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Objective:To explore the value of neutrophil to lymphocyte rate (NLR) combined with red blood cell distribution width to platelet count ratio (RPR) in evaluating the condition and prognosis of emergency elderly sepsis patients.Methods:A prospective research method was conducted to select 169 elderly patients with sepsis who visited the emergency department of Xuanwu Hospital of Capital Medical University from January 2020 to February 2022.After admission, blood routine examination, chest computerized tomography, biochemical examination, procalcitonin, and pathogenic examination were given, and the scores of acute physiology and chronic health evaluation (APACHE Ⅱ) were scored according to worst value of 24 hours. After 28 days of follow-up, the patients were divided into the survival group(125 cases) and the death group(44 cases) according to the prognosis. The differences of white blood cell count(WBC), NLR, PCT, RPR and APACHE Ⅱ scores were compared between the two groups. The correlation between NLR,RPR and APACHE Ⅱ scores were analyzed. The difference of area under receiver operating characteristic curve (ROC) of RPR, NLR, their combination and PCT in predicting mortality were compared in elderly patients with sepsis. The independent sample t test was used to compare the measurement data with normal distribution, and the χ 2 test was used to compare the enumeration data. The risk factors were analyzed by multiple logistic regression analysis. Results:There was no significant difference in WBC between the survival group and the death group ( P=0.361). The APACHE Ⅱ scores ((18.52±2.41) points), RPR (0.17±0.03), NLR (10.64±3.48), PCT ((2.55±1.14) μg/L) in the death group were higher than those in the survival group ((14.17±2.71) points, (0.14±0.03), NLR (7.67±3.33), (1.19±0.81) μg/L), the difference was statistically significant ( t values were 9.44,7.32,4.92, and 7.32, respectively; all P<0.001). RPR and NLR were positively correlated with APACHE Ⅱ scores ( r=0.393,0.368;both P<0.001). Multivariate logistic regression analysis showed that increased NLR ( OR=1.174,95% CI 1.041-1.325), procalcitonin ( OR=4.353,95% CI 2.382-7.954), RPR ( OR=14.247,95% CI 2.635-77.025) were independent risk factors for the prognosis of sepsis patients ( P values were 0.009,<0.001, and 0.002, respectively).The area under receiver operating characteristic curve (AUC) of PCT in predicting mortality was 0.859 (95% CI:0.801-0.917), the AUC of RPR was 0.755 (95% CI:0.665-0.845), and the AUC of NLR was 0.727 (95% CI: 0.643-0.812). The AUC of RPR and NLR was smaller than that of PCT ( P=0.033, 0.015), but the AUC of RPR combined with NLR was 0.799, which had no significant difference compared with PCT ( P=0.195). Conclusion:Both NLR and RPR had a certain predictive value for the condition and prognosis of elderly sepsis patients in emergency, and their combined evaluation value was similar to that of PCT.
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Objective:To study the effect of simulated case base on the training of resident’s post competency in the department of emergency.Methods:The study selected 63 residents who had the standardized training in the Department of Emergency, Xuanwu Hospital of Capital Medical University from June 2018 to October 2019, and they were randomly divided into observation group ( n=32) and control group ( n=31). The observation group was trained by emergency simulated case base, while the control group was trained by routine training methods such as theoretical lecturing and single skill training. The differences between the two training methods in the abilities of diagnosis and treatment, medical knowledge, interpersonal communication, practice-based learning and improvement of post competencies were compared by means of theoretical and operational assessments. Two groups were investigated with questionnaires, self-evaluation and satisfaction degree of post competency, and the differences between the two groups were compared. SPSS 19.0 software was used for t test and chi-square test. Results:There was no significant difference in the scores of medical knowledge and skill operation between the observation group [(43.53± 9.26) points and (7.32±1.03) points] and the control group [(42.47±8.64) points and (7.24±1.12) points] ( P>0.05). However, the scores of clinical diagnosis and treatment ability, professional accomplishment, interpersonal communication ability and practice-based learning and improvement were all significantly higher in the observation group than those in the control group ( P<0.05). The questionnaire self-assessment showed that there was no significant difference in scores of medical knowledge and skill operation between the observation group [(4.23±0.46) points and (4.05±0.52) points] and the control group [(4.14±0.38) points and (3.98±0.69) points] ( P>0.05), and the self-evaluation scores of professional accomplishment, interpersonal communication ability, clinical diagnosis and treatment ability, practice-based learning and improvement ability were higher than those in the control group ( P<0.05). The satisfaction with teaching method in the observation group was also higher than that in the control group ( P=0.020). Conclusion:The application of simulated case base can improve post competency in the standardized training of residents in the department of emergency, with good training effect.
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Sepsis associated encephalopathy (SAE) is one of the common encephalopathy in critically ill patients. It is a brain dysfunction caused by inflammatory reaction caused by non central nervous system infection. The pathogenesis of SAE is complex and unclear, and there is a lack of effective criteria for the diagnosis of SAE. SAE patients are often in critical condition with high mortality. At present, there is no specific method to treat SAE. The research on SAE treatment has a long way to go. This paper introduces the possible pathogenesis, diagnostic methods and treatment of SAE.
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Objective To evaluate the value of procalcitonin (PCT) combined with CURB-65 score in the elderly patients with community acquired pneumonia(CAP). Methods Seventy-eight elderly patients with CAP were selected in the Emergency Department of Xuanwu Hospital Capital Medical University,After admission,blood routine, PCT, blood gas analysis and biochemical examination were given, and Acute Physiology and Chronic Health Evaluation(APACHEⅡ) and CURB-65 score were carried out. According to the prognosis,the patients were divided into death group (16 cases) and survival group (62 cases),The difference of PCT,white blood cell(WBC),CURB-65 score and APACHE Ⅱ score in the two groups were compared. The differences of area under ROC curve of APACHE II score,procalcitonin (PCT),CURB-65 score,PCT and CURB-65 score were compared. Results The PCT,CURB-65 and APACHEE Ⅱ scores of the death group and the survival group were (3. 35±1. 79) μg/L vs. (2. 05±1. 89) μg/L,(2. 06±0. 85) points vs. (1. 40±0. 99) points,(20. 50±4. 06) points vs. (14. 13+5. 63) points,respectively. There were significant differences between the two groups ( P＜0. 05) . The number of WBCs in survival group and survival group were ( 9. 90 ± 3. 04)×109/L and ( 8. 77 ± 3. 70)×109/L, respectively, with no significant difference between the two groups (P＝0. 263); the area under the ROC curve of PCT predicting death was 0. 716 (P＝0. 001),the area under the ROC curve of CURB-65 predicting death was 0. 679 ( P＝0. 005), and the area under the ROC curve of APACHE II score was 0. 836 (P＝0. 001) ,which was larger than PCT and CRUB-65 (P＜0. 05). The area under ROC curve of death predicted by PCT and CRUB-65 was 0. 775 (P＝0. 001). There was no significant difference between PCT and CRUB-65 and APACHE II (P＝0. 345) . Conclusion PCT combined with CURB-65 score can accurately and rapidly assess the condition of elderly patients with community-acquired pneumonia,and has important application value.
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OBJECTIVE@#Medical image segmentation is a key step in medical image processing. An architecture of fully convolutional networks was proposed to realize automatic segmentation of anatomical areas in X-ray images.@*METHODS@#Enlightened by the advantages of convolutional neural networks on features extraction, fully convolutional networks consisting of 9 layers were designed to segment medical images. The networks used convolution kernels of various sizes to extract multi-dimensional image features in the images, meanwhile, eliminated pooling layers to avoid the loss of image details during downsampling procedures.@*RESULTS@#The experiment was conducted in accordance with the specific scene of X-ray images segmentation. Compared with traditional segmentation methods, this approach achieved more accurate segmentation of anatomical areas.@*CONCLUSIONS@#Fully convolutional networks can extract representative and multidimensional features of medical images, avoid the loss of image details during downsampling procedures, and complete automatic segmentation of anatomical areas accurately in X-ray images.
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Algorithms , Image Processing, Computer-Assisted , Neural Networks, Computer , X-RaysABSTRACT
Imipenem is a carbapenem antibiotic. However, Imipenem could not be marketed owing to its instability and nephrotoxicity until cilastatin, an inhibitor of renal dehydropeptidase-I (DHP-I), was developed. In present study, the potential roles of renal organic anion transporters (OATs) in alleviating the nephrotoxicity of imipenem by cilastatin were investigated and in rabbits. Our results indicated that imipenem and cilastatin were substrates of hOAT1 and hOAT3. Cilastatin inhibited hOAT1/3-mediated transport of imipenem with IC values comparable to the clinical concentration, suggesting the potential to cause a clinical drug-drug interaction (DDI). Moreover, imipenem exhibited hOAT1/3-dependent cytotoxicity, which was alleviated by cilastatin and probenecid. Furthermore, cilastatin and probenecid ameliorated imipenem-induced rabbit acute kidney injury, and reduced the renal secretion of imipenem. Cilastatin and probenecid inhibited intracellular accumulation of imipenem and sequentially decreased the nephrocyte toxicity in rabbit primary proximal tubule cells. Renal OATs, besides DHP-I, was also the target of interaction between imipenem and cilastatin, and contributed to the nephrotoxicity of imipenem. This therefore gives in part the explanation about the mechanism by which cilastatin protected against imipenem-induced nephrotoxicity. Thus, OATs can potentially be used as a therapeutic target to avoid the renal adverse reaction of imipenem in clinic.
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Treatment position recognition in medical images is a key technique in medical image processing. Due to the excellent performance of convolutional neural networks on features extraction and classification, an architecture of parallel convolutional neural networks is proposed to recognize treatment positions in X-ray images, which uses convolution kernels of different sizes to extract local features of different sizes in these images. The experimental analysis shows that parallel convolution neural networks, which can extract representative image features with more dimensions, are competent to classify and recognize treatment positions in medical images.
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Algorithms , Image Processing, Computer-Assisted , Neural Networks, Computer , X-RaysABSTRACT
Objective To investigate the epidemiological characteristics of emergency critical illness and disease spectrum in emergency department of a hospital in Beijing. Methods A retrospective study was conducted. The data of 3 176 critically ill patients aged ≥ 14 years old admitted to the emergency room of Xuanwu Hospital Capital Medical University from January 1st to December 31st in 2017 were analyzed, including gender, age, clinical time, discharge diagnosis, outcomes, etc. To analyze the epidemiological characteristics and disease spectrum distribution of emergency critically ill patients, annual and daily 24-hour emergency visits in 2017 were analyzed. Results Among the 3 176 cases of acute critical illness, there were more males than females (1 824 vs. 1 352, 1.35 : 1); the age ranged from 14 to 100 years old, with an average of (66.52±17.18) years old; the highest incidence age was 75-89 years old (35.2%, 516 males and 603 females), followed by 60-70 years old (30.0%, 572 males and 381 females). The top four prevalence diseases in the emergency critical disease spectrum were cardiovascular diseases [41.8%, 716 males and 610 females, age (70.25±15.08) years old], nervous system diseases [26.7%, 502 males and 346 females, age (60.28±17.57) years old], respiratory disease [12.3%, 226 males and 166 females, age (72.96±16.23) years old] and digestive system diseases [5.6%, 119 males and 60 females, age (65.40±17.96) years old], accounting for 86.4% of the total. There were more males than females (all P < 0.05), and the age difference was statistically significant (F = 84.094, P < 0.001). Arrhythmia was the most common cardiovascular disease (16.7%), followed by acute coronary syndrome (12.0%) and heart failure (9.1%); the main nervous system diseases were stroke (20.9%); respiratory diseases mainly included severe pneumonia (8.3%); digestive system diseases were mainly with digestive tract bleeding (4.4%). The high incidence of acute critical illness in the emergency department occurred in winter (287 cases in December and 277 cases in January) and the early stage of spring (282 cases in March). The daily peak period was midday and at night, especially from 18:00 to 23:00 (163 cases at 18:00, 173 cases at 19:00, 172 cases at 20:00, 186 cases at 21:00, 167 cases at 22:00, 169 cases at 23:00). The average treatment time of critically ill patients in emergency room was 1.5 days (the longest was 23.0 days, the shortest was 6 minutes), among them, 85.6% of the patients could be discharged from the emergency within 3 days, and 1.9% of the patients stayed in the emergency for more than 7 days. There were 305 deaths (9.6%), mainly among the elderly, with an average age of (71.10±16.08) years old. Conclusions Cardiovascular and cerebrovascular diseases, respiratory and digestive diseases are the main causes of acute critical diseases in department of emergency of Xuanwu Hospital Capital Medical University in 2017. Male and elderly patients are more common; different types of acute and severe patients tend to attack at different ages.
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To study the effect of practice while watching (PWW) teaching method in cardiopul-monary resuscitation training of standardized training residents. 196 standardized training residents were selected, and PWW teaching method was used to carry out cardiopulmonary resuscitation training and as-sessment. The results were significantly higher than that before the training, and the satisfaction rate of the residents to the PWW teaching method was 100%.PWW teaching method could improve the effect of stan-dardized training resident doctors in cardiopulmonary resuscitation,and increase the interest in learning.
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Objective: To compare the effects of bare-handed cardiopulmonary resuscitation (CPR) and cardiopulmonary resuscitator in emergency treatment. Methods: A total of 185 patients received CPR in our hospital from 2013-01 to 2015-10 were enrolled. The patients were divided into 2 groups: Bare-handed CPR (Bare-handed ) group, n=101 and Cardiopulmonary resuscitator (Mechanical) group, n=84;meanwhile, taking 30 min as border time, each group was further divided as short time CPR subgroup and long time CPR subgroup. High quality CPR was conducted in all patients. The success rates, time and blood levels of lactic acid after CPR were compared among short time subgroup, long time subgroup between Bare-handed group and Mechanical group respectively. Results: For short time CPR patients, the success rates, time and blood levels of lactic acid after CPR were similar between Bare-handed group and Mechanical group; for long term CPR patients, the success rates and time were similar between Bare-handed group and Mechanical group, while blood levels of lactic acid after CPR in Mechanical group (6.88 ± 1.82) mmol/L was lower than Bare-handed group (9.39 ± 2.39) mmol/L, P<0.05. Conclusion: The success rates of bare-handed CPR and mechanical CPR were similar for emergency treatment, both methods were effective; while mechanical CPR may save the manual labor, achieve better metabolic result which should be recommended in clinical practice.
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Adenine derivatives, in particular the scaffold bearing the acyclic nucleoside phosphonates (ANPS), possess significant antiviral and cytostatic activity. Till now, several effective adenine derivatives have been marketed for the treatment of HIV, HBV, CMV and other virus-infected diseases. These compounds are represented by tenofovir (PMPA), a medicine for both HIV and HBV, and adefovir as an anti-HBV agent. More than this, other analogs, such as GS9148, GS9131, and GS7340, are also well-known anti-viral agents that have been progressed to the clinical studies for their excellent activity. In general, the structures of these compounds include an adenine nucleobase linked to a phosphonate side chain. Considerable structural modifications on the scaffold itself and the peripheral sections were made. The structure-activity relationships (SARs) of this skeleton will provide valuable clues to identify more effective adenine derivatives as antiviral drugs. Here, we systematically summarized the SARs of the adenine derivatives, and gave important information for further optimizing this template.
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OBJECTIVE:To establish a method for determining the concentration of vinorelbine bitartrate in human plasma, and study the pharmacokinetic process of vinorelbine in human plasma. METHODS:The samples were extracted with Solid-phase extraction(SPE). LC-MS/MS was performed on the column of Agilent Extend C18 with the mobile phase of 5 mmol/L ammonium ac-etate solution(pH10.5)-acetonitrile-methano1(18∶10∶72,V/V/V)at the flow rate of 0.4 ml/min,the ion source was ESI and MRM mode was used to scan positive ion detection. The ion reaction of quantitative analysis was m/z 779.50→m/z 122.10 (vinorelbine) and m/z 811.60→m/z 224.50 (internal standard, vinblastine). 3p97 was used to calculate the pharmacokinetic parameters. RE-SULTS:The determination was not interfered by endogenous impurities,and there was no matrix effect;the lowest limit of quantita-tive analysis was 2.0 ng/ml with the linear range of 2.0-4 000.0 ng/ml(r=0.997 8);the linear range of vinorelbine in plasma was. The intra-day and inter-day precisions and accuracy results were all in line with the acceptable limit across all concentrations. t1/2γ of 30 mg/m2,40 mg/m2 Vinorelbine Emulsion for Injection groups and 30 mg/m2 Vinorelbine for Injection group were(37.958 ± 34.256)、(47.835±54.231)、(76.873±40.537)h respectively,cmax were(1 426.250±397.562)、(1 700.125±624.669)、(2 187.500± 828.040)ng/ml respectively,AUC0-48 h were(75 839±19 551)、(82 088±14 207)、(95 318±18 208)mg·h/L respectively. CONCLU-SIONS:The method is rapid,sensitive and specific,and suitable for the determination of vinorelbine and pharmacokinetic study. Metabolic processes of vinorelbine can be described as first order process of three-compartment model in cancer patients.
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Objective To study the mutation of STK11 gene in a Chinese family and a sporadic patient with Peutz-Jeghers syndrome (PJS),and to provide a basis for genetic diagnosis and counseling.Methods One sporadic patient and two patients from a family with PJS were collected,all of whom had typical mucosal pigmentation and gastrointestinal polyposis.Blood samples were obtained from the two patients and six unaffected relatives in this family,the sporadic patient,and 100 healthy controls.DNA was extracted,and PCR was performed to amplify nine exons and their adjacent introns in the STK11 gene followed by direct sequencing.The sequencing results were aligned to the published sequence of STK11 gene from Genbank.Results No mutation was found in the STK11 gene of any of the patients,unaffected relatives,or healthy controls.Conclusions Genetic heterogeneity exists in Peutz-Jeghers syndrome,hinting that there may be other causative genes or sites for this entity.
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Objective To study the effect of case-based learning(CBL) combined with problem-based learning (PBL) in emergency teaching for foreign students.Methods Totally 33 foreign students were selected in department of emergency,Xuanwu Hospital of Capital University of Medical Sciences and were randomly divided into the observation group (n =17) and control group (n =16).Students in observation group were taught by CBL combined with PBL while those in control group were taught by traditional teaching method.Theory examination,physical examination and Sirm4000 simulated cardiopulmonary resuscitation skill appraisal were given at the end of the internship and achievement differences were compared between 2 groups.Attitude on the teaching method was studied in observation group by questionnaire.SPSS 17.0 software was used for statistical analysis； measurement data were expressed as mean standard deviation ((x) ± s) ； independent sample t-test was applied for comparison between groups； P ＜ 0.05 stands for difference having statistical significances.Results Theory result was (83.5±7.9) in observation group and (76.6 ±8.7) in control group (P=0.012).Cardiopulmonary resuscitation skill score was (84.3 ± 10.1) in observation group and (75.6-± 11.3) in control group (P =0.013).100.0％ students thought that the teaching method could improve the ability of self-learning.Conclusions Teaching method of CBL combined with PBL can stimulate the students' interest in learning and improve students' achievement.
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Objective To study the prognostic value of modified early warning score (MEWS) and Acute Physiology and Chronic Health Evaluation (APACHE Ⅱ) score in emergency ICU elderly patients.Methods 113 elderly patients were collected in emergency ICU,after admission to calculate the MEWS score and APACHE Ⅱ score,the MEWS score and APACHE Ⅱ score difference were compared between death group and survival group.the differences were compared in MEWS score ≤ 3,4 ～6,7 ～ 9,≥ 10 scores groups respectively;analysis of the MEWS score and APACHE Ⅱ the relevance score.the correlation analysis of the MEWS score and APACHE Ⅱ score was given.Results The MEWS(7.91 ± 2.42) point and APACHE Ⅱ (21.9 ± 4.18) point in death group were greater than that in survival group [(4.51 ± 2.14) point,(19.53 ± 4.37) point] (t =7.49,2.70,all P ＜ 0.01).With MEWS score increasing,the fatality rate rose(P ＜0.01).the MEWS score and APACHE Ⅱ score was correlated(r =0.617,P ＜ 0.01).Conclusion The MEWS score was a simple and quick scoring system,as well as APACHE Ⅱ,it can predict the prognosis of elderly patients in emergency department,it has important application value.
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LC-MS/MS method was used to simultaneously determine anti-oxidative active catechins EGCG, ECG, EGC and EC in plasma of rats treated with tea polyphenols (TP). The integrated plasma concentration (C') of TP was calculated by means of self-defined weighing coefficient based on percent AUC of individual components, thereby assessing integrated pharmacokinetic (PK) parameters of TP via log C'-T curve. The anti-free radical effects of TP were estimated using inhibitory rate of drug-containing serum collected at different times from rats against in vitro lipid peroxidation of mouse liver homogenate. The obtained E-T curves were used to calculate anti-free radical pharmacodynamic (PD) parameters of TP. E-logC and E-log C' plots and linear regression were carried out in order to obtain the correlation coefficient (R2). The results indicated that the log C'-T curves of TP, which could be best described by three-compartment model, corresponded to elimination rule of iv administration of drugs. The integrated PK parameters showed that TP was distributed in body rapidly and widely, and eliminated from deep compartment slowly. From comparison of R2 values and consistence of C'-T course and E-T course, it was evident that TP integrated PK behaviors correlated much better with its PD behaviors than individual active components, and thus demonstrated that integrated PK parameters could characterize to maximal extent holistic disposition of Chinese herbal drugs and reflect residence properties of holistic effective substances in biological body.
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Objective To develop a liquid chromatography technique coupled with tandem mass spectrometry(LC-MS/MS)for simultaneous determination of four active catechins EGCC,ECG,EGC,and EC of tea polyphenols(TP)in rat plasma in order to further study its multi-component pharmacokinetics.Methods Following a single step liquid-liquid extraction of plasma samples with ethyl acetate,the four catechins were separated on a Hypersil ODS C18 column using an isocratic mobile phase composed of methanol-water(30:70).The detection using a mass spectrometer was performed under negative ESI in the MRM mode.The analytes were identified by reference to both MRM and tR values and quantified using peak area internal standard method.Results The method was shown to be specific without interference from matrix,metabolites,and impurities present in TP raw material and to be sensitive with LOD and LOQ of 1.5 and 10 ng/mL(EGCG)as well as 0.75 and 5 ng/mL(ECG,EGC,and EC).A good linearity was obtained over a wide range of 10-10000 ng/mL for EGCG and 5-5000 ng/mL for other three catechins(r > 0.996).The method was validated to be reproducible and reliable,as evidenced by intra-batch and inter-batch precision of less than 10% and 11%,accuracy of 97.13%-106.05% and 99.22%-103.14%,respectively.The recovery of extraction ranged from 72.74% to89.13%,matrix effect from 88.76% to 105.97% for four cateckins.The method was successfully used to study the pharmacokinetics of TP iv administered to rats at a dose of 100 mg/kg.Conclusion This method is shown to completely meet requirements for the multi-component pharmacokinetic study of TP in rats.
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Objective To investigate the changes of thyroid hormone levels and its relationship with prognosis in old patients with sepsis. Methods APACHE Ⅱ score and SIRS score were documented in 140 old patients with sepsis,who were divided into Multiorgan dysfunction syndrome (MODS) group and non MODS group. Results The levels of FT3 and FT4 descended obviously and APACHE Ⅱ score and SIRS score increased remarkably in old patients with severe sepsis(P <0.05 or P <0.01). The level of FT3 and FT4 in death group and MODS group was much lower than that in the survival group (P < 0.05). Conclusion Inflammatory resction and eytokines may effect the hypothalamic- pituitary-thyroid axis. The levels of thyroid hormone can reflect old patients with sepsis condition. The patients with severer conditions may have lower levels of thyroid hormone who will be more likely to died of MODS.
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Object To analyze and evaluate the result of using high fidelity Human Patient Simulator in the training of cardiopulmonary resuscitation.Methods Use SimMan4000 human analogue of Norway Laerdal company and the high fidelity Human Patient Simulator ofMedical Education Technology Incorporation,210 doctors were trained,and training contented contain cardiopulmonary resuscitation,malignant arrhythmia and respiratory failure.then,score was gaven by computer.The freeback questionnaire of trained residents were added up.Result The average score of artificial respiration and press chest outside were 65.41?24.36 and 75.62? 24.65 before training respectively,the scores were 88.37?22.45 and 88.23?21.46 after training respectively.The ability of cardiopulmonary resuscitation raised obviously(P
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Objective To study teaching method in emergency education of 7-year medical students during clinical practice. Methods 7-year program students during clinical practice were taught by PBL combined with computer simulation teaching and the teaching contents were acute coronary syndrome,upper gastrointestinal bleeding and cardiopulmonary resuscitation. The outcomes of theoretic examination,technique examination and teaching effect investigation were analyzed. Results After clinical practice,students’grades in acute coronary syndrome,upper gastrointestinal bleeding and cardiopulmonary resuscitation were improved obviously(P