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Objective:To investigate the effect of septic shock rapid response team (SSRRT) on the compliance and prognosis of hour-1 bundle therapy strategy in emergency department patients with septic shock.Methods:This study was conducted on emergency patients with septic shock who were admitted to Huai’an First Hospital Affiliated to Nanjing Medical University from January 2020 to December 2021. The inclusion criteria were emergency patients with septic shock who met the international guideline for surviving sepsis campaigns (Sepsis 3.0). Exclusion criteria: age<18 years, pregnant patients, patients transferred from another hospital who had received fluid resuscitation and/or vasoactive drugs, patients requiring emergency surgery, patients with emergency detention time<1 h, patients who refused to place central venous catheterization or had contraindications for catheterization, and patients who refused to give informed consent. SSRRT was established in January 2021. According to the establishment of SSRRT, patients were divided into the pre-SSRRT intervention group and the post-SSRRT intervention group. The general clinical data of the enrolled patients were collected, including vital signs, lactate, fluid resuscitation volume, maximum vasoactive drug pumping rate at the diagnosis of septic shock, implementation of hour-1 bundle therapy strategies, and ICU and 28-day mortality. Statistical software SPSS 25.0 was used. Pearson chi-squared test was used to compare categorical variables between groups, and Mann-Whitney U test was used to compare continuous variables between groups.Results:A total of 289 emergency patients met the inclusion criteria, 115 patients were excluded, and 174 patients were eventually included, including 83 patients in the pre-SSRRT group and 91 patients in the post-SSRRT group. Compared with the pre-SSRRT group, the proportion of lactate monitoring (54.2% vs. 100.0%, P<0.001), blood culture (27.7% vs. 93.4%, P<0.001), antibiotics (57.8% vs. 97.8%, P<0.001), fluid resuscitation volume ≥ 30 mL/kg (4.8% vs. 34.1%, P<0.001), and mean arterial pressure ≥ 65 mmHg (49.4% vs. 68.1%, P<0.001) were significantly increased. There was no significant difference in ICU mortality (50.6% vs. 37.4%, P=0.079) or 28-day mortality (53.0% vs. 38.5%, P=0.054) between the two groups. Conclusions:SSRRT can significantly improve the compliance of hour-1 bundle therapy strategy implementation in patients with emergency septic shock, and has a trend of decreasing mortality.
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Objective:To investigate the implementation status of sepsis hour-1 bundle strategy for patients with septic shock in emergency department.Methods:A total of 116 septic shock patients admitted to the emergency department from January 2020 to December 2020 were included in this prospective study, and the implementation of sepsis bundles and the clinical outcomes of patients were recorded.Results:Among 116 patients, 20 cases (17.2%) had lactic acid monitored within 1 h, 20 cases (17.2%) had blood culture before antibiotics, 82 cases (70.1%) received broad-spectrum antibiotics, 16 cases (13.8%) received fluid resuscitation ≥30 ml/kg, and 57 cases (49.1%) received vasoactive drugs during resuscitation. Finally, the sepsis hour-1 bundle strategy was fully implemented only in 13 cases (11.2%). Compared with the group with incomplete implementation of sepsis hour-1 bundle strategy, the volume of fluid recovery in the group with full implementation was significantly increased [33.7 (30.0,37.5) vs. 8.9(7.3,10.8) ml/kg, Z=-4.78, P<0.001], mean artery blood pressure significantly increased [70.0 (70.0,76.7) vs. 67.7 (61.7,76.7)mmHg(1 mmHg=0.133 kPa) , Z=-2.00, P<0.001], and lactic acid significantly decreased [3.0 (2.0,3.2) vs. 4.4 (3.7,7.2) mmol/L, Z=-2.76, P=0.006]. However, there were no significant differences in ICU mortality, in-hospital mortality and 28-day mortality between the two groups ( P>0.05). Conclusions:Septic shock patients in emergency department have poor compliance with the implementation of sepsis hour-1 bundle strategy, and relevant management training should be strengthened.
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Objective:To evaluate the effects of neuromuscular blocking agents (NMBA) on oxygenation and respiratory conditions in patients with acute respiratory distress syndrome(ARDS).Methods:English databases such as MEDLINE, Embase and Web of Science were searched online, as well as Chinese databases such as China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database and Wanfang Database. Randomized controlled trials (RCTs) of NMBA therapy for ARDS with publication date up to May 2020 were retrieved. Literature was screened according to inclusion and exclusion criteria, and the main analysis indicators were oxygenation index.Results:A total of 5 RCTs were included, and 1 462 ARDS patients were enrolled. Compared with the control group, the ratio of partial arterial oxygen pressure to fraction of inspired (PaO 2)/(FiO 2) significantly improved in the intervention group after 72 hours MD=14.39, (95 %CI 6.40-22.38, P=0.000 4) and 96 hours of NMBA, but there was no difference between PaO 2/FiO 2 at 24 and 48 hours ( P>0.05).Positive end expiratory pressure (PEEP) significantly decreased at 72 hours ( MD=-0.45, 95 %CI -0.87--0.03, P=0.04) and 96 hours ( MD=-0.82, 95 %CI -1.39--0.26, P=0.004) treatment with NMBA, while there was no significant difference in PEEP between 24 and 48 hours after treatment ( P>0.05). At 96 h, plateau pressure (Pplat) in the intervention group was significantly lower ( MD=-1.69, 95 %CI -2.64--0.75, P=0.000 4), and there was no significant difference in Pplat between 24, 48 and 72 h after treatment ( P>0.05). Conclusion:The early use of NMBA within 48 hours has a delayed improvement effect on oxygenation and ventilator conditions in ARDS patients.
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During the Huai′an Emergency Alliance meeting in January 2020, 143 emergency physicians from 21 level Ⅱ general hospitals in the region who attended the meeting, participated in a questionnaire survey on the knowledge of hour-1 bundle therapy for septic shock. The average score of the correct answer was (5.4±2.9), that for senior ( n=39), intermediate ( n=50) and primary ( n=54) physicians was (6.4±3.3), (6.0±3.2) and (3.4±1.9), respectively ( P<0.01); the rate of failure (≤5) for them was 28% (11/39), 40% (20/50) and 56% (30/54) ( P=0.03), respectively. The hour-1 bundle was summarized into four measures. For the measure of "blood culture", 95% of all levels emergency physicians answered correctly. In answering question of "liquid resuscitation and vasoactive drugs" the accurate rate was 15% (6/39), 24% (12/50) and 7% (4/54) for senior, intermediate and primary physicians; while in answering questions about other measures the overall correct rates were all around 50%. The correct rate for "time of implementing the bundle" in intermediate, senior and primary physicians was 60% (30/60), 59% (23/39) and 44% (24/54); for "monitoring lactate timing" in intermediate, senior and primary physicians was 64% (32/50), 80% (31/39) and 65% (35/54); for the target value of "MAP" was 68% (34/50), 62% (24/39) and 50%(27/54); for the "use time of vascular active drug" was 50% (25/50), 46% (18/39) and 17% (9/54), respectively. The survey suggested that the knowledge of hour-1 bundle therapy for septic shock among emergency physicians in Huai′an secondary general hospitals are insufficient, and relevant training should be strengthened.
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Objective@#To understand the knowledge and behavior towards COVID-19 among primary and middle school students in Guangdong province, so as to provide basis for health education on epidemic prevention and control.@*Methods@#An online questionnaire survey was conducted among 1 222 403 primary and middle school students in Guangdong Province from March 8 to 31, 2020.@*Results@#In Guangdong Province, 96.28%, 80.01% and 38.58% of primary and middle school students knew the transmission route of the novel coronavirus was droplet transmission, contact transmission and aerosol transmission respectively, and 78.22% of the students knew the two main transmission routes. Among COVID-19 prevention and control measures, the top three well-known measures were mask wearing(99.69%), frequent hand washing(99.06%) and social distancing(96.21%). During the pandemic, 88.48% of students wore masks every time they went out, 32.15% reported that they needed parental supervision, and 53.97% reported they would continue wearing masks after the pandemic. 87.21% of students washed their hands every time after going out, 18.78% reported that they needed parental supervision, and 94.92% reported that they would continue washing their hands frequently after the pandemic.@*Conclusion@#Primary and middle school students in Guangdong Province had high rates of awareness on transmission route and prevention and control measures of COVID-19. During the pandemic, the rates of wearing masks or washing hands every time after going out was high, and the rates of behavior intention of washing hands after the pandemic was high.
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Objective To evaluate the effects of intra-aortic balloon counterpulsation (IABP) on mortality of patients with acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI).Methods Randomized controlled trials (RCTs) of IABP compared with non-IABP control in AMI patients, from January 1970 to May 2015, were searched from MEDLINE, Embase and Web of Science.The data were analyzed with software RevMan 5.0.Results Five RCTs involving 1 450 AMI patients, including 722 treated with IABP (IABP group) and 728 without IABP (non-IABP group), were included for analysis.Compared with non-IABP group, IABP did not significantly decrease the hospital mortality or 30-day mortality (OR=0.92, 95%CI: 0.69-1.25,P=0.61).According to the timing of IABP before or after PCI, it was further divided into IABP-before-PCI subgroup and IABP-after-PCI subgroup.Compared with non-IABP group, the 30-day mortality was not decreased in IABP-before-PCI subgroup or in IABP-after-PCI subgroup (OR=0.64, 95%CI: 0.23-1.78,P=0.39;OR=1.25, 95%CI: 0.42-3.77,P=0.69, respectively).According to complicating with cardiogenic shock (CS) or not, patients were divided to AMI with CS subgroup and AMI with no-CS subgroup;the hospital or 30-day mortality were not significantly decreased in both subgroups (OR=0.96, 95%CI: 0.70-1.32,P=0.80;OR=0.68, 95%CI: 0.28-1.70,P=0.27, respectively).Conclusion IABP does not decrease the 30-day mortality of AMI patients treated with PCI.
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Objective To investigate the relationship and clinical significance between the concentration of 25-hydroxy vitamin D3 [25-(OH)D3 ]in the serum and community-acquired pneumonia(CAP)in infants.Methods The study recruited 98 infants.There were 68 cases of mild pneumonia and 30 cases of severe pneumonia.The con-centration of 25-(OH)D3 in serum,IgA and alkaline phosphatase(AKP)were measured.33 infants who accepted physical examination in the outpatient department were selected as control group at the same time.Results The serum 25-(OH)D3 concentration of severe pneumonia was (21.09 ±7.32)ng/mL,mild pneumonia was (25.77 ± 8.06)ng/mL and the control group was (37.13 ±6.94)ng/mL.The differences among the three groups had statisti-cally significant differences(t =9.18,3.72,5.34,all P 0.05).The prevalence of Vitamin D deficiency was 40.0%,which was higher than mild pneumonia patients(20.6%)and the healthy children(9.1%)(χ2 =8.43,17.55,all P <0.05).Conclusion The serum 25-(OH)D3 concentration and IgA of CAP patients were lower than healthy children,especially in severe pneumonia cases.The prevalence of Vita-min D deficiency was significantly higher than healthy children.There were no relevance between the serum concentra-tion of 25-(OH)D3 ,IgA and AKP.25-(OH)D3 plays an important role in the development of CAP.The low level of serum 25-(OH)D3 concentration may be one of the risk factors and has correlation to the severity of pneumonia.
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Objective To evaluate the effects of laparoscopic filling with pedicled greater retina for hepatic cysts. Methods Clinical data were reviewed on 36 patients with hepatic cysts undergoing laparoscopic filling with pedicled greater retina from January 2010 to May 2014.The diameters of cysts ranged from 10 to 26 cm, with a diameter smaller than 20 cm in 29 patients and bigger than 20 cm in 7 patients.Laparoscopic fenestration of hepatic cysts was performed to destroy cyst cells with iodine and absolute alcohol. Pedicled greater retina was used for filling the cavity of cysts. Results The procedures were completed smoothly.The operative time was 45-115 min, with an average of (80.4 ±13.1) min.No abdominal cavity infection happened.Primary healing of abdominal incision was achieved in all the patients.The postoperative hospital stay was 5-10 d, with an average of (6.4 ±1.2) d.All the 36 patients were followed up for 6-12 months with a mean of (9.3 ±1.5) months.None of the patients showed recurrence under liver B-ultrasonography or CT scanning. Conclusion Laparoscopic filling with pedicled greater retina for hepatic cysts has advantages of minimal invasion, quick postoperative recovery, short hospital stay, and good results.
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One case of secondary bleeding repeatedly after tonsillectomy. Secondary bleeding after tonsillectomy seldom happen to us. When the event occurs medical staff has to take effect way to control the bleeding immediately. Accumulated quantity of bleeding must be controlled to the lowest point as soon as possible. Other wise the bleeding may lead to death. This point should be considered by medical staff.
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Humans , Postoperative Hemorrhage , TonsillectomyABSTRACT
This study is to establish physiologically based pharmacokinetic (PBPK) models of famitinib in rat and monkey, and then to predict the pharmacokinetics and tissue distribution of famitinib in human based on the PBPK models. According to published paper, previous studies and the chemical properties of famitinib predicted by ACD/ADME suite and SimCYP, the PBPK models of rat and monkey were established and optimized using GastroPlus. And then, the PBPK models were applied to predict the pharmacokinetic and tissue distribution of famitinib in human. The results showed that the PBPK models of rat and monkey can fit the observed data well, and the AUC0-∞, ratios of observed and calculated data in rat and monkey were 1.00 and 0.97, respectively. The AUC0-∞, ratios of observed and predicted data in human were 1.63 (rat to human) and 1.57 (monkey to human), respectively. The rat and monkey PBPK models of famitinib were well established, and the PBPK models were applied in predicting pharmacokinetic of famitinib in human successfully. Hence, the PBPK model of famitinib in human could be applied in future drug-drug interaction study.
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OBJECTIVE@#In order to raise awareness of CSD and reduce misdiagnosis, we study the manisfection and treatment of CSD with enlarged masses.@*METHOD@#A retrospective study was carried out among the 10 identified patients with CSD on the basis of compatible clinical presentation and confirmatory pathology results for CSD.@*RESULT@#All the 10 patient's first symptoms were masses at some part of the body, more common in the neck. The ratio was 5% at neck, 3% at armpit, 1% at upper, 1% at groin. Two patients had low heat, increased leukocyte and larger masses of more than 2 cm in diameter After surgical resection, and anti-inflammatory treatment. All the patients were cured after surgery and postoperative anti-inflammatory treatment, and there was no recurrence during the 7-year follow-up.@*CONCLUSION@#If patients were diagnosed and treated timely, the prognosis will be good. For the cases with extremely enlarged lymphonodus, surgical operation followed by antimicrobial chemotherapy will be a effective treatment.
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Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Cat-Scratch Disease , Diagnosis , Lymphatic Diseases , Diagnosis , Retrospective StudiesABSTRACT
Objective To investigate the multi-organ lesions and the occurrence of coronary aneurysms in children with Kawasaki disease(KD).Methods 92 pediatric inpatients with KD were enrolled and studied.The organs involved and coronary aneurysms(CAA)were determined by checking blood routine,urine routine,stool routine,chest X-ray,electrokardiogram,liver function,echocardiogram,and clinical manifestation.Results The incidence of various organs involved in 92 patients with KD:heart 71.7%;lung 37.0%;liver 34.8%;brain 12.0%;kidney 18.5%;gastrointestinal tract 15.2%;spleen 2.2%;gallbladder 1.1%;joints 9.8%.In addition,the rate of two organs involved simultaneously was 40.2%,three and more 34.8%.The incidence of CAA in brain lesion,joints lesion and pericardial effusion complications of KD was 45.5%,44.4%,and 41.7%,respectively.Conclusions The data shows that the incidence of heart involvement in the sick-children with KD is highest,and other organs,such as lung,liver,kidney,gastrointestinal tract,brain and joints are involved in turn.The incidence of 2 and more organs involved simultaneously amounts to75.0%.CAA is the most serious complication of KD.Our study suggests that the incidence of CAA is obviously high in these lesions of brain,joints and pericardial effusion involvement in KD.
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0.05)except that the tmax of the testing preparation was faster than that of the control drug.The relative bioavailability of the testing drug was(93.83?15.21)%.CONCLUSION:The AUC0～24,AUC0～∞and Cmax of 2 preparations are similar,but there is a significant difference in tmax.