Heat stroke is a potentially life-threatening condition characterized by a core temperature that exceeds the external temperature and is accompanied by central nervous system (CNS) abnormalities. [1]It has two forms, classical heat stroke and exertional heat stroke (EHS).EHS is usually experienced by athletes, military personnel, and outdoor laborers in hot and humid environments. [2]iven the need for physical training and some intrinsic and extrinsic risk factors, military personnel have a high chance of having exertional heat illness (EHI), which is an occupational hazard.The incidence of EHI ranges from 0.2 to 10.5 cases per 1,000 person-years among military personnel, and severe EHI is classified as EHS. [3]In the United States Armed Forces, 4,188 cases of EHS were reported between 2008 and 2018, [4] and the overall crude incidence rate of EHS was 0.36 cases per 1,000 person-years in 2020; furthermore, male military personnel was more prone to EHS than female. [5]HS can lead to acute kidney injury (AKI), rhabdomyolysis, liver injury, and coagulation dysfunction and cause multiple organ dysfunction syndrome (MODS). [1,6]Its pre-hospital treatment involves a timely escape from the thermal environment and rapid cooling therapy.Its common feature is mild to moderate liver injury, and liver function usually return to normal in 2-16 d. [6] However, a small number of patients experience extensive hepatocyte damage leading to severe acute liver injury (SALI) and acute liver failure (ALF), which might be fatal. [7,8]The clinical course of ALF is initiated by a SALI, which is characterized by the development of coagulopathy and impaired liver function but does not have any level of clinical hepatic encephalopathy (HE). [9] As a new definition, SALI can be considered the prophase of ALF, affecting the prognosis of patients with acute hepatitis. [10]However, solid clinical research on the role of SALI in EHS remains lacking.In this study, we aimed to evaluate the clinical characteristics and 30-day outcomes of military personnel with SALI due to EHS. METHODS Study populationPatients who had EHS and were admitted to the First Medical Center of Chinese PLA General Hospital from January 2011 to December 2020 were retrospectively analyzed.This study was conducted following the Helsinki Declaration and approved by the Ethics Committee of Chinese PLA General Hospital.Inclusion criteria: military personnel and diagnosed with EHS.They were excluded if their length of stay was <24 h, they had incomplete laboratory results, or had uncertain prognosis on the 30 th day of onset.Fifty-two patients were included.Death on the 30 th day of onset was considered the primary outcome.Information on prognosis was confirmed through telephone follow-up and medical records.All patients were administered cooling treatment at the onset through pre-hospital emergency care.After admission, they were given fluid resuscitation, airway protection, sedation, brain protection, coagulation factor supplement, and platelet transfusion.In addition, some patients received mechanical ventilation, renal replacement therapy, artificial liver support, and anti-infection and
We use synchrotron x-ray and precision electron diffraction techniques to determine accurately the structure factors of selected reflections that are sensitive to the valence electron distribution in the superconductor MgB2. These values deviate significantly from calculated structure factors using the scattering factors of free atoms, but agree well with our calculated structure factors based on density functional theory. Having experimentally established the reliability of our firstprinciple calculated structure factors, we present electron density maps of the redistribution of the valence electrons that takes place when hypothetical free atoms of Mg and B in MgB2 interact to form the real crystal.
Weak is powerful: For the arylation of tin enolates, the palladium catalyst engages in weak CHO hydrogen bonds to control stereoselectivity (see scheme). Similar catalysts capable of NHO hydrogen bonding also works well.
The selective electrocatalytic conversion of CO2 into useful products is a major challenge in facilitating a closed carbon cycle. Here, on the basis of first-principles calculations combined with computational hydrogen electrode model, we report a curvature-dependent selectivity of CO2 reduction on cobalt–porphyrin nanotubes which are thermodynamically stable, displaying tunable geometric and electronic properties with tube radius. We have found that CO production is preferred on nanotubes with larger diameter, and the predicted current density from microkinetics is larger than that on Au, the best metal catalyst for CO production from CO2 electroreduction. In contrast, highly curved nanotubes with small radii tend to further catalyze CO reduction to CH4 gas and the overpotential is much lower in comparison with the cases on Cu surfaces. The selectivity and the feasibility of synthesis make cobalt–porphyrin nanotubes very promising for CO2 conversion.
Acute-on-chronic liver failure (ACLF), which includes hepatic and multiple extra-hepatic organ failure, is a severe emergency condition that has high mortality. ACLF can rapidly progress and requires an urgent assessment of condition and referral for liver transplantation. Bacterial infections (BIs) trigger ACLF and play pivotal roles in the deterioration of clinical course.To investigate the clinical characteristics and 28-d outcomes of first BIs either at admission or during hospitalization in patients with hepatitis B virus (HBV)-ACLF as defined by the Chinese Group on the Study of Severe Hepatitis B (COSSH).A total of 159 patients with HBV-ACLF and 40 patients with acute decompensation of HBV-related chronic liver disease combined with first BIs were selected for a retrospective analysis between October 2014 and March 2016. The characteristics of BIs, the 28-d transplant-free survival rates, and the independent predictors of the 28-d outcomes were evaluated.A total of 194 episodes of BIs occurred in 159 patients with HBV-ACLF. Among the episodes, 13.4% were community-acquired, 46.4% were healthcare-associated, and 40.2% belonged to nosocomial BIs. Pneumonia (40.7%), spontaneous bacterial peritonitis (SBP) (34.5%), and bloodstream infection (BSI) (13.4%) were the most prevalent. As the ACLF grade increased, the incidence of SBP showed a downward trend (P = 0.021). Sixty-one strains of bacteria, including 83.6% Gram-negative bacteria and 29.5% multidrug-resistant organisms, were cultivated from 50 patients with ACLF. Escherichia coli (44.3%) and Klebsiella pneumoniae (23.0%) were the most common bacteria. As the ACLF grade increased, the 28-d transplant-free survival rates showed a downward trend (ACLF-1, 55.7%; ACLF-2, 29.3%; ACLF-3, 5.4%; P < 0.001). The independent predictors of the 28-d outcomes of patients with HBV-ACLF were COSSH-ACLF score (hazard ratio [HR] = 1.371), acute kidney injury (HR = 2.187), BSI (HR = 2.339), prothrombin activity (HR = 0.967), and invasive catheterization (HR = 2.173).For patients with HBV-ACLF combined with first BIs, pneumonia is the most common form, and the incidence of SBP decreases with increasing ACLF grade. COSSH-ACLF score, acute kidney injury, BSI, prothrombin activity, and invasive catheterization are the independent predictors of 28-d outcomes.
Electronic structure and light absorption properties of the perovskite CH3NH3PbI3 are investigated by relativistic density functional theory with quasiparticle GW corrections and many-body interactions. The nature of the Wannier exciton is studied by solving the Bethe-Salpeter equation augmented with the analysis of a conceptual hydrogen-like model. The computed absorption spectrum unravels a remarkable absorption "gap" between the first two absorption peaks. This discontinuity is maintained in the calculated tetragonal structure that, however, is not stable at low temperature. Most importantly, the discontinuity is also observed in the experimental absorption spectrum of the orthorhombic single crystal at low temperature (4 K). However, in contrast to the single crystal, in a polycrystalline perovskite film at 5 K the "gap" is filled by a monotonously increasing absorption throughout the visible range. This feature of thin films points to the potential significance of defect absorption for the excellent light harvesting properties of perovskite-based solar cells.
Using first-principles calculations, we predict a Chern insulating phase in thin films of the ferromagnetic semi-metal GdN. In contrast to previously proposed Chern insulator candidates, which mostly rely on honeycomb lattices, this system affords a great chance to realize the quantum anomalous Hall Effect on a square lattice without either a magnetic substrate or transition metal doping, making synthesis easier. The band inversion between 5d-orbitals of Gd and 2p-orbitals of N is verified by first-principles calculation based on density functional theory, and the band gap can be as large as 100 meV within GdN trilayer. With further increase of film thickness, the band gap tends to close and the metallic bulk property becomes obvious.
'/%3e%3cuse xlink:href='%23a' transform='translate(288.889 -214.211)'/%3e%3cuse xlink:href='%23a' transform='translate(108 342.749)'/%3e%3cuse xlink:href='%23a' transform='translate(469.189 342.749)'/%3e%3c/svg%3e)
'/%3e%3cuse xlink:href='%23a' transform='rotate(23.036 .093 25.536)'/%3e%3cuse xlink:href='%23a' transform='rotate(45.87 1.273 16.18)'/%3e%3cuse xlink:href='%23a' transform='rotate(69.945 .996 12.078)'/%3e%3cuse xlink:href='%23a' transform='rotate(20.66 -19.689 31.932)'/%3e%3c/svg%3e)
'/%3e%3cuse xlink:href='%23a' transform='rotate(144 450 300)'/%3e%3cuse xlink:href='%23a' transform='rotate(216 450 300)'/%3e%3cuse xlink:href='%23a' transform='rotate(288 450 300)'/%3e%3c/svg%3e)
