced from 2000 to 2011. The results show that the algorithm can extract burned areas more accurately with the hiehest accuracy of 96.61%.
文摘Wild-land fires are a dynamic and destructive force in natural ecosystems. In recent decades, fire disturbances have increased concerns and awareness over significant economic loss and landscape change. The focus of this research was to study two northern California wild-land fires: Butte Humboldt Complex and Butte Lightning Complex of 2008 and assessment of vegetation recovery after the fires via ground based measurements and utilization of Landsat 5 imagery and analysis software to assess landscape change. Multi-temporal and burn severity dynamics and assessment through satellite imagery were used to visually ascertain levels of landscape change, under two temporal scales. Visual interpretation indicated noticeable levels of landscape change and relevant insight into the magnitude and impact of both wild-land fires. Normalized Burn Ratio (NBR) and delta NBR (DNBR) data allowed for quantitative analysis of burn severity levels. DNBR results indicate low severity and low re-growth for Butte Humboldt Complex “burned center” subplots. In contrast, DNBR values for Butte Lightning Complex “burned center” subplots indicated low-moderate burn severity levels.
文摘The severity of an initial burn injury is critical for determining the treatment plan and prognosis of burn patients. Here, we measured serum neutrophil gelatinase-associated lipocalin (NGAL) levels to determine whether NGAL can be used as a biomarker for severity of burn injuries. A study of the demographic, clinical, and laboratory markers for various organ damage was performed at Bestian Burn Center (n = 10 healthy people, n = 31 patients). NGAL and organ damage marker levels were measured in 31 patients with severe burns within 2 - 3 days following their admission to the intensive care unit. Serum NGAL level of the expired patients was 788.5 (685.0 - 998.0) pg/mL, whereas that of the discharged patients was 421.2 (356.2 - 480.6) pg/mL, showing that the initial serum NGAL level can be used to estimate mortality. We also determined the correlation between serum NGAL level and the currently used severity markers (total body surface area burned and abbreviated burn severity index) and confirmed that serum NGAL level could be used as a severity marker. We also found that serum NGAL level was correlated with damage of organs such as the liver, kidney, heart, and respiratory organs in patients with severe burns.
基金funded by the Turkish General Directorate of Forestry(project number:19.9402/2020-2023)。
文摘Fire severity classifications determine fire damage and regeneration potential in post-fire areas for effective implementation of restoration applications.Since fire damage varies according to vegetation and fire characteristics,regional assessment of fire severity is crucial.The objectives of this study were:(1)to test the performance of different satellite imagery and spectral indices,and two field—measured severity indices,CBI(Composite Burn Index)and GeoCBI(Geometrically structured Composite Burn Index)to assess fire severity;(2)to calculate classification thresholds for spectral indices that performed best in the study areas;and(3)to generate fire severity maps that could be used to determine the ecological impact of forest fires.Five large fires in Pinus brutia(Turkish pine)and Pinus nigra subsp.pallasiana var.pallasiana(Anatolian black pine)—dominated forests during 2020 and 2021 were selected as study sites.The results show that GeoCBI provided more reliable estimates of field—measured fire severity than CBI.While Sentinel-2 and Landsat-8/OLI images performed similarly well,MODIS performed poorly.Fire severity classification thresholds were determined for Sentinel-2 based RdNBR,dNBR,dSAVI,dNDVI,and dNDMI and Landsat-8/OLI based dNBR,dNDVI,and dSAVI.Among several spectral indices,the highest accuracy for fire severity classification was found for Sentinel-2 based RdNBR(72.1%)and Landsat-8/OLI based dNBR(69.2%).The results can be used to assess and map fire severity in forest ecosystems similar to those in this study.