BACKGROUND:The objective of this retrospective hospital-based study was to describe the epidemiological features of traumatic spinal cord injury(TSCI)in the intensive care unit(ICU)and assess the incidence and possibl...BACKGROUND:The objective of this retrospective hospital-based study was to describe the epidemiological features of traumatic spinal cord injury(TSCI)in the intensive care unit(ICU)and assess the incidence and possible risk factors for venous thromboembolism(VTE)following TSCI.METHODS:We retrospectively reviewed the medical records of 370 patients with TSCI who were admitted between January 2018 and March 2023.The following parameters were collected:age,sex,body mass index,occupation,underlying diseases,smoking history,education level,etiology of injury,injury segments,American Spinal Injury Association(ASIA)Impairment Scale score,severity of injury,injury severity score(ISS),VTE risk score(Caprini score),treatment,VTE prophylaxis,ICU length of stay,length of hospital stay,concomitant injuries,and complications.Descriptive statistics were used to summarize the demographic and clinical characteristics of the study participants.Logistic regression analysis was used to determine the risk factors for VTE.RESULTS:The mean age of patients with TSCI was 55.5±13.4 years,with a male-to-female ratio of 6.5:1.The leading cause of TSCI was falls from height(46.5%),followed by traffic accidents(36.5%).The cervical spinal cord was the most affected segment,followed by the thoracolumbar region.Among all the patients,362(97.8%)had concomitant injuries.Complications were observed in 255 patients(68.9%)during hospitalization.The incidence rate of VTE was 25.1%.Logistic regression analysis revealed that age(OR=1.721,95%CI:1.207-2.454,P=0.003),mechanical ventilation(OR=3.427,95%CI:1.873-6.271,P<0.001),and non-use of chemical prophylaxis(OR=2.986,95%CI:1.749-5.099,P<0.001)were risk factors for VTE.CONCLUSION:Falls from height and traffic accidents were the main causes of TSCIs in the ICU,especially for male patients with cervical spinal cord injuries.VTE is a frequent complication in patients with TSCI in the ICU.Age,mechanical ventilation,and non-use of chemical prophylaxis were found to be independent risk factors for VTE following TSCI.展开更多
Mitochondrial cytopathies are characterized by energy failure within the cellular system.These disorders exhibit a wide range of clinical presentations and are highly heterogeneous.The mitochondrial diseases include m...Mitochondrial cytopathies are characterized by energy failure within the cellular system.These disorders exhibit a wide range of clinical presentations and are highly heterogeneous.The mitochondrial diseases include mitochondrial encephalopathy,lactic acidosis,and stroke-like episodes (MELAS).MELAS syndrome has various manifestations,including stroke-like episodes,dementia,epilepsy,lactic acidemia,myopathy,recurrent headaches,hearing impairment,diabetes,and short stature.The initial report on MELAS syndrome was published by Pavlakis et al in 1984.^([1])展开更多
BACKGROUND:To investigate the clinical effectiveness of a pneumatic compression device(PCD)combined with low-molecular-weight heparin(LMWH)for the prevention and treatment of deep vein thrombosis(DVT)in trauma patient...BACKGROUND:To investigate the clinical effectiveness of a pneumatic compression device(PCD)combined with low-molecular-weight heparin(LMWH)for the prevention and treatment of deep vein thrombosis(DVT)in trauma patients.METHODS:This study retrospectively analyzed 286 patients with mild craniocerebral injury and clavicular fractures admitted to our department from January 2016 to February 2020.Patients treated with only LMWH served as the control group,and patients treated with a PCD combined with LMWH as the observation group.The incidence of DVT,postoperative changes in the visual analogue scale(VAS)score,and coagulation function were observed and compared between the two groups.Excluding the influence of other single factors,binary logistic regression analysis was used to evaluate the use of a PCD in the patient’s postoperative coagulation function.RESULTS:After excluding 34 patients who did not meet the inclusion criteria,252 patients were were included.The incidence of DVT in the observation group was significantly lower than that in the control group(5.6%vs.15.1%,χ^(2)=4.605,P<0.05).The postoperative VAS scores of the two groups were lower than those before surgery(P<0.05).The coagulation function of the observation group was significantly higher than that of the control group,with a better combined anticoagulant effect(P<0.05).There were no significant differences between the two groups in preoperative or postoperative Glasgow Coma Scale scores,intraoperative blood loss,postoperative infection rate,or length of hospital stay(P>0.05).According to logistic regression analysis,the postoperative risk of DVT in patients who received LMWH alone was 1.764 times that of patients who received LMWH+PCD(P<0.05).The area under the receiver operating characteristic(AUROC)curve of partial thromboplastin time(APTT)and platelet(PLT)were greater than 0.5,indicating that they were the influence indicators of adding PCD to prevent DVT.Excluding the influence of other variables,LMWH+PCD effectively improved the coagulation function of patients.CONCLUSIONS:Compared with LMWH alone,LMWH+PCD could improve blood rheology and coagulation function in patients with traumatic brain injury and clavicular fracture,reduce the incidence of DVT,shorten the length of hospital stay,and improve the clinical effectiveness of treatment.展开更多
The relationship between the cavitation and acoustic peak negative pressure in the high-intensity focused ultrasound （HIFU） field is analyzed in water and tissue phantom. The peak negative pressure at the focus is d...The relationship between the cavitation and acoustic peak negative pressure in the high-intensity focused ultrasound （HIFU） field is analyzed in water and tissue phantom. The peak negative pressure at the focus is determined by a hybrid approach combining the measurement with the simulation. The spheroidal beam equation is utilized to describe the nonlinear acoustic propagation. The waveform at the focus is measured by a fiber optic probe hydrophone in water. The relationship between the source pressure amplitude and the excitation voltage is determined by fitting the measured ratio of the second harmonic to the fundamental component at the focus, based on the model simulation. Then the focal negative pressure is calculated for arbitrary voltage excita- tion in water and tissue phantom. A portable B-mode ultrasound scanner is applied to monitor HIFU-indueed cavitation in real time, and a passive cavitation detection （PCD） system is used to acquire the bubble scattering signals in the HIFU focal volume for the cavitation quantification. The results show that： （1） unstable cavitation starts to appear in degassed water when the peak negative pressure of HIFU signals reaches 13.5 MPa; and （2） the cavitation activity can be detected in tissue phantom by B-mode images and in the PCD system with HIFU peak negative pressures of 9.0 MPa and 7.8 MPa, respectively, which suggests that real-time B-mode images could be used to monitor the cavitation activity in two dimensions, while PCD systems are more sensitive to detect scattering and emission signals from cavitation bubbles.展开更多
Background Cardiac implantable electronic devices （CIEDs） greatly improve survival and life quality of patients. However, there are gender differences regarding both the utilization and benefit of these devices. In ...Background Cardiac implantable electronic devices （CIEDs） greatly improve survival and life quality of patients. However, there are gender differences regarding both the utilization and benefit of these devices. In this prospective CIED registry, we aim to appraise the gender differences in CIED utilization in China. Methods Twenty centers from 14 provinces in China were included in our registry study. All patients who underwent a CIED implantation in these twenty centers between Jan 2015 and Dec 2016 were included. Results A total of 8570 patients were enrolled in the baseline cohort, including 7203 pacemaker, 664 implantable cardiac defibrillators （ICD） implants and 703 cardiac resynchronization therapy device （CRT/D）. Totally, 4117 （48.0%） CIED patients were female, and more than 59% pacemaker patients were female, but women account only one third of ICD or CRT/D implantation in this registry. There were significant differences between genders at pacemaker and ICD indications. Female was more likely received a pacemaker due to sick sinus syndrome （SSS） （63.9% vs. 51.0%, P 〈 0.001）. Female patients receiving an ICD were more likely due to cardiac ion channel disease （29.2% vs. 4.2%, P 〈 0.001）. The percentage of utilization of dual-chamber pacemaker in female patients was significantly higher than male （85.3% vs. 81.1%, P 〈 0.001）. But male patients were more likely received a cardiac resynchronization therapy devices with defibrillator than female （56.5% vs. 41.9%, P = 0.001）. In pacemaker patient, male was more likely to have structure heart disease （31.3% vs. 28.0%, P = 0.002）. In ICD patient, male patients were more likely to have ischemic heart disease （48.2% vs. 29.2%, P 〈 0.001）. The mean age of women at the time of CRT/D implantation was older than men （P = 0.014）. Nonischemic cardiomyopathy （70.9%） was the most common etiology in the patients who underwent the treat？ment of CRT/D, no matter male or female. Conclusions In real-world setting, female do have different epidemiology, pathophysiology and clinical presentation of many cardiac rhythm disorders when compared with male, and all these factors may affect the utilization of CIED implantation. But it also possibility that cultural and socioeconomic features may play a role in this apparent discrimination.展开更多
The coronavirus disease 2019(COVID-19)has affected the whole globe since its outbreak in December 2019,[1]and many countries have tried several measures to protect and mitigate against its spread.Although the outbreak...The coronavirus disease 2019(COVID-19)has affected the whole globe since its outbreak in December 2019,[1]and many countries have tried several measures to protect and mitigate against its spread.Although the outbreaks have been effectively controlled in China,COVID-19 is still emerging as a public health crisis worldwide,causing massive panic.[2]Additionally,there are still scattered new cases being reported in China.[3]Therefore,in order to adhere to the policy of preventing imported cases and domestic resurgence,varied strategic countermeasures against COVID-19 have been enforced on a regular basis.As respiratory droplet and contact are the main modes of COVID-19 transmission,[4]all endoscopy centers have a higher risk of exposure to COVID-19 than other areas in a hospital.展开更多
Continuous renal replacement therapy(CRRT)is widely used for treating critically-ill patients in the emergency department in China.Anticoagulant therapy is needed to prevent clotting in the extracorporeal circulation ...Continuous renal replacement therapy(CRRT)is widely used for treating critically-ill patients in the emergency department in China.Anticoagulant therapy is needed to prevent clotting in the extracorporeal circulation during CRRT.Regional citrate anticoagulation(RCA)has been shown to potentially be safer and more effective,and is now recommended as the preferred anticoagulant method for CRRT.However,there is still a lack of unified standards for RCA management in the world,and there are many problems in using this method in clinical practice.The Emergency Medical Doctor Branch of the Chinese Medical Doctor Association(CMDA)organized a panel of domestic emergency medicine experts and international experts of CRRT to discuss RCA-related issues,including the advantages and disadvantages of RCA in CRRT anticoagulation,the principle of RCA,parameter settings for RCA,monitoring of RCA(mainly metabolic acid-base disorders),and special issues during RCA.Based on the latest available research evidence as well as the paneled experts'clinical experience,considering the generalizability,suitability,and potential resource utilization,while also balancing clinical advantages and disadvantages,a total of 16 guideline recommendations were formed from the experts'consensus.展开更多
Drowning is a major cause of preventable death and pathology worldwide.Every year,more than 295,000people die from accidental drowning.Ninety percent of accidental drowning deaths occur in low-and middleincome countri...Drowning is a major cause of preventable death and pathology worldwide.Every year,more than 295,000people die from accidental drowning.Ninety percent of accidental drowning deaths occur in low-and middleincome countries,and nearly half occur in people under the age of 25.展开更多
Distal radius fracture is the most common fracture site of the human skeleton[1]and often occurs in young people resulting from high energy injury caused by severe trauma.However,complex distal radial intra-articular ...Distal radius fracture is the most common fracture site of the human skeleton[1]and often occurs in young people resulting from high energy injury caused by severe trauma.However,complex distal radial intra-articular fractures(AO type C3)are relatively rare and account for about 5%of all distal radius fractures.[2]Fracture comminution at the joint surface is the primary manifestation of these fractures,followed by avulsion of the bone fragments with displacement seen at both the metacarpal and ulnar bone.Treatment of these displaced and unstable fractures remains a challenge.The nature of the articular surface fracture indicates the use of either the open or close reduction technique.Treatment protocols focus on extra-articular reduction and restoration of radial length,maintaining the volar tilt.[3,4]It has been noted that incongruity of the intra-articular distal radius fracture is relevant to the development of arthritis.[5,6]展开更多
1 Introduction In-stent restenosis （ISR）, characterized by neointimal proliferation and/or neoatherosclerosis in the vessel of the stent, can cause a reduction in lumen diameter after stent implantation, which can d...1 Introduction In-stent restenosis （ISR）, characterized by neointimal proliferation and/or neoatherosclerosis in the vessel of the stent, can cause a reduction in lumen diameter after stent implantation, which can directly induce the recurrence of angina symptoms or an acute coronary syndrome in patients and is usually life-threatening.展开更多
Central venous catheterization(CVC)is an invasive medical procedure used to measure central venous pressure and provides a stable route for continuous drug administration.CVC is widely used in the emergency department...Central venous catheterization(CVC)is an invasive medical procedure used to measure central venous pressure and provides a stable route for continuous drug administration.CVC is widely used in the emergency department and intensive care units.It is typically performed by inserting a catheter through the internal jugular vein(IJV)into the superior vena cava near the right atrium.[1,2]While catheterization is a fundamental skill proficiently performed by healthcare professionals,lethal complications may occasionally occur because of undesirable positioning,depth and diameter.展开更多
Thiamine deficiency is characterized by a deficiency of thiamine(vitamin B1),lactic acidosis,pulmonary arterial hypertension(PAH),right-sided heart failure,and peripheral nerve damage.Thiamine deficiency is easily mis...Thiamine deficiency is characterized by a deficiency of thiamine(vitamin B1),lactic acidosis,pulmonary arterial hypertension(PAH),right-sided heart failure,and peripheral nerve damage.Thiamine deficiency is easily misdiagnosed and missed during clinical practice and is associated with death in severe cases.[1,2]Here we reported a patient who was admitted to the hospital with severe metabolic acidosis and pulmonary hypertension and finally diagnosed with thiamine deficiency by detecting plasma vitamin B1 levels.Since clinically obvious thiamine deficiency is rare,and cases of thiamine deficiency requiring extracorporeal membrane oxygenation(ECMO)treatment are rarer,we believe that our case will be helpful for emergency clinicians.展开更多
BACKGROUND Cardioneuroablation(CNA)has shown encouraging results in patients with vasovagal syncope(VVS).However,data on different subtypes was scarce.METHODS This observational study retrospectively enrolled 141 pati...BACKGROUND Cardioneuroablation(CNA)has shown encouraging results in patients with vasovagal syncope(VVS).However,data on different subtypes was scarce.METHODS This observational study retrospectively enrolled 141 patients[mean age:40±18 years,51 males(36.2%)]with the diagnosis of VVS.The characteristics among different types of VVS and the outcomes after CNA were analyzed.RESULTS After a mean follow-up of 4.3±1.5 years,41 patients(29.1%)experienced syncope/pre-syncope events after CNA.Syncope/pre-syncope recurrence significantly differed in each subtype(P=0.04).The cardioinhibitory type of VVS had the lowest recurrence rate after the procedure(n=6,16.7%),followed by mixed(n=26,30.6%)and vasodepressive(n=9,45.0%).Additionally,a significant difference was observed in the analyses of the Kaplan-Meier survival curve(P=0.02).Syncope/pre-syncope burden was significantly reduced after CNA in the vasodepressive type(P<0.01).Vasodepressive types with recurrent syncope/pre-syncope after CNA have a lower baseline deceleration capacity(DC)level than those without(7.4±1.0 ms vs.9.0±1.6 ms,P=0.01).Patients with DC<8.4 ms had an 8.1(HR=8.1,95%CI:2.2-30.0,P=0.02)times risk of syncope/pre-syncope recurrence after CNA compared to patients with DC≥8.4 ms,and this association still existed after adjusting for age and sex(HR=8.1,95%CI:2.2-30.1,P=0.02).CONCLUSIONS Different subtypes exhibit different event-free rates.The vasodepressive type exhibited the lowest event-free rate,but those patients with DC≥8.4 ms might benefit from CNA.展开更多
BACKGROUND: The increasing morbidity of liver cancer has led to a growing demand for transplantation. Split liver transplantation(SLT) is a promising way to ameliorate organ shortages. However, the safety and efficacy...BACKGROUND: The increasing morbidity of liver cancer has led to a growing demand for transplantation. Split liver transplantation(SLT) is a promising way to ameliorate organ shortages. However, the safety and efficacy of SLT are still controversial. The aim of this study was to assess the clinical outcome of SLT in liver cancer patients at our center. METHODS: A total of 74 patients who received liver transplantation at a tertiary hospital from March 2019 to July 2023 were retrospectively studied, of whom 37 recipients underwent SLT and 37 recipients underwent whole-graft liver transplantation(WGLT). Clinical data were analyzed and compared between patients who underwent SLT and WGLT.RESULTS: SLT and WGLT were successfully performed, with no intraoperative transplantrelated mortality. Postoperatively, no significant differences in total bilirubin(TB, P=0.266), alanine transaminase(ALT, P=0.403) and aspartate transaminase(AST, P=0.160) levels within 30 d were detected between the two groups. The transplant-related mortality rates were 8.1% in the SLT group and 5.4% in the WGLT group within 30 d of surgery(P=1.000), and 10.8% and 8.1%, respectively, at 90 d after surgery(P=1.000). There were no significant differences in overall survival(OS) and progress-free survival(PFS) between the SLT and WGLT groups(P=0.910, P=0.190). CONCLUSION: Our results show that SLT does not imply additional risks in treating liver cancer compared with WGLT.展开更多
Lung transplantation (LT)has emerged as a crucial life-saving option for critically ill patients with severe coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS) or irreversible lung ...Lung transplantation (LT)has emerged as a crucial life-saving option for critically ill patients with severe coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS) or irreversible lung injury.[1]Intensive care unit-acquired weakness (ICU-AW)is a prevalent complication in critically ill patients.[2] The recovery of recipients undergoing LT for COVID-19-related respiratory failure may face impediments due to ICU-AW,which negatively affects early mobilization and functional improvement. This study describes two cases of successful bilateral LT for severe COVID-19-related ARDS with the occurrence of ICU-AW and subsequent successful discharge.展开更多
BACKGROUND:Swallowing disorder is a common clinical symptom that can lead to a series of complications,including aspiration,aspiration pneumonia,and malnutrition.This study aimed to investigate risk factors of post-ex...BACKGROUND:Swallowing disorder is a common clinical symptom that can lead to a series of complications,including aspiration,aspiration pneumonia,and malnutrition.This study aimed to investigate risk factors of post-extubation dysphagia(PED)in intensive care unit(ICU)patients with endotracheal intubation,and to develop a risk-predictive model for PED,which could serve as an assessment tool for the prevention and control of PED.METHODS:Patients retrospectively selected from June to December 2021 in a tertiary hospital served as the derivation cohort.Patients recruited from the same hospital from March to June 2022served as the external validation cohort for the predictive model.We used a combination of variable screening and least absolute shrinkage and selection operator(LASSO)regression to select the most useful candidate predictors and checked the multicollinearity of independent variables using the variance inflation factor method.Multivariate logistic regression analysis was performed to calculate the odds ratio(OR;95%confidence interval[95%CI])and P-value for each variable to predict diagnosis.The screened risk factors were introduced into R software to build a nomogram model.The performance of the model,including discrimination ability,calibration,and clinical benefit,was evaluated by plotting the receiver operating characteristic(ROC),calibration,and decision curves.RESULTS:A total of 305 patients were included in this study.Among them,235 patients(53PED vs.182 non-PED)were enrolled in the derivation cohort,while 70 patients(17 PED vs.53 nonPED)were enrolled in the validation cohort.The independent predictors included age,pause of sedatives,level of consciousness,activities of daily living(ADL)score,nasogastric tube,sore throat,and voice disorder.These predictors were used to establish the predictive nomogram model.The model demonstrated good discriminative ability,and the area under the ROC curve(AUC)was 0.945(95%CI 0.904-0.970).Applying the predictive model to the validation cohort demonstrated good discrimination with an AUC of 0.907(95%CI 0.831-0.983)and good calibration.The decision-curve analysis of this nomogram showed a net benefit of the model.CONCLUSION:A predictive model that incorporates age,pause of sedatives,level of consciousness,ADL score,nasogastric tube,sore throat,and voice disorder may have the potential to predict PED in ICU patients.展开更多
Fat embolism syndrome(FES)is a fatal complication of long bone fractures and multiple traumas.Severe FES can lead to potentially fatal respiratory failure in the form of rapidly developing acute respiratory distress s...Fat embolism syndrome(FES)is a fatal complication of long bone fractures and multiple traumas.Severe FES can lead to potentially fatal respiratory failure in the form of rapidly developing acute respiratory distress syndrome(ARDS).Here,we report a case of venousarterial extracorporeal membrane oxygenation(VAECMO)treatment of a patient with near-fatal pulmonary fat emboli caused by severe trauma.展开更多
BACKGROUND: This systematic review aims to investigate the prediction value of diffusion tensor imaging for motor function recovery of ischemic stroke patients.METHODS: Cochrane Central Register of Controlled Trials(C...BACKGROUND: This systematic review aims to investigate the prediction value of diffusion tensor imaging for motor function recovery of ischemic stroke patients.METHODS: Cochrane Central Register of Controlled Trials(CENTRAL)(the Cochrane Library 2016, Issue 9), Pub Med, Embase, Clarivate Analytics, Scopus, CINAHL, Chinese Biomedical Literature Database, China National Knowledge Infrastructure and Google Scholar were searched for either motor recovery or corticospinal tract integrity by diffusion tensor imaging in different stroke phase from January 1, 1970, to October 31, 2016. The study design and participants were subjected to metrological analysis. Correlation coeffi cient(r) was used for evaluating the relationship between fractional anisotropy(FA) and motor function outcome. Correlation coeffi cient values were extracted from each study, and 95% confidence intervals(CIs) were calculated by Fisher's z transformation. Meta-analysis was conducted by STATA software.RESULTS: Fifteen studies with a total of 414 patients were included. Meta-analysis showed that FA in the subacute phase had the signifi cant correlation with motor function outcome(ES=0.75, 95%CI 0.62–0.87), which showed moderate quality based on GRADE system. The weight correlation coeffi cient revealed that an effect size(ES) of FA in acute phase and chronic phase was 0.51(95%CI 0.33–0.68) and 0.62(95%CI 0.47–0.77) respectively.CONCLUSION: This meta-analysis reveals that FA in the subacute phase after ischemic stroke is a good predictor for functional motor recovery, which shows moderate quality based on the GRADE system.展开更多
Dear editor,Uterine pyometra is a rare disease that mostly affects elderly women and is usually asymptomatic.Pyometra is defined as an accumulation of pus in the uterine cavity caused by genital tract malignancy or be...Dear editor,Uterine pyometra is a rare disease that mostly affects elderly women and is usually asymptomatic.Pyometra is defined as an accumulation of pus in the uterine cavity caused by genital tract malignancy or benign cervical diseases such as senile cervicitis,cervical polyps,or remaining intrauterine devices after menopause.[1]The incidence of spontaneous uterine perforation due to pyometra is extremely low,ranging from 0.01%to 0.05%.[2]Although it has low morbidity,it can progress to diffuse peritonitis,and the mortality rate associated with septic shock is as high as 25%-40%.[3]It is still difficult for emergency doctors to provide an accurate diagnosis and perform surgery on time.Here,we present a rare case of a 72-year-old woman who was diagnosed with spontaneous uterine perforation of pyometra and successfully treated with an emergency laparotomy.展开更多
Recurrent or incessant tachycardia is frequently found in symptomatic Wolff-Parkinson-White （WPW） syndrome, leading to ventricular dysfunction, dilated cardiomyopathy （DCM） and heart failure in infants and childre...Recurrent or incessant tachycardia is frequently found in symptomatic Wolff-Parkinson-White （WPW） syndrome, leading to ventricular dysfunction, dilated cardiomyopathy （DCM） and heart failure in infants and children.[1] Recently, Winter, et al.[2] report that WPW syndrome could provoke many kinds of cardiac dysfunction, leading to remodeling and progressive ventricular dilatation through pre-excita- tion-related dyssynchrony, even without arrhythmia.展开更多
基金supported in part by grants from the Science and Technology Plan Project of Linhai(2023YW05)Medical Health Science and Technology Project of Zhejiang(2024KY555).
文摘BACKGROUND:The objective of this retrospective hospital-based study was to describe the epidemiological features of traumatic spinal cord injury(TSCI)in the intensive care unit(ICU)and assess the incidence and possible risk factors for venous thromboembolism(VTE)following TSCI.METHODS:We retrospectively reviewed the medical records of 370 patients with TSCI who were admitted between January 2018 and March 2023.The following parameters were collected:age,sex,body mass index,occupation,underlying diseases,smoking history,education level,etiology of injury,injury segments,American Spinal Injury Association(ASIA)Impairment Scale score,severity of injury,injury severity score(ISS),VTE risk score(Caprini score),treatment,VTE prophylaxis,ICU length of stay,length of hospital stay,concomitant injuries,and complications.Descriptive statistics were used to summarize the demographic and clinical characteristics of the study participants.Logistic regression analysis was used to determine the risk factors for VTE.RESULTS:The mean age of patients with TSCI was 55.5±13.4 years,with a male-to-female ratio of 6.5:1.The leading cause of TSCI was falls from height(46.5%),followed by traffic accidents(36.5%).The cervical spinal cord was the most affected segment,followed by the thoracolumbar region.Among all the patients,362(97.8%)had concomitant injuries.Complications were observed in 255 patients(68.9%)during hospitalization.The incidence rate of VTE was 25.1%.Logistic regression analysis revealed that age(OR=1.721,95%CI:1.207-2.454,P=0.003),mechanical ventilation(OR=3.427,95%CI:1.873-6.271,P<0.001),and non-use of chemical prophylaxis(OR=2.986,95%CI:1.749-5.099,P<0.001)were risk factors for VTE.CONCLUSION:Falls from height and traffic accidents were the main causes of TSCIs in the ICU,especially for male patients with cervical spinal cord injuries.VTE is a frequent complication in patients with TSCI in the ICU.Age,mechanical ventilation,and non-use of chemical prophylaxis were found to be independent risk factors for VTE following TSCI.
文摘Mitochondrial cytopathies are characterized by energy failure within the cellular system.These disorders exhibit a wide range of clinical presentations and are highly heterogeneous.The mitochondrial diseases include mitochondrial encephalopathy,lactic acidosis,and stroke-like episodes (MELAS).MELAS syndrome has various manifestations,including stroke-like episodes,dementia,epilepsy,lactic acidemia,myopathy,recurrent headaches,hearing impairment,diabetes,and short stature.The initial report on MELAS syndrome was published by Pavlakis et al in 1984.^([1])
文摘BACKGROUND:To investigate the clinical effectiveness of a pneumatic compression device(PCD)combined with low-molecular-weight heparin(LMWH)for the prevention and treatment of deep vein thrombosis(DVT)in trauma patients.METHODS:This study retrospectively analyzed 286 patients with mild craniocerebral injury and clavicular fractures admitted to our department from January 2016 to February 2020.Patients treated with only LMWH served as the control group,and patients treated with a PCD combined with LMWH as the observation group.The incidence of DVT,postoperative changes in the visual analogue scale(VAS)score,and coagulation function were observed and compared between the two groups.Excluding the influence of other single factors,binary logistic regression analysis was used to evaluate the use of a PCD in the patient’s postoperative coagulation function.RESULTS:After excluding 34 patients who did not meet the inclusion criteria,252 patients were were included.The incidence of DVT in the observation group was significantly lower than that in the control group(5.6%vs.15.1%,χ^(2)=4.605,P<0.05).The postoperative VAS scores of the two groups were lower than those before surgery(P<0.05).The coagulation function of the observation group was significantly higher than that of the control group,with a better combined anticoagulant effect(P<0.05).There were no significant differences between the two groups in preoperative or postoperative Glasgow Coma Scale scores,intraoperative blood loss,postoperative infection rate,or length of hospital stay(P>0.05).According to logistic regression analysis,the postoperative risk of DVT in patients who received LMWH alone was 1.764 times that of patients who received LMWH+PCD(P<0.05).The area under the receiver operating characteristic(AUROC)curve of partial thromboplastin time(APTT)and platelet(PLT)were greater than 0.5,indicating that they were the influence indicators of adding PCD to prevent DVT.Excluding the influence of other variables,LMWH+PCD effectively improved the coagulation function of patients.CONCLUSIONS:Compared with LMWH alone,LMWH+PCD could improve blood rheology and coagulation function in patients with traumatic brain injury and clavicular fracture,reduce the incidence of DVT,shorten the length of hospital stay,and improve the clinical effectiveness of treatment.
基金Supported by the National Natural Science Foundation of China under Grant Nos 81127901,81420108018,81527803,81227004 and 11374155the Natural Science Foundation of Jiangsu Province under Grant No BK20131017+3 种基金the Main Scientific and Technological Project of Zhejiang Province under Grant No 2013C03044-1the Chinese Postdoctoral Science Foundation under Grant No134238the Postdoctoral Foundation of Jiangsu Province under Grant No 1401001Bthe Qing Lan Project
文摘The relationship between the cavitation and acoustic peak negative pressure in the high-intensity focused ultrasound （HIFU） field is analyzed in water and tissue phantom. The peak negative pressure at the focus is determined by a hybrid approach combining the measurement with the simulation. The spheroidal beam equation is utilized to describe the nonlinear acoustic propagation. The waveform at the focus is measured by a fiber optic probe hydrophone in water. The relationship between the source pressure amplitude and the excitation voltage is determined by fitting the measured ratio of the second harmonic to the fundamental component at the focus, based on the model simulation. Then the focal negative pressure is calculated for arbitrary voltage excita- tion in water and tissue phantom. A portable B-mode ultrasound scanner is applied to monitor HIFU-indueed cavitation in real time, and a passive cavitation detection （PCD） system is used to acquire the bubble scattering signals in the HIFU focal volume for the cavitation quantification. The results show that： （1） unstable cavitation starts to appear in degassed water when the peak negative pressure of HIFU signals reaches 13.5 MPa; and （2） the cavitation activity can be detected in tissue phantom by B-mode images and in the PCD system with HIFU peak negative pressures of 9.0 MPa and 7.8 MPa, respectively, which suggests that real-time B-mode images could be used to monitor the cavitation activity in two dimensions, while PCD systems are more sensitive to detect scattering and emission signals from cavitation bubbles.
文摘Background Cardiac implantable electronic devices （CIEDs） greatly improve survival and life quality of patients. However, there are gender differences regarding both the utilization and benefit of these devices. In this prospective CIED registry, we aim to appraise the gender differences in CIED utilization in China. Methods Twenty centers from 14 provinces in China were included in our registry study. All patients who underwent a CIED implantation in these twenty centers between Jan 2015 and Dec 2016 were included. Results A total of 8570 patients were enrolled in the baseline cohort, including 7203 pacemaker, 664 implantable cardiac defibrillators （ICD） implants and 703 cardiac resynchronization therapy device （CRT/D）. Totally, 4117 （48.0%） CIED patients were female, and more than 59% pacemaker patients were female, but women account only one third of ICD or CRT/D implantation in this registry. There were significant differences between genders at pacemaker and ICD indications. Female was more likely received a pacemaker due to sick sinus syndrome （SSS） （63.9% vs. 51.0%, P 〈 0.001）. Female patients receiving an ICD were more likely due to cardiac ion channel disease （29.2% vs. 4.2%, P 〈 0.001）. The percentage of utilization of dual-chamber pacemaker in female patients was significantly higher than male （85.3% vs. 81.1%, P 〈 0.001）. But male patients were more likely received a cardiac resynchronization therapy devices with defibrillator than female （56.5% vs. 41.9%, P = 0.001）. In pacemaker patient, male was more likely to have structure heart disease （31.3% vs. 28.0%, P = 0.002）. In ICD patient, male patients were more likely to have ischemic heart disease （48.2% vs. 29.2%, P 〈 0.001）. The mean age of women at the time of CRT/D implantation was older than men （P = 0.014）. Nonischemic cardiomyopathy （70.9%） was the most common etiology in the patients who underwent the treat？ment of CRT/D, no matter male or female. Conclusions In real-world setting, female do have different epidemiology, pathophysiology and clinical presentation of many cardiac rhythm disorders when compared with male, and all these factors may affect the utilization of CIED implantation. But it also possibility that cultural and socioeconomic features may play a role in this apparent discrimination.
基金This work was supported by the National Natural Science Foundation of China(82103496).
文摘The coronavirus disease 2019(COVID-19)has affected the whole globe since its outbreak in December 2019,[1]and many countries have tried several measures to protect and mitigate against its spread.Although the outbreaks have been effectively controlled in China,COVID-19 is still emerging as a public health crisis worldwide,causing massive panic.[2]Additionally,there are still scattered new cases being reported in China.[3]Therefore,in order to adhere to the policy of preventing imported cases and domestic resurgence,varied strategic countermeasures against COVID-19 have been enforced on a regular basis.As respiratory droplet and contact are the main modes of COVID-19 transmission,[4]all endoscopy centers have a higher risk of exposure to COVID-19 than other areas in a hospital.
文摘Continuous renal replacement therapy(CRRT)is widely used for treating critically-ill patients in the emergency department in China.Anticoagulant therapy is needed to prevent clotting in the extracorporeal circulation during CRRT.Regional citrate anticoagulation(RCA)has been shown to potentially be safer and more effective,and is now recommended as the preferred anticoagulant method for CRRT.However,there is still a lack of unified standards for RCA management in the world,and there are many problems in using this method in clinical practice.The Emergency Medical Doctor Branch of the Chinese Medical Doctor Association(CMDA)organized a panel of domestic emergency medicine experts and international experts of CRRT to discuss RCA-related issues,including the advantages and disadvantages of RCA in CRRT anticoagulation,the principle of RCA,parameter settings for RCA,monitoring of RCA(mainly metabolic acid-base disorders),and special issues during RCA.Based on the latest available research evidence as well as the paneled experts'clinical experience,considering the generalizability,suitability,and potential resource utilization,while also balancing clinical advantages and disadvantages,a total of 16 guideline recommendations were formed from the experts'consensus.
文摘Drowning is a major cause of preventable death and pathology worldwide.Every year,more than 295,000people die from accidental drowning.Ninety percent of accidental drowning deaths occur in low-and middleincome countries,and nearly half occur in people under the age of 25.
文摘Distal radius fracture is the most common fracture site of the human skeleton[1]and often occurs in young people resulting from high energy injury caused by severe trauma.However,complex distal radial intra-articular fractures(AO type C3)are relatively rare and account for about 5%of all distal radius fractures.[2]Fracture comminution at the joint surface is the primary manifestation of these fractures,followed by avulsion of the bone fragments with displacement seen at both the metacarpal and ulnar bone.Treatment of these displaced and unstable fractures remains a challenge.The nature of the articular surface fracture indicates the use of either the open or close reduction technique.Treatment protocols focus on extra-articular reduction and restoration of radial length,maintaining the volar tilt.[3,4]It has been noted that incongruity of the intra-articular distal radius fracture is relevant to the development of arthritis.[5,6]
文摘1 Introduction In-stent restenosis （ISR）, characterized by neointimal proliferation and/or neoatherosclerosis in the vessel of the stent, can cause a reduction in lumen diameter after stent implantation, which can directly induce the recurrence of angina symptoms or an acute coronary syndrome in patients and is usually life-threatening.
文摘Central venous catheterization(CVC)is an invasive medical procedure used to measure central venous pressure and provides a stable route for continuous drug administration.CVC is widely used in the emergency department and intensive care units.It is typically performed by inserting a catheter through the internal jugular vein(IJV)into the superior vena cava near the right atrium.[1,2]While catheterization is a fundamental skill proficiently performed by healthcare professionals,lethal complications may occasionally occur because of undesirable positioning,depth and diameter.
基金General Research Project of Education Bureau of Zhejiang Province(Y202353789)。
文摘Thiamine deficiency is characterized by a deficiency of thiamine(vitamin B1),lactic acidosis,pulmonary arterial hypertension(PAH),right-sided heart failure,and peripheral nerve damage.Thiamine deficiency is easily misdiagnosed and missed during clinical practice and is associated with death in severe cases.[1,2]Here we reported a patient who was admitted to the hospital with severe metabolic acidosis and pulmonary hypertension and finally diagnosed with thiamine deficiency by detecting plasma vitamin B1 levels.Since clinically obvious thiamine deficiency is rare,and cases of thiamine deficiency requiring extracorporeal membrane oxygenation(ECMO)treatment are rarer,we believe that our case will be helpful for emergency clinicians.
基金supported by the CAMS Central Public Welfare Scientific Research Institute Basal Research Expenses (No.2021-XCGC09-1&No.2022-I2M-C&T-B-045)the Beijing Municipal Science&Technology Commission (Z191100006619019)the High-level Hospital Clinical Scientific Research Business Fees (No.2022-GSP-QZ-4)
文摘BACKGROUND Cardioneuroablation(CNA)has shown encouraging results in patients with vasovagal syncope(VVS).However,data on different subtypes was scarce.METHODS This observational study retrospectively enrolled 141 patients[mean age:40±18 years,51 males(36.2%)]with the diagnosis of VVS.The characteristics among different types of VVS and the outcomes after CNA were analyzed.RESULTS After a mean follow-up of 4.3±1.5 years,41 patients(29.1%)experienced syncope/pre-syncope events after CNA.Syncope/pre-syncope recurrence significantly differed in each subtype(P=0.04).The cardioinhibitory type of VVS had the lowest recurrence rate after the procedure(n=6,16.7%),followed by mixed(n=26,30.6%)and vasodepressive(n=9,45.0%).Additionally,a significant difference was observed in the analyses of the Kaplan-Meier survival curve(P=0.02).Syncope/pre-syncope burden was significantly reduced after CNA in the vasodepressive type(P<0.01).Vasodepressive types with recurrent syncope/pre-syncope after CNA have a lower baseline deceleration capacity(DC)level than those without(7.4±1.0 ms vs.9.0±1.6 ms,P=0.01).Patients with DC<8.4 ms had an 8.1(HR=8.1,95%CI:2.2-30.0,P=0.02)times risk of syncope/pre-syncope recurrence after CNA compared to patients with DC≥8.4 ms,and this association still existed after adjusting for age and sex(HR=8.1,95%CI:2.2-30.1,P=0.02).CONCLUSIONS Different subtypes exhibit different event-free rates.The vasodepressive type exhibited the lowest event-free rate,but those patients with DC≥8.4 ms might benefit from CNA.
基金Key Project of Traditional Chinese Medicine Science and Technology Plan of Zhejiang Province (GZY-ZJ-KJ-24077)National Natural Science Foundation of China (No. U23A202181, 8207101520, 82272860)+2 种基金Central Guidance on Local Science and Technology Development Fund of Zhejiang Province (2023ZY1017)Fundamental Research Funds for the Central Universities (No. 226-2023-00038)Special Financial Support for Zhejiang Traditional Chinese Medicine Innovation Teams。
文摘BACKGROUND: The increasing morbidity of liver cancer has led to a growing demand for transplantation. Split liver transplantation(SLT) is a promising way to ameliorate organ shortages. However, the safety and efficacy of SLT are still controversial. The aim of this study was to assess the clinical outcome of SLT in liver cancer patients at our center. METHODS: A total of 74 patients who received liver transplantation at a tertiary hospital from March 2019 to July 2023 were retrospectively studied, of whom 37 recipients underwent SLT and 37 recipients underwent whole-graft liver transplantation(WGLT). Clinical data were analyzed and compared between patients who underwent SLT and WGLT.RESULTS: SLT and WGLT were successfully performed, with no intraoperative transplantrelated mortality. Postoperatively, no significant differences in total bilirubin(TB, P=0.266), alanine transaminase(ALT, P=0.403) and aspartate transaminase(AST, P=0.160) levels within 30 d were detected between the two groups. The transplant-related mortality rates were 8.1% in the SLT group and 5.4% in the WGLT group within 30 d of surgery(P=1.000), and 10.8% and 8.1%, respectively, at 90 d after surgery(P=1.000). There were no significant differences in overall survival(OS) and progress-free survival(PFS) between the SLT and WGLT groups(P=0.910, P=0.190). CONCLUSION: Our results show that SLT does not imply additional risks in treating liver cancer compared with WGLT.
文摘Lung transplantation (LT)has emerged as a crucial life-saving option for critically ill patients with severe coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS) or irreversible lung injury.[1]Intensive care unit-acquired weakness (ICU-AW)is a prevalent complication in critically ill patients.[2] The recovery of recipients undergoing LT for COVID-19-related respiratory failure may face impediments due to ICU-AW,which negatively affects early mobilization and functional improvement. This study describes two cases of successful bilateral LT for severe COVID-19-related ARDS with the occurrence of ICU-AW and subsequent successful discharge.
文摘BACKGROUND:Swallowing disorder is a common clinical symptom that can lead to a series of complications,including aspiration,aspiration pneumonia,and malnutrition.This study aimed to investigate risk factors of post-extubation dysphagia(PED)in intensive care unit(ICU)patients with endotracheal intubation,and to develop a risk-predictive model for PED,which could serve as an assessment tool for the prevention and control of PED.METHODS:Patients retrospectively selected from June to December 2021 in a tertiary hospital served as the derivation cohort.Patients recruited from the same hospital from March to June 2022served as the external validation cohort for the predictive model.We used a combination of variable screening and least absolute shrinkage and selection operator(LASSO)regression to select the most useful candidate predictors and checked the multicollinearity of independent variables using the variance inflation factor method.Multivariate logistic regression analysis was performed to calculate the odds ratio(OR;95%confidence interval[95%CI])and P-value for each variable to predict diagnosis.The screened risk factors were introduced into R software to build a nomogram model.The performance of the model,including discrimination ability,calibration,and clinical benefit,was evaluated by plotting the receiver operating characteristic(ROC),calibration,and decision curves.RESULTS:A total of 305 patients were included in this study.Among them,235 patients(53PED vs.182 non-PED)were enrolled in the derivation cohort,while 70 patients(17 PED vs.53 nonPED)were enrolled in the validation cohort.The independent predictors included age,pause of sedatives,level of consciousness,activities of daily living(ADL)score,nasogastric tube,sore throat,and voice disorder.These predictors were used to establish the predictive nomogram model.The model demonstrated good discriminative ability,and the area under the ROC curve(AUC)was 0.945(95%CI 0.904-0.970).Applying the predictive model to the validation cohort demonstrated good discrimination with an AUC of 0.907(95%CI 0.831-0.983)and good calibration.The decision-curve analysis of this nomogram showed a net benefit of the model.CONCLUSION:A predictive model that incorporates age,pause of sedatives,level of consciousness,ADL score,nasogastric tube,sore throat,and voice disorder may have the potential to predict PED in ICU patients.
文摘Fat embolism syndrome(FES)is a fatal complication of long bone fractures and multiple traumas.Severe FES can lead to potentially fatal respiratory failure in the form of rapidly developing acute respiratory distress syndrome(ARDS).Here,we report a case of venousarterial extracorporeal membrane oxygenation(VAECMO)treatment of a patient with near-fatal pulmonary fat emboli caused by severe trauma.
文摘BACKGROUND: This systematic review aims to investigate the prediction value of diffusion tensor imaging for motor function recovery of ischemic stroke patients.METHODS: Cochrane Central Register of Controlled Trials(CENTRAL)(the Cochrane Library 2016, Issue 9), Pub Med, Embase, Clarivate Analytics, Scopus, CINAHL, Chinese Biomedical Literature Database, China National Knowledge Infrastructure and Google Scholar were searched for either motor recovery or corticospinal tract integrity by diffusion tensor imaging in different stroke phase from January 1, 1970, to October 31, 2016. The study design and participants were subjected to metrological analysis. Correlation coeffi cient(r) was used for evaluating the relationship between fractional anisotropy(FA) and motor function outcome. Correlation coeffi cient values were extracted from each study, and 95% confidence intervals(CIs) were calculated by Fisher's z transformation. Meta-analysis was conducted by STATA software.RESULTS: Fifteen studies with a total of 414 patients were included. Meta-analysis showed that FA in the subacute phase had the signifi cant correlation with motor function outcome(ES=0.75, 95%CI 0.62–0.87), which showed moderate quality based on GRADE system. The weight correlation coeffi cient revealed that an effect size(ES) of FA in acute phase and chronic phase was 0.51(95%CI 0.33–0.68) and 0.62(95%CI 0.47–0.77) respectively.CONCLUSION: This meta-analysis reveals that FA in the subacute phase after ischemic stroke is a good predictor for functional motor recovery, which shows moderate quality based on the GRADE system.
文摘Dear editor,Uterine pyometra is a rare disease that mostly affects elderly women and is usually asymptomatic.Pyometra is defined as an accumulation of pus in the uterine cavity caused by genital tract malignancy or benign cervical diseases such as senile cervicitis,cervical polyps,or remaining intrauterine devices after menopause.[1]The incidence of spontaneous uterine perforation due to pyometra is extremely low,ranging from 0.01%to 0.05%.[2]Although it has low morbidity,it can progress to diffuse peritonitis,and the mortality rate associated with septic shock is as high as 25%-40%.[3]It is still difficult for emergency doctors to provide an accurate diagnosis and perform surgery on time.Here,we present a rare case of a 72-year-old woman who was diagnosed with spontaneous uterine perforation of pyometra and successfully treated with an emergency laparotomy.
文摘Recurrent or incessant tachycardia is frequently found in symptomatic Wolff-Parkinson-White （WPW） syndrome, leading to ventricular dysfunction, dilated cardiomyopathy （DCM） and heart failure in infants and children.[1] Recently, Winter, et al.[2] report that WPW syndrome could provoke many kinds of cardiac dysfunction, leading to remodeling and progressive ventricular dilatation through pre-excita- tion-related dyssynchrony, even without arrhythmia.
