Objective To delve into the causal relationship between 211 gut microbiota and sepsis employing bidirectional Mendelian randomization(MR).Methods The gut microbiota genome-wide association study(GWAS)data from the Microbiome Genetics Consortium(MiBioGen,n = 18 340)and sepsis GWAS data from the FinnGen(n = 286 146)were harnessed for this study.Initially,single nucleotide polymorphisms(SNP)significantly associated with the relative abundance of 211 gut microbiota taxa were identified as instrumental variables using predefined selection criteria.The primary analytical approach was characterized by the application of inverse variance weighting(IVW),with the effect measure represented by the odds ratio(OR)to assess the results of MR.To ensure precision and reliability,analyses were conducted,including leave-one-out analysis,heterogeneity testing,and tests for pleiotropy at both coherent and incoherent levels.Results The increased risk of sepsis was associated with the elevated abundance of Collinsella[OR = 1.28,95%confidence interval(95%CI)was 1.06-1.56,P = 0.01]and Ruminococcus(OR = 1.19,95%CI was 1.05-1.35,P = 0.005).Furthermore,a protective effect against the development of sepsis was observed in association with the increased abundance of Prevotella(OR = 0.88,95%CI was 0.79-0.97,P = 0.01)and Firmicutes(OR = 0.86,95%CI was 0.75-0.996,P = 0.04).No obvious heterogeneity and irrelevant level pleiotropy were detected.Conclusion Collinsella and Ruminococcus increase the risk of sepsis,while Prevotella and Firmicutes have protective effects against sepsis.
Objective To analyze the reasons of gastrointestinal function recovery related to postoperative esophagogastric fistula and the roles of the Xiaochengqi decoction by enema and jejunal nutrition tube on gastrointestinal function recovery.Method Clinical data of 1 patient with esophagogastric anastomotic fistula after gastric stromal tumors(GST)resection on March 16,2022 was retrospectively analyzed,to observe the influence of Traditional Chinese Medicine in postoperative recovery.Results The patient,a 77-year-old male,underwent laparoscopic proximal gastrectomy and esophagogastrostomy on March 16,2022 due to cardia tumor.Seven days after surgery,there was some turbid matter in the abdominal drain tube,severe pain on upper abdomindal occurred after digestive tract radiography,it was indicated that anastomotic fistula was existed.After intragastric administration and nasal feeding of Xiaochengqi decoction,anus ventilates and defecates much mushy stool on the 15th day after postoperative esophagogastric fistula.On the 21st day after fistula,Buzhongyiqi and Xiaochengqi decoction was applied by nasointestinal feeding tube.On the 47th day,the patient got out of bed and stood,the stools were out by enema.On the 58th day after surgery,the digestive tract radiography indicated there was not any contrast media overflow near the fistula and contrast media could get through the duodenum smoothly.Anastomotic stricture.After tube extraction,a liquid diet is fed,formed stool is defecated without abdominal distension and pain.On the 63rd day after surgery,the patient is discharged from hospital.Conclusions It is advantageous for the recovery of gastrointestinal function by enema and jejunal nutrition tube feeding of Xiaochengqi decoction.It shortens the anal exhaust time,fastens the recovery of gastrointestinal function,improves health status,promotes healing,and shortens the length of stay.
Objective To investigate the characteristics of pathogenic bacteria in cancer patients with severe infection after radiotherapy and chemotherapy and the application value of metagenomic next-generation sequencing(NGS)in the detection of pathogenic bacteria.Methods A total of 112 patients with severe infection after malignant tumor radiation and chemotherapy admitted to Department of Critical Care Medicine of Wuwei Tumor Hospital from October 2019 to August 2023 were selected as the research objects.A total of 150 specimens from suspected infection sites were collected and tested by traditional etiology and NGS.The characteristics of pathogenic bacteria in severe infection of cancer patients after chemoradiotherapy and the application value of NGS in pathogen detection were analyzed.Results Among 150 samples of 112 patients with severe infection after radiotherapy and chemotherapy,the highest proportion of respiratory system infection was 51.79%(58 cases),followed by 25.89%(29 cases)of bloodstream infection,the lowest central nervous system infection rate was 1.79%(2 cases).Gram-negative bacteria were the most common pathogenic bacteria[NGS 35.33%(53 cases),traditional pathogen detection 23.33%(35 cases)],followed by Gram-positive bacteria[NGS 20.67%(31 cases),traditional pathogen detection 12.00%(18 cases)],and multi-drug resistant bacteria infection rate was more than 80.00%,multi-drug resistant fungal infection rate also reached 28.57%.In the patients with severe infection after radiotherapy and chemotherapy,the positive rate of pathogenic bacteria of NGS was significantly higher than that of traditional pathogen detection[87.33%(131/150)vs.42.67%(64/150),P＜0.01],and the positive detection rate of Gram-negative bacteria,Gram-positive bacteria,fungi and other pathogens was significantly higher than that of traditional pathogen detection[Gram-negative bacteria:35.33%(53/150)vs.23.33%(35/150),Gram-positive bacteria:20.67%(31/150)vs.12.00%(18/150),fungi:22.67%(34/150)vs.6.67%(10/150),others:8.67%(13/150)vs.0.67%(1/150),both P＜0.05].Conclusions The detection rate of pathogenic bacteria of NGS in patients with severe infection after radiotherapy and chemotherapy was significantly higher than that of traditional pathogen detection.The distribution and drug resistance of pathogenic bacteria in severe infection after radiotherapy and chemotherapy are unique,and strengthening the detection of pathogenic bacteria is helpful to improve the curative effect.
Acute respiratory distress syndrome(ARDS)is a highly fatal syndrome in the intensive care unit(ICU),with a mortality rate of up to 40%.Early identification and treatment of ARDS are essential to improve the prognosis.Machine learning,the core of artificial intelligence and data science,is a set of computer tools designed to acquire new knowledge from existing data,which can assist medical staff in making clinical decisions.In recent years,machine learning has been increasingly used in the clinical diagnosis,precision treatment,and prognosis assessment of ARDS,which is expected to generate new ideas for diagnosing and treating ARDS.This article summarizes the application of machine learning in the clinical diagnosis of ARDS,classification of ARDS,treatment of ARDS,prognosis evaluation of ARDS,and the shortcomings of machine learning in the application of ARDS to explore the research progress of machine learning in diagnosing and treating ARDS and provide directions for further research.
Objective To observe the clinical efficacy of high-flow nasal cannula oxygen therapy(HFNC)and non-invasive mechanical ventilation in patients with typeⅡrespiratory failure during acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods A total of 84 patients with AECOPD combined with typeⅡrespiratory failure admitted to the department of internal medicine of Beijing Sijiqing Hospital from September 2019 to December 2021 were selected as the study objects.The patients were randomly divided into observation group and control group,with 42 cases in each group.Both groups were given conventional treatment,the observation group was given HFNC,and the control group was given non-invasive mechanical ventilation.The difference of clinical efficacy between the two groups was compared,and the changes of heart rate(HR),respiratory rate(RR),arterial blood gas analysis index,lung function before and 7 days after treatment,complications and tracheal intubation rate,mortality were observed in the two groups.Results The total effective rate of the observation group was higher than that of the control group[88.10%(37/42)vs.69.05%(29/42),P＜0.05].Before treatment,HR,RR,arterial blood gas analysis indexes[arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2),arterial oxygen saturation(SaO2),pH value],pulmonary function indexes[forced expiratory volume in one second(FEV1),forced vital capacity(FVC),FEV1/FVC]of the two groups were no statistically significant.After treatment,HR,RR and PaCO2 were significantly lower than before treatment,while PaO2,SaO2,pH,FEV1,FVC and FEV1/FVC were significantly higher than before treatment.After treatment,HR,RR and PaCO2 in the observation group were significantly lower than those in the control group[HR(bpm):90.14±5.66 vs.93.57±4.77,RR(times/min):21.90±4.88 vs.22.45±4.31,PaCO2(mmHg,1 mmHg≈0.133 kPa):60.02±5.93 vs.62.83±6.29],PaO2,SaO2,pH,FEV1,FVC,FEV1/FVC were significantly higher than the control group[PaO2(mmHg):80.70±7.81 vs.76.21±8.23,SaO2:0.94±0.04 vs.0.92±0.04,pH value:7.36±0.05 vs.7.32±0.06,FEV1(L):1.73±0.41 vs.1.53±0.35,FVC(L):2.80±0.48 vs.2.57±0.43,FEV1/FVC:(61.98±5.67)%vs.(59.14±5.34)%,all P＜0.05].The incidence of complications such as of dry throat[4.8%(2/42)vs.19.0%(8/42)],facial compression injury[0%(0/42)vs.14.3%(6/42)],abdominal distension[9.5%(4/42)vs.26.2%(11/42)]in the observation group were significantly lower than those in the control group(all P＜0.05).There was no significant difference in the rate of tracheal intubation and mortality between the observation group and the control group[11.90%(5/42)vs.26.19%(11/42)and 4.76%(2/42)vs.7.14%(3/42),both P＞0.05].Conclusion HFNC is effective in treating AECOPD patients with typeⅡrespiratory failure,with fewer complications and high safety.
Critical care medicine is an important component of clinical medicine,including multiple aspects such as screening,monitoring,treatment,and rehabilitation of the critical illness.With the formation of the critical care discipline system and the updating of rehabilitation medicine concepts,the early rehabilitation of critically ill patients has become a clinical concern.More and more evidence suggests that moderate sedation,early activity,and exercise in critically ill patients have a positive impact on cognitive function,physical function,mental health,and quality of life.Based on comprehensive rehabilitation assessment,following contraindications and indications,and appropriate and personalized rehabilitation treatment techniques are the key points.Combining artificial intelligence and information technology to assist rehabilitation may be the future development direction.However,there are still problems and obstacles in clinical practice such as low accessibility and uneven management of critical care rehabilitation.Therefore,by reviewing relevant literature on critical care rehabilitation in recent years,this article summarizes the evolution of critical care rehabilitation concepts,the composition and workflow of the multidisciplinary rehabilitation team,indications and contraindications,evaluation and commonly used technologies,the application of artificial intelligence,obstacles and countermeasures for carrying out critical care rehabilitation from the perspective of evaluation and treatment.To provide reference for the early clinical implementation of critical care rehabilitation.
Sepsis-induced cardiomyopathy(SIC)is an important cause of poor prognosis in patients with sepsis.As a key organelle for energy synthesis,mitochondrial damage leading to myocardial energy metabolism disorders has become the core pathophysiological mechanism of SIC.Traditional Chinese medicine treatment is of great significance for improving cardiac function and improving therapeutic effects in patients with sepsis.This article reviews the pathological and physiological mechanisms of mitochondrial dysfunction in myocardial cells during sepsis from the perspectives of mitochondrial dynamics,antioxidant stress damage,mitochondrial biosynthesis,and mitophagy,as well as the protective mechanisms of traditional Chinese medicine targeting the improvement of mitochondrial dynamics,mitochondrial biosynthesis,mitophagy,and mitochondrial antioxidant stress damage to alleviate myocardial injury.Explore the pharmacodynamic material basis of Traditional Chinese medicine for treating SIC,and expand new ideas for the treatment of SIC with traditional Chinese medicine.
Objective To evaluate whether the measurement of tibialis anterior muscle thickness(TA-MT)in sepsis can be used as an alternative method to understand systemic changes in skeletal muscle mass by comparing the trend of ultrasonic measurement of TA-MT with bioelectrical impedance analysis(BIA)in detecting skeletal muscle mass.Methods A single-center prospective study was conducted.The patients with tumor sepsis who were treated in the department of intensive care unit(ICU)of Tianjin Medical University Cancer Hospital from March to December 2022 were selected as the study subjects.The changes of TA-MT within 6 hours after sepsis and 3 days after treatment were measured by ultrasound.The changes of body mass,body mass index(BMI),lean body mass,body fat percentage,body fat,whole body protein,skeletal muscle mass,skeletal muscle index(SMI),arm circumference,right lower limb lean body mass,and body water were measured by BIA.The 28-day prognosis was followed up.The correlation between TA-MT and skeletal muscle indicators measured by BIA was analyzed by Pearson correlation analysis.Results Eventually,40 patients were included.Compared with before treatment,the levels of TA-MT by ultrasound and acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure assessment(SOFA)and oxygen metabolism index blood lactic acid(Lac)measured after treatment were significantly reduced[TA-MT(cm):2.31±0.35 vs.2.50±0.36,APACHEⅡscore:11.00±3.18 vs.17.50±5.44,SOFA score:3.28±2.18 vs.6.30±3.11,Lac(mmol/L):1.38±0.35 vs.2.40±1.02,all P＜0.05].Meanwhile,the BIA test showed that body mass,body mass index,lean body mass,body fat percentage,body fat,whole body protein,skeletal muscle mass,SMI,arm circumference,right lower limb lean body mass and body water were also significantly decreased after treatment[body mass(kg):63.87±13.96 vs.66.58±14.95,BMI(kg/m2):22.57±4.37 vs.23.52±4.59,lean body mass(kg):46.32±6.89 vs.49.66±7.84,whole body protein(kg):9.36±1.37 vs.9.93±1.55,skeletal muscle mass(kg):26.23±4.17 vs.27.96±4.72,SMI(kg/m2):7.12±1.04 vs.7.78±1.18,arm circumference(cm):29.41±3.66 vs.30.17±3.59,right lower limb lean body mass(kg):7.21±1.26 vs.7.77±1.42,total body water(L):36.38±5.44 vs.39.11±6.19,all P＜0.05],body fat percentage and body fat were significantly elevated[body fat percentage:(21.96±8.30)%vs.(19.98±8.43)%,body fat(kg):14.81±8.64 vs.14.12±8.81,both P＜0.05].Pearson correlation analysis showed that:the right TA-MT was negatively correlated with the electrical impedance of the right lower extremity(r =-0.445 2,P＜0.001),the right side TA-MT was positively correlated with the right lower limb lean body mass,whole body protein,skeletal muscle mass,SMI and lean body mass(r values were 0.571 4,0.629 9,0.628 3,0.575 9,0.634 4,all P＜0.000 1).Conclusion Significant skeletal muscle depletion can be observed in tumor patients with sepsis,and ultrasound measurement of TA-MT is an effective alternative method to assess systemic skeletal muscle mass trends.
Objective To analyze the level of post-traumatic stress disorder(PTSD)and its risk factors in patients with ischemic stroke.Methods A total of 183 cases of patients with ischemic stroke treated in Putuo District People's Hospital of Zhoushan City from May 2020 to June 2022 were selected as the observation objects.Basic information of patients was collected by self-made questionnaire,including gender,age,personality characteristics,family per capita monthly income,education level,marital status,ability of daily living,duration of ischemic stroke,family function,type of medical insurance,whether there was swallowing dysfunction,whether there was underlying disease(heart disease,hypertension,hyperlipidemia and diabetes),whether there is anxiety,coping style,level of social support.PTSD self-rating scale(PTSD-SS)was used to determine the complications of PTSD in ischemic stroke patients,and the incidence of PTSD was calculated.To compare the difference in basic information between the two groups of patients with PTSD.Factors with statistically significant differences in univariate analysis were included in multivariate Logistic regression analysis to screen out the risk factors affecting the development of PTSD in patients with ischemic stroke,and receiver operator characteristic curve(ROC curve)was drawn to evaluate the predictive value of each risk factor for the development of PTSD in patients with ischemic stroke.Results PTSD-SS score of 183 patients with ischemic stroke(48.76±9.21)was relatively low.Among them,37 case(20.22%)of patients developed PTSD.Compared with the non-PTSD group,the proportion of patients with introverted personality,dysfunctions of daily living,swallowing dysfunction,combined anxiety,negative coping style,and low/no social support was significantly increased in the PTSD group(all P＜0.05).Multivariate Logistic regression analysis showed that introverted personality,severe impairment of daily living ability,swallowing dysfunction,combined anxiety,negative coping style,and low/no social support were independent risk factors for PTSD in ischemic stroke patients[odds ratio(OR)and 95%confidence interval(95%CI)were 2.289(1.091-4.804),5.842(1.658-20.587),2.634(1.095-6.333),7.138(3.255-15.655),2.751(1.271-5.953),3.153(1.477-6.733),all P＜0.05].ROC curve analysis showed that introverted personality,severe impairment of daily living ability,swallowing dysfunction,combined anxiety,negative coping style,and low/no social support all had certain predictive value for the occurrence of PTSD in ischemic stroke patients,the area under the ROC curve(AUC)was 0.602,0.675,0.573,0.722,0.603,0.624,and 95%CI was 1.091-4.804,1.342-9.566,1.095-6.333,3.255-15.655,1.271-5.953,1.477-6.733,respectively,all P＜0.05.The sensitivity to predict PTSD in ischemic stroke patients was 58.2%,87.7%,87.7%,79.5%,80.1%,78.8%,and the specificity was 37.8%,67.6%,70.3%,35.1%,59.5%,54.1%,respectively.Conclusions Ischemic stroke patients have a certain risk of concurrent stress disorder after trauma,and are easily affected by stroke patients'personality characteristics,daily living ability,swallowing dysfunction,coping style and social support,etc.Targeted preventive interventions should be developed to reduce the risk of PTSD and improve the prognosis and quality of life.
Objective To evaluate the impact of customized rehabilitation exercise plans based on the results of cardiopulmonary exercise test(CPET)on cardiac function and prognosis in patients with chronic heart failure(CHF).Methods A total of 52 CHF patients admitted to Chengde Central Hospital from February 2020 to September 2021 were selected as the study subjects,and the patients were divided into observation group and control group according to the principle of randomized controlled study,with 26 cases in each group.The control group received rehabilitation treatment excluding exercise.The observation group was given routine rehabilitation treatment and high-intensity rehabilitation exercise plans based on CPET guidance.Above anaerobic threshold Δ50%power was exercise intensity,exercise time was 30 minutes/day,4 days/week,and intervention period was 12 weeks.Before and 12 weeks after intervention,CPET functional indicators,serum brain natriuretic peptide(BNP),left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),and 6-minute walking distance(6MWD)were measured.The Minnesota CHF quality of life questionnaire(LiHFe)was used to evaluate patient's quality of life,readmission rate and cardiogenic mortality within 1 year of follow-up,and univariate and multivariate Logistic regression analysis was used to analyze factors affecting readmission of CHF patients.Results ① Cardiopulmonary function indicators:there was no statistically significant difference in the anaerobic threshold,peak oxygen uptake,and peak oxygen pulse of CPET functional indicators before and after intervention in the control group,after intervention,the CPET functional indicators in the observation group were significantly higher than those before intervention,and the above indexes in the observation group were significantly higher than those of the control group[anaerobic threshold(mL·min-1·kg-1):10.77±1.40 vs.9.59±1.11,anaerobic threshold(%ped):78.95±11.39 vs.70.09±6.48,peak oxygen uptake(mL·min-1·kg-1):15.63±1.36 vs.14.27±1.72,peak oxygen uptake(%ped):72.42±6.91 vs.63.41±7.31,peak oxygen pulse(mL/order):11.38±1.29 vs.9.05±1.64,peak oxygen pulse(%ped):90.23±10.16 vs.80.53±6.73,all P＜0.05].②Serum indicators,cardiac function indicators,exercise ability indicators,and quality of life evaluation:there was no statistically significant difference in serum indicators BNP,cardiac function indicators LVEDD,LVEF,exercise ability indicators 6MWD,and quality of life LiHFe scores between the two groups before intervention.After intervention,BNP and LiHFe scores were significantly reduced compared with before intervention,while LVEF and 6MWD were both increased compared with before intervention,and the changes of the above indexes in the observation group were more significant than those in the control group[BNP(ng/L):313.25±77.91 vs.445.89±110.67,LVEF:0.41±0.08 vs.0.37±0.06,6MWD(m):495.62±91.35 vs.416.04±65.29,LiHFe score:23.27±6.02 vs.29.50±4.61,all P＜0.05].③ Prognostic follow-up:the readmission rate within 1 year in the observation group was significantly lower than that in the control group(23.08%vs.53.85%),and there was no statistically significant difference in the mortality rate of cardiogenic diseases between the two groups.④Logistic univariate analysis showed that hyperlipidemia,New York Heart Association(NYHA)grading,BNP,and rehabilitation exercise were factors that affect the prognosis of CHF patients[odds ratio(OR)and 95%confidence interval(95%CI)were 0.098(0.019-0.494),0.069(0.016-0.294),1.018(1.007-1.029),and 3.889(1.178-12.841),respectively,all P＜0.05].Multivariate analysis showed that after adjusting for other factors,hyperlipidemia,NYHA grading,and BNP were risk factors affecting the prognosis of CHF patients(OR and 95%CI were 0.068(0.007-0.687),0.048(0.005-0.415),1.016(1.002-1.030),respectively,with P＜0.05],the use of rehabilitation exercise therapy was a protective factor affecting the prognosis of CHF patients[OR and 95%CI were 11.179(1.135-10.124),P＜0.05].Receiver operator characteristic curve(ROC curve)analysis showed that hyperlipidemia,NYHA grading,BNP,rehabilitation exercise therapy,and combined testing all had predictive value for the patient's prognosis(all P＜0.05),and the prediction value of joint detection was the highest,with the area under the ROC curve(AUC)=0.984 and P = 0.000.Conclusion Developing a high-intensity individualized cardiac exercise rehabilitation plan under the guidance of CPET can help improve the cardiopulmonary function,cardiac function,and quality of life of CHF patients,which is of great benefit for improving the long-term prognosis of CHF patients and has high safety.
Objective To explore the effect of Dachaihu decoction on the Toll-like receptor 4/nuclear factor-κB(TLR4/NF-κB)signaling pathway and gastrointestinal mucosal barrier in rats with severe heat stroke.Methods Sixty SPF grade Sprague-Dawley(SD)male rats were divided into normal control group,model group,Dachaihu decoction standard dose group and Dachaihu decoction high dose group of 15 rats in each group.The heat stroke model was replicated in the rats at temperature(40.5±0.5)℃and humidity(65.0±2.0)%;the normal control group was not treated.From 6 hours after mold making,drug intervention was carried out in the Dachaihu decoction high dose group and the Dachaihu decoction standard dose group of 3.38 g·kg-1·d-1 and 1.69 g·kg-1·d-1,every 8 hours for 2 days.Equal amounts of normal saline were administered to the normal control group and model group.At 6,24 and 48 hours after the molding,5 mL abdominal main artery blood from 5 rats were randomly collected from each group,and the blood was obtained by enzyme-linked immunosorbent assay(ELISA)to determine the levels of tumor necrosis factor-α(TNF-α),interleukin-1(IL-1),D-lactic acid,intestinal fatty acid-binding protein(I-FABP).At the same time,the ileum tissue was retained,and the protein expression of TLR4 and NF-κB in intestinal tissue was determined by Western blotting.Some of the ileal tissue was obtained for hematoxylin-eosin(HE)staining,and the intestinal histopathological changes were observed under light microscopy.Results The normal control group of rats had no significant change,and the other three groups showed heatstroke symptoms after mold making.The overall mortality in drug group were significantly lower than that in the model group[3.3%(1/30)vs.20.0%(3/15),P＜0.05].Compared with the normal control group,the serum IL-1,TNF-α,I-FABP,D-lactic acid and the protein expression levels of TLR4 and NF-κB in the model group,Dachaihu decoction standard dose group and Dachaihu decoction high dose group all increased.Compared with the model group,at 24 hours and 48 hours after molding in the Dachaihu decoction standard dose group and Dachaihu decoction high dose group,the serum IL-1,TNF-α,I-FABP,D-lactic acid and the protein expression levels of TLR4 and NF-κB significant decreased[24 hours:TNF-α(ng/L):69.20±4.32,59.37±4.31 vs.76.99±5.02,IL-1(ng/L):132.68±4.93,112.59±9.64 vs.146.75±10.12,I-FABP(mmol/L):504.35±22.23,453.37±32.38 vs.542.58±13.83,D-lactic acid(mmol/L):114.55±8.52,90.57±3.09 vs.127.87±8.37,protein expression of TLR4(A value):1.50±0.08,1.23±0.01 vs.1.86±0.08,protein expression of NF-κB(A value):1.61±0.05,1.21±0.05 vs.1.97±0.08;48 hours:TNF-α(ng/L):58.46±5.13,38.98±5.53 vs.90.21±3.02,IL-1(ng/L):119.12±4.57,84.12±5.08 vs.170.20±6.21,I-FABP(mmol/L):436.04±27.63,321.85±22.03 vs.618.79±12.31,D-lactic acid(mmol/L):87.35±6.84,70.38±4.33 vs.154.14±10.83,protein expression of TLR4(A value):1.19±0.05,1.10±0.13 vs.2.09±0.06,protein expression of NF-κB(A value):1.15±0.09,0.97±0.08 vs.2.20±0.02,all P＜0.05].The expression levels of TNF-α,I-FABP,TLR4 and NF-κB protein in Dachaihu decoction high dose group decreased significantly at 24 hours and 48 hours compared with the standard dose group,however,IL-1 and D-lactic acid decreased significantly at 48 hours after molding(all P＜0.05).The pathology observation showed that,compared with the model group,the intestinal mucosa villus,the lamina propria drop and haemorrhage was decreased in the Dachaihu decoction standard dose group and Dachaihu decoction high dose group.Telangiectasia was reduced and no ulcer formation was observed.Conclusion Dachaihu decoction can inhibit TLR4/NF-κB signaling pathway,reduce intestinal inflammatory response,thus reduce gastrointestinal damage,and protect the gastrointestinal mucosal barrier in rats with severe heatstroke.
Objective To analyze the spectrum of poisoning diseases in the Tongliao area,and provide the scientific basis for standardized treatment of acute poisoning and formulation of toxin control strategies in this area.Methods A retrospective cross-sectional study method was conducted,clinical data of acute poisoning patients admitted to the emergency center(department of emergency)of Inner Mongolia University for Nationalities Affiliated Hospital from January 1,2018 to December 31,2022,were collected through the hospital information system(HIS),including gender,age,marital status,regional distribution,poisoning routes,cultural level,poisoning cause,seasonal distribution,occupation,past medical history,types of toxic drugs,and number of patients undergoing blood purification treatment.Analyze the disease spectrum characteristics of patients with different prognosis,gender,age,region,seasonal distribution and occupational poisoning,and observe the changes in treatment costs for acute poisoning patients of different types of poisoning.Pearson correlation analysis were used to analyze the correlation between gender,age,occupation,past medical history,poisoning routes,cause of poisoning,treatment methods(gastric lavage,blood purification),season,and total hospitalization expenses.Results A total of 701 patients with acute poisoning were enrolled,including 335 outpatients and 366 inpatients.The ratio of males to females was 1∶1.49,and the average age was(43.23±19.39)years old.①Gender characteristics:there was no significant difference in the growth rate of male and female cases of sexual poisoning over the past 5 years(P＞0.05).There was a statistically significant difference in the acute poisoning spectrum between males and females(χ2 = 39.75,P = 0.000);②In terms of age:acute poisoning patients were concentrated in those over 30 years old,with an average age of(52.41±14.47)years.Among them,169 cases(24.11%)over 60 years old were the most common.There was statistical significance in the comparison of poisoning spectra among patients of different age groups(χ2 = 87.57,P = 0.000);③ Past medical history:previous medical history has a significant impact on acute poisoning.In this study,244 cases(34.81%)had a previous medical history,of which 85 cases(34.84%)had a history of mental illness.Among the 47 cases of poisoning caused by psychotropic drugs;④Regional distribution:Horqin District had the highest number of acute poisoning patients(340 cases),while Huolingol City had the lowest number(5 cases).There were statistically significant differences in the number of acute poisoning patients in different regions(χ2 = 74.820,P = 0.034);⑤Seasonal characteristics:poisoning months were concentrated in May,June,July,August,and September,pesticide poisoning was concentrated in May,July,and August,and therapeutic drug poisoning was concentrated in June,July,August,and October;food poisoning mainly occurs in August and September;⑥ Occupational characteristics:farmers and herdsmen had the highest incidence of acute poisoning(63.33%),while retirees had the lowest incidence of poisoning(1.71%).There were statistically significant differences in the spectrum of occupational poisoning among different professions(χ2 = 86.130,P = 0.000);⑦ Treatment cost:pesticide poisoning and food poisoning have the highest per capita cost;⑧ Correlation analysis:correlation analysis showed that the total cost of treatment was significantly positively correlated with toxic drugs and blood purification(r = 0.105,0.678,P = 0.044,0.000),and negatively correlated with seasons(r =-0.125,P = 0.017).It was not correlated with gender,age,occupation,history,poisoning routes,poisoning cause,and gastric lavage(r values were 0.077,0.078,-0.025,0.036,0.069,-0.073,0.004,all P＞0.05);⑨Types and prognosis of toxins:therapeutic drugs(54.07%)and pesticides(37.95%)were the most common types of toxins.The main therapeutic drugs were sedatives and hypnotics(32.72%)and antipyretic analgesics(22.69%);pesticide poisoning was mainly caused by herbicides(31.20%),rodenticides(27.44%),and organophosphorus insecticides(24.81%).Poisoning routes mainly due to gastrointestinal intake(97.43%);545 cases(77.75%)were cured and improved,146 cases(20.83%)were not cured,and 10 cases(1.42%)died.There is no statistically significant difference in overall prognosis among different types of poisoning(χ2 = 10.380,P = 0.239).The blood purification treatment rate was 27.39%.Conclusion Acute poisoning in the Tongliao area has regional characteristics.The main causes were emergency stimuli such as arguments and alcohol consumption,as well as intentional poisoning caused by mental and neurological diseases such as anxiety,depression,sleep disorders,and cerebrovascular diseases.Reducing accessibility is crucial for the control of local toxins.
Objective To explore the distribution of traditional Chinese medicine basic syndromes in sepsis,and to provide evidence for the establishment of diagnostic criteria of sepsis syndromes.Methods Literatures related to sepsis syndrome included in China National Knowledge Infrastructure(CNKI),Wanfang Data,VIP database(VIP)and Chinese Biomedical Literature Database(CBM)databases were searched from the establishment of the database to May 30,2020.Screen the literature and extract data,establish a database for statistical description and analysis of syndrome elements,basic syndromes and symptoms.Analyze the association rule of syndrome elements based on the Apriori algorithm.Based on the two-step hidden tree analysis LTM-EAST algorithm,a symptom latent structure model was constructed,and a comprehensive cluster analysis and model interpretation were performed.Results A total of 383 articles related to sepsis syndromes were included,involving 31 basic syndromes,146 symptoms and 29 syndromes elements.The basic syndromes with frequencies≥5%and cumulative composition ratios≥75%were heat and toxin syndrome,blood stasis syndrome,Yin deficiency syndrome,heat and closing syndrome,Qi deficiency syndrome,phlegm and heat syndrome,Yang prostration syndrome,Fu-organ excess syndrome,and Yang deficiency syndrome.Perform the association rule analysis on syndrome elements with a frequency＞5,obtaining 8 strong association rules,and inferring 7 basic syndromes,including Fu-organ excess syndrome,heat and toxin syndrome,heat and closing syndrome,phlegm clouding the heart syndrome,heat disturbing the heart spirit syndrome,phlegm and heat syndrome,phlegm block syndrome.The symptoms with frequency＞5 were analyzed by hidden structure,41 hidden variables and 82 hidden categories were obtained,and 11 comprehensive clustering models were obtained through comprehensive clustering.Eleven basic syndromes were inferred,including heat and toxin syndrome,blood stasis syndrome,Yin deficiency syndrome,heat and closing syndrome,Qi deficiency syndrome,phlegm and heat syndrome,Yang prostration syndrome,Fu-organ excess syndrome,Yang deficiency syndrome,Yingfen syndrome,and phlegm-dampness syndrome.Combined with all of methods above,9 basic syndromes,heat and toxin syndrome,blood stasis syndrome,Yin deficiency syndrome,heat and closing syndrome,Qi deficiency syndrome,phlegm and heat syndrome,Yang prostration syndrome,Fu-organ excess syndrome,and Yang deficiency syndrome were finally confirmed.Conclusion There are 9 common basic syndromes of sepsis,and the sufficient syndromes are mainly heat and toxin syndrome,blood stasis syndrome,heat and closing syndrome,phlegm and heat syndrome and Fu-organ excess syndrome,while the deficiency syndromes are mainly Yin deficiency syndrome,Qi deficiency syndrome,Yang prostration syndrome,and Yang deficiency syndrome,with each basic syndrome having certain symptom characteristics.
对于需要持续使用血管活性药物支持的感染性休克患者,指南建议添加皮质类固醇治疗.但鲜见在感染性休克患者中氟氢可的松联合氢化可的松与单用氢化可的松疗效比较的研究.近期有加拿大学者进行了一项多中心回顾性队列研究.
Objective To examine the anticoagulant effectiveness and safety of a modified heparin anticoagulant method with those of the standard hepair anticoagulant method in children treated with hemoperfusion,and to provide a basis for optimizing the anticoagulant protocol of hemoperfusion treatment.Methods Twenty-three children treated with a total of 41 sessions of hemoperfusion from June 2021 to February 2022 in Department of Pediatric Nephrology of West China Second Hospital of Sichuan University were selected as research objects by convenient sampling method.The participants were divided into a standard anticoagulation group and an improved anticoagulation method group according to the different heparin-anticoagulation schemes.A total of 11 children in the standard anticoagulation group received 19 sessions of hemoperfusion treatment using the standard heparin anticoagulation scheme,i.e,the first dose of 0.5-1.0 mg/kg heparin was given intravenously,5-10 minates before hemoperfusion,followed by continuous intravenous infusion of 0.2-0.5 mg·kg-1·h-1 heparin which was expected to be stopped 30 minutes before the ending of hemoperfusion.A total of 12 patients in the improved anticoagulation method group underwent 22 sessions of hemoperfusion treatment using an improved heparin anticoagulant method,i.e,intravenous injection 1 mg/kg of heparin before the start of treatment without additional administrations of heparin thereafter.The changes in activated partial thromboplastin time(APTT)at 30,60,90 minutes,and the end of treatment in two groups of children,as well as the coagulation status of the two groups of pipelines and filters,together with the bleeding situation of the children,were monitored.The differences in platelet count(PLT)and recovery of APTT 1 hour after treatment between the two groups of children were compared.Results Compared with the standard anticoagulation method,the improved anticoagulation method showed 68.8%lower APTT value exceeding 300 seconds[β =-1.166,odds ratio(OR)= 0.312,95%confidence interval(95%CI)was 0.125-0.775,P = 0.012]was safer than standard method,and both of them showed good anticoagulation effects at 30,60,90 minutes,and at the end of treatment.The anticoagulation effect of heparin was not influenced by sex(P = 0.179)as well as age(P = 0.821).The improved anticoagulation method group showed better APTT recovery 1 hour after treatment than the standard anticoagulation group(11/22 vs.3/19,P＜0.05).Both anticoagulation methods did not show any coagulation in the pipeline or filter during the treatment process,and the patient did not experience active bleeding within 24 hours after the end of treatment.Conclusion The improved anticoagulant method can achieve anticoagulant effectiveness comparable to that of standard anticoagulation method,is safer than standard method,and at the same time,simplifies the operational process,thereby could reduce the risk of blood borne infections.
Objective To establish a project team to assess and manage the risk of out-of-town transport of extracorporeal membrane oxygenation(ECMO)patients using the healthcare failure mode and effects analysis(HFMEA),analyze the effectiveness of its application,and develop targeted improvement measures and processes.Methods Patients with ECMO who were treated in the department of intensive care unit(ICU)of Affiliated Hangzhou First People's Hospital,Zhejiang University School of Medicine March 2020 to September 2021 were selected as the study subjects.By comparing the differences in the accuracy of ECMO transport risk assessment,the rate of fixation against catheter slippage,the incidence of adverse transport events between the two groups before and after HFMEA,and the application effect of this model in ECMO transport adverse event risk management was evaluated.Results A total of 48 ECMO patients were enrolled,and 42 times of out-of-home transfers were performed,including 22 before HFMEA and 20 after HFMEA.Compared with pre-HFMEA,the accuracy of ECMO transport risk assessment[95.00%(19/20)vs.54.55%(12/22),P＜0.05]and the compliance rate of catheter slip fixation[100.00%(20/20)vs.68.18%(15/22),P＜0.05]in patients after HFMEA were significantly increased,the incidence of adverse events in transport was significantly lower[5.00%(1/20)vs.40.91%(9/22),P＜0.05].Conclusion The application of HFMEA in the risk management of ECMO transshipment adverse events is beneficial to standardize the prevention of ECMO transshipment accidents,effectively reduce the incidence of transshipment adverse events,and ensure patient safety.
Objective To investigate the related factors of citrin deficiency(CD)complicated with liver failure(LF).Methods A retrospective analysis was performed on 91 patients with CD admitted to the department of pediatrics of Fujian Children's Hospital and Fujian Maternity and Child Health Hospital from January 2011 to August 2022,including 28 patients with LF(LF group)and 63 patients without LF(non-LF group).The general information of the patients(gender,age,body weight,feeding method and whether they were co-infected,whether they had light-colored stool,whether they had congenital heart disease,and whether they were accompanied by hepatomegaly)and laboratory indicators of the patients[white blood cell count(WBC),neutrophil count(NEU),hemoglobin(Hb),platelet count(PLT),C-reactive protein(CRP),blood lactic acid(Lac),blood ammonia,blood sodium,blood potassium,alanine aminotransferase(ALT),aspartate aminotransferase(AST),γ-glutamyl transpeptides(γ-GGT),total bilirubin(TBil),direct bilirubin(DBil),albumin,alkaline phosphatase(ALP),bile acid,cholesterol,uric acid,MB isoenzyme of creatine kinase(CK-MB),blood glucose(GLU),prothrombin time(PT),international standard normalized ratio(INR)were collected.The above indicators in two groups were compared,and the indicators with statistically significant differences in univariate analysis were included in Logistic regression analysis to find the correlated factors of CD complicated with LF.The predictive value of each related factor for CD complicated with LF was analyzed by drawing receiver operator characteristic curve(ROC curve).The area under the ROC curve(AUC)was used to evaluate the prediction efficiency of each factor.Results Compared with non-LF group,the patients in LF group had higher proportion of infections(60.7%vs.12.7%),higher TBil[μmol/L:242.50(210.95-278.68)vs.168.20(141.50-232.65)]and DBil[μmol/L:146.40(100.73-173.55)vs.79.40(65.39-99.60)],lower Hb(g/L:79.21±20.39 vs.94.75±12.56),PLT(×109/L:215.61±148.73 vs.377.63±163.00)and GLU(mmol/L:2.79±1.32 vs.4.10±1.36),worse prognosis[mortality:15.0%(3/28)vs.0.0%(0/63)],the differences were statistically significant(all P＜0.05).Logistic regression multi-factor analysis showed infections[odds ratio(OR)=5.160,95%credibility interval(95%CI)was 1.006-26.455,P = 0.049],decreased Hb(OR = 0.930,95%CI was 0.869-0.996,P = 0.037),decreased PLT(OR = 0.992,95%CI was 0.987-0.998,P = 0.009),decreased GLU(OR = 0.355,95%CI was 0.174-0.724,P = 0.004)and increased TBil(OR = 1.016,95%CI was 1.001-1.030,P = 0.034)were the related factors of CD complicated with LF.ROC curve analysis showed that Hb,PLT,GLU,TBil and the combined diagnosis had certain predictive value for CD complicated with LF[AUC and 95%CI were 0.754(0.639-0.868),0.756(0.646-0.867),0.749(0.644-0.854),0.807(0.717-0.898)and 0.944(0.897-0.992),respectively,all P = 0.000],among them,the combined diagnostic efficiency was the highest.When the best cut-off values of Hb,PLT,GLU and TBil were 86.50 g/L,254.50×109/L,3.29 mmol/L and 185.40 μmol/L,the sensitivity of Hb,PLT,GLU and TBiL were 74.6%,81.0%,76.2%and 96.4%,respectively,the specificity were 71.4%,63.3%,64.3%and 65.1%,respectively.Conclusion Infections,decreased Hb,PLT,GLU and increased TBil are the related factors associated with LF in CD,and combined diagnosis can improve the diagnostic efficiency.
Objective To evaluate the effect of LEARNS[listen(L),establish(E),adopt(A),reinforce(R),name(N),strengthen(S)]model health education for patients with peripherally inserted central catheter(PICC)after discharge.Methods From June 2020 to June 2021,193 discharged patients with PICC were selected as the study objects.They were divided into observation group(95 cases)and control group(98 cases)according to random number table method.The control group received routine health education and continued follow-up for 3 months.In the observation group,health education was constructed and implemented at 2,4,8 and 12 weeks after discharge based on the control group and the basis of LEARNS model.The incidence of PICC-related complications and PICC-related adverse events were compared between the two groups,and self-management ability was evaluated using cancer patients PICC self-management scale(CPPSMS)score,strategies used by people to promote health(SUPPH)were used to evaluate self-efficacy.Results The incidence of PICC-related complications and adverse events in the observation group were significantly lower than those in the control group[11.58%(11/95)vs.40.82%(40/98)and 6.32%(6/95)vs.22.45%(22/98),both P＜0.05].There were no statistically significant differences in CPPSMS scores(daily catheter observation,maintenance compliance,management confidence,anomaly handling,information acquisition,tubeed exercise,and tubeed daily life)and SUPPH scores(positive attitude,self-stress reduction,and self-decision-making)in the two groups before intervention,and the above scores were higher than those before intervention.After intervention,the above scores in the observation group were significantly higher than those in the control group(CPPSMS total score was 131.37±27.20 vs.92.41±23.89,daily catheter observation score was 26.02±6.04 vs.18.27±5.43,maintenance compliance score was 18.45±4.36 vs.13.28±3.12,and management confidence score was 17.69±3.37 vs.13.81±3.65,anomaly processing score was 15.01±3.46 vs.10.25±2.74,information acquisition score was 11.98±2.56 vs.7.84±2.07,tube motion score was 15.94±3.46 vs.10.28±2.78,daily life with tubes score was 26.28±5.19 vs.18.68±4.46,all P＜0.05;SUPPH total score was 106.54±20.84 vs.93.93±18.50,positive attitude score was 56.89±11.45 vs.49.34±10.56,self-stress reduction score was 38.25±8.73 vs.34.76±6.28,the self-decision-making score was 11.40±2.57 vs.9.83±2.96,all P＜0.05).Conclusion The implementation of health education based on LEARNS model in discharged patients with PICC tube can improve their self-management ability and self-efficacy,and improve clinical prognosis.
Objective To analyze the prognosis and influencing factors of patients with acute myocardial infarction(AMI)complicated with cardiogenic shock(CS)under extracorporeal membrane oxygenation(ECMO)support.Methods Retrospective analysis of the clinical data of ECMO supported coronary angiography and percutaneous coronary intervention(PCI)treatment for AMI complicated with CS patients who visited the department of emergency medicine of the Second Hospital of Hebei Medical University from December 2018 to December 2021,including gender,age,body mass index(BMI),past history(smoking history,coronary heart disease,diabetes,hypertension,hyperlipidemia,cerebrovascular disease),acute physiological and chronic health evaluationⅡ(APACHEⅡ),vasoactive-inotropic score(VIS),the worst auxiliary examination indicators within 24 hours before ECMO[arterial lactate acid,white blood cell count(WBC),cardiac troponin I(cTnI),alanine transferase(ALT),total bilirubin(TBil),creatinine(Cr),serum potassium(K+),left ventricular ejection fraction(LVEF)],time from onset to PCI,coronary angiography results(involved anterior descending branch,circumflex branch,right coronary artery,three-vessel lesions,left main artery lesions),whether to use intra aortic-balloon counterpulsation(IABP)and continuous renal replacement therapy(CRRT).Patients were divided into survival and death groups based on the prognosis after 30 days of onset.Univariate analysis was used to compare the differences in the above indicators between the two groups with different prognoses,Logistic regression analysis was used to analyze the independent risk factors affecting the prognosis of AMI patients with CS under ECMO support coronary angiography and PCI treatment,and the receiver operator characteristic curve(ROC curve)was drawn to evaluate the predictive value of risk factors on patient prognosis.Results Out of 39 patients,21 cases(53.8%)survived and 18 cases(46.2%)died.Compared with the survival group,the VIS score,lactate acid,time from onset to PCI,involvement of the circumflex artery,three-vessel disease,and left main artery lesions significantly increased in the death group(all P＜0.05).Logistic regression analysis showed that lactate acid and three-vessel lesions were independent risk factors affecting the 30-day prognosis of AMI patients with CS[odds ratio(OR)and 95%confidence interval(95%CI)were 1.845(1.018-3.342)and 107.171(1.307-8 785.901),all P＜0.05].ROC curve analysis showed that lactate acid and three-vessel lesions has predictive value for the prognosis of AMI combined with CS patients undergoing ECMO supported coronary angiography and PCI treatment,the area under the ROC curve(AUC)were 0.756 and 0.752,95%CI were 0.601-0.911 and 0.588-0.916,P value were 0.007 and 0.008.When the cut-off value of lactic acid was 5 mmol/L,the sensitivity and specificity of predicting the prognosis of AMI combined with CS patients undergoing coronary angiography and PCI treatment were 94.1%and 57.1%,respectively.Conclusions The indications for using ECMO in critically ill patients with AMI combined with CS need to be further refined.VIS score,lactate acid,time from onset to PCI,three-vessel lesions,and left main artery lesions are risk factors for patient death.When using ECMO support for high lactate,high VIS score,and three-vessel lesions,caution should be exercised.Early ECMO support can improve the prognosis of appropriate patients by reducing lactate,reducing the use of vasoactive drugs,and shortening the time from onset to PCI.
Objective To explore the distribution of common syndromes in sepsis based on literature data mining.Methods The literature related to sepsis symptoms analysis included in China National Knowledge Infrastructure(CNKI),Chinese Biomedical Literature Database(CBM),VIP database(VIP)and Wanfang Data were searched by computer to extract relevant information and establish a database.Analysis of common syndromes and symptoms of sepsis by frequency statistics.Based on LTM-EAST algorithm of two-step hidden tree analysis,a symptom hidden structure model with frequency≥10 was constructed by Latern 5.0 software,and potential syndromes were inferred through comprehensive clustering.Symptoms with frequency＞5%were selected for factor analysis,common factors were extracted for further systematic cluster analysis,and potential syndromes were inferred according to the results.Based on the above results,the common syndromes and clinical characteristics of sepsis were analyzed.Results A total of 792 literatures and 961 syndromes records and 877 symptoms records were included,involving 48 syndromes after the regulation,with high frequency of pattern of blood stasis,pattern of yangming fu-organ excess,pattern of internal block of the heart orifices due to phlegm and heat,pattern of yang prostration,etc.The frequencies were 12.70%(122/961),9.68%(93/961),9.47%(91/961)and 7.80%(75/961).It involved 179 symptoms after the regulation,including high fever,red tongue,thirst,dysphoria,etc.The frequencies were 27.82%(244/877),27.36%(240/877),27.25%(239/877),25.54%(244/877).Forty-three hidden variables were obtained through implicit structure analysis,according to professional knowledge,12 potential syndromes were obtained by comprehensive clustering,including pattern of blood stasis,pattern of yangming fu-organ excess,pattern of phlegm and heat congesting in the lung,pattern of fire toxin entering the nutrient phase,pattern of Yin deficiency with exuberant heat,pattern of Yang prostration,pattern of Qi deficiency,pattern of Yang deficiency,pattern of turbid phlegm obstructing the lung,pattern of damp-heat encumbering the spleen,pattern of intense exuberant heat toxin,pattern of pathogenic factors repressing defensive Qi of lung.Twenty-five common factors were obtained by factor analysis,and 12 potential syndromes were inferred by systematic clustering,including pattern of heart-Yang deficiency,pattern of phlegm and heat congesting in the lung,pattern of yangming fu-organ excess,pattern of Yang prostration,pattern of intense exuberant heat toxin,pattern of Yang deficiency in spleen and kidney,pattern of Qi deficiency,pattern of phlegm and heat damaging Yin,pattern of Qi deficiency with blood stasis,pattern of Qi and Yin deficiency,pattern of pathogenic factors repressing defensive Qi of lung,and pattern of heat sinking into the pericardium.According to the standard of common traditional Chinese medicine(TCM)syndromes and their symptom characteristics,9 common syndromes of sepsis were finally obtained,including pattern of intense exuberant heat toxin,blood stasis,pattern of yangming fu-organ excess,pattern of phlegm and heat congesting in the lung,pattern of fire toxin entering,pattern of pathogenic factors repressing defensive Qi of lung,pattern of Qi and Yin deficiency,pattern of Qi deficiency,pattern of Yang prostration.Conclusion The symptoms and characteristics of common syndromes of sepsis are significant,which can provide evidence for the syndrome diagnosis standard of sepsis.
