Assessment of the Remediation Effect of Nano-hydroxyapatite in Exogenous Pb-contaminated Soil Using Toxicity Characteristic Leaching Procedure and Soil Enzyme Activities

Lead (Pb) is one of the most abundant metal soil pollutants. In this research, effects of nano-hydroxyapatite (NHAP) on remediation of Pb-contaminated soil were evaluated by the measure of extractable Pb using toxicity characteristic leaching procedure (TCLP) and soil enzyme activities. Results suggested NHAP significantly decreased the concentrations of extractable Pb, achieving the maximum decrement rate of 75.71%. Activity of urease decreased with increasing Pb concentrations. Moreover, activities of alkaline phosphatase, dehydrogenase, and catalase increased at the lower Pb levels and decreased at the higher Pb levels. NHAP had a positive effect on regulating soil enzymes. Thus, soil enzyme activities, especially dehydrogenase, could be used as biological indicators of Pb pollution and NHAP remediation. Moreover, NHAP could reduce the mobility and bioavailability of Pb, while increasing enzyme activities, thereby lowering the leaching risk and biotoxicity of Pb.

Development and verification of a prediction model for outcomes of elderly patients with nursing home-acquired pneumonia

BACKGROUND

Among all infections in nursing homes, pneumonia has the highest mortality. Nurses have a 24-h relationship with patients and have a key role in identifying and preventing adverse outcomes. However, tools to engage nurses in pneumonia patient outcomes evaluation have not occurred.

PURPOSE

This study aimed to develop and validate a prediction model to predict the outcome of elderly patients with nursing home-acquired pneumonia (NHAP).

METHODOLOGY

A retrospective observational study was conducted with 219 elderly NHAP patients. Baseline characteristics, health history, and treatment/nursing status were collected. Variables for constructing nomograms were screened by univariate and multivariate analysis. The nomogram model was evaluated using the concordance index (C-index), decision curve analysis (DCA) curves, and receiver operating characteristic (ROC) curves.

RESULTS

9 independent risk factors were identified and assembled into the nomogram. The nomogram exhibited reasonably accurate discrimination (area under the receiver operating characteristic curve (AUC-ROC): 0.931, P < 0.05) and calibration (C-index: 0.931, 95 % CI: 0.898-0.964) in the validation cohort. DCA and clinical impact curves demonstrated that the nomogram was clinically beneficial.

CONCLUSIONS

A visualization nomogram model was successfully established for predicting the outcome of the NHAP elderly patients. The model has extremely high reliability, extremely high predictive ability, and good clinical applicability.

Prognostic utility of CURB-65 and E-CURB-65 scoring systems in healthcare associated pneumonia patients: Short- and long-term mortality

Background

The aim of our study is to evaluate whether the CURB-65 or expanded-CURB-65 score can be used in healthcare-associated pneumonia (HCAP) and subgroups of HCAP patients at the same efficiency. Thirty and 90-day mortality rates of the patients and predictive values of CURB-65 and E-CURB-65 scores were compared.

Patients and Methods

This is a retrospective study of patients who presented to the Emergency Department between January 2015 and January 2016. All patient charts above 18 years of age were evaluated according to American Thoracic Society and the Infectious Diseases Society of America (ATS/IDSA) pneumonia diagnostic criteria and pneumonia diagnoses were confirmed.

Results

167 pneumonia patients (27.8%) of all pneumonia cases were grouped as HCAP and 433 (54.4%) were grouped as community-acquired pneumonia (CAP). 43% (n = 72) of HCAP patients were classified as nursing home-associated pneumonia (NHAP) and 57% (n = 95) were classified as HCAP (except NHAP) group. NHAP patients were older than the other groups. HCAP (except NHAP) group had somehow more comorbid diseases when compared with the other groups. However, the NHAP group had more unstable vital signs and confusion rates. Hospital and ICU admissions, 30-90-day mortality rates were all significantly higher in NHAP group E-CURB-65 was found to have better predictive values than CURB-65 for 30-day and 90-day mortalities overall.

Conclusion

According to our results, commonly used scoring systems, CURB 65 and E-CURB 65, are not suitable for HCAP, NHAP, and HCAP (except NHAP) patients. NHAP patients have significant worse prognosis compared with CAP and HCAP (except NHAP) in terms of admission to intensive care and 30 and 90-day mortality rates.