Prognostic impact of hypernatremia for septic shock patients in the intensive care unit

BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevance in patients with septic shock remains uncertain.AIM To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.METHODS In the present retrospective single-center study,a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University,between August 1,2018,and May 31,2023,were analyzed.Patients were categorized based on the timing of hypernatremia occurrence into the IAH group(n=62),the non-IAH group(n=41),and the normonatremia group(n=54).RESULTS In the present study,there was a significant association between the high serum sodium concentrations,excessive persistent inflammation,immunosuppression and catabolism syndrome and chronic critical illness,while rapid recovery had an apparent association with normonatremia.Moreover,multivariable analyses revealed the following independent risk factors for IAH:Total urinary output over the preceding three days[odds ratio(OR)=1.09;95%CI:1.02–1.17;P=0.014],enteral nutrition(EN)sodium content of 500 mg(OR=2.93;95%CI:1.13–7.60;P=0.027),and EN sodium content of 670 mg(OR=6.19;95%CI:1.75–21.98;P=0.005)were positively correlated with the development of IAH.Notably,the area under the curve for total urinary output over the preceding three days was 0.800(95%CI:0.678–0.922,P=0.001).Furthermore,maximum serum sodium levels,the duration of hypernatremia,and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients(P<0.05).CONCLUSION The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU.It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.

Sustained release of vascular endothelial growth factor A and basic fibroblast growth factor from nanofiber membranes reduces oxygen/glucose deprivation-induced injury to neurovascular units

Upregulation of vascular endothelial growth factor A/basic fibroblast growth factor(VEGFA/b FGF)expression in the penumbra of cerebral ischemia can increase vascular volume,reduce lesion volume,and enhance neural cell proliferation and differentiation,thereby exerting neuroprotective effects.However,the beneficial effects of endogenous VEGFA/b FGF are limited as their expression is only transiently increased.In this study,we generated multilayered nanofiber membranes loaded with VEGFA/b FGF using layer-by-layer self-assembly and electrospinning techniques.We found that a membrane containing 10 layers had an ideal ultrastructure and could efficiently and stably release growth factors for more than 1 month.This 10-layered nanofiber membrane promoted brain microvascular endothelial cell tube formation and proliferation,inhibited neuronal apoptosis,upregulated the expression of tight junction proteins,and improved the viability of various cellular components of neurovascular units under conditions of oxygen/glucose deprivation.Furthermore,this nanofiber membrane decreased the expression of Janus kinase-2/signal transducer and activator of transcription-3(JAK2/STAT3),Bax/Bcl-2,and cleaved caspase-3.Therefore,this nanofiber membrane exhibits a neuroprotective effect on oxygen/glucose-deprived neurovascular units by inhibiting the JAK2/STAT3 pathway.

Influence of Civil Authority on Rural Grass-roots Democracy and Social Autonomy in Northwest Minority Regions

System of villagers autonomy is one of the basic political systems in China and one of those systems ensuring that the people are the masters of the country. Northwest minorities generally live in the remote northwestern China where economy and education are relatively underdeveloped compared with those in central and eastern China and civil authority has great influence on rural grass-roots democracy as well as social autonomy there,which causes difficulties to the development of rural democracy and social autonomy. Assisting northwest minority regions in overcoming the difficulties of developing grass-roots democracy and social autonomy,carrying out effective measures to properly guide the development and influence of civil authority and finally achieving the construction of new socialist countryside have great significance in ensuring that people there are the masters of their country.

The neurovascular unit-on-a-chip:modeling ischemic stroke to stem cell therapy

The neurovascular unit and stem cell therapy in ischemic stroke:Ischemic stroke,accounts for approximately 85% of all stroke incidents and is a major global health burden.It is the leading cause of disability and death worldwide,posing immense societal and economic challenges due to the long-term care required for stro ke survivors and the significant healthcare costs associated with its treatment and management(Amarenco et al.,2009).

Resource Dependence Relationship between Grass-roots Government and Farmers' Specialized Cooperatives

Based on theories of resource dependence and government functions,this paper analyzed benefit interaction between grass-roots government and farmers' specialized cooperatives in Hubei Province. It was intended to make clear the path dependence relationship between grassroots government and farmers' specialized cooperatives and find out problems in between. Besides,from the perspective of grass-roots government and farmers' specialized cooperatives,it came up with corresponding recommendations,to promote constant improvement of farmers' specialized cooperatives,and help them to become key forces of leading farmers to get rich,pull agricultural economic development,and promote new socialist countryside construction.

Construction of Rural Grass-roots Water Conservancy Service System in the Context of Institutional Changes

At present,it is urgent to solve problems of reforming and improving grass-roots water conservancy management mode in rural areas and improving rural water conservancy public service ability. Through analyzing institutional changes of grass-roots water conservancy management in rural areas,this paper discussed current situations and outstanding problems in grass-roots water conservancy services in rural areas of Kunming City. On the basis of current situations and problems,it came up with policy recommendations from reform of management institutions,reform of personnel system,construction of human resources,development of rural water use cooperation organizations,and improvement of fund input mechanism,to build rural grass-roots water conservancy service system.

Assessment of Wet Season Precipitation in the Central United States by the Regional Climate Simulation of the WRFG Member in NARCCAP and Its Relationship with Large-Scale Circulation Biases

Assessment of past-climate simulations of regional climate models(RCMs)is important for understanding the reliability of RCMs when used to project future regional climate.Here,we assess the performance and discuss possible causes of biases in a WRF-based RCM with a grid spacing of 50 km,named WRFG,from the North American Regional Climate Change Assessment Program(NARCCAP)in simulating wet season precipitation over the Central United States for a period when observational data are available.The RCM reproduces key features of the precipitation distribution characteristics during late spring to early summer,although it tends to underestimate the magnitude of precipitation.This dry bias is partially due to the model’s lack of skill in simulating nocturnal precipitation related to the lack of eastward propagating convective systems in the simulation.Inaccuracy in reproducing large-scale circulation and environmental conditions is another contributing factor.The too weak simulated pressure gradient between the Rocky Mountains and the Gulf of Mexico results in weaker southerly winds in between,leading to a reduction of warm moist air transport from the Gulf to the Central Great Plains.The simulated low-level horizontal convergence fields are less favorable for upward motion than in the NARR and hence,for the development of moist convection as well.Therefore,a careful examination of an RCM’s deficiencies and the identification of the source of errors are important when using the RCM to project precipitation changes in future climate scenarios.

The Grass-Roots Governance of the National Government in Tianjin Recovery Area After the Triumph of the Anti-Japanese War

The national government wants to penetrate into the grass-roots unit after the triumph of the Anti-Japanese War in the recovery area.Through the reorganization of the Baojia system,the government expects to achieve local autonomy and then solve the people’s livelihood issues.The new Baojia system provides a platform for people to achieve their own demands,which presents the vision of civil rights to a certain extent.However,because of the complexity of the postwar social environment,the Baojia system cannot completely represent the will of the people,and finally becomes a militarized organization that was used as a tool to carry out the government decree.

基于Unity3D的油田抽油机三维可视化监控系统设计

针对抽油机监测形式单一、三维可视化程度低和联动性差的缺陷,引入信息―物理实时映射思想,开发了油田抽油机三维可视化监控系统。设计了抽油机数字空间,搭建虚实交互层设计架构;搭建三维可视化系统数据组成及关系框架;结合逆运动学,构建数学模型,基于五维模型和Unity 3D平台设计抽油机三维可视化系统总体架构;以游梁式抽油机为对象进行实验验证,实现了实时动态监测、虚实混合控制、运动轨迹追踪和在线预警等服务功能。为三维可视化监控在石油机械领域的落地应用和数字孪生系统的开发提供借鉴。

A gated recurrent unit model to predict Poisson’s ratio using deep learning

Static Poisson’s ratio(vs)is crucial for determining geomechanical properties in petroleum applications,namely sand production.Some models have been used to predict vs;however,the published models were limited to specific data ranges with an average absolute percentage relative error(AAPRE)of more than 10%.The published gated recurrent unit(GRU)models do not consider trend analysis to show physical behaviors.In this study,we aim to develop a GRU model using trend analysis and three inputs for predicting n s based on a broad range of data,n s(value of 0.1627-0.4492),bulk formation density(RHOB)(0.315-2.994 g/mL),compressional time(DTc)(44.43-186.9 μs/ft),and shear time(DTs)(72.9-341.2μ s/ft).The GRU model was evaluated using different approaches,including statistical error an-alyses.The GRU model showed the proper trends,and the model data ranges were wider than previous ones.The GRU model has the largest correlation coefficient(R)of 0.967 and the lowest AAPRE,average percent relative error(APRE),root mean square error(RMSE),and standard deviation(SD)of 3.228%,1.054%,4.389,and 0.013,respectively,compared to other models.The GRU model has a high accuracy for the different datasets:training,validation,testing,and the whole datasets with R and AAPRE values were 0.981 and 2.601%,0.966 and 3.274%,0.967 and 3.228%,and 0.977 and 2.861%,respectively.The group error analyses of all inputs show that the GRU model has less than 5% AAPRE for all input ranges,which is superior to other models that have different AAPRE values of more than 10% at various ranges of inputs.

"Emperor's Power Far Away from the Countryside"and"Town in Charge of Village Affairs":The Extreme Grass-roots Management System is Not Conducive to the Healthy Development of the Countryside

This paper compares the two different rural management methods of"emperor’s power far away from the countryside"and"town in charge of village affairs",which shows that the extreme grass-roots management system is not conducive to rural development.This paper also points out that rural development needs to find a road of sustainable development in line with its own characteristics,which is the fundamental shortcut to change poverty and become rich for a long time.

GENERALIZED FORELLI-RUDIN TYPE OPERATORS BETWEEN SEVERAL FUNCTION SPACES ON THE UNIT BALL OF C^(N)

In this paper,we investigate sufficient and necessary conditions such that generalized Forelli-Rudin type operators T_(λ,τ,k),S_(λ,τ,k),Q_(λ,τ,k)and R_(λ,τ,k)are bounded between Lebesgue type spaces.In order to prove the main results,we first give some bidirectional estimates for several typical integrals.

Uncertainties of landslide susceptibility prediction:influences of different study area scales and mapping unit scales

This study aims to investigate the effects of different mapping unit scales and study area scales on the uncertainty rules of landslide susceptibility prediction(LSP).To illustrate various study area scales,Ganzhou City in China,its eastern region(Ganzhou East),and Ruijin County in Ganzhou East were chosen.Different mapping unit scales are represented by grid units with spatial resolution of 30 and 60 m,as well as slope units that were extracted by multi-scale segmentation method.The 3855 landslide locations and 21 typical environmental factors in Ganzhou City are first determined to create spatial datasets with input-outputs.Then,landslide susceptibility maps(LSMs)of Ganzhou City,Ganzhou East and Ruijin County are pro-duced using a support vector machine(SVM)and random forest(RF),respectively.The LSMs of the above three regions are then extracted by mask from the LSM of Ganzhou City,along with the LSMs of Ruijin County from Ganzhou East.Additionally,LSMs of Ruijin at various mapping unit scales are generated in accordance.Accuracy and landslide suscepti-bility indexes(LSIs)distribution are used to express LSP uncertainties.The LSP uncertainties under grid units significantly decrease as study area scales decrease from Ganzhou City,Ganzhou East to Ruijin County,whereas those under slope units are less affected by study area scales.Of course,attentions should also be paid to the broader representativeness of large study areas.The LSP accuracy of slope units increases by about 6%–10%compared with those under grid units with 30 m and 60 m resolution in the same study area's scale.The significance of environmental factors exhibits an averaging trend as study area scale increases from small to large.The importance of environmental factors varies greatly with the 60 m grid unit,but it tends to be consistent to some extent in the 30 m grid unit and the slope unit.

Risk Factors for Mortality in Acute Kidney Injury in Intensive Care Units in Togo

Context: Acute kidney injury (AKI) in intensive care unit (ICU) is common and associated with very high mortality. In Togo, a tropical country with limited resources and only one nephrology department in the north, acute kidney injury seems to be a real tragedy with high mortality. Aims: to determine risk factors for mortality in acute kidney injury in the intensive care units. Methods and Material: We made a multicentric cross sectional study during 6 months in the four referral centers in northern Togo. Univariate and multivariate logistic regression was used to identify factors associated with mortality. Data were analyzed using RStudio 2023.04.1. Results: A total of 12.6% of patients admitted to intensive care had presented with AKI. The mean age was 49.6 ± 17.9. The sex ratio (M/F) was 2.1. Community-acquired AKI was in the majority (67.7%). Oligo anuria was the most frequent functional sign (38.4%). In our series, 81.6% of patients were in KDIGO stages 2 to 3. AKI was organic in 56.2% of cases. Mortality was 44.3%. In multivariate analysis, the main factors predictive of death were: respiratory distress (OR = 2.36;p Conclusions: Acute kidney injury in intensive care is common in northern Togo, and mortality is high. Identification of associated factors should help anticipate prognosis.

Nurse Stress Associated with Delirium Care in Intensive Care Units: A Cross-Sectional Study

Background and Objectives: Delirium is highly prevalent in Intensive Care Units (ICUs). While prior studies have identified hyperactive and hyperalert behaviors as major stressors for nurses caring for delirious patients, limited research exists on ICU nurses’ stress specifically related to delirium care. This study aims to investigate the stress experienced by ICU nurses in China when managing patients with delirium. Methods: This cross-sectional survey was conducted in China from January to February 2023. A total of 243 ICU nurses participated by completing an online survey that included the Personal Information Questionnaire and the Strain of Caring for Delirium Index (SCDI). Although 260 responses were initially collected, 29 invalid questionnaires were excluded, resulting in a final sample size of 243 valid responses. The SCDI scale demonstrated reliable internal consistency, with Cronbach’s α coefficients of 0.744, 0.812, 0.778, and 0.920 across its four subscales. Results: The survey results indicated that hypoactive delirium behaviors were perceived as the most significant stressors when caring for delirious patients. Among the behaviors, “noisy/yelling” was identified as the most challenging, whereas “pulling at tubes, dressings” was rated as the least challenging. No significant associations were found between demographic factors and stress levels. Conclusion: This study sheds light on the stress levels ICU nurses experience when caring for delirious patients, particularly in relation to hypoactive behaviors. Based on these findings, it is recommended that nurse managers implement stress management strategies and provide targeted delirium-related care training to better support ICU nurses and enhance the quality of delirium care.

A Retrospective Analysis of Intoxicated Patients Admitted to the Intensive Care Unit: A Single-Institution Assessment in the Post-Pandemic Period

Background: The aim of this study was to evaluate the clinical and epidemiological characteristics of patients with acute intoxication admitted to the Intensive Care Unit (ICU). Material and Methods: An observational retrospective study was conducted on intoxicated patients who admitted to ICU between January 2022 and January 2024. Data were collected from the patients medical records. The demographic characteristics, causes of intoxications, clinical parameters, the mean stay in the ICU, treatment modalities and prognosis were recorded. Results: A total of 2875 critically ill patients were admitted during the study period, and 109 (3.79%) of them were acute intoxications. Their mean of ages was 38.09 ± 12.29. The female-to-male ratio was 1.37/1. Drugs were found to be the primary cause (62.39%) of intoxications, and analgesics, antidepressants, and antibiotics were the most frequent agents. Suicidal attempts were present in 66 patients, most of them were female (62.13%) and between 17 - 24 years (40.91%). The other common causes of intoxications were carbon monoxide (CO) (22.02%), methyl/ethyl alcohol (8.26%) and mushroom (5.50%). The mean stay in the ICU was 2.69 ± 0.89 days. Mechanical ventilation was applied to 10 of our patients. Renal replacement therapy was required in 6 patients. Despite all treatments, 6 of our patients died, and we found the mortality rate to be 5.50%. Conclusion: Intoxications were more frequent in young female patients and drugs were the most common cause with suicidal intent. Unfortunately, CO poisoning continues to be a very important problem in our city. These findings provided significant information about the characteristics of intoxications in Karabuk.

A conceptual analysis of facilitation to improve clinical outcomes in critical care units

Objectives:Effective facilitation is crucial to improve critical care outcomes in life-threatening conditions through improved teamwork,caring,decision-making,and problem-solving.The meaning of facilitation remains unprecise in a critical care context despite its frequent usage in nursing education and clinical practice.This study aimed to report a thorough concept analysis to clarify the meaning of facilitation in the critical care context by formulating attributes,antecedents,and consequences and providing model cases related to facilitation.Methods:This analysis was performed by searching online sources published from 1999 to 2023.EBSCOhost,CINAHL,PubMed,and Google Scholar databases were searched using online search engines.The analysis also included the manual search of books,thesaurus and dictionaries that showed relevance to facilitation.Walker and Avant’s eight-step approach was applied to explore and analyze the meaning of facilitation in critical care units.Results:A total of 68 articles were included in the analysis of this study.Eleven attributes,six antecedents,and seven consequences related to facilitation were formulated.The attributes included dynamic,interactive processes,creating a positive environment,mobilizing resources,assistance,studentcentered,shared goals,collaboration,engagement,participation,and feedback.Antecedents were facilitator qualities,motivation,a positive learning environment,student-facilitator relationship,time availability,and specified learning outcomes.The consequences of facilitation were identified as follows:change,professional development,competency,quality development,increased job satisfaction,staff retention,and self-confidence.Conclusions:The findings from the analysis indicated that effective facilitation results in nurses and critical care staff developing competency,caring,critical thinking,and independence.Therefore,clinical outcomes in critical care environments are improved through teamwork,decision-making,and problemsolving in life-threatening situations.

Cleaning of two mirrors in the first mirror unit using radiofrequency capacitively coupled plasma

First mirror(FM)cleaning,using radio frequency(RF)plasma,has been proposed to recover FM reflectivity in nuclear fusion reactors such as the International Thermonuclear Experimental Reactor(ITER).To investigate the influence of simultaneous cleaning of two mirrors on mirror cleaning efficiency and uniformity,experiments involving single-mirror cleaning and dual-mirror cleaning were conducted using RF capacitively coupled plasma in the laboratory.For the test and simultaneous cleaning of two mirrors,the FM and second mirror(SM),both measuring 110 mm×80 mm,were placed inside the first mirror unit(FMU).They were composed of 16 mirror samples,each with a dimension of 27.5 mm×20 mm.These mirror samples consist of a titanium-zirconium-molybdenum alloy substrate,a 500 nm Mo intermediate layer and a 30 nm Al_(2)O_(3) surface coating as a proxy for Be impurities.The cleaning of a single first mirror(SFM)and the simultaneous cleaning of the FM and SM(DFM and DSM)lasted for 9 h using Ar plasma at a pressure of 1 Pa.The total reflectivity of mirror samples on the DSM did not fully recover and varied with location,with a self-bias of−140 V.With a self-bias of−300 V,the total reflectivity of mirror samples on the SFM and DFM was fully recovered.The energy dispersive spectrometer results demonstrated that the Al_(2)O_(3) coating had been completely removed from these mirror samples.However,the mass loss of each mirror sample on the SFM and DFM before and after cleaning varied depending on its location,with higher mass loss observed for mirror samples located in the corners and lower loss for those in the center.Compared with SM cleaning,the simultaneous cleaning of two mirrors reduced the difference between the highest and lowest mass loss.Furthermore,this mass loss for the mirror samples of the DFM facing the DSM was increased.This indicated that mirror samples cleaned face to face in the FMU simultaneously could influence each other,highlighting the need for special attention in future studies.

Research on process-induced effect in 14-nm FinFET gate formation and digital unit optimization design

The advanced fin-shaped field-effect transistor(FinFET)technology offers higher integration density and stronger channel control capabilities,however,more complex process effects are also introduced which have significant influence on device performance.To address these issues,we complete a design-technology co-optimization(DTCO)focused on FinFET,including both process-induced effect during gate formation and corresponding digital unit optimization design.The 14 nm Fin-FET complementary metal oxide semiconductor(CMOS)technology is used to illustrate the sensitivity of transistor perfor-mance to process-induced effect,specifically the poly pitch effect(PPE)and cut poly effect(CPE).Predictive technology com-puter aided design(TCAD)simulations have been carried out to evaluate the transistor performance in advance.Based on the results,optimizations in digital unit design is proposed.Fall delay of the digital unit inverter is decreased by 0.7%,and the rise delay is decreased by 2.1%.For multiple selector(MUX2NV),the delay decreases by 4.64%for rise and 3.56%for drop,respec-tively.

One memristor–one electrolyte-gated transistor-based high energy-efficient dropout neuronal units

Artificial neural networks(ANN) have been extensively researched due to their significant energy-saving benefits.Hardware implementations of ANN with dropout function would be able to avoid the overfitting problem. This letter reports a dropout neuronal unit(1R1T-DNU) based on one memristor–one electrolyte-gated transistor with an ultralow energy consumption of 25 p J/spike. A dropout neural network is constructed based on such a device and has been verified by MNIST dataset, demonstrating high recognition accuracies(> 90%) within a large range of dropout probabilities up to40%. The running time can be reduced by increasing dropout probability without a significant loss in accuracy. Our results indicate the great potential of introducing such 1R1T-DNUs in full-hardware neural networks to enhance energy efficiency and to solve the overfitting problem.