Serum procalcitonin levels are associated with rhabdomyolysis following exertional heatstroke: an over 10-year intensive care survey

BACKGROUND:Heatstroke has become a common emergency event in hospitals.Procalcitonin(PCT)is used as a biomarker of infection in the emergency department(ED),but its role in rhabdomyolysis(RM)following exertional heatstroke(EHS)remains unclear.METHODS:A retrospective cohort study enrolled patients with EHS from the intensive care unit(ICU).We collected RM biomarkers,inflammation markers,critical disease scores at admission,24 h,48 h,and discharge,and 90-day mortality.Correlation analysis,linear regression and curve fi tting were used to identify the relationship between PCT and RM.RESULTS:A total of 162 patients were recruited and divided into RM(n=56)and non-RM(n=106)groups.PCT was positively correlated with myoglobin(Mb),acute hepatic injury,disseminated intravascular coagulation(DIC),Sequential Organ Failure Assessment(SOFA)score,and Acute Physiology and Chronic Health Evaluation II(APACHE II)score,with correlation coefficients of 0.214,0.237,0.285,0.454,and 0.368,respectively(all P<0.05).Interestingly,the results of curve fi tting revealed a nonlinear relationship between PCT and RM,and a two-piecewise linear regression model showed that PCT was related to RM with an odds ratio of 1.3 and a cut-off of<4.6 ng/mL.Survival analysis revealed that RM was associated with higher mortality compared to non-RM cases(P=0.0093).CONCLUSION:High serum PCT concentrations are associated with RM after EHS in critically ill patients.Elevated PCT concentrations should be interpreted cautiously in patients with EHS in the ED.

Sequential intraventricular injection of tigecycline and polymyxin B in the treatment of intracranial Acinetobacter baumannii infection after trauma: a case report and review of the literature

Background:Intracranial infection after craniotomy is one of the most serious postoperative complications,especially multidrug-resistant(MDR)or extensively drug-resistant(XDR)bacterial meningitis,and strongly affects the prognosis of patients.Current treatment experience regarding these infections is scarce.Case presentation:We report a case of severe intracranial infection of XDR Acinetobacter baumannii(A.baumannii)that was treated by intravenous(IV)injection,sequential intraventricular(IVT)injection of tigecycline and polymyxin B,and other anti-infective drugs.Good results were obtained,and the patient was eventually discharged from the hospital.This case is characterized by intracranial infection.Conclusions:The polymyxin B IV+IVT pathway is an ideal treatment strategy for XDR A.baumannii.The tigecycline IVT pathway is also a safe treatment option.

A Medical Case of Acne Vulgaris Treated with Danggui Shaoyao Powder Combined with Sini Powder

Acne vulgaris is a chronic inflammatory skin disease damaging face,and the incidence of acne vulgaris is increasing year by year in China.Acne falls into the category of pimple in traditional Chinese medicine,and there are many dialectical understandings of acne in modern traditional Chinese medicine.Dr.He Aijuan has a unique diagnosis and treatment thinking in treating acne vulgaris(liver stagnation and spleen deficiency type)with traditional Chinese medicine in her clinical work for many years.Her application of Danggui Shaoyao Powder combined with Sini Powder has a remarkable effect in the clinical treatment process,so a clinical medical case is selected for discussion.

Correlation analysis of osteonecrosis of the femoral head with blood lipid and coagulation indexes

Objective: To explore the correlation between different types of osteonecrosis of the femoral head and blood lipids and coagulation indexes, in order to provide relevant references for the pathogenesis of osteonecrosis of the femoral head. Methods: 308 cases of ONFH were divided into alcohol group (165 cases), hormone group (113 cases), trauma group (30 cases), and basic data of patients were collected. Blood lipid indicators: total cholesterol, triglycerides, high density lipoprotein cholesterol, low density lipoprotein cholesterol, apolipoprotein A, apolipoprotein B;coagulation indicators: activated partial thromboplastin time, plasma prothrombin time, fibrinogen, thrombin time indicators, using analysis of variance method for different types of osteonecrosis of the femoral head and blood lipids, coagulation indicators Search for relevance. Results: 1. Comparison of three groups of blood lipid indicators: total cholesterol and low density lipoprotein cholesterol in the alcohol group were higher than those in the trauma group (P<0.05);total cholesterol, triglycerides, and low density lipoprotein in the alcohol group The three indexes of cholesterol were higher than those of the hormone group (P<0.05). There was no significant difference in the serum lipid indexes of the hormone group and the trauma group (P>0.05). 2. Comparison of three groups of coagulation indicators: hormone The fibrinogen index of the group was higher than that of the trauma group (P<0.05). There was no significant difference in the coagulation index between the alcohol group and the trauma group (P>0.05). The coagulation index of the hormone group and the alcohol group was compared. The differences were not statistically significant (P>0.05). Conclusions: 1. Non-traumatic osteonecrosis of the femoral head (alcoholic, hormonal) patients are characterized by markedly elevated blood lipids (total cholesterol, low density lipoprotein cholesterol) and coagulation (fibrinogen) indicators;2. Intravascular coagulation and lipid metabolism disorders may be the pathological basis of non-traumatic Osteonecrosis of the femoral head.

Xiaoyaosan improves depressive-like behaviors by regulating the NLRP3 signaling pathway in the rat cerebral cortex

Objective:To observe changes in the molecular expression of the NLR Family Pyrin Domain Containing Protein 3(NLRP3)pathway in depressed rats after treatment with Xiaoyaosan,and identify the regulatory mechanism of this compound.Methods:Male SpragueeD awley rats were randomly divided into five groups with 12 rats in each group,including the control group,model group,Fluoxetine group,Xiaoyaosan group,and MCC950 group.A depression model was generated by chronic immobilization stress(induced by 3 h of restraint immobilization every day),and the drugs were administered at the same time in each group for 21 days.The effects of Xiaoyaosan on behavioral changes of depressed rats were observed through macroscopic characterization,body mass,open field experiments,and a sucrose preference test.The m RNA and protein expression of the NLRP3 signaling pathway was examined by fluorescence real-time quantitative PCR and Western blot assays.Results:The Xiaoyaosan group,Fluoxetine group,and MCC950 group rats showed improved depressive behavior and an increased weight of sucrose water consumption.The protein and mRNA expression levels of NLRP3,Caspase-1,and IL-1 b were also decreased in the Fluoxetine,Xiaoyaosan,and MCC950 groups.Conclusion:NLRP3,Caspase-1,and IL-1 b protein and mRNA expression levels were increased in the cortex of depressed rats,while Xiaoyaosan protected cortical tissue in these rats by decreasing NLRP3,Caspase-1,and IL-1 b protein and mRNA expression.

Risk factors for brain injury in patients with exertional heatstroke:A 5-year experience

Purpose:Minimal data exist on brain injury in patients with exertional heatstroke(EHS)in developing country.In this study,we explored the risk factors for brain injury induced by EHS 90-day after onset.Methods:A retrospective cohort study of patients with EHS was conducted in the intensive care unit of the General Hospital of Southern Theater Command of PLA in China from April 2014 to June 2019.Patients were divided into non-brain injury(fully recovered)and brain injury groups(comprising deceased patients or those with neurological sequelae).The brain injury group was further subdivided into a death group and a sequela group for detailed analysis.General information,neurological performance and information on important organ injuries in the acute stage were recorded and analysed.Multivariable logistic regression was used to identify risk factors for brain injury after EHS and mortality risk factors for brain injury,and Kaplan-Meier survival curve was used to evaluate the effect of the neurological dysfunction on survival.Results:Out of the 147 EHS patients,117 were enrolled,of which 96(82.1%)recovered,13(11.1%)died,and 8(6.8%)experienced neurological sequelae.Statistically significant differences were found between non-brain injury and brain injury groups in age,hypotension,duration of consciousness disorders,time to drop core body temperature below 38.5℃,lymphocyte counts,platelet counts,procalcitonin,alanine aminotransferase,aspartate aminotransferase,creatinine,cystatin C,coagulation parameters,international normalized ratio,acute physiology and chronic health evaluation II scores,sequential organ failure assessment(SOFA)scores,and Glasgow coma scale scores(all p<0.05).Multivariate logistic regression showed that age(OR=1.090,95%CI:1.02-1.17,p=0.008),time to drop core temperature(OR=8.223,95%CI:2.30-29.40,p=0.001),and SOFA scores(OR=1.676,95%CI:1.29-2.18,p<0.001)are independent risk factors for brain injury induced by EHS.The Kaplan-Meier curves suggest significantly prolonged survival(p<0.001)in patients with early Glasgow coma scale score>8 and duration of consciousness disorders≤24 h.Conclusions:Advanced age,delayed cooling,and higher SOFA scores significantly increase the risk of brain injury post-EHS.These findings underscore the importance of rapid cooling and early assessment of organ failure to improve outcomes in EHS patients.

Natural okra-based hydrogel for chronic diabetic wound healing

As a representative of chronic wounds,the long-term high levels of oxidative stress and blood sugar in chronic diabetic wounds lead to serious complications,making them the biggest challenge in the research on wound healing.Many edible natural biomaterials rich in terpenes,phenols,and flavonoids can act as efficient antioxidants.In this study,okra extract was selected as the main component of a wound dressing.The okra extracts obtained via different methods comprehensively maintained the bioactivity of multiple molecules.The robust antioxidant properties of okra significantly reduced intracellular reactive oxygen species production,thereby accelerating the wound healing process.The results showed that okra extracts and their hydrogel dressings increased cell migration,angiogenesis,and re-epithelization of the chronic wound area,considerably promoting wound remodeling in diabetic rats.Therefore,okra-based hydrogels are promising candidates for skin regeneration and wider tissue engineering applications.

Electroacupuncture attenuates chronic salpingitis via transforming growth factor-β1/p38 mitogen-activated protein kinase signaling pathway

OBJECTIVE:To explore the effect of electroacupuncture(EA)on rats with chronic fallopian tube inflammation and its potential mechanisms.METHODS:Thirty-six female Sprague-Dawley rats were divided into Control,Model and EA groups.The pathological morphology of the fallopian tubes was observed by hematoxylin-eosin(HE)and Masson staining.The results of transforming growth factor-β1(TGF-β1),P38 mitogen-activated protein kinase(MAPK),phosphorylation(p)-p38MAPK in rat oviduct tissues were detected by immunohistochemistry.Results of P38MAPK,p-P38MAPK and TGF-β1 in rat oviduct tissues were detected by immunofluorescence.The expression level of p38MAPK,p-P38MAPK,TGF-β1 protein in rats was detected by Western blot.Quantitative real-time polymerase chain reaction(RT-q PCR)was used to detect m RNA expression levels of TGF-β1.RESULTS:It found that collagen fibers counts decreased significantly in EA group compared to Model group.The phosphorylation of P38MAPK in EA group was significantly reduced compared to Model group.The serum TGF-β1 expressions in EA group increased decreased significantly.CONCLUSION:Electroacupuncture was able to attenuate chronic salpingitis through down-regulating TGF-β1/MAPK signaling pathway.