The prognosis of preoperative preemptive intubation for acute type A aortic dissection patients: a retrospective propensity score matching study.

Background: Acute type A aortic dissection (AADA) is a life-threatening cardiovascular disease, and improving perioperative mortality remains a significant challenge. The purpose of this study is to investigate the impact of preemptive intubation under adequate sedation and analgesia on the prognosis of AADA patients under the high rupture risk. Methods: The medical records of patients diagnosed with AADA and admitted to Changhai Hospital from January 2019 to January 2020 were retrospectively reviewed. Patients were divided into two groups based on whether they received preoperative preemptive intubation in the cardiac intensive care unit (ICU) before surgery. We used propensity score matching (PSM) analysis to conduct statistical analyses on the preoperative, intraoperative, and postoperative clinical data of the two groups. Results: A total of 134 patients were eventually included in the study. One patient (3.8%) in the pre-intubation group and 15 (13.9%) in the control group died of dissection rupture before surgery. After excluding patients with dissection rupture, there were 25 patients in the pre-intubation group and 93 patients in the non-intubation group. After PSM, there were 17 patients in the pre-intubation group and 68 patients in the non-intubation group. Baseline data analysis showed that the pre-intubation group had a higher Sequential Organ Failure Assessment (SOFA) score (10.2±3.9 vs. 8.0±4.7, P=0.036) and a higher proportion of patients with coronary artery disease (16.0% vs. 1.1%, P=0.007). The rate of massive pericardial effusion was also higher in the intubation group (28.0% vs. 10.8%, P=0.049), and preoperative oxygenation index was lower (273.2±97.3 vs. 322.1±100.9, P=0.032) compared to the control group. The results showed no significant differences in intraoperative and postoperative data for the two groups. Kaplan-Meier survival curves indicated a trend towards a more favorable prognosis for patients in the preemptive intubation group, but this difference was not significant either before or after PSM. Conclusions: Preemptive pre-intubation may benefit high-risk patients with factors such as hypoxia, massive pericardial effusion, and agitation, improving the more critically AADA patients' perioperative outcomes.

A cross-sectional survey on the lung ultrasound training and practice of respiratory therapists in mainland China.

PURPOSE: This national study aimed to investigate the lung ultrasound (LUS) training and practice of respiratory therapists (RTs) in mainland China. METHODS: A cross-sectional multicenter survey was conducted from May 22, 2021 to August 12, 2021, through online platforms. This survey included RTs in mainland China. The survey was divided into four sections: (1) demographic characteristics and basic information; (2) basic information about LUS training and practice; (3) LUS practice details; and (4) Other ultrasound training and practice. RESULTS: A total of 514 responses were received, and 494 valid responses were included in the analysis. 81.2% (401/494) participants' highest degree of education was a bachelor's degree, and 43.1% (213/494) participants were at level II in terms of job ranking. 99.2%(490/494) participants agreed that the RTs needed to learn lung ultrasound, but only 12.3% (61/494) participants had received a LUS training course. Further, 66.2% (327/494) experienced participants responded to Sect. 3. Most of RTs used LUS when the patient had hypoxia (265/327, 81%) or dyspnea (260/317, 79.5%); they also used it during spontaneous breathing trial(SBT) (191/327, 58.4%) or in prone position (177/327, 54.1%). The A-line (302/327, 92.4%), B-line (299/327, 91.4%), lung slide (263/327, 80.4%), and bat sign (259/327, 79.2%) were well known as LUS signs. Also, 30.6% (100/327) participants did not use the LUS protocol in their clinical practice, and only 25.4%(83/327) participants said they had used LUS scores. Moreover, 55.7% (182/327) participants frequently changed the respiratory therapy strategy according to LUS results. CONCLUSIONS: We should improve the number and workplace of RTs in mainland China in the future. We should also standardize the application of LUS practice and training for RTs in mainland China and establish corresponding certification pathways.

Geographical variations in risk factors associated with HIV infection among drug users in a prefecture in Southwest China.

BACKGROUND: Previous studies have shown inconsistent or even contradictory results for some risk factors associated with HIV infection among drug users, and these may be partially explained by geographical variations. METHODS: Data were collected from 11 methadone clinics in the Liangshan Yi Autonomous Prefecture from 2004 to 2012. A non-spatial logistical regression model and a geographically weighted logistic regression model were fitted to analyze the association between HIV infection and specific factors at the individual level. RESULTS: This study enrolled 6,458 patients. The prevalence of HIV infection was 25.1 %. The non-spatial model indicated that being divorced was positively associated with HIV infection. The spatial model also showed that being divorced was positively associated with HIV infection, but only for 49.4 % of individuals residing in some northern counties. The non-spatial model suggested that service sector work was negatively associated with HIV infection. However, the spatial model indicated that service work was associated with HIV infection, but only for 23.0 % of patients living in some western counties. The non-spatial model did not show that being married was associated with HIV infection in our study field, but the spatial model indicated that being married was negatively associated with HIV infection for 12.0 % of individuals living in some western counties. For other factors, the non-spatial and spatial models showed similar results. CONCLUSION: The spatial model may be useful for improving understanding of geographical heterogeneity in the relationship between HIV infection and individual factors. Spatial heterogeneity may be useful for tailoring intervention strategies for local regions, which can consequently result in a more efficient allocation of limited resources toward the control of HIV transmission.

HIV-, HCV-, and co-infections and associated risk factors among drug users in southwestern China: a township-level ecological study incorporating spatial regression.

BACKGROUND: The human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are major public health problems. Many studies have been performed to investigate the association between demographic and behavioral factors and HIV or HCV infection. However, some of the results of these studies have been in conflict. METHODOLOGY/PRINCIPAL FINDINGS: The data of all entrants in the 11 national methadone clinics in the Yi Autonomous Prefecture from March 2004 to December 2012 were collected from the national database. Several spatial regression models were used to analyze specific community characteristics associated with the prevalence of HIV and HCV infection at the township level. The study enrolled 6,417 adult patients. The prevalence of HIV infection, HCV infection and co-infection was 25.4%, 30.9%, and 11.0%, respectively. Prevalence exhibited stark geographical variations in the area studied. The four regression models showed Yi ethnicity to be associated with both the prevalence of HIV and of HIV/HCV co-infection. The male drug users in some northwestern counties had greater odds of being infected with HIV than female drug users, but the opposite was observed in some eastern counties. The 'being in drug rehabilitation variable was found to be positively associated with prevalence of HCV infection in some southern townships, however, it was found to be negatively associated with it in some northern townships. CONCLUSIONS/SIGNIFICANCE: The spatial modeling creates better representations of data such that public health interventions must focus on areas with high frequency of HIV/HCV to prevent further transmission of both HIV and HCV.

The geographic distribution patterns of HIV-, HCV- and co-infections among drug users in a national methadone maintenance treatment program in Southwest China.

BACKGROUND: HIV-, HCV- and HIV/HCV co-infections among drug users have become a rapidly emerging global public health problem. In order to constrain the dual epidemics of HIV/AIDS and drug use, China has adopted a methadone maintenance treatment program (MMTP) since 2004. Studies of the geographic heterogeneity of HIV and HCV infections at a local scale are sparse, which has critical implications for future MMTP implementation and health policies covering both HIV and HCV prevention among drug users in China. This study aimed to characterize geographic patterns of HIV and HCV prevalence at the township level among drug users in a Yi Autonomous Prefecture, Southwest of China. METHODS: Data on demographic and clinical characteristics of all clients in the 11 MMTP clinics of the Yi Autonomous Prefecture from March 2004 to December 2012 were collected. A GIS-based geographic analysis involving geographic autocorrelation analysis and geographic scan statistics were employed to identify the geographic distribution pattern of HIV-, HCV- and co-infections among drug users. RESULTS: A total of 6690 MMTP clients was analyzed. The prevalence of HIV-, HCV- and co-infections were 25.2%, 30.8%, and 10.9% respectively. There were significant global and local geographic autocorrelations for HIV-, HCV-, and co-infection. The Moran's I was 0.3015, 0.3449, and 0.3155, respectively (P < 0.0001). Both the geographic autocorrelation analysis and the geographic scan statistical analysis showed that HIV-, HCV-, and co-infections in the prefecture exhibited significant geographic clustering at the township level. The geographic distribution pattern of each infection group was different. CONCLUSION: HIV-, HCV-, and co-infections among drug users in the Yi Autonomous Prefecture all exhibited substantial geographic heterogeneity at the township level. The geographic distribution patterns of the three groups were different. These findings imply that it may be necessary to inform or invent site-specific intervention strategies to better devote currently limited resource to combat these two viruses.

The changing trends of HIV/AIDS in an ethnic minority region of China: modeling the epidemic in Liangshan prefecture, Sichuan Province.

OBJECTIVE: This study was to investigate the HIV current situation in Liangshan prefecture, in order to predict prevalence and transmission trends. METHODS: Region-specific population, behavior, serosurveillence, and policy/program data (from 1995 to 2010) were gathered from various local and national organizations and applied to the Asian Epidemic Model (AEM) and used to derive estimates of future HIV prevalence, epidemic trends, and outcomes of intervention strategies. RESULTS: The AEM projections for 2020 included increased number of people living with HIV (PLHIV; to 136 617), increased HIV prevalence (2.51%), and 8037 deaths from acquired immunodeficiency syndrome (AIDS) in this region. However, the overall HIV incidence rate (per 10 000) was projected to decline from 27 in 2015 to 22 in 2020, largely due to a predicted decrease in HIV infection rate (per 10 000) from 658 in 2013 to 621 in 2020 among intravenous drug users. In contrast, the cases of HIV infection per 10 000 was projected to increase from 420 in 2010 to 503 in 2020 among men who have sex with men, and from 8 in 2010 to 15 in 2020 among the general population. The predominant risk factor for HIV transmission over the next decade in Liangshan was casual sex. Community-based outreach strategies to reduce injected drug use and casual sex, and to promote condom use, were predicted as effective interventions to decrease HIV transmission. CONCLUSION: Implementation of a comprehensive public health program, with targeting to the region-specific at-risk populations, will help to mitigate HIV/AIDS spread in Liangshan.

[Acceptability and relevant impact factors of provider initiated testing counseling in Liangshan Yi autonomous prefecture of Sichuan province].

OBJECTIVE: To understand the acceptability and relevant impact factors of provider initiated testing counseling (abbreviated as PITC) in Liangshan Yi autonomous prefecture, so as to promote strategies for the sustainable development of PITC in AIDS epidemic areas. METHODS: Four medical institutions were selected with rates of acceptance counted. Multi-factors logistic regression was used to analyze the impact factors from the completed questionnaires. RESULTS: Among the 413 respondents, 197 patients accepted the PITC, with an acceptance rate as 47.7% (95%CI: 42.9% - 52.3%). Factors as being female (OR = 7.283, 95%CI: 3.933 - 13.465), acceptance of publicity (OR = 1.855, 95%CI: 1.013 - 3.395), worried about being infected of HIV/AIDS (OR = 2.699, 95%CI: 1.616 - 4.506) etc. were protect factors of PITC, while those who previously received HIV testing (OR = 0.226, 95%CI: 0.124 - 0.409), afraid of taking blood test (OR = 0.052, 95%CI: 0.024 - 0.106), knowing more AIDS related knowledge (OR = 0.446, 95%CI: 0.258 - 0.773) would significantly reduce the rate of acceptance. CONCLUSION: Nearly half of the outpatients from medical institutions were willing to accept PITC in Liangshan Yi prefecture, thus provided important chance for HIV screening. Ways as strengthening related counseling before and after HIV test, launching effective HIV/AIDS-related publicity and advocating correct knowledge on blood testing, etc. need to be promoted, in order to improve the acceptability of PITC.

[An outbreak of gastroenteritis caused by poisonous Boletus mushroom in Sichuan, China, 2012].

OBJECTIVE: To identify the source of infection and risk factors and to provide control measures regarding an outbreak of gastroenteritis involving 30 villagers. Who attended the same wedding party held on March 5(th), 2012, a survey was carried out. METHODS: Case was defined as having onset of vomiting, nausea, stomachache or diarrhea among the attendees of a wedding party. We randomly selected and interviewed 140 from 470 attendees on their symptoms and food exposures at the wedding. We compared food-specific attack rates (AR) for gastroenteritis in a retrospective cohort study. The leftover foods were tested for Salmonella, Shigella, and Staphylococcus aureus. The leftover Boletus mushrooms were examined and species determined by the Kunming Institute of Botany, Chinese Academy of Sciences. RESULTS: Of the 140 attendees 61% (85) developed gastroenteritis. Case-attendees had vomiting (94%), nausea (89%), stomachache (53%), and diarrhea (51%). The AR among attendees who ate Boletus mushroom was 69% (81/118), compared to 18% (4/22) of those who did not (RR = 3.8, 95%CI: 1.5 - 9.2). When comparing the ARs between the attendees on consumption of other foods, data did not show statistically significant differences. Among the 7 species of Boletus identified from the leftover mushrooms, 3 (B. venenatus, B. sinicus and B. magnificus) were toxic. Store keepers bought dried or fresh mushrooms from local villagers who had picked up them from the mountains. Salmonella, Shigella, and Staphylococcus aureus tests on those leftover food showed negative results. CONCLUSION: Poisonous Boletus mushroom contributed to this outbreak. We recommended that education should be targeted on mushroom-pickers regarding how to recognize the poisonous mushrooms. Regulations and laws should also be developed to facilitate the necessary process.

Impact of positive end-expiratory pressure on cerebral injury patients with hypoxemia.

BACKGROUND: Traumatic brain injury or intracranial hemorrhage patients with acute lung injury/acute respiratory distress syndrome need mechanical ventilation. The use of positive end-expiratory pressure (PEEP) in this situation remains controversial. This study explored the impact of PEEP on intracranial pressure (ICP), cerebral perfusion pressure (CPP), central venous pressure (CVP), and mean arterial pressure (MAP) in cerebral injury patients. METHODS: Nine cerebral injury patients with lung injury who needed mechanical ventilation and met the criteria for ICP monitoring were included in this study. Intraventricular catheters were positioned in 1 of the bilateral ventricles and connected to pressure transducers. Invasive arterial pressure and CVP were monitored continuously. Pressure control ventilation was applied during this clinical trial in a stepwise recruitment maneuver (RM) with 3 cm H2O intermittent increments and decrements of PEEP. RESULTS: A total of 28 RMs were completed in 9 patients. Mean values of MAP, CVP, ICP, and CPP 5 minutes after RMs showed no significant differences compared with baseline (P > 0.05). Correlation analysis of all the mean values of MAP, CVP, ICP, and CPP showed significant correlation between MAP and CPP, PEEP and CVP, PEEP and ICP, and PEEP and CPP with all P values less than 0.05. CONCLUSION: The impact of PEEP on blood pressure, ICP, and CPP varies greatly in cerebral injury patients. Mean arterial pressure and ICP monitoring is of benefit when using PEEP in cerebral injury patients with hypoxemia.

[Drug resistance and associated factors on HIV in Liangshan prefecture, Sichuan province].

OBJECTIVE: To investigate the HIV drug resistance among HIV/AIDS patients who had received highly active antiretroviral treatment (HAATR) in Liangshan prefecture and related factors. METHODS: This investigation was conducted from August to October 2010. Data on epidemiology, treatment, CD4(+) T cell, viral load and drug resistance tests were collected. RESULTS: 233 (73.50%) had a viral load of < 1000 copy/ml, with the median CD4(+) T cell count as 329 cell/µl. 26 samples appeared to be drug resistant, with the rate as 8.20%. Among 84 patients with antiviral therapy failure, the overall drug resistance rate was 30.95% (26/84). While 24 (28.57%) were resistant to non-nucleoside reverse transcriptase inhibitor (NNRTI) drugs. Among nucleoside reverse transcriptase inhibitors (NRTI), 7 (8.33%) were resistant. 1 (1.19%) had protease inhibitor (PI) resistance mutations identified. Factors that significantly associated with drug resistance would include: being injecting drug users (AOR = 3.37, 95%CI: 1.06 - 10.66, P = 0.0390), having had chronic diarrhea > 1 month (AOR = 8.38, 95%CI: 1.87 - 37.69, P = 0.0055), having had CD4(+) T cell < 200 (AOR = 3.48, 95%CI: 1.29 - 9.39, P = 0.0139), being residents from Butuo area (AOR = 17.68, 95%CI: 4.97 - 62.86, P < 0.0001). When comparing with other areas, data from Butuo showed that people who carried Yi ethnicity (AOR = 17.35, 95%CI: 2.01 - 149.73, P = 0.0095) and were literate (having had primary or higher levels of education) (AOR = 0.18, 95%CI: 0.08 - 0.42, P < 0.0001), being married or having cohabited relations (AOR = 8.17, 95%CI: 2.35 - 28.39, P = 0.001) were found to be less adherent (AOR = 0.05, 95%CI: 0.02 - 0.13, P < 0.0001) to the treatment. CONCLUSION: Successful antiviral outcomes were seen among those AIDS patients under treatment, in Liangshan prefecture. Resistance rates were significantly different in regions. For IDUs, enforcement on subjects including prevention on drug resistance, adherence to HAART and treatment for drug addiction should be strengthened and programs being integrated.

Effects of a flutter mucus-clearance device on pulmonary function test results in healthy people 85 years and older in China.

OBJECTIVE: To investigate the impact of a new flutter-type mucus-clearance device on pulmonary function test results in people ≥ 85 years old. METHODS: We conducted a randomized controlled trial with 60 people ≥ 85 years old. The subjects were distributed randomly into an intervention group and a control group. Spirometry was performed at baseline and after 28 days of using the flutter mucus-clearance device. We recorded peak expiratory flow (PEF), FEV1, forced vital capacity (FVC), and FEV1/FVC. The intervention group used the flutter mucus-clearance device during pulmonary exercises. The control group had no interventions other than routine healthcare. We recorded episodes of fever, antibiotic therapy, and hospital visits during the 28 days of the study. RESULTS: PEF, FEV1, FVC and FEV1/FVC showed no significant differences between the 2 groups at baseline. The mean ± SD baseline values were: PEF 103.2 ± 43.0 L/min, FEV1 0.98 ± 0.43 L, and FVC 1.76 ± 0.68 L. Compared to baseline, on day 28 there was no significant difference in PEF, FEV1, or FEV1/FVC, in either group. The mean ± SD difference in FVC between baseline and day 28 was 0.33 ± 0.30 L in the intervention group, and 0.20 ± 0.14 L in the control group (P = .03). There were no significant differences in the number of cases of fever, antibiotic therapy, or hospital visits between the groups. CONCLUSIONS: The new flutter mucus-clearance device improved elderly patients' FVC.

[The impact of positive end-expiratory pressure on cerebral perfusion pressure and hemodynamics in patients receiving lung recruitment maneuver].

OBJECTIVE: To explore the impact of lung recruitment maneuver (RM) on intracranial pressure (ICP), cerebral perfusion pressure (CPP) and mean arterial pressure (MAP). METHODS: RM was performed and ICP, MAP, central venous pressure (CVP), saturation of arterial oxygen (SpO2) were monitored continuously in 6 severe cerebral injury patients combined with lung injury, who were indicated for mechanical ventilation and meeting the criteria for intracranial pressure monitoring. RM included pressure control ventilation with stepwise increase in positive end-expiratory pressure (PEEP). RESULTS: RM was performed for 22 times in 6 patients, among them two were moribund due to sharp drop of blood pressure and CPP. In the remaining 20 attempts, the mean values of MAP, CVP, ICP, CPP measured at each PEEP level showed no significant difference compared with baseline values (all P>0.05). MAP was significantly correlated with CPP (r=0.706, P=0.000). In the remaining RMs, a correlation between MAP and CPP accounted for 85% (17/20) of total RMs, that between PEEP and CVP accounted for 75% (15/20), that between PEEP and ICP accounted for 75% (15/20), and that between PEEP and CPP existed in 40% (8/20). In a total of 22 cases, there were 6 patterns of response of MAP to alteration in PEEP: MAP maintained relatively stable in 8 case, MAP decreased when PEEP increased and increased when PEEP decreased in 6 case; in 2 cases MAP elevated with increase in PEEP, and drop to baseline with decrease in PEEP, in 2 cases it fell with increase in PEEP but it did not rise with decrease in PEEP, in 2 cases it rose with increase in PEEP but remained at a high level with PEEP decreased to baseline, in 2 cases, MAP dropped abruptly with increase in PEEP resulting in termination of RM. In 11 cases, ICP increased with increase in PEEP and decreased with lowering of PEEP. ICP maintained stable in 6 cases, and ICP maintained at a high level and did not return to baseline after RM in 3 cases. CPP decreased with increase in PEEP and increased when PEEP decreased, and it returned to baseline when PEEP was back to baseline in 12 case. CPP kept constant in 6 case. In 2 cases, CPP remained at a low level, and it returned to baseline 10-20 minutes after PEEP was lowered to baseline. CONCLUSION: There is considerable individual difference in impact of RM on MAP, ICP and CPP in patients with cerebral. ICP monitoring is helpful to assure safety of RM in patients with cerebral injury complicated with lung injury.

[The analysis of 252 episodes of recruitment maneuver during mechanical ventilation in surgery intensive care unit].

OBJECTIVE: To analyze the clinical effects of recruitment maneuver and the impacts on blood pressure and oxygen saturation in patients with mechanical ventilation. METHODS: To analyze all related data from 252 episodes of recruitment maneuver of 46 patients admitted from July 2005 to February 2007. Recruitment maneuver method: the drive pressure constant was kept at 15 cm H(2)O (1 cm H(2)O=0.098 kPa) and the positive end-expiratory pressure (PEEP) level was increased gradually. RESULTS: Of the 252 episodes of recruitment maneuver, this procedure was effective in 91% of the patients, with pneumothorax and pneumo-mediastinum occurred in a patient with legionnaire pneumonia, and no improvement of oxygen saturation in one patient with patent foramen ovale. The value of effective PEEP used ranged from a minimum of 8 cm H(2)O to a maximum of 30 cm H(2)O and the duration of satisfactory oxygen saturation ranged from a minimum of 0.4 hour to a maximum of 368 hours. On average, each patient received 5.48 episodes of recruitment maneuver with one of the patients received 16 episodes of recruitment maneuver. Twenty-three out of the 46 patients (50%) had experienced an episode of hypoxemia. One hundred and one episodes of hypoxemia occurred in 252 recruitment maneuver (40%) and the minimum PEEP inducing hypoxemia is 8 cm H(2)O, and the maximum PEEP was 22 cm H(2)O, with an average value of 12.7 cm H(2)O. Twenty-five of the 46 patients (54%) had experienced transient hypotension with 93 episodes of hypoxemia in 252 episodes of recruitment maneuver (37%), and the minimum PEEP inducing hypotension was 6 cm H(2)O and the maximum PEEP was 23 cm H(2)O, with an average value of 13.9 cm H(2)O. CONCLUSION: Recruitment maneuver could effectively improve oxygenation while the value of PEEP used should be individualized according to clinical condition.