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PurposeThis study assessed the effect of amoxicillin on outcomes in intensive care unit (ICU) patients with acute kidney injury (AKI), focusing on mortality rates and acute kidney disease (AKD) occurrence.Materials and MethodsWe conducted a retrospective cohort analysis utilizing data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The study included intensive care unit patients diagnosed with AKI to assess the effects of post-admission amoxicillin administration on 30-day and 90-day mortality rates and acute kidney disease incidence. We employed Cox proportional hazards models, propensity score matching, and inverse probability of treatment weighting to control for potential confounders.ResultsAmong 24,650 AKI patients, 676 (2.7%) received amoxicillin. The results indicated significantly lower mortality rates at 30 days (hazard ratio [HR] 0.54, 95% confidence interval [CI] 0.42–0.69) and 90 days (HR 0.64, 95% CI 0.52–0.77) in the amoxicillin group compared to non-recipients. Additionally, amoxicillin administration was associated with a reduced incidence of AKD (HR 0.49, 95% CI 0.36–0.65) but resulted in a modestly increased length of hospital stay (mean difference [MD] 1.95 days, 95% CI 1.15–2.75). A dose‒response relationship was evident, with higher doses (>875 mg) further decreasing mortality rates. Subgroup analysis revealed consistent benefits across most patient groups.ConclusionAmoxicillin administration following ICU admission in patients with AKI was associated with improved survival rates and a lower incidence of AKD, highlighting its potential as a therapeutic measure for AKI management.

BackgroundAn increase in Heatstroke cases occurred in southwest China in 2022 due to factors like global warming, abnormal temperature rise, insufficient power supply, and other contributing factors. This resulted in a notable rise in Heatstroke patients experiencing varying degrees of organ dysfunction. This descriptive study aims to analyze the epidemiology and clinical outcomes of Heatstroke patients in the ICU, providing support for standardized diagnosis and treatment, ultimately enhancing the prognosis of Heatstroke.MethodsA retrospective, multicenter, descriptive analysis was conducted on Heatstroke patients admitted to ICUs across 83 hospitals in southwest China. Electronic medical records were utilized for data collection, encompassing various aspects such as epidemiological factors, onset symptoms, complications, laboratory data, concurrent infections, treatments, and patient outcomes.ResultsThe dataset primarily comprised classic heatstroke, with 477 males (55% of total). The patient population had a median age of 72 years (range: 63–80 years). The most common initial symptoms were fever, mental or behavioral abnormalities, and fainting. ICU treatment involved respiratory support, antibiotics, sedatives, and other interventions. Among the 700 ICU admissions, 213 patients had no infection, while 487 were diagnosed with infection, predominantly lower respiratory tract infection. Patients presenting with neurological symptoms initially (n = 715) exhibited higher ICU mortality risk compared to those without neurological symptoms (n = 104), with an odds ratio of 2.382 (95% CI 1.665, 4.870) (p = 0.017).ConclusionIn 2022, the majority of Heatstroke patients in southwest China experienced classical Heatstroke, with many acquiring infections upon admission to the ICU. Moreover, Heatstroke can result in diverse complications.

BackgroundThe Controlling Nutritional Status (CONUT) score was designed to assess the immune-nutritional status in patients. This study aimed to investigate the role of the CONUT score in the short-term prognosis of severe acute pancreatitis.MethodsThis was a retrospective cohort study. 488 patients with severe acute pancreatitis at the Department of Critical Care Medicine of the West China Hospital of Sichuan University (Chengdu, China) were enrolled in the study. Baseline data were collected from the West China Hospital of Sichuan University database. The primary outcome during follow-up was all-cause mortality. The secondary outcomes were 28 day mortality, renal insufficiency, length of stay (LOS) in the ICU, and length of stay (LOS) in the hospital. Patients were divided into two groups based on a median CONUT score of 7, and baseline differences between the two groups were eliminated by propensity matching. Univariate Cox regression analyses were performed to estimate the association between CONUT score and outcomes. The Kaplan–Meier method was used to estimate the survival rate of patients.ResultsCONUT score was an independent predictor of all-cause mortality (hazard ratio [HR]:2.093; 95%CI: 1.342–3.263; p

Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection and is associated with high morbidity and mortality. Circulating histones (CHs), a group of damage-associated molecular pattern molecules mainly derived from neutrophil extracellular traps, play a crucial role in sepsis by mediating inflammation response, organ injury and death through Toll-like receptors or inflammasome pathways. Herein, we first elucidate the molecular mechanisms of histone-induced inflammation amplification, endothelium injury and cascade coagulation activation, and discuss the close correlation between elevated level of CHs and disease severity as well as mortality in patients with sepsis. Furthermore, current state-of-the-art on anti-histone therapy with antibodies, histone-binding proteins (namely recombinant thrombomodulin and activated protein C), and heparin is summarized to propose promising approaches for sepsis treatment.

The electrocaloric effect (ECE), known for its environmentally friendly characteristics, holds significant promise for advancing next-generation solid-state refrigeration technologies. Achieving a large ECE along with a wide working temperature range near room temperature remains a key developmental goal. In this study, we successfully obtained a substantial ECE of 1.78 K and an extensive working temperature range of 103 K (ΔT > 1.52 K) near room temperature in CaZrO3-modified BaTiO3 lead-free ferroelectric ceramics. Furthermore, this achievement was verified using direct methods. The piezoresponse force microscopy (PFM) results suggest that the broad temperature range is attributed to the formation of ferroelectric microdomains and polar nanoregions (PNRs). Furthermore, X-ray photoelectron spectroscopy (XPS) and ultraviolet‒visible (UV‒Vis) spectroscopy reveal a decrease in the oxygen vacancy concentration and an increase in the bandgap for higher CaZrO3 doping levels. These changes synergistically enhance the maximum applied electric field, helping to achieve a high-performance ECE near room temperature. This research presents a straightforward and effective approach for achieving high-performance ECEs in BaTiO3 lead-free ceramics, offering promising prospects for application in next-generation solid-state refrigeration technologies.

Abstract Background Early detection is critical for improving the survival of breast cancer (BC) patients. Exhaled breath testing as a non-invasive technique might help to improve BC detection. However, the breath test accuracy for BC diagnosis is unclear. Methods This multi-center cohort study consecutively recruited 5047 women from four areas of China who underwent BC screening. Breath samples were collected through standardized breath collection procedures. Volatile organic compound (VOC) markers were identified from a high-throughput breathomics analysis by the high-pressure photon ionization–time-of-flight mass spectrometry (HPPI-TOFMS). Diagnostic models were constructed using the random forest algorithm in the discovery cohort and tested in three external validation cohorts. Results A total of 465 (9.21%) participants were identified with BC. Ten optimal VOC markers were identified to distinguish the breath samples of BC patients from those of non-cancer women. A diagnostic model (BreathBC) consisting of 10 optimal VOC markers showed an area under the curve (AUC) of 0.87 in external validation cohorts. BreathBC-Plus, which combined 10 VOC markers with risk factors, achieved better performance (AUC = 0.94 in the external validation cohorts), superior to that of mammography and ultrasound. Overall, the BreathBC-Plus detection rates were 96.97% for ductal carcinoma in situ, 85.06%, 90.00%, 88.24%, and 100% for stages I, II, III, and IV BC, respectively, with a specificity of 87.70% in the external validation cohorts. Conclusions This is the largest study on breath tests to date. Considering the easy-to-perform procedure and high accuracy, these findings exemplify the potential applicability of breath tests in BC screening.

The electrocaloric effect (ECE) offers a pathway to environmentally sustainable and easily miniaturized refrigeration technology, positioning it as a front-runner for the next generation of solid-state cooling solutions. This research unveils a remarkable ECE in a finely tuned (Ba0.86Ca0.14)0.98La0.02Ti0.92Sn0.08O3 ceramic, exhibiting a temperature shift (ΔT) of 1.6 K across more than 85% of the maximum ΔT (ΔTmax) and spanning an exceptionally wide operational range of 92 K. Our investigation on dielectric responses and ferroelectric polarization-electric field (P–E) loops suggests that the broad operational scope results from the fragmentation of extended ferroelectric domains into smaller domains and polar nano-regions (PNRs) supported by PFM analysis. Furthermore, the introduction of La enhances spontaneous polarization by significantly extending the maximum electric field that can be applied, facilitating high-performance ECE at ambient temperature. This study positions BaTiO3-based lead-free ceramic as a sustainable alternative for addressing the cooling demands of modern electronic components, marking a significant stride toward next-generation solid-state refrigeration.

Purpose Numerous indicators can be used to predict tumor patients’ prognosis and tumor regression grade (TRG). The role of the neutrophil-lymphocyte ratio (NLR) among individuals with locally advanced rectal cancer (LARC) following neoadjuvant chemoradiotherapy (nCRT) hasn't been studied, nevertheless. This study aims to explore the predictive value of the NLR before nCRT (pre-NLR) in TRG and prognosis of LARC patients undergoing nCRT.. Methods In this retrospective investigation, 326 LARC patients receiving nCRT in total were included. The link between the pre-NLR and TRG was examined using a logistic regression analysis. A Cox-based nomogram was created in the meanwhile to forecast overall survival (OS). With the use of calibration plots and receiver operating characteristic (ROC) curves, we evaluated the nomogram's predictive capabilities. Results The median pre-NLR across 326 patients was 2.2 (interquartile range, IQR: 1.7-2.7). In the logistic regression analysis, only the pre-NLR for TRG in LARC patients receiving nCRT was statistically significant (odds ratio, OR = 0.62, 95% CI: 0.47-0.80, P

Background: Personal protective equipment (PPE)-related occupational dermatosis (PROD) represents a significant occupational burden to health care workers (HCWs), and understanding its epidemiology is imperative in formulating mitigation strategies. Objectives: To determine the prevalence of PROD in HCWs, characterize its manifestations, identify its risk factors, and evaluate behavioral modifications of HCW. Methods: A cross-sectional study using an online questionnaire was conducted from July to September 2020. HCWs who had direct contact with COVID-19 patients for a minimum of 2 weeks cumulatively were invited to participate. Results: The prevalence of PROD among 416 valid respondents was 73.8% (307/416), with face masks being the most common cause (93.8% [n = 288]). The most common PROD associated with face masks, protective eyewear, hairnets, gowns, and gloves were acne (71.5% [206/288]), pressure-related injuries (70.7% [99/140]), scalp itch (53.3% [16/30]), itch/rash (78.8% [26/33]), and xerosis (75.0% [27/36]), respectively. Exposure to PPE beyond an hour increased the odds of PROD by 4.8-fold. The majority of HCWs made behavioral modifications to mitigate PROD. Conclusions: We underscore evidence-based recommendations for HCWs to be (1) scheduled hourly breaks from PPE wear, (2) fitted to various PPE models, (3) screened for preexisting dermatoses before deployment, and (4) educated on mitigation strategies and avenues for help should they encounter PROD.

BackgroundHER2-low expression breast cancer (BC) accounts for approximately 45%-55% of all BC cases. The purpose of this study was to investigate the prognostic difference between patients with HER2-low expression and HER2-zero BC.MethodsAn electronic search of Pubmed, Embase, Cochrane Library, and Web of Science databases was performed to screen studies that included prognostic comparisons between HER2-zero and HER2-low expression groups. A total of 14 studies involving 52106 patients were included.ResultsOur results indicated that HER2-low expression was associated with a significant benefit in OS among all patients with early BC (HR, 0.83; 95% CI, 0.78–0.88), patients with hormone-receptor positive BC (HR, 0.83; 95% CI, 0.77–0.89), and patients with TNBC (HR, 0.78; 95% CI, 0.70–0.87). HER2-low expression was associated with a significant benefit in DFS among all patients (HR, 0.81; 95% CI, 0.71–0.93), patients with hormone receptor-positive BC (HR, 0.81; 95% CI, 0.72–0.90), but no significant difference in DFS was found in patients with TNBC (HR, 0.87; 95% CI, 0.65–1.17). HER2-low expression was associated with a significant benefit in RFS among all patients (HR, 0.90; 95% CI, 0.85–0.95), patients with hormone receptor-positive BC (HR, 0.90; 95% CI, 0.84–0.96), but no significant difference in RFS was found in patients with TNBC (HR, 0.80; 95% CI, 0.55–1.16).ConclusionsAmong patients with early-stage BC, patients with HER2-low expression BC had better OS in the overall population, hormone receptor-positive and TNBC subgroups. Besides, favorable DFS and RFS were observed in both the overall population and hormone receptor-positive subgroup.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier (CRD 42022349458).

Abstract Cutaneous manifestations are variable in patients with eosinophilic granulomatosis with polyangiitis (EGPA). We report a case where bullous eruption was a presenting manifestation of EGPA. A 55‐year‐old Chinese man with a background of adult‐onset asthma and chronic sinusitis was admitted for a 3‐week history of lower limb weakness and a large bulla on his right calf with surrounding erythema. Skin biopsy showed a subepidermal blister with significant dermal eosinophilia, without vasculitis. The patient was diagnosed with EGPA with systemic involvement on the basis of a thorough medical history, eosinophilia, cardiac magnetic resonance imaging showing acute myocarditis, and nerve biopsy with eosinophilic vasculitic neuropathy. He responded well to corticosteroids and rituximab. Nonvasculitic bullous eruptions are rarely described as manifestations of EGPA. Prompt recognition of this entity is crucial for its early diagnosis.