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To analyze a case of severe avian influenza A (H5N6) virus infection resulting in severe pneumonia and acute respiratory distress syndrome (ARDS) was admitted to Guilin Municipal Hospital of Traditional Chinese Medicine on July 6, 2023. The clinical data and treatment of this patient were analyzed retrospectively. The initial clinical manifestations of the patient were fever, cough, and expectoration, and the antigen test for influenza A virus was positive. Chest CT showed: double lung texture increased and thickened, and multiple patchy high-density shadows with air-containing bronchial shadows were found in the left lung, especially in the left upper lobe; a few patchy increased-density shadows were also seen in the lower lobe of the right lung, along with left-sided pleural effusion. Metagenomic next-generation metagenomic sequencing (mNGS) of bronchoalveolar lavage fluid was performed to identify the pathogen as influenza A virus H5N6. On the 4th day of admission, the patient's condition rapidly progressed to ARDS, which could not be improved by high-flow oxygen therapy, mechanical ventilation, and prone position ventilation. Subsequently, with the assistance of veno-venous extracorporeal membrane oxygenation (VV-ECMO), the patient's lung function gradually improved. Extracorporeal membrane oxygenation (ECMO) was withdrawn after 25 days, and the patient recovered and was discharged after a hospital stay of 41 days. Patients with severe avian influenza A (H5N6) usually have critical illness and rapid progression, often rapidly progressing to ARDS. When conventional mechanical ventilation cannot correct hypoxemia, VV-ECMO auxiliary treatment should be administered as early as possible. In addition, mNGS can help to quickly identify the diagnosis and differential diagnosis of avian influenza A (H5N6) in the early stage of the disease, particularly suitable for the diagnosis of severe and emergency infections. [ABSTRACT FROM AUTHOR]

Clarifying the ambiguous correlation between the coordination/electronic state and reactivity of heterogeneous catalysts is crucial in designing high-performance water-splitting catalysts. Herein, the metal–support interaction is constructed by interfacial coupling of iridium (Ir) cluster and metal-rich copper monophosphide (IrCL@Cu3P). Based on refined structural characterization and theoretical calculations, the interfacial coupling leads to shrinkage in the Ir–Ir bond distance and significant charge transfer from the cluster to the substrate, which brings about an electronic perturbation and breaks the improper charge distribution, promoting water-splitting kinetics. The fabricated catalyst yields superior bifunctional activities toward hydrogen and oxygen evolution reactions with overpotentials as low as 21 and 216 mV at the current density of 10 mA cm−2 in alkaline electrolyte, respectively. Moreover, the practical application is verified in the alkaline membrane electrode assembly, which shows an electrolyzer voltage of as low as 1.94 V at 1 A cm−2 with the fabricated catalyst working as both the anode and cathode. Precisely tuning electronic perturbation by interfacial coupling could provide valuable insights into designing highly efficient water splitting catalysts and beyond. [ABSTRACT FROM AUTHOR]

Objective: To compare the effect and safety of continuous veno-venous hemofiltration (CVVH)+double plasma molecular absorption (DPMA)+hemoperfusion (HP), CVVH+HP, and CVVH+plasma exchange (PE) in treatment of patient with severe wasp stings injury., Methods: Multicenter, historical cohort study and superiority test were used. From July 2020 to October 2022, patients with wasp sting injury and multiple organ damage admitted to the intensive care units (ICU) of five hospitals were consecutively screened and recruited into the CVVH+DPMA+HP group (intervention group). Propensity score matching was used to establish historical cohorts. Patients with severe wasp sting injury who hospitalized from January 2016 to June 2020 in each ICU were collected and matched 1:1 with the intervention group, and divided into CVVH+HP group and CVVH+PE group according to their actual hemopurification protocols (historical control groups). The primary outcome was the acute physiology and chronic health evaluation II (APACHE II) score on days 3 and 7 after initiation of treatment. Secondary outcomes included complications, length of ICU and hospital stays, and all-cause mortality. Multivariate Cox proportional risk regression was used to analyze the prognosis of patients., Results: After propensity score matching, 56 patients in intervention group and each of the two historical control groups were matched successfully. There were no significant differences in age, gender, comorbidities, biochemical test indices and critical illness scores among the groups. After treatment, APACHE II score markedly declined in all groups, and the decrease was faster in the intervention group; treatment with DPMA [hazard ratio (HR) = 1.04, 95% confidence interval (95%CI) was 1.02-1.08, P = 0.00], the decreased levels of body temperature (HR = 1.02, 95%CI was 1.00-1.03, P = 0.02), serum creatine kinase (CK; HR = 0.98, 95%CI was 0.96-1.00, P = 0.05) and myoglobin (MYO; HR = 2.88, 95%CI was 1.24-6.69, P = 0.01) were independent risk factors for APACHE II score decline to the target value (15 scores). There were no significant differences in the incidence of bleeding complications, filter or perfusion thrombosis, blood pressure reduction, catheter-related infection and anaphylaxis among the groups., Conclusions: CVVH+DPMA+HP regimen can significantly reduce the APACHE II score of patients with severe wasp sting injury, and the efficacy is superior to CVVH+HP and CVVH+PE regimens, with safety.