Predictive factors for poor prognosis of young patients with upper gastrointestinal bleeding in emergency department / 中华急诊医学杂志

Objective:To investigate the prognostic risk factors of young patients with upper gastrointestinal bleeding (UGIB) in emergency department (ED), so as to improve the efficiency of emergency treatment and diversion of these patients.Methods:A retrospective analysis was performed on the clinical data of young patients with UGIB in the ED of Hainan Provincial People's Hospital from January 1, 2019 to December 30, 2020. In-hospital mortality was the primary endpoint of the study, and admission to the Intensive Care Unit (ICU) and length of hospital stay were the secondary endpoints. Inclusion criteria: (1) patients met the diagnostic criteria of acute UGIB; (2) age ranged from 18 to 40 years old; and (3) complete clinical data. Exclusion criteria: (1) bleeding and hemoptysis from the mouth, nose and throat; (2) gastrointestinal bleeding occurred in hospital; (3) lower gastrointestinal bleeding; (4) incomplete clinical data.Results:Among the 383 patients, 268 (70.0%) underwent upper gastrointestinal endoscopy, and the most frequent endoscopic diagnoses were duodenal ulcer (64.6%) and esophageal-gastric varices bleeding (16.8%). Seventy-one (18.5%) patients required endoscopic treatment, 5 (1.3%) patients required surgical treatment, and 7 (1.8%) patients required intervention treatment. The mortality rate was 2.1%, the ICU admission rate was 2.3%, and the length of hospital stay was 5 (3, 6) d. The ICU admission rate and mortality rate were significantly higher in patients with liver disease and in patients with syncope/coma (all P<0.05). Patients with thrombocyte levels (<120×10 9/L) had a significantly longer length of hospital stay than that of patients with normal platelets [8 (5, 11) d vs. 4 (3, 6) d, P<0.001]. The dead patients had significantly higher white blood cell count, urea nitrogen, creatinine, aspartate aminotransferase, alanine aminotransferase and activated partial thrombin time levels (all P<0.05), and significantly lower hemoglobin, albumin, SpO 2 and Glasgow coma score (GCS) levels (all P<0.05). Low GCS was an independent risk factor of ICU admission ( OR=33.973, 95% CI: 1.582~729.417, P=0.024) and mortality ( OR=20.583, 95% CI: 1.368~309.758, P=0.029). Conclusions:The poor prognostic factors of young patients with UGIB in ED are concomitant liver disease, syncope/coma, co-infection, hyperazotemia, impaired kidney function, liver dysfunction, coagulopathy, anemia, and low SpO 2, low GCS, and low hypoproteinemia on admission.

Expert consensus on prevention and cardiopulmonary resuscitation for cardiac arrest in COVID-19

Background: Cardiopulmonary resuscitation (CPR) strategies in COVID-19 patients differ from those in patients suffering from cardiogenic cardiac arrest. During CPR, both healthcare and non-healthcare workers who provide resuscitation are at risk of infection. The Working Group for Expert Consensus on Prevention and Cardiopulmonary Resuscitation for Cardiac Arrest in COVID-19 has developed this Chinese Expert Consensus to guide clinical practice of CPR in COVID-19 patients. Main recommendations: 1) A medical team should be assigned to evaluate severe and critical COVID-19 for early monitoring of cardiac-arrest warning signs. 2) Psychological counseling and treatment are highly recommended, since sympathetic and vagal abnormalities induced by psychological stress from the COVID-19 pandemic can induce cardiac arrest. 3) Healthcare workers should wear personal protective equipment (PPE). 4) Mouth-to-mouth ventilation should be avoided on patients suspected of having or diagnosed with COVID-19. 5) Hands-only chest compression and mechanical chest compression are recommended. 6) Tracheal-intubation procedures should be optimized and tracheal-intubation strategies should be implemented early. 7) CPR should be provided for 20-30 min. 8) Various factors should be taken into consideration such as the interests of patients and family members, ethics, transmission risks, and laws and regulations governing infectious disease control. Changes in management: The following changes or modifications to CPR strategy in COVID-19 patients are proposed: 1) Healthcare workers should wear PPE. 2) Hands-only chest compression and mechanical chest compression can be implemented to reduce or avoid the spread of viruses by aerosols. 3) Both the benefits to patients and the risk of infection should be considered. 4) Hhealthcare workers should be fully aware of and trained in CPR strategies and procedures specifically for patients with COVID-19.

Efficacy of cryoablation combined with zoledronic acid sequential therapy for bone metastases pain / 国际肿瘤学杂志

Objective To investigate the clinical efficacy and safety of cryoablation combined with zoledronic acid sequential therapy for bone metastases pain. Methods Twenty-four patients from our depart-ment suffering from malignant tumors with moderate to severe pain due to bone metastases were enrolled in this study. Those patients with 28 metastatic bone tumors were successfully treated with cryoablation operations under CT-guided. Three days after cryoablation they were offered zoledronic acid(4 mg added in 100 ml normal saline,dripping for more than 15 min),once 4 weeks. Pain level and life quality were respectively evaluated by NRS(Numerical rating scale)and KPS(Karnofsky performance status),before cryoablation,3 days after cryoablation,2 weeks and 12 weeks after zoledronic acid sequential therapy. Results Without serious compli-cations,all of 24 patients were successfully punctured to tumor lesions. Patients’pain scores were 7. 70 ± 0. 86 (before cryoablation),3. 29 ± 0. 95(3 d after cryoablation),2. 54 ± 0. 83(2 weeks after zoledronic acid sequential therapy)and 2. 17 ± 0. 76(12 weeks after zoledronic acid sequential therapy),with a significant sta-tistical difference between pretherapy and post-treatment(F = 530. 64,P < 0. 001);during observation period after treatment,the effective rate in pain was 91. 67% . KPS scores were 45. 83 ± 6. 54(before cryoablation), 49. 58 ± 6. 24(3 d after cryoablation),61. 67 ± 7. 01(2 weeks after zoledronic acid sequential therapy)and 78. 33 ± 8. 68(12 weeks after zoledronic acid sequential therapy),with a significant statistical difference between pretherapy and post-treatment(F = 418. 99,P < 0. 001);during observation period after treatment, the effective rate in KPS was 75. 00% . Six months after the treatment,there were 10 cases of CR,11 cases of PR,and the effective rate was 87. 50% . Conclusion Cryoablation combined with zoledronic acid may be an effective therapeutic method with good safety in the treatment of patients with bone metastases pain.

To assess the prognosis of patients with return of spontaneous circulation after cardiac arrest by shock index and adjusted shock index / 中华急诊医学杂志

Objective To examine the usefulness of shock index (Sl) and adjusted shock index (corrected to temperature) (ASI) in predicting prognosis of patients with return of spontaneous circulation after cardiac arrest.Methods A prospective study,which data such as vital signs of the cases were collected by the Utstein template,was conducted in 111 of cases with return of spontaneous circulation after cardiac arrest to assess the value of SI and ASI for predicting their prognoses.Results There was no evidence to show difference between the cases with survival to hospital discharge and the ones who died about systolic blood pressure and heart rate (P ＞0.05).SI and ASI [(1.109 ±0.428) and (1.082 ±0.410)] of the group of death were higher significantly than the ones [(0.899 ± 0.303) and (0.844 ± 0.265)] of the group with survival to hospital discharge,P ＜ 0.05.The risk of death was elevated in the group with ASI ＞ 1.1,which odds ratio (5.4) higher than the ones of systolic blood prcssure ＜90 mm Hg (1.6)and ventricular rat ＞ 100 beat/min (3.1) significantly.The odds ratio of death with AS ＞ 1 was 2.8.Conclusions Shock index and adjusted shock index are easy to derive and conducive to predict effectively diseases prognosis such as survival to hospital discharge or death of patients with ROSC.

A prospective investigation of the epidemiology of in-hospital cardiopulmonary resuscitation using the international Utstein reporting style / 中华急诊医学杂志

Objective To investigate the usefulness of Utstein template to guide the assessment and study of cardiopulmonary resuscitation (CPR) in our medical practice because it has been popularized in many countries since 1991.Methods A prospective observational study using Utstein CPR registry form to evaluate the epidemiological features and outcomes of 511 patients resuscitated in the emergency department.Results Of 511 CPR patients registered,higher cardiac arrest rates were observed in the group of patients aged 40- 70 years. In 511 CPR patients registered,preexisting chronic diseases were common including cardiovascular diseases ( 190,37.2％ ) cerebrovascular diseases (48,9.4％ ) and respiratory diseases (39,7.6％ ).Of them,173 cardiac arrest patients (33.9％) had underlying cardiac causes,such as acute myocardial infarction (AMI) found in 109 (21.3％) patients,and ventricular fibrillation witnessed during first cardiac monitoring in eighty ( 15.7％ ) patients.The restoration of spontaneous circulation (ROSC) rate and survival rate at discharge of in - hospital cardiac arrest (IHCA) patients were 47.0％ and 13.5％respectively,but 16.7％ and 4.7％ respectively in the out - hospital cardiac arrest (OHCA) patients (P ＜0.01,both ). Conclusions This study indicated that the cardiovascular diseases, cerebrovascular diseases,and respiratory diseases were the most common preexisting chronic diseases found in cardiac arrest patients.Myocardial infarct,stroke and trauma were the most common precipitation causes of cardiac arrest in the recruited patients.The rates of ROSC and survival at discharge were significantly higher in statistics in patients with IHCA than those in ones with OHCA.

Cryoablation and anti-tumor inmune response / 国际肿瘤学杂志

Cryoablation,a kind of physical ablation for tumor treatment,is minimally invasive,safe and effective.Studies suggest that cryoablation can not only kill tumor cells directly,but also the anti-tumor immune response triggered by cryoablation plays an important role in inhibiting the growth of local tumors and eliminating the residual tumor cells.

A multi- centre study of cardiopulmonary resuscitation by using the Hainan Utstein templates for resuscitation registries / 中华急诊医学杂志

Objective To study the Hainan Utstein templates used for cardiac arrest and resuscitation registries to evaluate the epidemiological characteristics and outcomes of the patients with CPR by multi-center study. Methodsccording to the Utstein templates for cardiac arrest and CPR set by International Liaison Committee on resuscitation in 2004, a Hainan Utstein CPR registry chart was designed and a prospective descriptive study was carried out to evaluate the epidemiological characteristics, impact factors and outcomes of the patients with resuscitation attempt in emergency departments of thirteen hospitals in Hainan Island between January 2007 and December 2010.Results Of 1125 patients with cardiac arrest, male accounted for 73. 8％ and female was 26. 2％. The mean ( ± S. D) age of the cardiac arrest patients was 53.9 ± 13. 1 years old.Coronary heart diseases and hypertension were the most common preexisting chronic diseases in the studied patients. The ROSC rate and discharge rates after survival in 1125 patients with CPR were 23. 8％ and 7.4％ respectively. The ROSC rate and discharge rates after survival were 36. 3％ and 11.6％ in the in-hospital cardiac arrest (IHCA) group, respectively whereas 11.5％ and 3. 3％ in out-hospital cardiac arrest (OHCA) group. Of 188 patients with ventricular fibrillation/Pulseless ventricular tachycardia, the ROSC rate and discharge rate after survival were 58.0％and 21.8％,respectively. Of them, 448 (39. 8％ ) of the cardiac arrest patients had underlying cardiac causes, and the ROSC rate and discharge rate after survival were 36. 3％ and 11.5％ respectively in IHCA group whereas 11.6％ and 3. 3％ in OHCA group. The ROSC rate and discharge rate after survival were 69. 8％ and 7. 4％respectively in the tertiary hospitals whereas 30. 2％ and 7. 3％ in the secondary hospitals. Conclusions Patients experienced cardiac arrest were predominantly male. Coronary heart disease and hypertension were the two most common preexisting chronic diseases. The ROSC rate and discharge rate of patients with IHCA were higher than those with OHCA. ROSC rate and discharge rate after survival were higher in the ventriculat fibrillation/Pulseless ventricular tachycardia group than the other cardiac rhythms first witnessed groups. The time delayed of starting CPR after onset of cardiac arrest had a critical impact on survival and discharge rate in both IHCA and OHCA groups.

Correlative study between portal vein pressure and portal hemodynamics in patients with portal hypertension / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To explore the characteristics of the portal vein hemodynamics and the correlation with the portal vein pressure.</p><p><b>METHODS</b>There were 41 cases of hepatic cirrhosis complicating portal hypertension. The liver function was graded Child-Pugh A+B in 31 cases and Child-Pugh C in 10 cases. The inner-diameter and blood stream speed of the portal vein (PV), the spleen vein (SV) and the superior mesentery vein (SMV) were measured by the color Doppler ultrasonography. The vascular acreage and blood flow volume were calculated. The portal vein pressure was directly measured during the operation. Thirty-two healthy people and 26 patients with chronic hepatitis B (CHB) served as controls in this study.</p><p><b>RESULTS</b>The inner-diameter of the three veins was obviously wider and the blood flow speed was slower in two portal hypertension groups than in CHB and normal groups (P<0.01). In Child C group, the speed was the slowest. The speed of SV and SMV in two hypertension groups did not show any significant difference (P>0.05). In Child A+B group, the blood flow volume of the three veins was larger than that in normal and CHB groups (P<0.01 or P<0.05). The volume of PV was less in Child C group than Child A+B group (P<0.01), but the volume of SV and SMV was not obviously different (P>0.05). In Child A+B group, the portal vein pressure (Ppv) had a close correlation with the portal vein width, blood flow quantitation (Qpv), and blood stream volume (Qsv) of the spleen vein.</p><p><b>CONCLUSIONS</b>The Qpv in Child A+B grade can be measured by the color Doppler ultrasonography technique, and the portal vein pressure can be monitored easily by the equation of Ppv=1.8951+0.0011Qpv.</p>