Is elevated SUA associated with a worse outcome in young Chinese patients with acute cerebral ischemic stroke?

<p>Abstract</p> <p>Background</p> <p>Elevated serum uric acid (SUA) levels can enhance its antioxidant prosperities and reduce the occurrence of cerebral infarction. Significantly elevated SUA levels have been associated with a better prognosis in patients with cerebral infarction; however, the results from some studies on the relationship between SUA and the prognosis of patients with cerebral infarction remain controversial.</p> <p>Methods</p> <p>We analyzed the relationship between SUA and clinical prognosis of 585 young Chinese adults with acute ischemic stroke as determined by the modified Rankin Scale at discharge. Using multivariate logistic regression modeling, we explore the relationship between SUA levels and patient's clinical prognosis.</p> <p>Results</p> <p>Lower SUA levels at time of admission were observed more frequently in the lowest quintile for patients with severe stroke (P = 0.02). Patients with cerebral infarction patients caused by small-vessel blockage had higher SUA concentrations (P = 0.01) and the lower mRS scores (P < 0.01) were observed in, while the lowest SUA concentrations and the highest mRS scores were seen in patients with cardiogenic cerebral infarction patients. Logistic regression analysis adjusted for confounders confirmed the following independent predictors for young cerebral infarction: uric acid (-0.003: 95%CI 0.994 to 0.999) and platelet (0.004, 95%CI 0.993 to 0.996).</p> <p>Conclusion</p> <p>Elevated SUA is an independent predictor for good clinical outcome of acute cerebral infarction among young adults.</p

Gastric versus postpyloric enteral nutrition in elderly patients (age ≥ 75 years) on mechanical ventilation: a single-center randomized trial

Abstract Background The risk of ventilator-associated pneumonia (VAP) is reduced when postpyloric enteral nutrition (EN) is administered compared to when gastric EN is administered in specific populations. In the present study, we tested the hypothesis that postpyloric EN is superior to gastric EN in reducing the incidence of VAP in elderly patients (age ≥ 75 years) who are admitted to the intensive care unit (ICU) and require mechanical ventilation. Methods We performed a single-center randomized clinical trial involving elderly patients (age ≥ 75 years) who were admitted to the ICU and required mechanical ventilation. The patients were randomly assigned to either the postpyloric EN group or the gastric EN group. The primary outcome was the VAP rate. Results Of the 836 patients screened, 141 patients were included in the study (70 in the postpyloric EN group and 71 in the gastric EN group). The patients in the postpyloric EN group were 82.0 (75.0–99.0) years old (male 61.4%), and those in the gastric EN group were 82.0 (75.0–92.0) years old (male 63.4%). The Acute Physiology and Chronic Health Evaluation II scores were 28.09 ± 6.75 in the postpyloric EN group and 27.80 ± 7.60 in the gastric EN group (P = 0.43). VAP was observed in 8 of 70 patients (11.4%) in the postpyloric EN group and in 18 of 71 patients (25.4%) in the gastric EN group, which resulted in a significant between-group difference (OR 0.38, 95% CI 0.15–0.94; P = 0.04). In the postpyloric EN group, there were significant reductions in vomiting (12 patients in the postpyloric EN group vs 29 patients in the gastric EN group; OR 0.30, 95% CI 0.14–0.65; P = 0.002) and abdominal distension (18 patients in the postpyloric EN group vs 33 patients in the gastric EN group; OR 0.40, 95% CI 0.20–0.81; P = 0.01). No significant differences were observed between the two groups regarding mortality and other secondary outcomes. Conclusions Our study demonstrated that, compared with gastric EN, postpyloric EN reduced the VAP rate among elderly patients who were admitted to the ICU and required mechanical ventilation. Trial registration Chinese Clinical Trial Registry, ChiCTR-IPR-16008485. Registered on 17 May 2016

Nasogastric Nutrition versus Nasojejunal Nutrition in Patients with Severe Acute Pancreatitis: A Meta-Analysis of Randomized Controlled Trials

Introduction. Previous studies have shown that the nasogastric (NG) route seems equivalent to the nasojejunal (NJ) route in patients with severe acute pancreatitis (SAP). However, these studies used a small sample size and old criteria for diagnosing SAP, which may include some patients with moderate SAP, according to the newly established SAP criteria (Atlanta 2012 classification). Based on the changes in the criteria for classifying SAP, we performed an up-to-date meta-analysis. Method. We reviewed the PubMed, EMbase, China National Knowledge Infrastructure, Wanfang Database, and Cochrane Central Register of Controlled Trials electronic databases. We included randomized controlled trials comparing NG and NJ nutrition in patients with SAP. We performed the meta-analysis using the Cochrane Collaborations’ RevMan 5.3 software. Results. We included four randomized controlled trials involving 237 patients with SAP. There were no significant differences in the incidence of mortality, infectious complications, digestive complications, achievement of energy balance, or length of hospital stay between the NG and NJ nutrition groups. Conclusions. NG nutrition was as safe and effective as NJ nutrition in patients with SAP. Further studies are needed to confirm our results

Additional file 1: of High-flow nasal cannula oxygen therapy versus conventional oxygen therapy in patients with acute respiratory failure: a systematic review and meta-analysis of randomized controlled trials

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Energy-efficient timetabling and rolling stock circulation planning based on automatic train operation levels for metro lines

We investigate the energy-efficient train timetabling and rolling stock circulation planning problem for metro lines based on flexible selections of train operation levels, which involve running levels (various running times and speed profiles) and dwell levels (various dwell times at stations). The travel demand of passengers is involved in the energy-efficient train timetabling problem via service patterns, i.e., different operation headways are used in peak and off-peak hours to satisfy the passenger demand. A mixed integer nonlinear programming (MINLP) formulation is presented to optimize train timetables and circulation plans of rolling stocks simultaneously with the aim of minimizing the headway deviations relating to service patterns, the headway variations among neighboring train services, the needed depot movements for rolling stocks, and the overall energy consumption. To increase the regularity (i.e., the consistency of operation level selections of train services) of train timetables and to improve the computational efficiency, two extensions of the energy-efficient timetabling formulation are proposed, i.e. the energy-efficient train timetabling models with pre-fixed selections and optimal identical (or consistent) selections of the operation levels. The proposed MINLP formulations are transformed into mixed integer linear programming formulations, which could be effectively solved, e.g., by Cplex and Gurobi solvers. To investigate the effectiveness of the proposed models, we perform computational experiments based on the real-world data of the Beijing Yizhuang line. The numerical results illustrate that the energy consumption of the daily train timetable obtained by the proposed energy-efficient train timetabling model with flexible selection of operation levels is reduced by 9.90% when compared with that of the train timetables without operation level selections. Moreover, the energy savings of the energy-efficient train timetables with optimal identical selection and pre-fixed selection of operation levels are 7.67% and 5.75%, respectively. However, the computation time of the energy-efficient train timetabling models with operation level selections is significantly longer than that without operation level selections

The Development of Critical Care Medicine in China: From SARS to COVID-19 Pandemic

BACKGROUND: Critical care medicine is a branch of medical science that deals with the characteristics and regularity of life-threatening processes initiated by any injury or disease and, accordingly, relevant treatment for patients with critical illness. Conceptions of critical care medicine in China stemmed in the early 1970s. Ever since the establishment of the first intensive care unit (ICU) along with the increasingly incomparable role of ICU in medical practices, critical care medicine has become an indispensable part of the Chinese medical and health system. Currently, critical care medicine as a secondary clinical discipline and a well-constructed science is in sustainable development on the way towards systematization and standardization. METHODS: The gross domestic product (GDP) and population data were obtained from the National Bureau of Statistics. The number of ICUs, ICU beds, and hospital beds and other data regarding ICU staffing and facility resources were obtained from the Yearbook of Health in the People's Republic of China and National Bureau of Statistics. The mortality rates of SARS and COVID-19 and the number of health workers aiding Hubei amid COVID-19 pandemic were obtained from the National Health Commission. FINDINGS: Critical care medicine in mainland China has made significant strides: both quantity and quality are progressing at a fast pace after SARS in 2003. Although there exist some disparities in healthcare personnel and medical resources, they have not hindered the country from mobilizing its healthcare workers and resources against a public health emergency

Multidimensional Integrated Chalcogenides Nanoarchitecture Achieves Highly Stable and Ultrafast Potassium-Ion Storage

Potassium-ion batteries (KIBs) have come into the spotlight in large-scale energy storage systems because of cost-effective and abundant potassium resources. However, the poor rate performance and problematic cycle life of existing electrode materials are the main bottlenecks to future potential applications. Here, the first example of preparing 3D hierarchical nanoboxes multidimensionally assembled from interlayer-expanded nano-2D MoS2@dot-like Co9S8 embedded into a nitrogen and sulfur codoped porous carbon matrix (Co9S8/NSC@MoS2@NSC) for greatly boosting the electrochemical properties of KIBs in terms of reversible capacity, rate capability, and cycling lifespan, is reported. Benefiting from the synergistic effects, Co9S8/NSC@MoS2@NSC manifest a very high reversible capacity of 403 mAh g(-1) at 100 mA g(-1) after 100 cycles, an unprecedented rate capability of 141 mAh g(-1) at 3000 mA g(-1) over 800 cycles, and a negligible capacity decay of 0.02% cycle(-1), boosting promising applications in high-performance KIBs. Density functional theory calculations demonstrate that Co9S8/NSC@MoS2@NSC nanoboxes have large adsorption energy and low diffusion barriers during K-ion storage reactions, implying fast K-ion diffusion capability. This work may enlighten the design and construction of advanced electrode materials combined with strong chemical bonding and integrated functional advantages for future large-scale stationary energy storage