Unveiling the heightened susceptibility: Exploring early hypophosphatemia in critically ill trauma patients.

BACKGROUND: Phosphorus is a vital mineral crucial for various physiological functions. Critically ill trauma patients frequently experience hypophosphatemia during the immediate post-traumatic phase, potentially impacting outcomes. This study aims to investigate the incidence of early hypophosphatemia in critically major trauma patients. METHODS: In this prospective observational study, trauma patients admitted to the intensive care unit (ICU) within one day were enrolled. These patients were categorized into Hypo-P groups and Non-hypo groups based on the development of new-onset hypophosphatemia within 72 h after feeding. The primary outcome assessed was the incidence of new-onset hypophosphatemia. The secondary outcomes included ICU and hospital stay, ventilation duration, and mortality. RESULTS: 76.1% of patients developed a new onset of hypophosphatemia within 72 h after feeding. The Hypo-P group had significantly longer ICU stays (8.1 days ± 5.5 vs. 4.4 days ± 3.1; p = 0.0251) and trends towards extended hospital stay, ventilation duration, and higher mortality. Additionally, they demonstrated significantly higher urine fractional excretion of phosphate (FEPO4) on the first ICU day (29.2% ± 14.23 vs. 19.5% ± 8.39; p = 0.0242). CONCLUSION: Critically ill trauma patients exhibited a significantly higher incidence of early hypophosphatemia than typical ICU rates, indicating their heightened vulnerability. The significantly high urine FEPO4 underscores the crucial role of renal loss in disrupting phosphate metabolism in this early acute phase after trauma. A significant correlation was observed between hypophosphatemia and longer ICU stays. Monitoring and managing phosphate levels may influence outcomes, warranting further investigation.

The use of immobilised bacteria cross-linked within magnetic alginate beads enhances the treatment of benzophenone-type UV filter chemicals by the SBR system.

Benzophenone-n compounds (BPs) are applied in a broad spectrum of commercial products, one of which is sunscreen. These chemicals are frequently detected in a variety of environmental matrices worldwide, especially water bodies. BPs are defined as emerging contaminants as well as endocrine-disrupting contaminants; thus, it has become necessary to develop aggressive and green treatments to remove BPs. In this study, we used immobilised BP-biodegrading bacteria linked to reusable magnetic alginate beads (MABs). The MABs were added to a sequencing batch reactor (SBR) system to enhance the removal of 2,4-dihydroxybenzophenone (BP-1) and oxybenzone (BP-3) from sewage. The BP-1 and BP-3 biodegrading bacteria in the MABs consisted of strains from up to three genera to allow for efficient biodegradation. The strains used were Pseudomonas spp., Gordonia sp., and Rhodococcus sp. The optimal composition of the MABs consisted of 3% (w/v) alginate and 10% (w/v) magnetite. The MABs resulted in 60.8%-81.7% recovery by weight after 28 days, and there was a continuous release of bacteria. Moreover, the biological treatment of the BPs sewage improved after adding 100 g of BP1-MABs (1:27) and also 100 g BP3-MABs (1:27) into the SBR system at a hydraulic retention time (HRT) of 8 h. Compared with the SBR system without MABs, the removal rates of BP-1 and BP-3 increased from 64.2% to 71.5% and from 78.1% to 84.1%, respectively. Furthermore, the COD removal increased from 36.1% to 42.1%, and total nitrogen increased from 30.5% to 33.2%. Total phosphorus remained constant at 29%. The bacterial community analysis showed that the Pseudomonas population was <2% before the MAB addition, but increased to 56.1% by day 14. In contrast, the Gordonia sp. And Rhodococcus sp. Populations (<2%) remained unchanged throughout the 14-day treatment period.

Applying the Student Response System in the Online Dermatologic Video Curriculum on Medical Students' Interaction and Learning Outcomes during the COVID-19 Pandemic.

Background: The coronavirus disease 2019 (COVID-19) pandemic impacted medical education worldwide. Online lecture is increasingly prevalent in higher education, but students' completion rate is quite low. Aims: This study aimed to determine the effectiveness of the student response system (SRS) in the online dermatologic video curriculum on medical students. Methods: A prospective study was conducted on 176 undergraduate fourth-year medical students. The online video lecture was integrated with SRS. Results: A total of 173 students completed the pre-test, and the attendance rate (pre-test/total) was 98.3%. A total of 142 students completed the post-test, and the completion rate (post-test/pre-test) was 82.8%. The post-test score (83.69 ± 4.34) was found to be significantly higher than that of the pre-test (62.69 ± 6.08, P =0.0002). A total of 138 students completed the questionnaire, and 92% of students opined that SRS was easy to operate. 86% of students agreed with the fact that the use of SRS could increase their learning performance by interacting with teachers. In the open-ended question, students stated that SRS offered opportunities for student-faculty interaction, allowed them to get immediate feedback, and promote active participation. Conclusions: These results highlight that the integration of SRS in the online video curriculum increases students' completion rates and learning outcomes. Moreover, the SRS is easy to operate for the students and enhances student-faculty interaction. The SRS may be adopted in online learning during this challenging time.

Degradation of Decabromodiphenyl Ether in an Aerobic Clay Slurry Microcosm Using a Novel Immobilization Technique.

A novel chitosan immobilization technique that entraps photocatalyst and microbes was developed and applied to decompose decabromodiphenyl ether (BDE-209) in a clay slurry microcosm. The optimized conditions for immobilization were obtained by mixing 1.2% (w/v) chitosan dissolved in 1% (v/v) acetic acid with nano-TiO2 particles and the BDE-209-degrading bacterial mixed culture. This aqueous mixture was injected into 1% (w/v) water solution containing sodium tripolyphosphate to form spherical immobilized beads. The surface of the immobilized beads was reinforced by 0.25% (v/v) glutaraldehyde cross-linking. These beads had enough mechanical strength during BDE-209 degradation to maintain their shape in the system at a stirring rate of 200-rpm, while undergoing continuous 365 nm UVA irradiation. This novel TiO2-Yi-Li immobilized chitosan beads system allowed a successful simultaneous integration of photolysis, photocatalysis and biodegradation to remove BDE-209. The remaining percentage of BDE-209 was 41% after 70 days of degradation using this system. The dominant bacteria in the BDE-209-degrading bacterial mixed culture during remediation were Chitinophaga spp., Methyloversatilis spp., Terrimonas spp. and Pseudomonas spp. These bacteria tolerated the long-term UVA irradiation and high-level free radicals present, while utilizing BDE-209 as their primary carbon resource. This new method has great potential for the treatment of a range of pollutants.

Epidemiology investigation of metabolic syndrome and its score and related behaviors in Zhongshan Community， Shanghai / 上海预防医学

Objective:To investigate the prevalence of metabolic syndromes （MS） and MS scores as well as related health behavior factors in Zhongshan Community， Songjiang， Shanghai. Methods:A total of 6 802 residents aged 20-74 years old in Zhongshan Community were selected. Face-to-face survey and body measurement were used to collect information such as MS-related behavioral factors （including smoking， alcohol intake， exercise and diet） and to determine the MS scores. MS scores were divided into 6 levels. Ordered logit model was used to analyze the factors related to MS score， and logit model was used to analyze the factors related to MS. Results:The prevalence of 6 metabolic syndrome scores in the sample population were 13.5%， 24.3%， 25.1%， 19.7%， 12.3%， 5.1%， respectively. The prevalence of MS was 37.0%. The related factors of high MS score in male were advanced age， alcohol intake and tea drinking， while the related factors of high MS score in female were advanced age and previous smoking. The related factors of MS was alcohol intake in male while female with advanced age had higher risk in developing MS. Conclusion:The prevalence of MS in Zhongshan Community is relatively high， which has become one of the important public health problems in this community. Attention should be paid to the elderly men who drink alcohol and tea， and aged women who have ever smoked.

Epidemiology investigation of type 2 diabetes mellitus and its associated renal insufficiency in a community-based population in Shanghai / 中华疾病控制杂志

Objective To investigate the prevalence and related factors of type 2 diabetes mellitus(T2DM) and its associated renal insufficiency in adult residents of a community in Shanghai. Methods A total of 9 257 residents aged 20-75 years old in a community of Shanghai were selected by random cluster sampling. All participants were interviewed to complete questionnaires, physical examination, examination of blood, urine and common biochemical indicators for T2DM, renal insufficiency and other related factors. Then the SPSS 19.0 software was used for analysis. Results Of the 9 257 respondents, eligible data of 8 207 subjects were enrolled in the study. The prevalence of T2DM was 12.7% (95% CI: 12.0%-13.4%), and the prevalence of its associated renal insufficiency was 15.4% (95% CI: 12.3%-18.4%), and majority of patients (65.8%) were in the early stage. Among the T2DM patients in this survey, the prevalence of renal insufficiency in obese patients was higher than that in patient with the normal body mass index. Logistic regression analysis showed that elder (OR=1.35), central obesity (OR=1.50), hyperuricemia (OR=2.51) were independent risk factors related with renal insufficiency in T2DM patients. Conclusions Renal insufficiency has become one of the important public health problems in T2DM patients. It shows a more urgent need for early prevention and control of CKD to prevent the incidence of end-stage renal disease and related complications in T2DM patients with advanced age, obesity, and hyperuricemia.

Relationship between hyperuricemia and chronic kidney disease in adult residents of communities in the Songjiang district, Shanghai / 中华疾病控制杂志

Objective To explore the relationships between hyperuricemia (HUA)，serum uric acid (SUA) level and the chronic kidney disease (CKD) in adult residents of communities. Methods A cross-sectional study was conducted in Xinqiao town of Songjiang district, Shanghai and a total of 9 527 residents aged 20-75 years were selected by random cluster sampling. Logistic regression models were used to evaluate the association between SUA and CKD. Results Subjects were divided into five groups according to the gender-specific quintiles of SUA. The CKD prevalence in serum uric acid quintiles of male were 4.9%, 5.7%, 6.0%, 8.0% and 13.8% respectively，while of female were 12.8%, 12.7%, 11.9%, 13.3% and 18.2% respectively, increasing along with the increase of SUA among both sexes (all P420 μmol/L(male) or >360 μmol/L(female). In the unadjusted model, HUA was significantly associated with CKD of all subjects (OR=2.03, 95% CI:1.69-2.44, P<0.001), and the association was still significant (OR=2.04, 95% CI:1.68-2.49, P<0.001) after adjustment for the potential confounders. The multivariate-adjusted odds of CKD associated with HUA was 2.89 (95% CI:2.12-3.94,) and 1.98 (95% CI:1.51-2.60) for male and female, respectively. Conclusion Hyperuricemia was independently associated with the increased prevalence of CKD among community-based population living in the Songjiang district, Shanghai.

[Application of Transcutaneous Electrical Acupoint Stimulation Combined with Transversus Abdominis Plane Block to Enhanced Recovery After Surgery in Patients Undergoing Laparoscopic Colorectal Cancer Resection: A Randomized Controlled Clinical Trial].

OBJECTIVE: To explore the effect of transcutaneous electrical acupoint stimulation (TEAS) combined with transversus abdominis plane (TAP) block in the enhanced recovery after surgery (ERAS) in patients undergoing laparoscopic colorectal cancer resection (LCCR). METHODS: A total of 101 patients undergoing LCCR were randomly divided into three groups: control (n＝34), TAP (n＝35) and TEAS＋TAP (n＝32). Conventional perioperative anesthesia management of the 3 groups was performed according to the ERAS guidelines. All the patients experienced patient controlled epidural analgesia (PCEA), and those of the TAP and TEAS＋TAP groups received TAP block by injection of 0.3% Roperca hydrochloride (15 mL) into the space between the internal oblique and the transverse abdominis after induction of anesthesia. For patients of the TEAS＋TAP group, TEAS (2 Hz/10 Hz, an endurable stimulation strength) was applied to bilateral Zusanli (ST 36) from 30 min before anesthesia to the end of the surgery. The blood glucose value and dosage of Remifentanil used were recorded. The pain severity was assessed at 4, 12, 24 and 48 h after surgery by using visual analogue scale (VAS). Moreover, postoperative anal exhaust time, postoperative oral feeding time, postoperative first ambulation time and postoperative hospital stay length were recorded. RESULTS: The total dosages of Remifentanil used during surgery, and the blood glucose levels were significantly lower in the TAP and TEAS＋TAP groups than in the control group (P<0.05), but had no significant differences between the TAP and TEAS＋TAP groups (P>0.05). The VAS scores of the TAP and TEAS＋TAP groups were considerably lower than those of the control group at 4, 12, 24 and 48 h after surgery (P<0.05, except 48 h of TAP group). Of the 34, 35 and 32 cases in the control, TAP and TEAS＋TAP groups, 5(14.7%), 3(8.6%) and 1(3.1%) on the 1st day post-surgery, and 2(5.9%), 0(0) and 0(0) on the 2nd day after surgery experienced nausea and vomiting. The postoperative anal exhaust time and postoperative oral feeding time were significantly earlier in both TAP and TEAS＋TAP groups than in the control group (P<0.05), and the exhaust time of the TEAS＋TAP group was even earlier than that of the TAP group (P<0.05). No significant differences were found among the 3 groups in the postoperative ambulation time and postoperative hospitalization time (P>0.05). CONCLUSION: TEAS combined with TAP block analgesia is superior to simple TAP block analgesia in relieving postoperative pain, shortening the recovery time of gastrointestinal function and promoting postoperative rehabilitation in patients undergoing LCCR.

Nanopolymeric micelle effect on the transdermal permeability, the bioavailability and gene expression of plasmid.

This study attempts to investigate the transdermal permeability, the bioavailability and gene expression of plasmid formulated with nonionic poly(ethylene oxide)-poly(propylene oxide)-poly(ethylene oxide) (PEO-PPO-PEO) polymeric micelles (PM). Dynamic light scattering (DLS) and atomic force microscopy (AFM) were used to analyze the PM formulated pCMV-Lac Z (P/PM) containing the gene for ß-galactosidase (ß-Gal) driven by cytomegalovirus early promoter. Franz diffusion cell was used for in vitro transdermal permeability analysis. Real-time PCR was used to quantify the permeated plasmid in vitro and in vivo. ß-Gal activity assay was performed to evaluate transgene expression in vivo. The size of P/PM was ~50 nm with round shape. PM significantly enhanced the in vitro transdermal permeability of plasmid in a direction- and temperature-dependent manner. Following transdermal application of P/PM, higher area under the curve (AUC(P/PM): 98.34 h·ng/mL) and longer half-life of plasmid were detected compared with that of plasmid alone (AUC(P): 10.12 h·ng/mL). Additionally, the ß-Gal activity was significantly increased in skin, stomach, brain and spinal cord at both 48 and 72 h after P/PM application and in testis and spleen at 72 h postapplication. In conclusion, PM formulation enhanced the permeation of plasmid through skin into blood circulation, increasing its absorption and the transgene expression in various tissues.