Time-related association between fluid balance and prognosis in sepsis patients: a cohort study based on MIMIC-IV database / 中华危重病急救医学

OBJECTIVE@#To investigate time-related association between fluid balance and prognosis in sepsis patients.@*METHODS@#A retrospective cohort study was conducted based on the data of sepsis patients in the Medical Information Database for Intensive Care-IV 2.0 (MIMIC-IV 2.0) from 2008 to 2019. Sepsis patients aged ≥ 18 years who were admitted to intensive care unit (ICU) for at least 2 days were included. The daily fluid balance and cumulative fluid balance (CFB) were calculated from days 1 to 7 after ICU admission. According to CFB,the patients were divided into negative fluid balance group (CFB% < 0%), fluid balance group (0% ≤ CFB% ≤ 10%), and fluid overload group (CFB% > 10%). In-hospital mortality was the primary outcome. Multifactorial Logistic regression was used to analyze time-related association between different CFB and the risk of in-hospital mortality in patients with sepsis during 7 days after ICU admission. In addition, subgroup analysis was performed on patients with septic shock and patients with sepsis who stayed in the ICU for 7 days or longer.@*RESULTS@#A total of 11 437 patients with sepsis were included, of which 6 595 were male and 4 842 were female. The mean age was (64.4±16.4) years. A total of 10 253 patients (89.6%) survived and 1 184 patients (10.4%) died during hospitalization. Compared with the survival group, patients in the death group were older, lighter, had higher sequential organ failure assessment (SOFA), simplified acute physiology score II (SAPS II), longer ICU stay, higher incidence of septic shock, and higher proportion of invasive mechanical ventilation, renal replacement therapy (RRT) and vasoactive drugs. In terms of comorbidities, congestive heart failure, renal disease, liver disease, and malignancy were more common in the death group. The death group had a higher daily fluid balance than the survival group during 7 days after ICU admission, the CFB in the two groups gradually increased with length of ICU stay. After adjusting variables such as age, gender, race, SOFA score, SAPS II score, comorbidities, and the use of invasive mechanical ventilation, RRT and vasoactive drugs, multivariate Logistic regression analysis showed that fluid overload on day 1 after ICU admission was a protective factor for the reduced risk of in-hospital mortality in sepsis patients [odds ratio (OR) = 0.74, 95% confidence interval (95%CI) was 0.64-0.86, P = 0.001]. However, fluid overload on day 3 was a risk factor for in-hospital mortality in sepsis patients (OR = 1.70, 95%CI was 1.47-1.97, P < 0.001) and the risk of in-hospital mortality was significantly increased from day 4 to day 7. Furthermore, the same results were obtained in patients with septic shock and sepsis patients who stayed in the ICU for 7 days or longer.@*CONCLUSIONS@#Fluid overload on day 1 was associated with reduced in-hospital mortality. However, from the third day, fluid overload increases the risk of in-hospital mortality. Thus, managing fluid balance at different times may improve prognosis.

The role of respiratory therapists in the treatment of coronavirus disease 2019 patients in China / 中华危重病急救医学

Objective:To investigate the clinical practice of Chinese respiratory therapists (RTs) participating in the treatment of coronavirus disease 2019 (COVID-19) patients and summarize the experience and role of RTs in the treatment of pandemic infectious diseases.Methods:A self-designed questionnaire was used to investigate the RTs who treated COVID-19 patients in 31 provinces, cities and autonomous regions in China. The survey questionnaire included the basic work of RTs, the specific work of the treatment for COVID-19 patients and problems encountered at work.Results:A total of 126 questionnaires were issued and 40 valid questionnaires were collected from RTs who treated COVID-19 patients at 22 COVID-19 designated hospitals in 8 provinces and municipalities. This included 7 hospitals in Wuhan, the epicenter of the epidemic. In their medical team, RTs accounted for 2.9% (1.5%, 6.7%) of medical staff, the working experience of the RTs was about (6.2±5.4) years, the ratio of RTs to beds was about 1∶11 (1∶5, 1∶26), and 85.0% (34/40) of RTs were transferred from other hospitals. 97.5% (39/40) of RTs were involved in formulating individual respiratory care strategies in their medical teams, and they were all involved in the evaluation of respiratory care and decision-making as well as the early identification of deterioration of respiratory function. All RTs [100% (40/40)] indicated that they would actively monitor patients' respiratory status, increase the means and frequency of the monitoring, implement standardized oxygen therapy, prevent ventilator-associated lung injury (VALI), and standardize the management of artificial airway. However, less than 50% of RTs had carried out stress and strain, transpulmonary pressure, partial pressure of end-tidal carbon dioxide (PetCO 2), end-expiratory lung volume, electrical impedance tomography (EIT) and other respiratory function monitoring. 85% of RTs conducted training and education related to respiratory care and formulated relevant standard operating procedures for their medical teams. More than 90% of RTs led the implementation of high-flow nasal cannula oxygen therapy (HFNC), pulmonary protective mechanical ventilation, prone ventilation, pulmonary rehabilitation, airway management, transfer of critical patients, and other respiratory treatment. Conclusions:RTs performed their professional role fully in the assessment, decision-making, and clinical practice in the treatment of COVID-19 patients. However, the manpower shortage of RTs is extremely prominent, the practical experience has provided the basis for the future treatment of infectious respiratory diseases and effectively promoted the development of respiratory care in China.

Annual progress in critical care medicine in 2020 / 中华危重病急救医学

The epidemic of coronavirus disease 2019 (COVID-19) puts higher demands on critical care medicine. Lots of studies have been conducted to solve COVID-19-related problems. Therefore, we reviewed the annual progress for COVID-19-related issues including antivirals threapies, respiratory support and immunomodulatory therapies and other critical issues, including the effect of antibiotic on mitochondrial damage and its relationship with sepsis, the goal and direction of antimicrobial de-escalation, drug prophylaxis of constipation, bleeding in gastrointestinal disorders and management of critical illness in the informalization era and so on. We hope to provide reference for clinical and scientific research work of the intensivists.

Expressions and clinical significances of IGF-1R and IRS-1 in squamous cell lung cancer / 实用肿瘤学杂志

Objective The aim of the study is to detect the expression of IGF -1R and IRS-1 in squa-mous cell lung cancer ( SQCLC) and to explore the role in the development of squamous cell lung cancer and clini -cal significance .Methods Specimens from 246 surgical SQCLC and 40 adjacent normal lung tissues were evalu-ated for IGF-1R and IRS-1 expression by immunohistochemistry .We explored the correlation between IGF -1R and IRS-1,their relationship with clinicopathological parameters and their impact on outcome in SQCLC pa -tients.Results SQCLC of IGF -1R positive expression rate was 54.07%,which was higher than in adjacent normal tissue(32.5%),SQCLC of IRS-1 positive expression rate was 38.21%,which was lower than in adja-cent normal tissue(70%),the pairwise difference was statistically significant (P<0.05);Expression of IGF-1R was correlated with lymph node metastasis (P<0.05),IRS-1 expression was related with degree of differentia-tion and lymph node metastasis (P<0.05).Survival of IGF -1R expression group of patients was significantly shorter than the expression of IGF -1R negative patients ,the survival of the IRS-1 expression was significantly longer than patients who negatively expressed IRS -1,the difference was statistically significant (P=<0.001 and=0.021).IGF-1R was negatively correlated with IRS -1 expression in SQCLC(r=-0.125,P<0.001). Conclusion IGF-1R,IRS-1 are involved in the occurrence of SQCLC ,the development .The IGF-1R is an independent prognostic factor in SQCLC .

The progress on cell signaling pathways related lung cancer / 实用肿瘤学杂志

Lung cancer is one of the most common malignant tumors in the world .However,its pathogen-esis is still unclear .With the deep research of related signal pathways underlying the development ,progression and prognosis of lung cancer , we find that the mTOR signaling pathway , JAK-STAT pathway , Notch signaling and IGF have been identified to play a major role in the growth ,proliferation,differentiation,apoptosis and invasion of tumor cells.Therefore this paper is to review the effects of the above several pathways ,which may prove a new ba-sis for the pathogenesis and therapy of lung cancer .

Determination of four alkaloids in Corydalis decumbens by HPLC / 中国中药杂志

<p><b>OBJECTIVE</b>To establish a quantitative HPLC method for determination of protopine, palmatine hydrochloride, bicuculline and tetrahydropalmatine, in Corydalis decumbens.</p><p><b>METHOD</b>The separation was performed on a ZORBAX Eclipse XDB-C18 column (4.6 mm x 150 mm, 5 microm) at a flow rate of 1.0 mL x min(-1) using mixtures of two solvents [A(20 mmol x L(-1) ammonium acetate)-B(acetonitrile)]: with a gradient elution. The column oven temperature was 30 degrees C and the detection wavelength was set at 280 nm.</p><p><b>RESULT</b>The 4 alkaloids were well separated by this HPLC method. Linearifies of protopine, palmatine hydrochloride, bicuculline and tetrahydropalmatine were good in the ranges of 1.44-46.0 (r = 0.999 4), 1.2640.2 (r = 0.999 8), 1.37-44.0 (r = 0.999 9), and 1.3643.6 mg x L(-1) (r = 0.999 9), respectively. The average recoveries were 98.2% with RSD 2.7% for protopine, 101.9% with RSD 2.5% for palmatine hydrochloride, 102.8% with RSD 3.5% for tetrahydropalmatine, and 98.8% with RSD 3.1% for tetrahydropalmatine.</p><p><b>CONCLUSION</b>This method is proved to be convenient, reliable and accurate., and it can be used for quality control of C. decumbens.</p>

Preliminary discussion on the relationship of pregnancy to endometrial thickness and its change range / 重庆医科大学学报

Objective:To study the endometrial thickness on the day of M3 and on the day of HCG administration and relationship between pregnancy and the thickness change.Methods:120 unexplained infertility patients were divided into pregnancy group and non-pregnancy group according to the treatment outcome, The thickness of endometrium on the day of menses day3(M3)and on the day of HCG administration and the increase in HMG stimulating cycles were analysed. Resufts:The thickness of endometrium in the pregnancy and non- pregnancy group on respectively the day of M3 were 5.42?1.05mm(pregnancy group)and 5.43?1.08mm(non-pregnancy group),on the day of HCG administration were 10.76?l.68 mm(pregnancy group)and 9.25?I.75mm(non-pregnancy group)respectively,The chang in the two groups between this two test points were5.26?l.67mm and 3.89?l.40mm respectively.Conclusion:The endometrial thickness in the pregnancy group on the day of HCG administration is thicker than that in non-pregnant group. The functional layer plays a more important role in pregnancy.