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Background: Several early warning scores have been designed to optimize acute care by identifying patients at risk of deterioration. Methods: In this post hoc dual center study, we analyzed the performance of six clinical scores (the Goodacre score, Groarke, Worthing Physiological Score, Rapid Acute Physiology Score, Rapid Emergency Medicine Score, United Kingdom National Early Warning Score. The primary outcome is 30-day all-cause mortality after inclusion and data were obtained from previous studies performed at two different emergency departments on two continents (Denmark, Europe, and Hong Kong, Asia). Results: We included 2952 people; 1482 (50.2%) were male, mean age (standard deviation) was 65.7 (18.3) years, and 109 (3.7%) died within 30 days. Mortality rate increased steadily with increasing scores for all six scoring systems in Hong Kong while this was less obvious in Denmark. In all patients, Rapid Acute Physiology Score had the lowest discriminatory power while National Early Warning Score had the highest. National Early Warning Score performed best in Hong Kong while Worthing performed marginally better in Denmark. Discussion: Surprisingly, the performance of the scoring systems varied considerably, but were largely unaffected by location, and none of them performed close to what clinicians would normally require for predicting 30-day all-cause mortality Conclusion: All scores performed similarly across both centers, with poor prediction of 30-day all-cause mortality. Based on these findings, we believe that clinical scores must be supplemented by either biochemical values or global markers of physiological reserve to reflect reality and to be of true value. [ABSTRACT FROM AUTHOR]

Since its first identification in 1894 during the third pandemic in Hong Kong, there has been significant progress in understanding the lifestyle of Yersinia pestis, the pathogen that is responsible for plague. Although we now have some understanding of the pathogen's physiology, genetics, genomics, evolution, gene regulation, pathogenesis and immunity, there are many unknown aspects of the pathogen and its disease development. Here, we focus on some of the knowns and unknowns related to Y. pestis and plague. We notably focus on some key Y. pestis physiologic and virulence traits that are important for its mammal-flea-mammal life cycle, but also its emergence from the enteropathogen, Yersinia pseudotuberculosis. Some aspects of the genetic diversity of Y. pestis, the distribution and ecology of plague, as well as the medical countermeasures to protect our population are also provided. Lastly, we present some biosafety and biosecurity information related to Y. pestis and plague. [ABSTRACT FROM AUTHOR]

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Spotted sea bass (Lateolabrax maculatus) is a popular and important commercial fish throughout the world, but it is unknown whether introducing domesticated fish to locations that experience cold weather might alter physiological performance. In this study, we evaluated the behavior, fatty acid content, histological analysis of liver and gills, liver enzymatic activity in carbohydrate and lipid metabolism, and gene expression in liver related to carbohydrate and lipid metabolism of spotted sea bass acclimatized at 22 °C (control), 16 °C, 10 °C, 8 °C, and 4 °C for 24 h, and 8 °C for 4 days. When L. maculatus was exposed to acute cold stress for 24 h, the gill showed curling, lamellar disorganization, lamellar epithelium hyperplasia, and formed aneurysms inside of the secondary lamellae. Long term stress over four days resulted in severe lamellar epithelium hyperplasia and curling. Continued extreme cold exposure (4 °C) in L. maculatus caused liver HK, PK levels and LDH activities to achieve a peak value at 0 h, and decreased over time. These indicated that glucose metabolism might play critical roles in the initial time of stress. Results of carbohydrate and lipid metabolism showed that lipids appear to play roles in prolonged cold stress. The constitutive transcriptional levels of six genes related to glucose (G6Pase) and lipid metabolism (PPAR-α , PPAR-γ) and mTOR signal pathway (eif4ebp1 , eif4ebp2 , mlst8) genes increased significantly in most groups during cold stress. • Gill showed curling, lamellar disorganization, and formed aneurysms inside the secondary lamellae after cold stress. • An increase of T-CHO was detected after cold stress, suggesting that the carbohydrates are not the only energy source. • Six genes related to glucose, lipid metabolism and mTOR signal pathway genes increased significantly after cold stress. [ABSTRACT FROM AUTHOR]