Hyperchloremia Is Associated With Poorer Outcome in Critically Ill Stroke Patients

Background and Purpose: This study aims to explore the cause and predictive value of hyperchloremia in critically ill stroke patients.Materials and Methods: We conducted a retrospective study of a prospectively collected database of adult patients with first-ever acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH) admitted to the neurointensive care unit (NICU) of a university-affiliated hospital, between January 2013 and December 2016. Patients were excluded if admitted beyond 72 h from onset, if they required neurocritical care for less than 72 h, and were treated with hypertonic saline within 72 h or had creatinine clearance less than 15 mL/min.Results: Of 405 eligible patients, the prevalence of hyperchloremia ([Cl−] ≥ 110 mmol/L) was 8.6% at NICU admission ([Cl−]0) and 17.0% within 72 h ([Cl−]max). Thirty-eight (9.4%) patients had new-onset hyperchloremia and 110 (27.1%) had moderate increase in chloride (Δ[Cl−] ≥ 5 mmol/L; Δ[Cl−] = [Cl−]max − [Cl−]0) in the first 72 h after admission, which were found to be determined by the sequential organ failure assessment score in multivariate logistic regression analysis. Neither total fluid input nor cumulative fluid balance had significant association with such chloride disturbance. New-onset hyperchloremia and every 5 mmol/L increment in Δ[Cl−] were both associated with increased odds of 30-day mortality and 6-month poor outcome, although no independent significance was found in multivariate models.Conclusion: Hyperchloremia tends to occur in patients more severely affected by AIS and ICH. Although no independent association was found, new-onset hyperchloremia and every 5 mmol/L increment in Δ[Cl−] were related to poorer outcome in critically ill AIS and ICH patients.Subject terms: clinical studies, intracranial hemorrhage, ischemic stroke, mortality/survival, quality and outcomes

Outcome Prediction by 40-Hz Steady-State Response After Large Hemispheric Infarction

Background and Purpose: The 40-Hz steady state response (SSR) reflects early sensory processing and has the potential to differentiate disease severity. This study aims to evaluate the predictive value of 40-Hz SSRs on the prognosis of patients with large hemispheric infarction (LHI).Methods: We conducted a retrospective study in patients with LHI admitted to the neurological intensive care unit (NICU) of Nanfang Hospital, Southern Medical University, Guangzhou, China, between June 2008 and December 2014. Forty-hertz SSRs were recorded within 72 h of onset and categorized into 3 grades. The correlation between 40-Hz SSR grading and clinical outcome was examined.Results: Of the 97 eligible participants, 41 (42.3%) died within 30 days and 68 (70.1%) exhibited a poor outcome (modified Rankin Scale of 5 and 6) at 90 days after the onset of LHI. We found that 40-Hz SSRs correlated significantly with NIHSS scores at admission and patient outcome. Moreover, Grade III 40-Hz SSR (bilateral sine waves that either disappeared or were not clearly identifiable) had a specificity of 97% and a positive predictive value of 94% in predicting 90-days poor outcome; Grade III 40-Hz SSR also had a specificity of 91% and a positive predictive value of 74% in predicting 30-days mortality.Conclusions: 40-Hz SSR could be used as a simple and specific method in predicting poor prognosis after LHI

Public Health Emergency Command System of China

China has formed a national emergency management system consisting of “one contingency plan and three sets of institutions” since the outbreak of the severe acute respiratory syndrome (SARS) in 2003. This system is further improved after the establishment of the Ministry of Emergency Management in 2018 and the great achievements made in the fight against the coronavirus disease 2019 (COVID-19). This study aims to improve China’s public health emergency command system via investigating the history, current status, and challenges of the system. In this article, we summarize the emergency command systems responding to the SARS outbreak, the H1N1 2009 pandemic, and the COVID-19 pandemic using literature research, theoretical analysis, and case comparison. China’s public health emergency command system played a significant role in dealing with these public health emergencies and has been increasingly improved; however, it still faces various challenges. Therefore, we propose several policy suggestions to address these challenges, which involve the aspects of joint prevention and control mechanism, law system for public health emergencies, advisory board, and central–local relations

Metabolomics analysis of the yolk of Zhijin white goose during the embryogenesis based on LC-MS/MS.

The egg yolk of the goose is rich in lipids, proteins and minerals, which is the main source of nutrition during the goose embryogenesis. Actually, the magnitude and variety of nutrients in yolk are dynamically changed to satisfy the nutritional requirements of different growth and development periods. The yolk sac membrane (YSM) plays a role in metabolizing and absorbing nutrients from the yolk, which are then consumed by the embryo or extra-fetal tissues. Therefore, identification of metabolites in egg yolk can help to reveal nutrient requirement in goose embryo. In this research, to explore the metabolite changes in egg yolk at embryonic day (E) 7, E12, E18, E23, and E28, we performed the assay using ultra-high performance liquid chromatography/tandem mass spectrometry (UHPLC-MS/MS). The findings showed that E7 and E12, E23 and E28 were grouped together, while E18 was significantly separated from other groups, indicating the changes of egg yolk development and metabolism. In total, 1472 metabolites were identified in the egg yolk of Zhijin white goose, and 636 differential metabolites (DMs) were screened, among which 264 were upregulated and 372 were downregulated. The Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis showed that the DMs were enriched in the biosynthesis and metabolism of amino acids, digestion and absorption of protein, citrate cycle (TCA cycle), aminoacyl-tRNA biosynthesis, phosphotransferase system (PTS), mineral absorption, cholesterol metabolism and pyrimidine metabolism. Our study may provide new ideas for improving prehatch embryonic health and nutrition

Separation of Li and Al from spent ternary Li-ion batteries by in-situ aluminum‑carbon reduction roasting followed by selective leaching

Publisher Copyright: © 2022 Elsevier B.V.During the reduction roasting of waste ternary Li-ion batteries (LIBs), a large amount of carbon reductant is introduced in the recycling process, which is not conductive to achieve the goal of carbon peaking and carbon neutrality. This research proposes to make full use of aluminum and carbon – main constituents of waste LIBs – as reductants in the roasting process. Results show that the aluminum-carbon reduction roasting method has a higher efficiency compared with the traditional carbon reduction. Lithium present in ternary materials can be almost completely transformed into soluble Li2CO3, while the associated Ni, Co and Mn are all converted into insoluble metal elements or their corresponding oxides at 650 °C (t = 90 min). The presence of Al decreases the carbothermal roasting temperature, while the presence of waste carbon allows Li to be converted into easily soluble lithium carbonate in preference to lithium aluminate. The optimal amount of carbon and Al in the spent LIBs were 14.7% and 7.0%, respectively. After roasting, > 97% of Li could be selectively leached by carbonated water leaching, while only 99% Al separation. These results suggest that the in-situ aluminum-carbon reduction roasting, followed by selective leaching of Li and Al, mitigates several of the challenges related to battery recycling: (i) Li extraction is increased substantially above the state-of-the-art recovery efficiencies, (ii) Al - known to decrease battery metals extraction in hydrometallurgical processing - is selectively removed after making full use of its reducibility and (iii) battery metal-rich residues with low impurity levels is produced for further refining, therefore paving the way towards more economical, efficient and environmentally friendly spent LIBs recycling.Peer reviewe

High Peel Strength and Flexible Aligned Carbon Nanotubes/Etched Al Foil Composites with Boosted Supercapacitor and Thermal Dissipation Performances

In this work, aligned carbon nanotubes (ACNTs) were grown on etched Al foil with improved bonding strength by direct thermal chemical vapor deposition. In the interface of the ACNTs adjacent to the etched Al substrate, the ACNTs, tangled together as irregularly shaped “tiny twine balls,” were embedded in the cavities of the etched Al foil. Such a unique structure generated strong bonding strength between the as-grown ACNTs and etched Al substrate. The minimal changes for the equivalent series resistance and deformation of the ACNT/etched Al foil after bending test demonstrated the good flexibility and structural stability of the as-prepared composite material. This flexible, binder-free ACNTs/etched Al foil composite material exhibited excellent electrochemical and thermal dissipation performances. This work provided a versatile and adaptable method by forming micro-sized and irregularly shaped cavities on different kinds of substrates to grow CNTs with strong peel strength for various practical applications

Table_1_Hyperchloremia Is Associated With Poorer Outcome in Critically Ill Stroke Patients.DOCX

<p>Background and Purpose: This study aims to explore the cause and predictive value of hyperchloremia in critically ill stroke patients.</p><p>Materials and Methods: We conducted a retrospective study of a prospectively collected database of adult patients with first-ever acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH) admitted to the neurointensive care unit (NICU) of a university-affiliated hospital, between January 2013 and December 2016. Patients were excluded if admitted beyond 72 h from onset, if they required neurocritical care for less than 72 h, and were treated with hypertonic saline within 72 h or had creatinine clearance less than 15 mL/min.</p><p>Results: Of 405 eligible patients, the prevalence of hyperchloremia ([Cl⁻] ≥ 110 mmol/L) was 8.6% at NICU admission ([Cl⁻]₀) and 17.0% within 72 h ([Cl⁻]_max). Thirty-eight (9.4%) patients had new-onset hyperchloremia and 110 (27.1%) had moderate increase in chloride (Δ[Cl⁻] ≥ 5 mmol/L; Δ[Cl⁻] = [Cl⁻]_max − [Cl⁻]₀) in the first 72 h after admission, which were found to be determined by the sequential organ failure assessment score in multivariate logistic regression analysis. Neither total fluid input nor cumulative fluid balance had significant association with such chloride disturbance. New-onset hyperchloremia and every 5 mmol/L increment in Δ[Cl⁻] were both associated with increased odds of 30-day mortality and 6-month poor outcome, although no independent significance was found in multivariate models.</p><p>Conclusion: Hyperchloremia tends to occur in patients more severely affected by AIS and ICH. Although no independent association was found, new-onset hyperchloremia and every 5 mmol/L increment in Δ[Cl⁻] were related to poorer outcome in critically ill AIS and ICH patients.</p><p>Subject terms: clinical studies, intracranial hemorrhage, ischemic stroke, mortality/survival, quality and outcomes.</p

A radiomic signature as a non-invasive predictor of progression-free survival in patients with lower-grade gliomas

Objective: The aim of this study was to develop a radiomics signature for prediction of progression-free survival (PFS) in lower-grade gliomas and to investigate the genetic background behind the radiomics signature. Methods: In this retrospective study, training (n = 216) and validation (n = 84) cohorts were collected from the Chinese Glioma Genome Atlas and the Cancer Genome Atlas, respectively. For each patient, a total of 431 radiomics features were extracted from preoperative T2-weighted magnetic resonance images. A radiomics signature was generated in the training cohort, and its prognostic value was evaluated in both the training and validation cohorts. The genetic characteristics of the group with high-risk scores were identified by radiogenomic analysis, and a nomogram was established for prediction of PFS. Results: There was a significant association between the radiomics signature (including 9 screened radiomics features) and PFS, which was independent of other clinicopathologic factors in both the training (P < 0.001, multivariable Cox regression) and validation (P = 0.045, multivariable Cox regression) cohorts. Radiogenomic analysis revealed that the radiomics signature was associated with the immune response, programmed cell death, cell proliferation, and vasculature development. A nomogram established using the radiomics signature and clinicopathologic risk factors demonstrated high accuracy and good calibration for prediction of PFS in both the training (C-index, 0.684) and validation (C-index, 0.823) cohorts. Conclusions: PFS can be predicted non-invasively in patients with LGGs by a group of radiomics features that could reflect the biological processes of these tumors. Keywords: Radiomic analysis, Lower-grade gliomas, Progression-free survival, Radiogenomic

Table_3_Hyperchloremia Is Associated With Poorer Outcome in Critically Ill Stroke Patients.DOCX

<p>Background and Purpose: This study aims to explore the cause and predictive value of hyperchloremia in critically ill stroke patients.</p><p>Materials and Methods: We conducted a retrospective study of a prospectively collected database of adult patients with first-ever acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH) admitted to the neurointensive care unit (NICU) of a university-affiliated hospital, between January 2013 and December 2016. Patients were excluded if admitted beyond 72 h from onset, if they required neurocritical care for less than 72 h, and were treated with hypertonic saline within 72 h or had creatinine clearance less than 15 mL/min.</p><p>Results: Of 405 eligible patients, the prevalence of hyperchloremia ([Cl⁻] ≥ 110 mmol/L) was 8.6% at NICU admission ([Cl⁻]₀) and 17.0% within 72 h ([Cl⁻]_max). Thirty-eight (9.4%) patients had new-onset hyperchloremia and 110 (27.1%) had moderate increase in chloride (Δ[Cl⁻] ≥ 5 mmol/L; Δ[Cl⁻] = [Cl⁻]_max − [Cl⁻]₀) in the first 72 h after admission, which were found to be determined by the sequential organ failure assessment score in multivariate logistic regression analysis. Neither total fluid input nor cumulative fluid balance had significant association with such chloride disturbance. New-onset hyperchloremia and every 5 mmol/L increment in Δ[Cl⁻] were both associated with increased odds of 30-day mortality and 6-month poor outcome, although no independent significance was found in multivariate models.</p><p>Conclusion: Hyperchloremia tends to occur in patients more severely affected by AIS and ICH. Although no independent association was found, new-onset hyperchloremia and every 5 mmol/L increment in Δ[Cl⁻] were related to poorer outcome in critically ill AIS and ICH patients.</p><p>Subject terms: clinical studies, intracranial hemorrhage, ischemic stroke, mortality/survival, quality and outcomes.</p