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Objectives. Nonhepatic hyperammonemia often occurs in patients with sepsis. Ammonia plays an essential role in the occurrence of hepatic encephalopathy. However, the relationship between nonhepatic serum ammonia levels and sepsis-associated encephalopathy (SAE) remains unclear. Thus, we aimed to evaluate the association between serum ammonia levels and patients with SAE. Methods. Data of critically ill adults with sepsis who were admitted to the intensive care unit were retrieved from the Medical Information Mart for Intensive Care IV (MIMIC IV) between 2008 and 2019 and retrospectively analyzed. Data of patients with sepsis patients and serum ammonia not related to acute or chronic liver disease were not included. Results. Data from 720 patients with sepsis were included. SAE was found to have a high incidence (64.6%). After adjusting for other risk factors, a serum ammonia level of ≥45 μmol/L (odds ratio (OR): 3.508, 95% confidence interval (CI): 2.336–5.269, p < 0.001) was found to be an independent risk factor for patients with SAE; moreover, as the serum ammonia level increased, the hospital mortality of SAE gradually increased in a certain range (serum ammonia <150 μmol/L). Serum ammonia levels of ≥45 μmol/L were associated with higher Simplified Acute Physiology Score II and Sequential Organ Failure Assessment (SOFA) scores in patients with SAE. Besides, our study found that patients with SAE used opioid analgesics (OR:3.433, 95% CI: 1.360–8.669, p = 0.009) and the SOFA scores of patients with SAE (OR: 1.126, 95% CI: 1.062–1.194, p < 0.001) were significantly higher than those without SAE. Conclusions. Nonhepatic serum ammonia levels of ≥45 μmol/L evidently increased the incidence of SAE. Serum ammonia levels should be closely monitored in patients with sepsis. [ABSTRACT FROM AUTHOR]

Objective. The study focused on the nursing strategies of patients with ventilator-associated pneumonia (VAP) and multicriteria decision analysis (MCDA) in nursing supervision, so as to improve the survival rate and prognosis of patients with VAP. Methods. 200 patients of the database in the ICU who required mechanical ventilation were selected as research subjects. They were divided into control group and intervention group according to different nursing measures. The incidence of VAP was compared between the two groups, and 15 experts were consulted on the prevention measures of VAP. On the basis of ARIMA-GARCH mathematical modeling, using the method of multicriteria decision analysis, the cluster nursing strategy for ventilator-associated pneumonia patients was developed and verified. Results. In the control group, of the 34 patients infected with VAP, Gram-positive bacteria were detected in 11 cases, including 6 cases of Streptococcus pneumoniae, 3 cases of Escherichia coli, and 2 cases of golden yellow Staphylococcus. Gram-negative bacteria were detected in 10 cases, including 5 (50%) cases of Acinetobacter baumannii, 2 cases of Klebsiella pneumoniae, 2 cases of Brucella Bacillus, and 1 case of Pseudomonas aeruginosa. In the intervention group, 18 cases were diagnosed with VAP, including 4 (44.4%) cases of bacterial infection, 3 (44.4%) cases of virus infection, and 2 (22.2%) cases of fungal infection. According to the opinions of the 15 experts, a total of 6 bundled measures were adopted to prevent VAP, including 0.1% chlorhexidine for oral care; strict implementation of hand hygiene; the daily wake-up for spontaneous breath training and extubation assessment; continuous subglottic suction; raising the bed head by 30°–45°; and nasal feeding through the nasal tube without special condition. Conclusion. There are many factors that affect the occurrence of VAP in mechanically ventilated patients in the ICU, and the imperfect measures of bundles of care are the main one. The implementation rates of distinct intervention strategies are different. The implementation rate of 2 measures is lower than 95%, which are the continuous subglottic suction and daily wake-up for spontaneous breath training and extubation assessment. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is now the fourth leading cause of death in the world, and it continues to increase in developing countries. The World Health Organization expects COPD to be the third most common cause of death in the world by 2020. Effective and continuous postdischarge care can help patients to maintain good health. The use of electronic health records (EHRs) as an element of community health care is new technology in China.Objective: The aim of this study was to develop and evaluate a Web-based coaching program using EHRs for physical function and health-related quality of life for patients with COPD in China.Methods: A randomized controlled trial was conducted from 2008 to 2015 at two hospitals. The control group received routine care and the intervention group received routine care with the addition of the Web-based coaching program using EHRs. These were used to manage patients' demographic and clinical variables, publish relevant information, and have communication between patients and health care providers. Participants were not blinded to group assignment. The effects of the intervention were evaluated by lung function, including percent of forced expiratory volume in 1 second (FEV1%), percent of forced vital capacity (FVC%), peak expiratory flow (PEF), maximum midexpiratory flow; St George's Respiratory Questionnaire (SGRQ); Modified Medical Research Council Dyspnea Scale (MMRC); and 6-Minute Walk Test (6MWT). Data were collected before the program, and at 1, 3, 6, and 12 months after the program.Results: Of the 130 participants, 120 (92.3%) completed the 12-month follow-up program. There were statistically significant differences in lung function (FEV1%: F1,4=5.47, P=.002; FVC%: F1,4=3.06, P=.02; PEF: F1,4=12.49, P<.001), the total score of SGRQ (F1,4=23.30, P<.001), symptoms of SGRQ (F1,4=12.38, P<.001), the activity of SGRQ (F1,4=8.35, P<.001), the impact of SGRQ (F1,4=12.26, P<.001), MMRC (F1,4=47.94, P<.001), and 6MWT (F1,4=35.54, P<.001) between the two groups with the variation of time tendency.Conclusions: The Web-based coaching program using EHRs in China appears to be useful for patients with COPD when they are discharged from hospital into the community. It promotes the sharing of patients' medical information by hospital and community nurses, and achieves dynamic management and follow-up analysis for patients' disease. In addition, this program can postpone the decreasing rate of lung function, improve quality of life, decrease dyspnea, and increase physical capacity. [ABSTRACT FROM AUTHOR]

Black liquor and Fenton sludge are common industrial wastes that come from the conventional kraft pulping process and the Fenton wastewater treatment process, respectively. In this study, the biochar-supported iron-based catalysts were synthesized through a simple one-step pyrolysis method using acid-precipitated black liquor (APBL) as carbon source and Fenton sludge as iron source, and were then applied for Fenton-like removal of rhodamine B (RhB) dyes. The optimized catalyst (Fe@BC FAK), pyrolyzed at 900 ºC with KOH as the activator, was mesoporous biochar-supported nanoscale zero-valent iron (nZVI). Under the optimal conditions (50 mg L−1 RhB, initial pH 3, 2 mM H 2 O 2 concentration, catalyst dosage of 0.2 g L−1), the Fe@BC FAK /H 2 O 2 system achieved almost 100% RhB dye removal within 10 min. Moreover, the Fe@BC FAK /H 2 O 2 system also exhibited excellent removal efficiencies for malachite green, crystal violet, and methylene blue. The Fe@BC FAK had a good magnetic separation ability (146.4 emu g−1) and maintained a high removal efficiency of RhB (83.8%) in the presence of H 2 O 2 after five times of recycling/reuse. The degradation of RhB dye was mainly attributed to •OH, including surface-bound •OH and free •OH. Besides the excellent catalytic ability and Fe(III) reduction ability of nZVI itself, the biochar supports with high specific surface area and mesoporous structure also played important roles in the removal of RhB dye, such as adsorbing RhB dyes, alleviating nZVI aggregation, and accelerating the reduction of Fe(III) to Fe(II). [Display omitted] • Catalyst was synthesized from two industrial wastes by one-step pyrolysis method. • The degradation reaction was obtained efficiently at pH 3 with low H 2 O 2 consumption. • Fe@BC FAK exhibited excellent catalytic ability and reusability in removing RhB. • Biochar support facilitated Fe(III) reduction, mass transfer and H 2 O 2 activation. [ABSTRACT FROM AUTHOR]

Background: Sepsis-associated encephalopathy (SAE) is a neuronal injury with poor prognosis. Mitochondrial dysfunction is critical in SAE development, and hydrogen gas (H 2 ) has a protective effect on septic mice. This study aimed to investigate the effect of high concentration (67%) of H 2 on SAE and whether it is related to mitochondrial biogenesis and mitochondrial dynamics., Methods: A mouse sepsis model was induced by cecal ligation and puncture. The mice inhalated 67% H 2 for 1 h at 1 and 6 h post-surgery, respectively. The 7-day survival rate was recorded. Cognitive function was assessed using the Y-maze test and Morris water maze test. Serum inflammatory factors, antioxidant enzymes, as well as mitochondrial function indexes including mitochondrial membrane potential (MMP) and ATP in the hippocampal tissue were evaluated 24 h after surgery. Mitochondrial dynamic proteins (DRP1 and MFN2) and biosynthetic proteins (PGC-1α, NRF2, and TFAM) in the hippocampal tissue were detected. Moreover, the morphology of mitochondria was observed by transmission electron microscopy., Results: Inhalation of 67% H 2 improved the 7-day survival rates and recognition memory function of septic mice, alleviated brain antioxidant enzyme activity (SOD and CAT), and reduced serum proinflammatory cytokine levels. H 2 inhalation also enhanced the expression of MFN2 and mitochondrial biogenesis-related factors (PGC-1α, NRF2, and TFAM) and decreased the expression of fission protein (DRP1), leading to improvement in mitochondrial function, as evidenced by MMP and ATP levels., Conclusions: Inhalation of high concentration (67%) of H 2 in septic mice improved the survival rate and reduced neuronal injury. Its mechanism might be mediated by enhancing mitochondrial biogenesis and mitochondrial dynamics., (© 2024 The Author(s). CNS Neuroscience & Therapeutics published by John Wiley & Sons Ltd.)

Objective: Sepsis Associated Encephalopathy (SAE) is a common complication in critically ill patients and perioperative period, but its pathogenesis is still unclear. This study aimed to explore the effect of the HIF-1α (hypoxia-inducible factor-1α)/BNIP3L (Bcl-2/adenovirus E1B 19-kDa interaction protein) signaling pathway on SAE., Methods: C57BL/6J male mice were divided into four groups, using a random number table method: control group, sham group, sepsis group, sepsis+HIF-1α activity inhibitor (echinomycin) group. Sepsis was induced by cecal ligation and puncture (CLP). At 24 h after surgery, brain tissue was sampled. HE was staining to observe changes in the hippocampus structure. Fluoroscopy observes changes in mitochondrial structure. Western blot, QT-PCR, and immunofluorescence were used to assess the amount of expression of HIF-1α and BNIP3L in the hippocampus and mitochondrion of hippocampus neurons. Observation of neuronal apoptosis by TUNEL staining. Seven days after surgery, mice were tested in a Morris water maze test to assess cognitive function after CLP., Results: Our results show that CLP-induced hippocampus-dependent cognitive deficits were accompanied with increased HIF 1a and decreased BNIP3L, increased protein levels of TNF-α, IL-6, and IL-β, and damage to mitochondrial structures and neuronal apoptosis in the hippocampus. In addition, administration of echinomycin rescues cognitive deficits, ameliorates HIF-1α and BNIP3L-mediated neuronal pyroptosis and damaged mitochondrial structures, and decreases the expression of TNF-α and IL-6 in the hippocampus., Conclusions: HIF-1α and the BNIP3L promote mitochondrial damage, and neuronal apoptosis and the expression of inflammatory factors may be the mechanism of SAE in critically ill patients and perioperative period., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Zhao, Song, Zhang, Liu, Shen, Fan, Li and Xie.)

Background: Previous studies have reported that the Toll-like receptors (TLRs) are related with the progress of chronic obstructive pulmonary disease (COPD). We aimed to explore the association of TLRs single nucleotide polymorphisms (SNPs) and COPD risk. Methods: 170 COPD patients and 181 healthy controls were enrolled in this case-control study. MassARRAY platform was used for genotyping seven tagging SNPs ( TLR2 : rs3804100, rs4696480, rs3804099; TLR3 : rs3775290, rs3775291, rs5743305; TLR9 : rs352140) of TLRs. The correlations between the SNPs and COPD risk were determined using logistic regression. Results: We found that the rs3775291 of TLR3 significant decreased the risk of COPD (TT versus CC: non-adjusted OR = 0.329, 95% CI = 0.123-0.879, p = 0.027). In the genetic models analysis, the rs3775291 was associated with a decreased effect of COPD based on the recessive model (TT versus CC/CT: non-adjusted OR = 0.377, 95% CI = 0.144-0.988  p = 0.047). The rs4696480 of TLR2 gene was associated with a decreased risk of COPD after adjustment by age and gender (TA versus AA: adjusted OR = 0.606, 95% CI = 0.376-0.975, p = 0.039). Conclusion: Our study showed that genetic variants in TLRs were associated with risk of COPD. The rs3775291 and rs4696480 may act as a potential biomarker for predicting the risk of COPD in Chinese population., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Sun, Shen and Feng.)

Background: Chronic obstructive pulmonary disease (COPD) is now the fourth leading cause of death in the world, and it continues to increase in developing countries. The World Health Organization expects COPD to be the third most common cause of death in the world by 2020. Effective and continuous postdischarge care can help patients to maintain good health. The use of electronic health records (EHRs) as an element of community health care is new technology in China., Objective: The aim of this study was to develop and evaluate a Web-based coaching program using EHRs for physical function and health-related quality of life for patients with COPD in China., Methods: A randomized controlled trial was conducted from 2008 to 2015 at two hospitals. The control group received routine care and the intervention group received routine care with the addition of the Web-based coaching program using EHRs. These were used to manage patients' demographic and clinical variables, publish relevant information, and have communication between patients and health care providers. Participants were not blinded to group assignment. The effects of the intervention were evaluated by lung function, including percent of forced expiratory volume in 1 second (FEV1%), percent of forced vital capacity (FVC%), peak expiratory flow (PEF), maximum midexpiratory flow; St George's Respiratory Questionnaire (SGRQ); Modified Medical Research Council Dyspnea Scale (MMRC); and 6-Minute Walk Test (6MWT). Data were collected before the program, and at 1, 3, 6, and 12 months after the program., Results: Of the 130 participants, 120 (92.3%) completed the 12-month follow-up program. There were statistically significant differences in lung function (FEV1%: F1,4=5.47, P=.002; FVC%: F1,4=3.06, P=.02; PEF: F1,4=12.49, P<.001), the total score of SGRQ (F1,4=23.30, P<.001), symptoms of SGRQ (F1,4=12.38, P<.001), the activity of SGRQ (F1,4=8.35, P<.001), the impact of SGRQ (F1,4=12.26, P<.001), MMRC (F1,4=47.94, P<.001), and 6MWT (F1,4=35.54, P<.001) between the two groups with the variation of time tendency., Conclusions: The Web-based coaching program using EHRs in China appears to be useful for patients with COPD when they are discharged from hospital into the community. It promotes the sharing of patients' medical information by hospital and community nurses, and achieves dynamic management and follow-up analysis for patients' disease. In addition, this program can postpone the decreasing rate of lung function, improve quality of life, decrease dyspnea, and increase physical capacity., (©Lan Wang, Lin He, Yanxia Tao, Li Sun, Hong Zheng, Yashu Zheng, Yuehao Shen, Suyan Liu, Yue Zhao, Yaogang Wang. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 21.07.2017.)