Exertional heat stroke (EHS) is a life-threatening condition characterized by profound central nervous system (CNS)dysfunction and core temperature typically>40°C.^([1])This condition involves complex pathophy...Exertional heat stroke (EHS) is a life-threatening condition characterized by profound central nervous system (CNS)dysfunction and core temperature typically>40°C.^([1])This condition involves complex pathophysiological processes in which heat triggers a cascade of dysregulated inflammatory responses,endothelial dysfunction,coagulation abnormalities,and muscle damage.These processes can lead to multiorgan failure,significantly increasing the risk of mortality.^([2])Given the severity of EHS,early identification and timely intervention are crucial.However,there are no specific diagnostic markers for EHS,^([1])highlighting the need to identify reliable clinical parameters that can assist early decision-making.展开更多
Dear Editor,The most serious heat related injury is exertional heat stroke(EHS).EHS occurs when healthy individuals perform physical activity in a hot and humid environment[1].A disrupted balance between heat producti...Dear Editor,The most serious heat related injury is exertional heat stroke(EHS).EHS occurs when healthy individuals perform physical activity in a hot and humid environment[1].A disrupted balance between heat production and dissipation in the human body results in excessive body heat storage in cases.It occurs frequently in the military population because of work characteristics such as the requirements to perform essential duties under prolonged heat stress,the need to achieve mission objectives during deployment operations,or the opportunities for training and selection for elite units[2].The pathophysiology of EHS is complex,which often results in thermoregulation failure,hemodynamic disturbance,and endotoxin release,and further causes multiple organ failure,probably increasing myocardial enzymes and N-terminal pro-brain natriuretic peptide(NT-proBNP)levels.Rhabdomyolysis caused by EHS often results from mechanical and metabolic injury to the striated muscle fibers accompanied with the release of muscle contents into the circulation[3].Liu et al.展开更多
Background:Heat stroke(HS)is a serious,life-threatening disease.However,there is no scoring system for HS so far.This research is to establish a scoring system that can quantitatively assess the severity of exertional...Background:Heat stroke(HS)is a serious,life-threatening disease.However,there is no scoring system for HS so far.This research is to establish a scoring system that can quantitatively assess the severity of exertional heat stroke(EHS).Methods:Data were collected from a total of 170 exertional heat stroke(EHS)patients between 2005 and 2016 from 52 hospitals in China.Univariate statistical methods and comparison of the area under the receiver operating characteristic(ROC)curve(AUC)were used to screen exertional heat stroke score(EHSS)parameters,including but not limited body temperature(T),Glasgow Coma Scale(GCS)and others.By comparing the sizes of the AUCs of the APACHE II,SOFA and EHSS assessments,the effectiveness of EHSS in evaluating the prognosis of EHS patients was verified.Results:Through screening with a series of methods,as described above,the present study determined 12 parameters–body temperature(T),GCS,p H,lactate(Lac),platelet count(PLT),prothrombin time(PT),fibrinogen(Fib),troponin I(Tn I),aspartate aminotransferase(AST),total bilirubin(TBIL),creatinine(Cr)and acute gastrointestinal injury(AGI)classification–as EHSS parameters.It is a 0–47 point system designed to reflect increasing severity of heat stroke.Low(EHSS<20)and high scores(EHSS>35)showed 100%survival and 100%mortality,respectively.We found that AUCEHSS>AUCSOFA>AUCAPACHE II.Conclusions:A total of 12 parameters–T,GCS,p H,Lac,PLT,PT,Fib,Tn I,AST,TBIL,Cr and gastrointestinal AGI classification–are the EHSS parameters with the best effectiveness in evaluating the prognosis of EHS patients.As EHSS score increases,the mortality rate of EHS patients gradually increases.展开更多
BACKGROUND:Heatstroke has become a common emergency event in hospitals.Procalcitonin(PCT)is used as a biomarker of infection in the emergency department(ED),but its role in rhabdomyolysis(RM)following exertional heats...BACKGROUND:Heatstroke has become a common emergency event in hospitals.Procalcitonin(PCT)is used as a biomarker of infection in the emergency department(ED),but its role in rhabdomyolysis(RM)following exertional heatstroke(EHS)remains unclear.METHODS:A retrospective cohort study enrolled patients with EHS from the intensive care unit(ICU).We collected RM biomarkers,inflammation markers,critical disease scores at admission,24 h,48 h,and discharge,and 90-day mortality.Correlation analysis,linear regression and curve fi tting were used to identify the relationship between PCT and RM.RESULTS:A total of 162 patients were recruited and divided into RM(n=56)and non-RM(n=106)groups.PCT was positively correlated with myoglobin(Mb),acute hepatic injury,disseminated intravascular coagulation(DIC),Sequential Organ Failure Assessment(SOFA)score,and Acute Physiology and Chronic Health Evaluation II(APACHE II)score,with correlation coefficients of 0.214,0.237,0.285,0.454,and 0.368,respectively(all P<0.05).Interestingly,the results of curve fi tting revealed a nonlinear relationship between PCT and RM,and a two-piecewise linear regression model showed that PCT was related to RM with an odds ratio of 1.3 and a cut-off of<4.6 ng/mL.Survival analysis revealed that RM was associated with higher mortality compared to non-RM cases(P=0.0093).CONCLUSION:High serum PCT concentrations are associated with RM after EHS in critically ill patients.Elevated PCT concentrations should be interpreted cautiously in patients with EHS in the ED.展开更多
BACKGROUND: Exertional heatstroke(EHS) is a life-threatening disease without ideal prognostic markers for predicting hospital mortality.METHODS: This is a single-center retrospective study. Clinical data from EHS pati...BACKGROUND: Exertional heatstroke(EHS) is a life-threatening disease without ideal prognostic markers for predicting hospital mortality.METHODS: This is a single-center retrospective study. Clinical data from EHS patients admitted to the Intensive Care Unit(ICU) of the General Hospital of Southern Theatre Command between January 1, 2008, and December 31, 2020, were recorded and analyzed. Univariate and multivariate logistic regression were used to identify the factors for mortality. The prediction model was developed with the prognostic markers, and a nomogram was established.RESULTS: The study ultimately enrolled 156 patients, and 15(9.6%) of patients died before discharge. The lymphocyte count(Lym) and percentage(Lym%) were significantly lower in nonsurvivors(P<0.05). The univariate and multivariate logistic regression analyses indicated that Lym% at the third day of admission(Lym% D3)(OR=0.609, 95%CI: 0.454–0.816) and hematocrit(HCT)(OR=0.908, 95%CI: 0.834–0.988) were independent protective factors for hospital mortality. A nomogram incorporating Lym% D3 with HCT was developed and demonstrated good discrimination and calibration ability. The comparison between the prediction model and scoring systems revealed that the prediction model had the largest area under the curve(AUC)(0.948, 95%CI: 0.900–0.977), with 100.00% sensitivity and 83.69% specificity, and a greater clinical net benefit.CONCLUSION: Severe EHS patients had a higher risk of experiencing prolonged lymphopenia. A nomogram based on Lym% D3 and HCT was developed to facilitate early identification and timely treatment of patients with potentially unfavorable prognoses.展开更多
In view of the enormous popularity of mass sporting events such as half-marathons, the number of patients with exertional rhabdomyolysis or exercise-induced heat stroke admitted to intensive care units(ICUs) has incre...In view of the enormous popularity of mass sporting events such as half-marathons, the number of patients with exertional rhabdomyolysis or exercise-induced heat stroke admitted to intensive care units(ICUs) has increased over the last decade. Because these patients have been reported to be at risk for malignant hyperthermia during general anesthesia, the intensive care community should bear in mind that the same risk of life-threatening rhabdomyolysis is present when these patients are admitted to an ICU, and volatile anesthetic sedation is chosen as the sedative technique. As illustrated by the three case studies we elaborate upon, a thorough diagnostic work-up is needed to clarify the subsequent risk of strenuous exercise, and the anesthetic exposure to volatile agents in these patients and their families. Other contraindications for the use of volatile intensive care sedation consist of known malignant hyperthermia susceptibility, congenital myopathies, Duchenne muscular dystrophy, and intracranial hypertension.展开更多
BACKGROUND Exertional heat stroke(EHS)is a critical condition arising from prolonged physical exertion in high temperatures that typically presents with normal hemoglobin levels.However,atypical presentations can also...BACKGROUND Exertional heat stroke(EHS)is a critical condition arising from prolonged physical exertion in high temperatures that typically presents with normal hemoglobin levels.However,atypical presentations can also occur,leading to significant complications such as hemolytic anemia and organ dysfunction.CASE SUMMARY This case report describes a male patient who experienced moderate-to-severe anemia that was difficult to correct,with a confirmed diagnosis of microangiopathic hemolytic anemia accompanying multiple organ dysfunction syndrome,indicative of critical EHS.Despite intensive resuscitation efforts,the patient’s condition deteriorated,necessitating admission to the intensive care unit for advanced management.CONCLUSION This case highlights the importance of recognizing atypical presentations of EHS,particularly that with significant hemolytic anemia and concurrent organ failure.Clinicians should maintain a high level of suspicion for these complications in patients displaying symptoms of heat-related illness,especially when caused by strenuous activity,as early diagnosis and intervention are crucial to improve patient outcomes.展开更多
BACKGROUND Accessory soleus muscle(ASM)is a rare congenital variation that is almost asymptomatic,but several papers have recently described symptomatic ASM.The clinical features of this condition are similar to tarsa...BACKGROUND Accessory soleus muscle(ASM)is a rare congenital variation that is almost asymptomatic,but several papers have recently described symptomatic ASM.The clinical features of this condition are similar to tarsal tunnel syndrome(TTS)and include pain and numbness around the medial side of the ankle.ASM commonly originates from the fibula or soleus muscle and inserts into the Achilles tendon or calcaneus.Usually,it is identified as posteromedial swelling and definitely diagnosed by magnetic resonance imaging.In most cases,treatment is observation,but surgical excision can be considered if symptoms are severe.CASE SUMMARY A 23-year-old male Korean soldier presented with complaints of bilateral foot and ankle pain and a swelling medial to the Achilles tendon that was more pronounced on the right side.Symptoms first occurred after playing soccer 10 mo before this presentation,worsened after physical exertion,and were relieved by rest.He had no medical history,and no one in his family had the condition.Laboratory results were non-specific.Several tests were performed to exclude common diseases such as tumors or TTS.However,MRI revealed a bulky accessory soleus muscle in both feet,though the patient complained of more severe pain on the right side during physical activity.Accordingly,surgical resection was adopted.At surgery,a large accessory soleus muscle was noted anterior to the Achilles tendon with distinctive insertion from a normal soleus muscle.At 12 mo after surgery,there was no pain,numbness,or swelling of the right foot or ankle,no evidence of recurrence,and the patient could do all sports activities.CONCLUSION Accessory soleus muscle should be added to the list of differential diagnosis if a patient has pain,sole numbness or swelling of the posteromedial ankle.展开更多
BACKGROUND Endoscopic fasciotomy of the forearm for chronic exertional compartment syndrome(CECS)has gained popularity recently.AIM To systematically review the literature of endoscopic fasciotomy for CECS of the fore...BACKGROUND Endoscopic fasciotomy of the forearm for chronic exertional compartment syndrome(CECS)has gained popularity recently.AIM To systematically review the literature of endoscopic fasciotomy for CECS of the forearm,aiming to assess the outcomes and complications of the different endoscopic fasciotomy techniques described in the literature.METHODS On January 18,2021,PubMed and EMBASE were searched by 3 reviewers independently,and all relevant studies published up to that date were considered based on predetermined inclusion/exclusion criteria.The subject headings“endoscopic fasciotomy”and“compartment syndrome”and their related key terms were used.The Preferred Reporting Item for Systematic Reviews and Meta-Analyses statement was used to screen the articles.RESULTS A total of seven studies including 183 patients(355 forearms)were included.The mean age of the patients was 31.2 years(range:15-42 years).The postoperative follow-up duration ranged from 6 wk to 4.9 years.All patients were able to return to sport activities between postoperative weeks 1 to 8.Recurrence of the compartment syndrome occurred in three patients,giving a rate of 1.6%per patient and 0.8%per forearm.The overall complication rate was 8.7%per patient,and 4.5%per forearm.The most common reported complication was hematoma(7 forearms;2.0%).CONCLUSION Endoscopic fasciotomy for CECS of the forearm has favorable short-and midterm outcomes with very low recurrence and complication rates.This,however,needs to be confirmed in larger,long-term follow-up,prospective,comparative studies between open,mini-open and endoscopic fasciotomy techniques.展开更多
[Objectives]To explore the effects of Shentong Zhuyu decoction combined with massage therapy in the treatment of exertional chronic lumbar muscle strain.[Methods]Sixty-four cases of exertional chronic lumbar muscle st...[Objectives]To explore the effects of Shentong Zhuyu decoction combined with massage therapy in the treatment of exertional chronic lumbar muscle strain.[Methods]Sixty-four cases of exertional chronic lumbar muscle strain were randomly divided into two groups(32 cases each group).The patients in the control group only took celecoxib capsules,and those in the treatment group additionally took Shentong Zhuyu decoction combined with massage therapy.TCM syndrome score,lumbar function,hemorrheology index and clinical effect were compared between the two groups before and after treatment.[Results]After treatment,the TCM syndrome scores of lumbar distension/dull pain,tingling-like lumbago,adverse lateral turn,body weight loss,dark purple tongue,slow or astringent pulse,and Oswestry disability index(ODI)score in the treatment group were lower than those in the control group,and the levels of plasma viscosity,red blood cell aggregation index,platelet aggregation rate(PAG)and fibrinogen(Fib)were lower than those in the control group,showing statistical significance(P<0.05).The overall clinical effect distribution of the treatment group was better than that of the control group,and the difference was statistically significant(P<0.05).[Conclusions]Shentong Zhuyu decoction combined with massage therapy can effectively relieve the symptoms of patients with lumbago and improve the lumbar mobility function and hemorrheology,with obvious therapeutic effects in the treatment of exertional chronic lumbar muscle strain.展开更多
Background: The exRML (exertional rhabdomyolysis) is a pathophysiologic condition of skeletal muscle cell damage and breakdown associated with high intensity or prolonged exercise, normal exercise under extreme circum...Background: The exRML (exertional rhabdomyolysis) is a pathophysiologic condition of skeletal muscle cell damage and breakdown associated with high intensity or prolonged exercise, normal exercise under extreme circumstances, or sudden and excessive skeletal muscle contraction. It may manifest from the increase in CK (creatine kinase) or MYO (myoglobin), a protein that can cause life-threatening injury to the kidney (AKI, acute kidney injury), and may or may not be associated with myoglobinuria. Here, we presented a case of exRML with AKI, and then reviewed the related reports. Vigorous hydration, sodium bicarbonate and furosemide are key treatments. Aim: To examine an elderly patient with exRML induced AKI and the key treatment process. Case summary: A 61-year-old man left our hospital without permission after his admission and has been walking for almost 30 kms with no water and food intake, then was diagnosed exRML and exRML induced AKI with an obvious elevation of CK, MYO and decrease of eGFR (estimated glomerular filtration rate) after coming back, and was treated with vigorous hydration, loop diuresis, sodium bicarbonate, prostaglandin and Shenkang injection. After vigorous resuscitation, the patient’s renal function, CK and MYO returned normal. Conclusions: The exRML can cause serious complications such as AKI and death. Delayed diagnosis can be critical;therefore, manner of time should be taken to achieve a favorable prognosis.展开更多
Marching band(MB)artists are often part of the general student population and not required to complete a preparticipation health screening to identify predisposing medical conditions or risks for injury/illness.Anecdo...Marching band(MB)artists are often part of the general student population and not required to complete a preparticipation health screening to identify predisposing medical conditions or risks for injury/illness.Anecdotally,exertional heat illnesses(EHI)are a concern for MB artists.As more athletic trainers provide MB healthcare,research is needed on EHI occurrence and MB associated EHI risk factors.We utilized an exploratory crosssectional study design to determine EHI risk factors,including previous EHI occurrence,among collegiate MB artists.MB artists(n=1207;age=[19.6±1.3]years)actively participating in their college/university's MB during the 2019 football season completed an online survey to characterize demographics,medical history,medication and supplement use,and nutrition behaviors.Chi-square and binomial logistical regressions assessed associations between categorical variables.Previous EHI was reported by 50.6%of MB artists,with 466(76.3%)experiencing exertional heat exhaustion and 31(5.1%)exertional heat stroke.More females reported exertional heat exhaustion overall(68.2%,p<0.001)and in the previous year(73.3%,p<0.001).Experiencing a previous EHI was significantly associated with having a mood/neurological condition(63.5%,p<0.001),diagnosed(74.3%,p=0.004)or perceived eating disorder(66.7%,p<0.001),and taking prescription medications(59.4%,p<0.001),over-the-counter medications(58.9%,p=0.002),and supplements(55.4%,p=0.037).Half of collegiate MB artists reported experiencing previous EHIs and engaged in behaviors known to increase EHI risk.MB artists should complete pre-participation examinations to identify pre-existing medical conditions and risks for adverse medical events.Healthcare providers working with MB artists should develop policies and procedures to mitigate EHI risks and occurrence.展开更多
Background:The roles of the Pink1/Parkin pathway and mitophagy in lung injury during heat stroke remain unclear.In this study,we investigated the role of Pink1/Parkin-mediated mitophagy in acute lung injury(ALI)in rat...Background:The roles of the Pink1/Parkin pathway and mitophagy in lung injury during heat stroke remain unclear.In this study,we investigated the role of Pink1/Parkin-mediated mitophagy in acute lung injury(ALI)in rats with exertional heat stroke(EHS).Methods:Sixty Sprague Dawley rats were randomly divided into control(CON),control+Parkin overexpression(CON+Parkin),EHS,and EHS+Parkin overexpression(EHS+Parkin)groups.Parkin was overexpressed by injecting an adeno-associated virus carrying the Parkin gene into the tail vein,and a rat model of EHS was established.Pathological changes in the lung tissue were analyzed using microcomputed tomography(micro-CT),and the lung coefficient and pulmonary capillary permeability were measured.Enzyme-linked immunosorbent assay were used to determine the levels of interleukin-6(IL-6),IL-1β,and tumor necrosis factor-α,and reactive oxygen species.The morphology of mitochondria in typeⅡepithelial cells of lung tissue was observed using transmission electron microscopy;and the apoptosis of lung tissue,the level of mitophagy,and the co-localization of Pink1 and Parkin were determined using immunofluorescence.The expression of Pink1,Parkin,mitofusin-2(MFN2),phosphatase and tensin homolog(PTEN),PTEN-L,p62,and the autophagy marker microtubule-associated protein 1 light chain 3(LC3)in rat lung tissue was measured by Western blotting,and the ratio of LC3II/LC3I was calculated.Results:Compared with the EHS group,the survival rate of rats in the EHS+Parkin group was significantly higher.Their lung coefficient and pulmonary vascular permeability decreased and the pathological changes were significantly alleviated(P<0.05).Their levels of inflammatory factors and reactive oxygen species were significantly decreased(P<0.05),and the degree of mitochondrial swelling in pulmonary type II epithelial cells was alleviated.The apoptosis of lung tissue was alleviated,the colocalization of Pink1 and Parkin,LC3 and Tom20 was enhanced,and the ratio of LC3-II/LC3-I increased.The expression of Pink1,MFN2,PTEN-L,and p62 decreased,whereas the expression of PTEN was not significantly different from that in the EHS group(P>0.05).Conclusion:Pink1/Parkin-mediated mitophagy dysfunction is one of the mechanisms underlying ALI in rats with EHS,and activation of Parkin overexpression-mediated mitophagy can alleviate ALI caused by EHS.展开更多
Background and Aims:Exertional heatstroke(EHS)is associated with strenuous physical activity in hot environments.The present study aimed to investigate dynamic changes of hepatic function indices in EHS patients and d...Background and Aims:Exertional heatstroke(EHS)is associated with strenuous physical activity in hot environments.The present study aimed to investigate dynamic changes of hepatic function indices in EHS patients and determine risk factors for death.Methods:This single-center retrospective cohort study considered all patients with EHS admitted to the intensive care unit at the General Hospital of Southern Theater Command of PLA from October 2008 to May 2019.Data on general characteristics,organ function parameters,and the 90-day outcome of enrolled patients were collected.Hepatic indices were collected dynamically,and patients with acute hepatic injury(AHI)were identified by plasma total bilirubin(TBIL)≥34.2μmol/L and an international normalized ratio≥1.5,or with any grade of hepatic encephalopathy.Results:In patients who survived,TBIL,alanine aminotransferase and aspartate aminotransferase were increased at 24 h,peaked at 2–3 days,and began to decrease at 5 days.In non-survivors,TBIL continuously increased post-admission.The area under the receiver operating characteristic curve for the prediction of mortality based on sequential organ failure assessment(SOFA)scores was 89.8%,and the optimal cutoff value was 7.5.Myocardial injury and infection were identified as independent risk factors for death in EHS patients with AHI.Conclusions:In EHS patients,hepatic dysfunction usually occurred within 24 h.Patients with AHI had more severe clinical conditions,and significantly increased 90-day mortality rates.SOFA scores over 7.5,complicated with myocardial injury or infection,were found to be risk factors for death in EHS patients with AHI.展开更多
Purpose:Minimal data exist on brain injury in patients with exertional heatstroke(EHS)in developing country.In this study,we explored the risk factors for brain injury induced by EHS 90-day after onset.Methods:A retro...Purpose:Minimal data exist on brain injury in patients with exertional heatstroke(EHS)in developing country.In this study,we explored the risk factors for brain injury induced by EHS 90-day after onset.Methods:A retrospective cohort study of patients with EHS was conducted in the intensive care unit of the General Hospital of Southern Theater Command of PLA in China from April 2014 to June 2019.Patients were divided into non-brain injury(fully recovered)and brain injury groups(comprising deceased patients or those with neurological sequelae).The brain injury group was further subdivided into a death group and a sequela group for detailed analysis.General information,neurological performance and information on important organ injuries in the acute stage were recorded and analysed.Multivariable logistic regression was used to identify risk factors for brain injury after EHS and mortality risk factors for brain injury,and Kaplan-Meier survival curve was used to evaluate the effect of the neurological dysfunction on survival.Results:Out of the 147 EHS patients,117 were enrolled,of which 96(82.1%)recovered,13(11.1%)died,and 8(6.8%)experienced neurological sequelae.Statistically significant differences were found between non-brain injury and brain injury groups in age,hypotension,duration of consciousness disorders,time to drop core body temperature below 38.5℃,lymphocyte counts,platelet counts,procalcitonin,alanine aminotransferase,aspartate aminotransferase,creatinine,cystatin C,coagulation parameters,international normalized ratio,acute physiology and chronic health evaluation II scores,sequential organ failure assessment(SOFA)scores,and Glasgow coma scale scores(all p<0.05).Multivariate logistic regression showed that age(OR=1.090,95%CI:1.02-1.17,p=0.008),time to drop core temperature(OR=8.223,95%CI:2.30-29.40,p=0.001),and SOFA scores(OR=1.676,95%CI:1.29-2.18,p<0.001)are independent risk factors for brain injury induced by EHS.The Kaplan-Meier curves suggest significantly prolonged survival(p<0.001)in patients with early Glasgow coma scale score>8 and duration of consciousness disorders≤24 h.Conclusions:Advanced age,delayed cooling,and higher SOFA scores significantly increase the risk of brain injury post-EHS.These findings underscore the importance of rapid cooling and early assessment of organ failure to improve outcomes in EHS patients.展开更多
Objective:To investigate the correlation between interleukin-6(IL-6),serum amyloid A(SAA),C-reactive protein(CRP)and exertional heat stroke in rats.Methods:A total of 90 adult Sprague-Dawley rats without specific path...Objective:To investigate the correlation between interleukin-6(IL-6),serum amyloid A(SAA),C-reactive protein(CRP)and exertional heat stroke in rats.Methods:A total of 90 adult Sprague-Dawley rats without specific pathogens were randomly divided into three groups:control group,classical group and exertion group,with 30 rats in each group.The control group was maintained at a temperature of(26±1)℃and humidity of(60±5)%,while the classical and exertion groups were exposed to a temperature of(40±0.5)℃and humidity of(70±5)%.Additionally,the exertion group underwent treadmill running under these conditions.The levels of IL-6,SAA,and CRP in the three groups were assessed and compared at various time points:before modeling,immediately after onset,and at 2,4,and 8 h after onset.Furthermore,Spearman correlation analysis was employed to examine.Results:The findings from the repeated measures analysis of variance indicated significant variations in the levels of IL-6,SAA,and CRP across the three groups(P<0.05).Both the classic and exertion groups exhibited higher levels of IL-6,SAA,and CRP compared to the control group,with the exertion group demonstrating even higher levels than the classic group(P<0.05).Additionally,Spearman correlation analysis revealed a positive correlation between the onset of heat stroke and the levels of IL-6,SAA,and CRP at the onset,as well as at 2,4,and 8 h post-onset(P<0.05).Furthermore,the types of heat stroke were found to be positively correlated with the levels of IL-6,SAA and CRP(P<0.05).Conclusion:The initiation and nature of heat stroke in rats are significantly associated with the concentrations of IL-6,SAA,and CRP.The concentrations of IL-6,SAA,and CRP within 8 h of onset can reliably forecast the occurrence of heat stroke in rats,serving as a basis for distinguishing classical heat stroke from exertional heat stroke.Nevertheless,the predictive and differentiating efficacy may diminish as the onset time prolongs.展开更多
A 64-year-old woman who presented with progressive exertional dyspnea(NYHA class IIb)over the previous month,unresponsive to adjustments in diuretic therapy.She denied chest pain or palpitations.On physical examinatio...A 64-year-old woman who presented with progressive exertional dyspnea(NYHA class IIb)over the previous month,unresponsive to adjustments in diuretic therapy.She denied chest pain or palpitations.On physical examination,bilateral lower extremity edema and a right parasternal systolic murmur were noted.Electrocardiography showed sinus rhythm with first-degree atrioventricular block and complete right bundle branch block.展开更多
Bone has long been acknowledged as a fundamental structural entity that provides support and protection to the body’s organs.However,emerging research indicates that bone plays a crucial role in the regulation of sys...Bone has long been acknowledged as a fundamental structural entity that provides support and protection to the body’s organs.However,emerging research indicates that bone plays a crucial role in the regulation of systemic metabolism.This is achieved through the secretion of a variety of hormones,cytokines,metal ions,extracellular vesicles,and other proteins/peptides,collectively referred to as bone-derived factors(BDFs).BDFs act as a medium through which bones can exert targeted regulatory functions upon various organs,thereby underscoring the profound and concrete implications of bone in human physiology.Nevertheless,there remains a pressing need for further investigations to elucidate the underlying mechanisms that inform the effects of bone on other body systems.This review aims to summarize the current findings related to the roles of these significant modulators across different organs and metabolic contexts by regulating critical genes and signaling pathways in vivo.It also addresses their involvement in the pathogenesis of various diseases affecting the musculoskeletal system,circulatory system,glucose and lipid metabolism,central nervous system,urinary system,and reproductive system.The insights gained from this review may contribute to the development of innovative therapeutic strategies through a focused approach to bone secretomes.Continued research into BDFs is expected to enhance our understanding of bone as a multifunctional organ with diverse regulatory roles in human health.展开更多
Gut microbiota(GM)exerts an indispensable effect in human health,especially in metabolism regulation.^(1)Recent studies have identified a potential association with osteoporosis.^(2–5)At the same time,GM intervention...Gut microbiota(GM)exerts an indispensable effect in human health,especially in metabolism regulation.^(1)Recent studies have identified a potential association with osteoporosis.^(2–5)At the same time,GM intervention,such as antibiotic treatment,^(6)fecal microbiota transplantation(FMT),^(7–8)supplement of probiotics^(9–10)and other means,will also subsequently affect bone metabolism.Further,GM dysbiosis was also mentioned as one of pathophysiological mechanism of osteoporosis,even written in the clinical diagnosis and treatment guidelines^(11)[Fig.1,based on Guidelines for the diagnosis and treatment of primary osteoporosis in China(2022)].展开更多
The treatment of severe diabetic foot remains a clinical challenge.While it is established that bone can exert systemic effects through the secretion of osteokines on other organs,whether this endocrine function can b...The treatment of severe diabetic foot remains a clinical challenge.While it is established that bone can exert systemic effects through the secretion of osteokines on other organs,whether this endocrine function can be harnessed to promote diabetic wound healing remains unexplored.Here,we investigate the impact of a bone injury strategy on diabetic wound healing,leveraging the body’s innate regenerative capacity to stimulate osteokine release and influence remote skin wound repair.This study demonstrates that the tibial defect significantly accelerates ipsilateral diabetic foot skin wound healing.Mechanistically,we identify osteokines,platelet-derived growth factor-BB(PDGF-BB),as the key to initiating this process.Bone defect triggers a substantial release of PDGF-BB,which reaches the skin wound site via peripheral circulation.At the skin wound site,PDGF-BB mediates the secretion of keratinocyte growth factor(KGF)from fibroblasts via the PDGFRβsignaling pathway,thereby promoting the rapid re-epithelialization of epidermal cells through a paracrine pathway.Additionally,elevated PDGF-BB levels enhance the regeneration of CD31hi Emcnhi blood vessels within the wound.展开更多
基金funded by Research Fund of Zhejiang Provincial Health Commission (2025KY8662025)。
文摘Exertional heat stroke (EHS) is a life-threatening condition characterized by profound central nervous system (CNS)dysfunction and core temperature typically>40°C.^([1])This condition involves complex pathophysiological processes in which heat triggers a cascade of dysregulated inflammatory responses,endothelial dysfunction,coagulation abnormalities,and muscle damage.These processes can lead to multiorgan failure,significantly increasing the risk of mortality.^([2])Given the severity of EHS,early identification and timely intervention are crucial.However,there are no specific diagnostic markers for EHS,^([1])highlighting the need to identify reliable clinical parameters that can assist early decision-making.
基金supported by the Natural Science Foundation of Hainan Province(821QN389,821MS112,822MS198,820MS126,820QN383)the Military Medical Science and Technology Youth Incubation Program(20QNPY110,19QNP060)+6 种基金the Excellent Youth Incubation Program of Chinese PLA General Hospital(2020-YQPY-007)the Heatstroke Treatment and Research Center of Chinese PLA(413EGZ1D10)the Simulation Training for Treatment of Heatstroke,the Major Science and Technology Programme of Hainan Province(ZDKJ2019012)the National Key Research and Development Program of China(2018YFC2000400)the National S&T Resource Sharing Service Platform Project of China(YCZYPT[2018]07)the Specific Research Fund of Innovation Platform for Academicians of Hainan Province(YSPTZX202216)the Medical Big Data Research and Development Project of Chinese PLA General Hospital(MBD2018030).
文摘Dear Editor,The most serious heat related injury is exertional heat stroke(EHS).EHS occurs when healthy individuals perform physical activity in a hot and humid environment[1].A disrupted balance between heat production and dissipation in the human body results in excessive body heat storage in cases.It occurs frequently in the military population because of work characteristics such as the requirements to perform essential duties under prolonged heat stress,the need to achieve mission objectives during deployment operations,or the opportunities for training and selection for elite units[2].The pathophysiology of EHS is complex,which often results in thermoregulation failure,hemodynamic disturbance,and endotoxin release,and further causes multiple organ failure,probably increasing myocardial enzymes and N-terminal pro-brain natriuretic peptide(NT-proBNP)levels.Rhabdomyolysis caused by EHS often results from mechanical and metabolic injury to the striated muscle fibers accompanied with the release of muscle contents into the circulation[3].Liu et al.
基金supported by the National Natural Science Foundation of China(81671966)the Beijing Natural Science Foundation(7182155)+2 种基金the Application Research and Achievement Extension of Clinical Characteristics in Chinese Capital Foundation(Z171100001017160)the Cultivation Program for Military Medical Science and Technology Youth-Growth Project(16QNP139)the Clinical Research Support Foundation of Chinese PLA General Hospital(2015FC-ZHCG-1002)。
文摘Background:Heat stroke(HS)is a serious,life-threatening disease.However,there is no scoring system for HS so far.This research is to establish a scoring system that can quantitatively assess the severity of exertional heat stroke(EHS).Methods:Data were collected from a total of 170 exertional heat stroke(EHS)patients between 2005 and 2016 from 52 hospitals in China.Univariate statistical methods and comparison of the area under the receiver operating characteristic(ROC)curve(AUC)were used to screen exertional heat stroke score(EHSS)parameters,including but not limited body temperature(T),Glasgow Coma Scale(GCS)and others.By comparing the sizes of the AUCs of the APACHE II,SOFA and EHSS assessments,the effectiveness of EHSS in evaluating the prognosis of EHS patients was verified.Results:Through screening with a series of methods,as described above,the present study determined 12 parameters–body temperature(T),GCS,p H,lactate(Lac),platelet count(PLT),prothrombin time(PT),fibrinogen(Fib),troponin I(Tn I),aspartate aminotransferase(AST),total bilirubin(TBIL),creatinine(Cr)and acute gastrointestinal injury(AGI)classification–as EHSS parameters.It is a 0–47 point system designed to reflect increasing severity of heat stroke.Low(EHSS<20)and high scores(EHSS>35)showed 100%survival and 100%mortality,respectively.We found that AUCEHSS>AUCSOFA>AUCAPACHE II.Conclusions:A total of 12 parameters–T,GCS,p H,Lac,PLT,PT,Fib,Tn I,AST,TBIL,Cr and gastrointestinal AGI classification–are the EHSS parameters with the best effectiveness in evaluating the prognosis of EHS patients.As EHSS score increases,the mortality rate of EHS patients gradually increases.
基金funded by the National Natural Science Foundation of China(82072143,81873943,82360903)Sanming Project of Medicine in Shenzhen(SZSM20162011)+3 种基金Shenzhen Science and Technology Innovation Commission(JCYJ20190806163603504)Shenzhen Second People’s Hospital Clinical Research Fund of Guangdong Province High-level Hospital Construction Project(20203357014,2023xgyj3357001,2023yjlcyj022)Guizhou Science and Technology Planning Project(Guizhou Science and Technology Cooperation Support[2021]General 413)and PhD Start-up Fund(GYZYYFY-BS-2023[09]).
文摘BACKGROUND:Heatstroke has become a common emergency event in hospitals.Procalcitonin(PCT)is used as a biomarker of infection in the emergency department(ED),but its role in rhabdomyolysis(RM)following exertional heatstroke(EHS)remains unclear.METHODS:A retrospective cohort study enrolled patients with EHS from the intensive care unit(ICU).We collected RM biomarkers,inflammation markers,critical disease scores at admission,24 h,48 h,and discharge,and 90-day mortality.Correlation analysis,linear regression and curve fi tting were used to identify the relationship between PCT and RM.RESULTS:A total of 162 patients were recruited and divided into RM(n=56)and non-RM(n=106)groups.PCT was positively correlated with myoglobin(Mb),acute hepatic injury,disseminated intravascular coagulation(DIC),Sequential Organ Failure Assessment(SOFA)score,and Acute Physiology and Chronic Health Evaluation II(APACHE II)score,with correlation coefficients of 0.214,0.237,0.285,0.454,and 0.368,respectively(all P<0.05).Interestingly,the results of curve fi tting revealed a nonlinear relationship between PCT and RM,and a two-piecewise linear regression model showed that PCT was related to RM with an odds ratio of 1.3 and a cut-off of<4.6 ng/mL.Survival analysis revealed that RM was associated with higher mortality compared to non-RM cases(P=0.0093).CONCLUSION:High serum PCT concentrations are associated with RM after EHS in critically ill patients.Elevated PCT concentrations should be interpreted cautiously in patients with EHS in the ED.
基金supported by the Natural Science Foundation of Guangdong Province (2022A1515010353)Science and Technology Projects of Guangzhou (SL2024A03J00951)Military Medical Innovation Project (18CXZ032)。
文摘BACKGROUND: Exertional heatstroke(EHS) is a life-threatening disease without ideal prognostic markers for predicting hospital mortality.METHODS: This is a single-center retrospective study. Clinical data from EHS patients admitted to the Intensive Care Unit(ICU) of the General Hospital of Southern Theatre Command between January 1, 2008, and December 31, 2020, were recorded and analyzed. Univariate and multivariate logistic regression were used to identify the factors for mortality. The prediction model was developed with the prognostic markers, and a nomogram was established.RESULTS: The study ultimately enrolled 156 patients, and 15(9.6%) of patients died before discharge. The lymphocyte count(Lym) and percentage(Lym%) were significantly lower in nonsurvivors(P<0.05). The univariate and multivariate logistic regression analyses indicated that Lym% at the third day of admission(Lym% D3)(OR=0.609, 95%CI: 0.454–0.816) and hematocrit(HCT)(OR=0.908, 95%CI: 0.834–0.988) were independent protective factors for hospital mortality. A nomogram incorporating Lym% D3 with HCT was developed and demonstrated good discrimination and calibration ability. The comparison between the prediction model and scoring systems revealed that the prediction model had the largest area under the curve(AUC)(0.948, 95%CI: 0.900–0.977), with 100.00% sensitivity and 83.69% specificity, and a greater clinical net benefit.CONCLUSION: Severe EHS patients had a higher risk of experiencing prolonged lymphopenia. A nomogram based on Lym% D3 and HCT was developed to facilitate early identification and timely treatment of patients with potentially unfavorable prognoses.
文摘In view of the enormous popularity of mass sporting events such as half-marathons, the number of patients with exertional rhabdomyolysis or exercise-induced heat stroke admitted to intensive care units(ICUs) has increased over the last decade. Because these patients have been reported to be at risk for malignant hyperthermia during general anesthesia, the intensive care community should bear in mind that the same risk of life-threatening rhabdomyolysis is present when these patients are admitted to an ICU, and volatile anesthetic sedation is chosen as the sedative technique. As illustrated by the three case studies we elaborate upon, a thorough diagnostic work-up is needed to clarify the subsequent risk of strenuous exercise, and the anesthetic exposure to volatile agents in these patients and their families. Other contraindications for the use of volatile intensive care sedation consist of known malignant hyperthermia susceptibility, congenital myopathies, Duchenne muscular dystrophy, and intracranial hypertension.
文摘BACKGROUND Exertional heat stroke(EHS)is a critical condition arising from prolonged physical exertion in high temperatures that typically presents with normal hemoglobin levels.However,atypical presentations can also occur,leading to significant complications such as hemolytic anemia and organ dysfunction.CASE SUMMARY This case report describes a male patient who experienced moderate-to-severe anemia that was difficult to correct,with a confirmed diagnosis of microangiopathic hemolytic anemia accompanying multiple organ dysfunction syndrome,indicative of critical EHS.Despite intensive resuscitation efforts,the patient’s condition deteriorated,necessitating admission to the intensive care unit for advanced management.CONCLUSION This case highlights the importance of recognizing atypical presentations of EHS,particularly that with significant hemolytic anemia and concurrent organ failure.Clinicians should maintain a high level of suspicion for these complications in patients displaying symptoms of heat-related illness,especially when caused by strenuous activity,as early diagnosis and intervention are crucial to improve patient outcomes.
文摘BACKGROUND Accessory soleus muscle(ASM)is a rare congenital variation that is almost asymptomatic,but several papers have recently described symptomatic ASM.The clinical features of this condition are similar to tarsal tunnel syndrome(TTS)and include pain and numbness around the medial side of the ankle.ASM commonly originates from the fibula or soleus muscle and inserts into the Achilles tendon or calcaneus.Usually,it is identified as posteromedial swelling and definitely diagnosed by magnetic resonance imaging.In most cases,treatment is observation,but surgical excision can be considered if symptoms are severe.CASE SUMMARY A 23-year-old male Korean soldier presented with complaints of bilateral foot and ankle pain and a swelling medial to the Achilles tendon that was more pronounced on the right side.Symptoms first occurred after playing soccer 10 mo before this presentation,worsened after physical exertion,and were relieved by rest.He had no medical history,and no one in his family had the condition.Laboratory results were non-specific.Several tests were performed to exclude common diseases such as tumors or TTS.However,MRI revealed a bulky accessory soleus muscle in both feet,though the patient complained of more severe pain on the right side during physical activity.Accordingly,surgical resection was adopted.At surgery,a large accessory soleus muscle was noted anterior to the Achilles tendon with distinctive insertion from a normal soleus muscle.At 12 mo after surgery,there was no pain,numbness,or swelling of the right foot or ankle,no evidence of recurrence,and the patient could do all sports activities.CONCLUSION Accessory soleus muscle should be added to the list of differential diagnosis if a patient has pain,sole numbness or swelling of the posteromedial ankle.
文摘BACKGROUND Endoscopic fasciotomy of the forearm for chronic exertional compartment syndrome(CECS)has gained popularity recently.AIM To systematically review the literature of endoscopic fasciotomy for CECS of the forearm,aiming to assess the outcomes and complications of the different endoscopic fasciotomy techniques described in the literature.METHODS On January 18,2021,PubMed and EMBASE were searched by 3 reviewers independently,and all relevant studies published up to that date were considered based on predetermined inclusion/exclusion criteria.The subject headings“endoscopic fasciotomy”and“compartment syndrome”and their related key terms were used.The Preferred Reporting Item for Systematic Reviews and Meta-Analyses statement was used to screen the articles.RESULTS A total of seven studies including 183 patients(355 forearms)were included.The mean age of the patients was 31.2 years(range:15-42 years).The postoperative follow-up duration ranged from 6 wk to 4.9 years.All patients were able to return to sport activities between postoperative weeks 1 to 8.Recurrence of the compartment syndrome occurred in three patients,giving a rate of 1.6%per patient and 0.8%per forearm.The overall complication rate was 8.7%per patient,and 4.5%per forearm.The most common reported complication was hematoma(7 forearms;2.0%).CONCLUSION Endoscopic fasciotomy for CECS of the forearm has favorable short-and midterm outcomes with very low recurrence and complication rates.This,however,needs to be confirmed in larger,long-term follow-up,prospective,comparative studies between open,mini-open and endoscopic fasciotomy techniques.
基金Supported by General Program of National Natural Science Foundation of China(31470075).
文摘[Objectives]To explore the effects of Shentong Zhuyu decoction combined with massage therapy in the treatment of exertional chronic lumbar muscle strain.[Methods]Sixty-four cases of exertional chronic lumbar muscle strain were randomly divided into two groups(32 cases each group).The patients in the control group only took celecoxib capsules,and those in the treatment group additionally took Shentong Zhuyu decoction combined with massage therapy.TCM syndrome score,lumbar function,hemorrheology index and clinical effect were compared between the two groups before and after treatment.[Results]After treatment,the TCM syndrome scores of lumbar distension/dull pain,tingling-like lumbago,adverse lateral turn,body weight loss,dark purple tongue,slow or astringent pulse,and Oswestry disability index(ODI)score in the treatment group were lower than those in the control group,and the levels of plasma viscosity,red blood cell aggregation index,platelet aggregation rate(PAG)and fibrinogen(Fib)were lower than those in the control group,showing statistical significance(P<0.05).The overall clinical effect distribution of the treatment group was better than that of the control group,and the difference was statistically significant(P<0.05).[Conclusions]Shentong Zhuyu decoction combined with massage therapy can effectively relieve the symptoms of patients with lumbago and improve the lumbar mobility function and hemorrheology,with obvious therapeutic effects in the treatment of exertional chronic lumbar muscle strain.
文摘Background: The exRML (exertional rhabdomyolysis) is a pathophysiologic condition of skeletal muscle cell damage and breakdown associated with high intensity or prolonged exercise, normal exercise under extreme circumstances, or sudden and excessive skeletal muscle contraction. It may manifest from the increase in CK (creatine kinase) or MYO (myoglobin), a protein that can cause life-threatening injury to the kidney (AKI, acute kidney injury), and may or may not be associated with myoglobinuria. Here, we presented a case of exRML with AKI, and then reviewed the related reports. Vigorous hydration, sodium bicarbonate and furosemide are key treatments. Aim: To examine an elderly patient with exRML induced AKI and the key treatment process. Case summary: A 61-year-old man left our hospital without permission after his admission and has been walking for almost 30 kms with no water and food intake, then was diagnosed exRML and exRML induced AKI with an obvious elevation of CK, MYO and decrease of eGFR (estimated glomerular filtration rate) after coming back, and was treated with vigorous hydration, loop diuresis, sodium bicarbonate, prostaglandin and Shenkang injection. After vigorous resuscitation, the patient’s renal function, CK and MYO returned normal. Conclusions: The exRML can cause serious complications such as AKI and death. Delayed diagnosis can be critical;therefore, manner of time should be taken to achieve a favorable prognosis.
文摘Marching band(MB)artists are often part of the general student population and not required to complete a preparticipation health screening to identify predisposing medical conditions or risks for injury/illness.Anecdotally,exertional heat illnesses(EHI)are a concern for MB artists.As more athletic trainers provide MB healthcare,research is needed on EHI occurrence and MB associated EHI risk factors.We utilized an exploratory crosssectional study design to determine EHI risk factors,including previous EHI occurrence,among collegiate MB artists.MB artists(n=1207;age=[19.6±1.3]years)actively participating in their college/university's MB during the 2019 football season completed an online survey to characterize demographics,medical history,medication and supplement use,and nutrition behaviors.Chi-square and binomial logistical regressions assessed associations between categorical variables.Previous EHI was reported by 50.6%of MB artists,with 466(76.3%)experiencing exertional heat exhaustion and 31(5.1%)exertional heat stroke.More females reported exertional heat exhaustion overall(68.2%,p<0.001)and in the previous year(73.3%,p<0.001).Experiencing a previous EHI was significantly associated with having a mood/neurological condition(63.5%,p<0.001),diagnosed(74.3%,p=0.004)or perceived eating disorder(66.7%,p<0.001),and taking prescription medications(59.4%,p<0.001),over-the-counter medications(58.9%,p=0.002),and supplements(55.4%,p=0.037).Half of collegiate MB artists reported experiencing previous EHIs and engaged in behaviors known to increase EHI risk.MB artists should complete pre-participation examinations to identify pre-existing medical conditions and risks for adverse medical events.Healthcare providers working with MB artists should develop policies and procedures to mitigate EHI risks and occurrence.
基金supported by the 2020 Special Tasks for Military Health and Epidemic Prevention and Protection(grant number Hou Wei Han[2021]No.208)Hospital Project(grant number 2016ZD-008).
文摘Background:The roles of the Pink1/Parkin pathway and mitophagy in lung injury during heat stroke remain unclear.In this study,we investigated the role of Pink1/Parkin-mediated mitophagy in acute lung injury(ALI)in rats with exertional heat stroke(EHS).Methods:Sixty Sprague Dawley rats were randomly divided into control(CON),control+Parkin overexpression(CON+Parkin),EHS,and EHS+Parkin overexpression(EHS+Parkin)groups.Parkin was overexpressed by injecting an adeno-associated virus carrying the Parkin gene into the tail vein,and a rat model of EHS was established.Pathological changes in the lung tissue were analyzed using microcomputed tomography(micro-CT),and the lung coefficient and pulmonary capillary permeability were measured.Enzyme-linked immunosorbent assay were used to determine the levels of interleukin-6(IL-6),IL-1β,and tumor necrosis factor-α,and reactive oxygen species.The morphology of mitochondria in typeⅡepithelial cells of lung tissue was observed using transmission electron microscopy;and the apoptosis of lung tissue,the level of mitophagy,and the co-localization of Pink1 and Parkin were determined using immunofluorescence.The expression of Pink1,Parkin,mitofusin-2(MFN2),phosphatase and tensin homolog(PTEN),PTEN-L,p62,and the autophagy marker microtubule-associated protein 1 light chain 3(LC3)in rat lung tissue was measured by Western blotting,and the ratio of LC3II/LC3I was calculated.Results:Compared with the EHS group,the survival rate of rats in the EHS+Parkin group was significantly higher.Their lung coefficient and pulmonary vascular permeability decreased and the pathological changes were significantly alleviated(P<0.05).Their levels of inflammatory factors and reactive oxygen species were significantly decreased(P<0.05),and the degree of mitochondrial swelling in pulmonary type II epithelial cells was alleviated.The apoptosis of lung tissue was alleviated,the colocalization of Pink1 and Parkin,LC3 and Tom20 was enhanced,and the ratio of LC3-II/LC3-I increased.The expression of Pink1,MFN2,PTEN-L,and p62 decreased,whereas the expression of PTEN was not significantly different from that in the EHS group(P>0.05).Conclusion:Pink1/Parkin-mediated mitophagy dysfunction is one of the mechanisms underlying ALI in rats with EHS,and activation of Parkin overexpression-mediated mitophagy can alleviate ALI caused by EHS.
基金This work was supported by grants from the National Natural Science Foundation of China[No.82072143]the Natural Science Foundation of Guangdong Province of China[No.2021A1515010170]the PLA Logistics Research Project of China[Nos.18CXZ030,BLJ20J006].
文摘Background and Aims:Exertional heatstroke(EHS)is associated with strenuous physical activity in hot environments.The present study aimed to investigate dynamic changes of hepatic function indices in EHS patients and determine risk factors for death.Methods:This single-center retrospective cohort study considered all patients with EHS admitted to the intensive care unit at the General Hospital of Southern Theater Command of PLA from October 2008 to May 2019.Data on general characteristics,organ function parameters,and the 90-day outcome of enrolled patients were collected.Hepatic indices were collected dynamically,and patients with acute hepatic injury(AHI)were identified by plasma total bilirubin(TBIL)≥34.2μmol/L and an international normalized ratio≥1.5,or with any grade of hepatic encephalopathy.Results:In patients who survived,TBIL,alanine aminotransferase and aspartate aminotransferase were increased at 24 h,peaked at 2–3 days,and began to decrease at 5 days.In non-survivors,TBIL continuously increased post-admission.The area under the receiver operating characteristic curve for the prediction of mortality based on sequential organ failure assessment(SOFA)scores was 89.8%,and the optimal cutoff value was 7.5.Myocardial injury and infection were identified as independent risk factors for death in EHS patients with AHI.Conclusions:In EHS patients,hepatic dysfunction usually occurred within 24 h.Patients with AHI had more severe clinical conditions,and significantly increased 90-day mortality rates.SOFA scores over 7.5,complicated with myocardial injury or infection,were found to be risk factors for death in EHS patients with AHI.
基金supported by grants from the National Natural Science Foundation of China[NO.82072143,82360903]Natural Science Foundation of Guangdong Province(2021A1515010170)+1 种基金The grants from the Guizhou Science and Technology Planning Project[Guizhou Science and Technology Cooperation Support(2021)General 413]PhD start-up fund of Guizhou University of Traditional Chinese Medicine[GYZYYFY-BS-2023(09)].
文摘Purpose:Minimal data exist on brain injury in patients with exertional heatstroke(EHS)in developing country.In this study,we explored the risk factors for brain injury induced by EHS 90-day after onset.Methods:A retrospective cohort study of patients with EHS was conducted in the intensive care unit of the General Hospital of Southern Theater Command of PLA in China from April 2014 to June 2019.Patients were divided into non-brain injury(fully recovered)and brain injury groups(comprising deceased patients or those with neurological sequelae).The brain injury group was further subdivided into a death group and a sequela group for detailed analysis.General information,neurological performance and information on important organ injuries in the acute stage were recorded and analysed.Multivariable logistic regression was used to identify risk factors for brain injury after EHS and mortality risk factors for brain injury,and Kaplan-Meier survival curve was used to evaluate the effect of the neurological dysfunction on survival.Results:Out of the 147 EHS patients,117 were enrolled,of which 96(82.1%)recovered,13(11.1%)died,and 8(6.8%)experienced neurological sequelae.Statistically significant differences were found between non-brain injury and brain injury groups in age,hypotension,duration of consciousness disorders,time to drop core body temperature below 38.5℃,lymphocyte counts,platelet counts,procalcitonin,alanine aminotransferase,aspartate aminotransferase,creatinine,cystatin C,coagulation parameters,international normalized ratio,acute physiology and chronic health evaluation II scores,sequential organ failure assessment(SOFA)scores,and Glasgow coma scale scores(all p<0.05).Multivariate logistic regression showed that age(OR=1.090,95%CI:1.02-1.17,p=0.008),time to drop core temperature(OR=8.223,95%CI:2.30-29.40,p=0.001),and SOFA scores(OR=1.676,95%CI:1.29-2.18,p<0.001)are independent risk factors for brain injury induced by EHS.The Kaplan-Meier curves suggest significantly prolonged survival(p<0.001)in patients with early Glasgow coma scale score>8 and duration of consciousness disorders≤24 h.Conclusions:Advanced age,delayed cooling,and higher SOFA scores significantly increase the risk of brain injury post-EHS.These findings underscore the importance of rapid cooling and early assessment of organ failure to improve outcomes in EHS patients.
文摘Objective:To investigate the correlation between interleukin-6(IL-6),serum amyloid A(SAA),C-reactive protein(CRP)and exertional heat stroke in rats.Methods:A total of 90 adult Sprague-Dawley rats without specific pathogens were randomly divided into three groups:control group,classical group and exertion group,with 30 rats in each group.The control group was maintained at a temperature of(26±1)℃and humidity of(60±5)%,while the classical and exertion groups were exposed to a temperature of(40±0.5)℃and humidity of(70±5)%.Additionally,the exertion group underwent treadmill running under these conditions.The levels of IL-6,SAA,and CRP in the three groups were assessed and compared at various time points:before modeling,immediately after onset,and at 2,4,and 8 h after onset.Furthermore,Spearman correlation analysis was employed to examine.Results:The findings from the repeated measures analysis of variance indicated significant variations in the levels of IL-6,SAA,and CRP across the three groups(P<0.05).Both the classic and exertion groups exhibited higher levels of IL-6,SAA,and CRP compared to the control group,with the exertion group demonstrating even higher levels than the classic group(P<0.05).Additionally,Spearman correlation analysis revealed a positive correlation between the onset of heat stroke and the levels of IL-6,SAA,and CRP at the onset,as well as at 2,4,and 8 h post-onset(P<0.05).Furthermore,the types of heat stroke were found to be positively correlated with the levels of IL-6,SAA and CRP(P<0.05).Conclusion:The initiation and nature of heat stroke in rats are significantly associated with the concentrations of IL-6,SAA,and CRP.The concentrations of IL-6,SAA,and CRP within 8 h of onset can reliably forecast the occurrence of heat stroke in rats,serving as a basis for distinguishing classical heat stroke from exertional heat stroke.Nevertheless,the predictive and differentiating efficacy may diminish as the onset time prolongs.
文摘A 64-year-old woman who presented with progressive exertional dyspnea(NYHA class IIb)over the previous month,unresponsive to adjustments in diuretic therapy.She denied chest pain or palpitations.On physical examination,bilateral lower extremity edema and a right parasternal systolic murmur were noted.Electrocardiography showed sinus rhythm with first-degree atrioventricular block and complete right bundle branch block.
基金supported, in part, by the National Natural Science Foundation of China Grants (82430078, 82261160395, 82230081, 82004395, 82302767)the Shenzhen Medical Research Funds (B2402033, C2401029)+5 种基金the Shenzhen Fundamental Research Program (JCYJ20220818100617036)the National Key Research and Development Program of China Grants (2019YFA0906004)the Guangdong Provincial Science and Technology Innovation Council Grant (2017B030301018)the Shenzhen Key Laboratory of Cell Microenvironment Grant (ZDSYS20140509142721429)the Hubei Provincial Natural Science Foundation of China (2024AFB610)the Science Foundation of Wuhan Union Hospital (2022xhyn032)
文摘Bone has long been acknowledged as a fundamental structural entity that provides support and protection to the body’s organs.However,emerging research indicates that bone plays a crucial role in the regulation of systemic metabolism.This is achieved through the secretion of a variety of hormones,cytokines,metal ions,extracellular vesicles,and other proteins/peptides,collectively referred to as bone-derived factors(BDFs).BDFs act as a medium through which bones can exert targeted regulatory functions upon various organs,thereby underscoring the profound and concrete implications of bone in human physiology.Nevertheless,there remains a pressing need for further investigations to elucidate the underlying mechanisms that inform the effects of bone on other body systems.This review aims to summarize the current findings related to the roles of these significant modulators across different organs and metabolic contexts by regulating critical genes and signaling pathways in vivo.It also addresses their involvement in the pathogenesis of various diseases affecting the musculoskeletal system,circulatory system,glucose and lipid metabolism,central nervous system,urinary system,and reproductive system.The insights gained from this review may contribute to the development of innovative therapeutic strategies through a focused approach to bone secretomes.Continued research into BDFs is expected to enhance our understanding of bone as a multifunctional organ with diverse regulatory roles in human health.
基金supported by the National Key Research and Development Program(2021YFC2501700)the National Natural Science Foundation of China(82330078,82272554)Beijing Natural Science Foundation(7232214,L241067)。
文摘Gut microbiota(GM)exerts an indispensable effect in human health,especially in metabolism regulation.^(1)Recent studies have identified a potential association with osteoporosis.^(2–5)At the same time,GM intervention,such as antibiotic treatment,^(6)fecal microbiota transplantation(FMT),^(7–8)supplement of probiotics^(9–10)and other means,will also subsequently affect bone metabolism.Further,GM dysbiosis was also mentioned as one of pathophysiological mechanism of osteoporosis,even written in the clinical diagnosis and treatment guidelines^(11)[Fig.1,based on Guidelines for the diagnosis and treatment of primary osteoporosis in China(2022)].
基金supported by the Key Program of the National Natural Science Foundation of China grants 32230059the Basic Science Center Program T2288102+1 种基金the National Natural Science Foundation of China grants 32301123the Foundation of Frontiers Science Center for Materiobiology and Dynamic Chemistry JKVD1211002.
文摘The treatment of severe diabetic foot remains a clinical challenge.While it is established that bone can exert systemic effects through the secretion of osteokines on other organs,whether this endocrine function can be harnessed to promote diabetic wound healing remains unexplored.Here,we investigate the impact of a bone injury strategy on diabetic wound healing,leveraging the body’s innate regenerative capacity to stimulate osteokine release and influence remote skin wound repair.This study demonstrates that the tibial defect significantly accelerates ipsilateral diabetic foot skin wound healing.Mechanistically,we identify osteokines,platelet-derived growth factor-BB(PDGF-BB),as the key to initiating this process.Bone defect triggers a substantial release of PDGF-BB,which reaches the skin wound site via peripheral circulation.At the skin wound site,PDGF-BB mediates the secretion of keratinocyte growth factor(KGF)from fibroblasts via the PDGFRβsignaling pathway,thereby promoting the rapid re-epithelialization of epidermal cells through a paracrine pathway.Additionally,elevated PDGF-BB levels enhance the regeneration of CD31hi Emcnhi blood vessels within the wound.
