Prevalence, risk factors and characteristics of delirium in intensive care unit patients: a prospective observational study / 中华危重病急救医学

OBJECTIVE@#To investigate the prevalence, risk factors, duration and outcome of delirium in intensive care unit (ICU) patients.@*METHODS@#A prospective observational study was conducted for critically ill patients admitted to the department of critical care medicine, the Affiliated Hospital of Guizhou Medical University from September to November 2021. Delirium assessments were performed twice daily using the Richmond agitation-sedation scale (RASS) and confusion assessment method of ICU (CAM-ICU) for patients who met the inclusions and exclusion criteria. Patient's age, gender, body mass index (BMI), underlying disease, acute physiologic assessment and chronic health evaluation (APACHE) at ICU admission, sequential organ failure assessment (SOFA) at ICU admission, oxygenation index (PaO2/FiO2), diagnosis, type of delirium, duration of delirium, outcome, etc. were recorded. Patients were divided into delirium and non-delirium groups according to whether delirium occurred during the study period. The clinical characteristics of the patients in the two groups were compared, and risk factors for the development of delirium were screened using univariate analysis and multivariate Logistic regression analysis.@*RESULTS@#A total of 347 ICU patients were included, and delirium occurred in 57.6% (200/347) patients. The most common type was hypoactive delirium (73.0% of the total). Univariate analysis showed statistically significant differences in age, APACHE score and SOFA score at ICU admission, history of smoking, hypertension, history of cerebral infarction, immunosuppression, neurological disease, sepsis, shock, glucose (Glu), PaO2/FiO2 at ICU admission, length of ICU stay, and duration of mechanical ventilation between the two groups. Multivariate Logistic regression analysis showed that age [odds ratio (OR) = 1.045, 95% confidence interval (95%CI) was 1.027-1.063, P < 0.001], APACHE score at ICU admission (OR = 1.049, 95%CI was 1.008-1.091, P = 0.018), neurological disease (OR = 5.275, 95%CI was 1.825-15.248, P = 0.002), sepsis (OR = 1.941, 95%CI was 1.117-3.374, P = 0.019), and duration of mechanical ventilation (OR = 1.005, 95%CI was 1.001-1.009, P = 0.012) were all independent risk factors for the development of delirium in ICU patients. The median duration of delirium in ICU patients was 2 (1, 3) days. Delirium was still present in 52% patients when they discharged from the ICU.@*CONCLUSIONS@#The prevalence of delirium in ICU patients is over 50%, with hypoactive delirium being the most common. Age, APACHE score at ICU admission, neurological disease, sepsis and duration of mechanical ventilation were all independent risk factors for the development of delirium in ICU patients. More than half of patients with delirium were still delirious when they discharged from the ICU.

Factors influencing pulmonary infection in elderly neurocritical patients and their predictive values: a data analysis for consecutive four-year / 中华危重病急救医学

Objective:To analyze the factors influencing pulmonary infections in elderly neurocritical patients in the intensive care unit (ICU) and to explore the predictive value of risk factors for pulmonary infections.Methods:The clinical data of 713 elderly neurocritical patients [age ≥ 65 years, Glasgow coma score (GCS) ≤ 12 points] admitted to the department of critical care medicine of the Affiliated Hospital of Guizhou Medical University from 1 January 2016 to 31 December 2019 were retrospectively analyzed. According to whether or not they had HAP, the elderly neurocritical patients were divided into hospital-acquired pneumonia (HAP) group and non-HAP group. The differences in baseline data, medication and treatment, and outcome indicators between the two groups were compared. Logistic regression analysis was used to analyze the factors influencing the occurrence of pulmonary infection.The receiver operator characteristic curve (ROC curve) was plotted for risk factors and a predictive model was constructed to evaluate the predictive value for pulmonary infection.Results:A total of 341 patients were enrolled in the analysis, including 164 non-HAP patients and 177 HAP patients. The incidence of HAP was 51.91%. According to univariate analysis, compared with the non-HAP group, mechanical ventilation time, the length of ICU stay and total hospitalization in the HAP group were significantly longer [mechanical ventilation time (hours): 171.00 (95.00, 273.00) vs. 60.17 (24.50, 120.75), the length of ICU stay (hours): 263.50 (160.00, 409.00) vs. 114.00 (77.05, 187.50), total hospitalization (days): 29.00 (13.50, 39.50) vs. 27.00 (11.00, 29.50), all P < 0.01], the proportion of open airway, diabetes, proton pump inhibitor (PPI), sedative, blood transfusion, glucocorticoids, and GCS ≤ 8 points were significantly increased than those in HAP group [open airway: 95.5% vs. 71.3%, diabetes: 42.9% vs. 21.3%, PPI: 76.3% vs. 63.4%, sedative: 93.8% vs. 78.7%, blood transfusion: 57.1% vs. 29.9%, glucocorticoids: 19.2% vs. 4.3%, GCS ≤ 8 points: 83.6% vs. 57.9%, all P < 0.05], prealbumin (PA) and lymphocyte count (LYM) decreased significantly [PA (g/L): 125.28±47.46 vs. 158.57±54.12, LYM (×10 9/L): 0.79 (0.52, 1.23) vs. 1.05 (0.66, 1.57), both P < 0.01]. Logistic regression analysis showed that open airway, diabetes, blood transfusion, glucocorticoids and GCS ≤ 8 points were independent risk factors for pulmonary infection in elderly neurocritical patients [open airway: odds ratio ( OR) = 6.522, 95% confidence interval (95% CI) was 2.369-17.961; diabetes: OR = 3.917, 95% CI was 2.099-7.309; blood transfusion: OR = 2.730, 95% CI was 1.526-4.883; glucocorticoids: OR = 6.609, 95% CI was 2.273-19.215; GCS ≤ 8 points: OR = 4.191, 95% CI was 2.198-7.991, all P < 0.01], and LYM, PA were the protective factors for pulmonary infection in elderly neurocritical patients (LYM: OR = 0.508, 95% CI was 0.345-0.748; PA: OR = 0.988, 95% CI was 0.982-0.994, both P < 0.01). ROC curve analysis showed that the area under the ROC curve (AUC) for predicting HAP using the above risk factors was 0.812 (95% CI was 0.767-0.857, P < 0.001), with a sensitivity of 72.3% and a specificity of 78.7%. Conclusions:Open airway, diabetes, glucocorticoids, blood transfusion, GCS ≤ 8 points are independent risk factors for pulmonary infection in elderly neurocritical patients. The prediction model constructed by the above mentioned risk factors has certain predictive value for the occurrence of pulmonary infection in elderly neurocritical patients.

Association between single nucleotide polymorphism of microRNA-146a and recurrence after liver cancer surgery / 临床肝胆病杂志

ObjectiveTo investigate the association between the single nucleotide polymorphism (SNP) of miRNA-146a rs2910164 and recurrence after liver cancer surgery. MethodsA total of 89 patients with primary liver cancer who underwent radical resection for liver cancer in Maojian Hospital of Dongfeng Medical Group were enrolled, and according to the presence or absence of postoperative recurrence, they were divided into recurrence group and non-recurrence group. The TaqMan probe method was used to determine the genotypes (G/C) of miRNA-146a rs2910164. The frequency of each genotype was compared between the two groups to investigate the association between the SNP of MicroRNA-146a and recurrence after liver cancer surgery. The independent-samples t test was used for comparison of continuous data between the two groups, the chi-square test was used for comparison of categorical data between the two groups, and multivariate logistic regression analysis was used to determine the factors associated with the recurrence of liver cancer. ResultsThe three genotypes of miRNA-146a G/C in non-recurrence group conformed to the Hardy-Weinberg equilibrium law (P＞0.05). After the surgery for liver cancer, the frequency of miRNA-146a G/C genotype showed a significant difference between the recurrence group and the non-recurrence group (χ2=9.115, P=0.010), and compared with the non-recurrence group, the recurrence group had a significantly higher frequency of miRNA-146a (rs2910164) CG genotype (χ2=4.013, P=0.039) and a significantly lower frequency of GG genotype (χ2=9.046, P=0.003). The multivariate logistic regression analysis showed that tumor diameter (OR=1.075, P=0.003 9) and miRNA-146a (rs2910164) CG genotype (OR=6.215, P=0.001 4) were the risk factors for recurrence after the surgery for liver cancer, and that miRNA146a(rs2910164) GG genotype was the protective factor against recurrence after the surgery for liver cancer (OR = 0.382, P=0002 5). ConclusionThe SNP of MiRNA-146a (rs2910164 C/G) is associated with recurrence after the radical surgery for liver cancer, and the CG genotype of rs2910164 may be the risk factor for postoperative recurrence after the surgery for liver cancer.

2011 after-service customer satisfaction survey of monitoring devices in Shanghai area / 中国医疗器械杂志

In 2011, Shanghai Medical Equipment Management Quality Control Center launched the fifth after-sale service satisfaction survey for medical devices in Shanghai area. There are 8 classes medical devices involving in the survey. This paper demonstrates the investigation results of monitoring devices which are from different manufacturers.

Hospital clinical engineer orientation and function in the maintenance system of hospital medical equipment / 中国医疗器械杂志

The quantity of medical equipment in hospital rise quickly recent year. It provides the comprehensive support to the clinical service. The maintenance of medical equipment becomes more important than before. It is necessary to study on the orientation and function of clinical engineer in medical equipment maintenance system. Refer to three grade health care system, the community doctors which is called General practitioner, play an important role as the gatekeeper of health care system to triage and cost control. The paper suggests that hospital clinical engineer should play similar role as the gatekeeper of medical equipment maintenance system which composed by hospital clinical engineer, manufacture engineer and third party engineer. The hospital clinical engineer should be responsible of guard a pass of medical equipment maintenance quality and cost control. As the gatekeeper, hospital clinical engineer should take the responsibility of "General engineer" and pay more attention to safety and health of medical equipment. The responsibility description and future transition? development of clinical engineer as "General Engineer" is discussed. More attention should be recommended to the team building of hospital clinical engineer as "General Engineer".

Biological Killing Effects of an Antitank Mine Explosion in Simulated Test:Pathomorphologic Observation / 第二军医大学学报

In this paper,we report the effective killing radius and the biological killing effects of the antitank mines after bursting to cut through a base deck of the tank.The mines had different types of structure and were exploded at various angles. It was found that the fragmentation damage was the primary killing factor and a blast wave came second, accompanied by a minor thermic burn. The incidence of the blast wave was higher than the casting structure when the antitank mines with separate layer structure were exploded, as compared to those with the casting structure, but there was no significant difference in the effective killing radius.

THE TOXIC EFFECT OF PRIMAQUINE ON THE HEARTS OF LABORATORY ANIMALS-A HISTOLOGICAL AND ULTRASTRUCTURAL INVESTIGATION / 第二军医大学学报

It has been known that quinoline antimalariai drugs may cause inhibition of heart conduction or Adamsstokes syndrome. Its morphologic bases were obscure, We observed the histological and ultrastructural features of dogs, monkey and rats, in the toxic experiments of primaquine, with the stress on the heart. Myo-cardial granular degeneration, eosinophilic degeneration, coaggulation necrosis,vacuolar degeneration and colliguative myocytolysis were found in most of the intoxicated dogs. The heart conduction systems of dogs also showed above mentioned lesions. Electro-microsopically the myocardial cells of intoxicated dogs showed swelling of mitochondria, dilatation of transvers tubules and sarcoplasmic reticulum, fusion or dissolution of myofibrils, deformity of nuclei, clumping of chromatin,and evertually cell necrosis. The severities of lesions were parallel to the doses of the drug used.These lesions were supposed to be the morpholoic bases of the intoxication symptoms and signs caused by primaquine. A few experimental rats also revealed myocardial eosinophilic degeneration, No important cardiac lesion was found in the experimental monkeys, but the pathologic changes in the liver were obv :ous. Different Species of laboratory animals showed different sensitivitiss to primaquine, but the heart lesions should be considered an important toxic effect of primaquine.