Abstract Background Sepsis may be accompanied by acute respiratory distress syndrome (ARDS) in patients admitted to intensive care units (ICUs). It is essential to identify prognostic biomarkers in patients with sepsis and ARDS. Objective Determine whether changes in the level of serum fibroblast growth factor 21 (FGF21) can predict the 28-day mortality of ICU patients with sepsis and ARDS. Methods Consecutive sepsis patients were divided into two groups (Sepsis + ARDS and Sepsis-only), and the Sepsis + ARDS group was further classified as survivors or non-survivors. Demographic data and comorbidities were recorded. The Sequential Organ Failure Assessment (SOFA) score and serum levels of cytokines and other biomarkers were recorded 3 times after admission. Multiple Cox proportional hazards regression was used to identify risk factors associated with 28-day mortality in the Sepsis + ARDS group. Multivariate receiver operating characteristic curve analysis was used to assess the different predictive value of FGF21 and SOFA. Results The Sepsis + ARDS group had a greater baseline SOFA score and serum levels of cytokines and other biomarkers than the Sepsis-only group; the serum level of FGF21 was almost twofold greater in the Sepsis + ARDS group (P < 0.05). Non-survivors in the Sepsis + ARDS group had an almost fourfold greater level of FGF21 than survivors in this group (P < 0.05). The serum level of FGF21 persistently increased from the baseline to the peak of shock and death in the non-survivors, but persistently decreased in survivors (P < 0.05). Changes in the serum FGF21 level between different time points were independent risk factors for mortality. No statistical difference was observed between the AUC of FGF21 and SOFA at baseline. Conclusion A large increase of serum FGF21 level from baseline is associated with 28-day mortality in ICU patients with sepsis and ARDS.
In extreme cases where the power grid is subject to external attacks, ensuring the continuous and reliable supply of electricity to critical users is a crucial cornerstone for maintaining social stability and national security. The inter-connected large power grid is highly exposed and vulnerable to external attacks, which can result in primary and secondary equipment failures. Furthermore, the cascading effects of such failures can lead to widespread blackouts, causing a significant disruption on a global scale. Therefore, implementing active zoning operations for regional power grids in extreme circumstances can effectively reduce the impact, safeguarding the security and stability of the system. This article proposes a regional power grid active zoning strategy to address extreme external attacks. It is based on a comprehensive vulnerability index derived from the operational state of the regional power grid. This index serves as the trigger criteria for initiating the active zoning of the regional power grid. Using a typical regional power grid as a case study, the effectiveness of the proposed strategy is validated through PSDBPA simulation calculations.
Abstract BackgroundSepsis may be accompanied by acute respiratory distress syndrome (ARDS) in patients admitted to intensive care units (ICUs). It is essential to identify prognostic biomarkers in patients with sepsis and ARDS.ObjectiveDetermine whether changes in the level of serum fibroblast growth factor 21 (FGF21) can predict the 28-day mortality of ICU patients with sepsis and ARDS.MethodsConsecutive sepsis patients were divided into two groups (Sepsis+ARDS and Sepsis-only), and the Sepsis+ARDS group was further classified as survivors or non-survivors. Demographic data and comorbidities were recorded. The Sequential Organ Failure Assessment (SOFA) score and serum levels of cytokines and other biomarkers were recorded 3 times after admission. Multiple Cox proportional hazards regression was used to identify risk factors associated with 28-day mortality in the Sepsis+ARDS group.ResultsThe Sepsis+ARDS group had a greater baseline SOFA score and serum levels of cytokines and other biomarkers than the Sepsis-only group; the serum level of FGF21 was almost 2-fold greater in the Sepsis+ARDS group (P<0.05). Non-survivors in the Sepsis+ARDS group had an almost 5-fold greater level of FGF21 than survivors in this group (P<0.05). The serum level of FGF21 persistently increased from the baseline to the peak of shock and death in the non-survivors, but persistently decreased in survivors (P<0.05). Changes in the serum FGF21 level between different time points were independent risk factors for mortality.ConclusionA large increase of serum FGF21 level from baseline is associated with 28-day mortality in ICU patients with sepsis and ARDS.
Fibroblast growth factor 15 (FGF15) through its FGF-receptor (FGFR)-4 inhibits hepatic inflammation. The current study aimed at investigating whether FGF15 could inhibit septic inflammation and its compensative regulatory T cell (Treg) responses in a mouse sepsis model of cecal ligation and puncture (CLP) and in vitro transwell co-culture.Following the sham or CLP procedure, male CLP C57BL/6 mice were intravenously injected with vehicle saline or FGF15 beginning at 2 h post the procedure every 12 h for three days. Some mice were euthanized and their serum and liver samples were collected for examination of cytokines and Tregs by enzyme-linked immunosorbent assay (ELISA), Western blot and flow cytometry. The remaining mice were monitored for their survival up to 14 days post procedure. Moreover, the purified hepatic CD4+ T cells were co-cultured in transwell plates with unmanipulated NCTC 1469 cells or the cells that had been transfected with the control or FGFR4-specific siRNA and treated with, or without, Lipopolysaccharides (LPS) for 24 h, followed by treatment with vehicle PBS or FGF15 for 48 h.Compared with the CLP group of mice, treatment with FGF15 significantly prolonged the mean survival days of mice (12 vs 1.17 in the CLP group, P = 0.022), mitigated hepatic inflammation and reduced the frequency of apoptotic cells in the liver of mice. FGF15 treatment decreased the percentages of hepatic Tregs, hepatic IL-2, TGF-β and FOXP3 expression in septic mice, accompanied by decreasing serum IL-1β, TNF-α, IL-6 and IL-10 levels. Similarly, FGF15 treatment also attenuated the LPS-increased frequency of Tregs, FOXP3 and IL-2 expression and IL-1β, TNF-α, IL-6 and IL-10 secretion in vitro after co-culture with NCTC 1469 cells, but not co-cultured FGFR4-silenced NCTC 1649 cells.FGF15 treatment through FGFR4 ameliorated hepatic inflammation and its compensative Treg responses, which were associated with protecting from septic death in mice.
Clean energy (including hydropower, wind power, solar power, nuclear power, etc.) provides an effective solution to deal with the issue of environmental protection and alleviate the depletion pressure of traditional fossil energy. However, in real practices, there are also many barriers that can challenge the accommodation of clean energy, including geographical condition, economy growth, energy endowment, technology limitation and so on. Due to regional discrepancies, unevenly distribution of power resources and electricity consumption, it is also a challenge for China Southern Power Grid (CSG) to utilize clean energy. To better develop clean energy, CSG has put a series of efforts, include: the long-transmission power network construction, power market support, dispatch optimization, technology innovation, etc. This paper mainly reviews the challenges and practices for the accommodation of clean energy in CSG. The corresponding outcome and future trends are also comprehensively introduced. It is expected through this paper, the case of CSG can inspire the development and accommodation of clean energy, as well as can provide beneficial references to other worldwide regions.
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