With the rapid development of emergency medicine,emergency physicians are working around the clock,[1]including additional workloads due to sudden public health emergencies and disasters.Occupational risks for emergen...With the rapid development of emergency medicine,emergency physicians are working around the clock,[1]including additional workloads due to sudden public health emergencies and disasters.Occupational risks for emergency physicians are significantly high due to an increasing number of patients with acute and severe diseases,an increased workload.展开更多
Sepsis is a lethal condition characterized by multiple organ dysfunction due to disrupted host responses to severe infections.[1]Aff ected patients often have a Sequential Organ Failure Assessment(SOFA)score≥2.[2]Pat...Sepsis is a lethal condition characterized by multiple organ dysfunction due to disrupted host responses to severe infections.[1]Aff ected patients often have a Sequential Organ Failure Assessment(SOFA)score≥2.[2]Patients with a SOFA score<2 and at least one of the following were considered as“suspected sepsis”:(1)quick SOFA(qSOFA)score≥2;(2)SOFA score=1;or(3)National Early Warning Score(NEWS)4-6.[3]Compared with studies on fluid resuscitation in sepsis patients,there are few studies on fluid management in patients with suspected sepsis.Therefore,we conducted a retrospective cohort study to evaluate the relationship between fluid management and disease progression in suspected sepsis patients.展开更多
BACKGROUND:Due to the still sparse literature in China,the investigation of hyperoxemia management is required.Thus,we aim to conduct a retrospective study to provide more information about hyperoxemia management in i...BACKGROUND:Due to the still sparse literature in China,the investigation of hyperoxemia management is required.Thus,we aim to conduct a retrospective study to provide more information about hyperoxemia management in intensive care unit(ICU)patients.METHODS:We retrospectively screened the medical records of adult patients(age≥18 years)who required mechanical ventilation(MV)≥24 hours from January 1,2018,to December 31,2018.All arterial blood gas(ABG)tested during MV was retrieved,and MV settings were recorded.The median arterial partial pressure of oxygen(PaO2)>120 mmHg(1 mmHg=0.133 kPa)was defined as mild to moderate hyperoxemia,and PaO2>300 mmHg as extreme hyperoxemia.Intensivists’response to hyperoxemia was assessed based on the reduction of fraction of inspired oxygen(FiO2)within one hour after hyperoxemia was recorded.Multivariable logistic regression analysis was performed to determine the independent factors associated with the intensivists’response to hyperoxemia.RESULTS:A total of 592 patients were fi nally analyzed.The median Acute Physiology and Chronic Health Evaluation II(APACHE II)score was 21(15-26).The PaO2,arterial oxygen saturation(SaO2),FiO2,and positive end expiratory pressure(PEEP)were 96.4(74.0-126.0)mmHg,97.8%(95.2%-99.1%),0.4(0.4-0.5),and 5(3-6)cmH2O,respectively.Totally 174(29.39%)patients had PaO2>120 mmHg,and 19(3.21%)patients had extreme hyperoxemia at PaO2>300 mmHg.In cases of mild to moderate hyperoxemia with FiO2≤0.4,only 13(2.20%)patients had a decrease in FiO2 within one hour.The multivariable logistic regression analysis showed that a positive response was independently associated with FiO2(odds ratio[OR]1.09,95%confi dence interval[CI]1.06-1.12,P<0.001),PaO2(OR 1.01,95%CI 1.00-1.01,P=0.002),and working shifts(OR 5.09,95%CI 1.87-13.80,P=0.001).CONCLUSIONS:Hyperoxemia occurs frequently and is neglected in most cases,particularly when mild to moderate hyperoxemia,hyperoxemia with lower FiO2,hyperoxemia during night and middle-night shifts,or FiO2 less likely to be decreased.Patients may be at a risk of oxygen toxicity because of the liberal oxygen strategy.Therefore,further research is needed to improve oxygen management for patients with MV in the ICUs.展开更多
Background Anosmia is one of the symptoms in individuals with SARS-CoV-2 infection.In anosmic patients,SARS-CoV-2 temporarily alters the signaling process in olfactory nerve cells and olfactory bulb(OB),which eventual...Background Anosmia is one of the symptoms in individuals with SARS-CoV-2 infection.In anosmic patients,SARS-CoV-2 temporarily alters the signaling process in olfactory nerve cells and olfactory bulb(OB),which eventually damages the structure of the olfactory epithelium,leading to a permanent disorder in the olfactory pathway that this damaged structure is showed in MRI imaging Method Two investigators independently searched four databases consisting of PubMed,ProQuest,Scopus,and Web of Science for relevant records as of November 11,2020 with no time,space,and language restrictions.Google Scholar was also searched for the related resources within the time limit of 2020.All the found articles were reviewed based on the PRISMA flow diagram.Qualitative studies,case reports,editorials,letters,and other non-original studies were excluded from this systematic analysis.Results Initial search yielded 434 records.After reviewing the titles and abstracts,we selected 74 articles;finally,8 articles were depicted to be investigated and read in full text.The obtained results showed an increase in the width and volume of the olfactory cleft(OC),complete or partial destruction of OC,and complete occlusion of OC in COVID-19 patients.Deformation and degeneration as well as a subtle asymmetry were evident in the OBs.Computed tomography(CT),meganetic resonance imaging(MRI),and positron emission tomography(PET)were used to detect the outcomes of anosmia in these studies.Conclusions The changes in OC are greater than those in OB in patients with COVID-19,mainly due to the inflammatory and immune responses in OC.However,fewer changes in OB are due to neurological or vascular disorders.Topical steroid therapy and topical saline can be helpful.展开更多
Objective Congestive heart failure （CHF） is the final common pathway of various heart diseases.Calcineurin,a calcium/calmodulindependent phosphatase consisting of a catalytic subanit A （CnA） and a regulatory calci...Objective Congestive heart failure （CHF） is the final common pathway of various heart diseases.Calcineurin,a calcium/calmodulindependent phosphatase consisting of a catalytic subanit A （CnA） and a regulatory calcium-binding subunit B （CnB）,is activated in heart failure.This study aimed to investigate the relationship between mRNA level of calcineurin in circulating T-lymphocyte and that in myocardium in patients with CHF. Methods A total of 38 patients with CHF （aged from 29 to 62 years） were included in this study.The mRNA levels of alpha-and beta-isoform of CnA in left ventricular anterior papillary muscle and peripheral lymphocytes were determined by semi-quantitative reverse transcription polymerase chain reaction.Pearson linear correlation analysis was performed,and difference was considered statistically significant at a P value 〈0.05. Results Calcineurin mRNA levels in lymphocytes were positively correlated with those in myocardium （for CnA-alpha mRNA,r=0.820;for CnA-beta mRNA,r=0.875;both P〈0.01）.CnA-beta mRNA levels in both circulating lymphocytes and myocardium increased significantly with increasing NYHA class （r=0.877 for peripheral blood and r=0.805 for cardiac muscle;both P〈0.01）. Conclusions The mRNA level of CnA-beta in circulating lymphocytes is positively correlated with that in myocardium and is a promising marker for the severity of cardiac dysfunction in patients with CHF.展开更多
基金Beijing Key Specialized Department for Major Epidemic Prevention and Control (Construction Project)National Major Science and Technology Projects (2017ZX10305501)Beijing Social Science Foundation Planning Project (17SRC019)。
文摘With the rapid development of emergency medicine,emergency physicians are working around the clock,[1]including additional workloads due to sudden public health emergencies and disasters.Occupational risks for emergency physicians are significantly high due to an increasing number of patients with acute and severe diseases,an increased workload.
文摘Sepsis is a lethal condition characterized by multiple organ dysfunction due to disrupted host responses to severe infections.[1]Aff ected patients often have a Sequential Organ Failure Assessment(SOFA)score≥2.[2]Patients with a SOFA score<2 and at least one of the following were considered as“suspected sepsis”:(1)quick SOFA(qSOFA)score≥2;(2)SOFA score=1;or(3)National Early Warning Score(NEWS)4-6.[3]Compared with studies on fluid resuscitation in sepsis patients,there are few studies on fluid management in patients with suspected sepsis.Therefore,we conducted a retrospective cohort study to evaluate the relationship between fluid management and disease progression in suspected sepsis patients.
文摘BACKGROUND:Due to the still sparse literature in China,the investigation of hyperoxemia management is required.Thus,we aim to conduct a retrospective study to provide more information about hyperoxemia management in intensive care unit(ICU)patients.METHODS:We retrospectively screened the medical records of adult patients(age≥18 years)who required mechanical ventilation(MV)≥24 hours from January 1,2018,to December 31,2018.All arterial blood gas(ABG)tested during MV was retrieved,and MV settings were recorded.The median arterial partial pressure of oxygen(PaO2)>120 mmHg(1 mmHg=0.133 kPa)was defined as mild to moderate hyperoxemia,and PaO2>300 mmHg as extreme hyperoxemia.Intensivists’response to hyperoxemia was assessed based on the reduction of fraction of inspired oxygen(FiO2)within one hour after hyperoxemia was recorded.Multivariable logistic regression analysis was performed to determine the independent factors associated with the intensivists’response to hyperoxemia.RESULTS:A total of 592 patients were fi nally analyzed.The median Acute Physiology and Chronic Health Evaluation II(APACHE II)score was 21(15-26).The PaO2,arterial oxygen saturation(SaO2),FiO2,and positive end expiratory pressure(PEEP)were 96.4(74.0-126.0)mmHg,97.8%(95.2%-99.1%),0.4(0.4-0.5),and 5(3-6)cmH2O,respectively.Totally 174(29.39%)patients had PaO2>120 mmHg,and 19(3.21%)patients had extreme hyperoxemia at PaO2>300 mmHg.In cases of mild to moderate hyperoxemia with FiO2≤0.4,only 13(2.20%)patients had a decrease in FiO2 within one hour.The multivariable logistic regression analysis showed that a positive response was independently associated with FiO2(odds ratio[OR]1.09,95%confi dence interval[CI]1.06-1.12,P<0.001),PaO2(OR 1.01,95%CI 1.00-1.01,P=0.002),and working shifts(OR 5.09,95%CI 1.87-13.80,P=0.001).CONCLUSIONS:Hyperoxemia occurs frequently and is neglected in most cases,particularly when mild to moderate hyperoxemia,hyperoxemia with lower FiO2,hyperoxemia during night and middle-night shifts,or FiO2 less likely to be decreased.Patients may be at a risk of oxygen toxicity because of the liberal oxygen strategy.Therefore,further research is needed to improve oxygen management for patients with MV in the ICUs.
文摘Background Anosmia is one of the symptoms in individuals with SARS-CoV-2 infection.In anosmic patients,SARS-CoV-2 temporarily alters the signaling process in olfactory nerve cells and olfactory bulb(OB),which eventually damages the structure of the olfactory epithelium,leading to a permanent disorder in the olfactory pathway that this damaged structure is showed in MRI imaging Method Two investigators independently searched four databases consisting of PubMed,ProQuest,Scopus,and Web of Science for relevant records as of November 11,2020 with no time,space,and language restrictions.Google Scholar was also searched for the related resources within the time limit of 2020.All the found articles were reviewed based on the PRISMA flow diagram.Qualitative studies,case reports,editorials,letters,and other non-original studies were excluded from this systematic analysis.Results Initial search yielded 434 records.After reviewing the titles and abstracts,we selected 74 articles;finally,8 articles were depicted to be investigated and read in full text.The obtained results showed an increase in the width and volume of the olfactory cleft(OC),complete or partial destruction of OC,and complete occlusion of OC in COVID-19 patients.Deformation and degeneration as well as a subtle asymmetry were evident in the OBs.Computed tomography(CT),meganetic resonance imaging(MRI),and positron emission tomography(PET)were used to detect the outcomes of anosmia in these studies.Conclusions The changes in OC are greater than those in OB in patients with COVID-19,mainly due to the inflammatory and immune responses in OC.However,fewer changes in OB are due to neurological or vascular disorders.Topical steroid therapy and topical saline can be helpful.
文摘Objective Congestive heart failure （CHF） is the final common pathway of various heart diseases.Calcineurin,a calcium/calmodulindependent phosphatase consisting of a catalytic subanit A （CnA） and a regulatory calcium-binding subunit B （CnB）,is activated in heart failure.This study aimed to investigate the relationship between mRNA level of calcineurin in circulating T-lymphocyte and that in myocardium in patients with CHF. Methods A total of 38 patients with CHF （aged from 29 to 62 years） were included in this study.The mRNA levels of alpha-and beta-isoform of CnA in left ventricular anterior papillary muscle and peripheral lymphocytes were determined by semi-quantitative reverse transcription polymerase chain reaction.Pearson linear correlation analysis was performed,and difference was considered statistically significant at a P value 〈0.05. Results Calcineurin mRNA levels in lymphocytes were positively correlated with those in myocardium （for CnA-alpha mRNA,r=0.820;for CnA-beta mRNA,r=0.875;both P〈0.01）.CnA-beta mRNA levels in both circulating lymphocytes and myocardium increased significantly with increasing NYHA class （r=0.877 for peripheral blood and r=0.805 for cardiac muscle;both P〈0.01）. Conclusions The mRNA level of CnA-beta in circulating lymphocytes is positively correlated with that in myocardium and is a promising marker for the severity of cardiac dysfunction in patients with CHF.
