Objectives . Early warning prediction of massive hemorrhages can greatly reduce mortality in trauma patients. This study aimed to develop and validate dynamic prediction models for massive hemorrhage in trauma patients. Methods . Based on vital signs (e.g., heart rate, respiratory rate, pulse pressure, and peripheral oxygen saturation) time-series data and the gated recurrent unit algorithm, we characterized a group of models to flexibly and dynamically predict the occurrence of massive hemorrhages in the subsequent T hours (where T = 1, 2, and 3). Models were evaluated in terms of accuracy, sensitivity, specificity, positive predictive value, negative predictive value, F 1 score, and the area under the curve (AUC). Results . Results show that of the 2205 trauma patients selected for model development, a total of 265 (12.02%) had a massive hemorrhage. The AUCs of the model in the 1-h-group, 2-h-group, and 3-h-group were 0.763 (95% CI: 0.708–0.820), 0.775 (95% CI: 0.728–0.823), and 0.756 (95% CI: 0.715–0.797), respectively. Finally, the models were used in a web calculator and information system for the hospital emergency department. Conclusions . This study developed and validated a group of dynamic prediction models based on vital sign time-series data and a deep-learning algorithm to assist medical staff in the early diagnosis and dynamic prediction of a future massive hemorrhage in trauma.
With aging of population and improvement of medical technology,the number of elderly patients receiving surgical treatment is increasing.Cardiovascular events after noncardiac surgery are one of the leading causes of death.Perioperative cardiovascular events have a high risk and incidence rate,thus severely affecting the prognosis of patients.In recent years,a growing number of studies have focused on the prevention and treatment of perioperative cardiovascular events in elderly patients.Assessing the risk of perioperative cardiovascular events and using effective interventions can effectively reduce the incidence of cardiovascular events and improve the prognosis of elderly patients.This article discusses cardiovascular risk assessment and management in elderly patients during noncardiac surgeries from the perspective of preoperative,intraoperative,postoperative periods,and perioperative medication used to provide assistance to clinical practice.
For axial spondyloarthritis/ankylosing spondylitis,rehabilitation is very important for controlling disease activity,preventing disease progression and improving quality of life.Initiated by China Spine Alliance and jointly formulated by Air Force Specialty Medical Center and Chinese PLA General Hospital,the current guidelines were developed according to World Health Organization Guidelines Development Manual and the Basic Methods and Procedures for the Development/Revision of the Clinical Diagnosis and Treatment Guidelines,Appraisal of Guidelines for Research and Evaluation Ⅱ(AGREE Ⅱ),Grading of Recommendations Assessment,Development and Evaluation(GRADE).Two basic princlples and 12 suggestions were made for important issues such as diagnosis,rehabilitation assessment,rehabilitation intervention and management for axial spondyloarthritis/ankylosing spondylitis.
Dexmedetomidine is a highly selective α2 adrenergic receptor agonist,exerting anti-sympathetic,sedative,analgesic and anti-anxiety effects,with minimal impact on respiration.In recent years,dexmedetomidine has been widely used in clinical anesthesia,perioperative treatment,and intensive care.Organ-protection is an important focus of anesthesia and perioperative medicine,with clinical significance in reducing complications and improving short-and long-term outcomes.Increasing clinical evidence and basic research have shown that the application of dexmedetomidine could protect the heart,brain,lung,kidney,liver,gastrointestinal tract and other important organs.The mechanism may be related to dexmedetomidine's effects of anti-inflammation,anti-oxidation,anti-apoptosis,and autophagy regulation.From our perspectives,clinical use should follow the principle of individualization,and the dose should be adjusted in time according to patients'responses,so as to avoid adverse reactions such as hypotension and bradycardia while protecting the organs.Moreover,more strictly designed clinical studies and in-depth mechanistic investigations are needed for the optimal dexmedetomidine therapy and better organ protection during the perioperative course.In order to facilitate better understanding of clinicians,this paper reviews the organ-protective effects and underlying mechanisms of dexmedetomidine.
Objective To explore the change of brain functional connectivity strength in patients with type 2 diabetes mellitus(T2DM)and its neuropathological mechanism.Methods Fifty-six T2DM patients who visited Gansu Provincial Hospital from October 2017 to March 2021 were selected as T2DM group,and 48 healthy controls were selected as control group.A prospective study was conducted on the changes in brain function in T2DM patients by analysis of resting state functional connectivity strength(FCS)and functional connectivity(FC)based on seed points.Brain functional magnetic resonance imaging,clinical variable collection,and neuropsychological testing of patients in two groups were performed.We calculate the FCS value,evaluate the brain function changes of the two groups in the resting state,take the brain regions with significant differences between the groups as the seed points and perform functional connectivity analysis with the whole brain.Correlation analysis was conducted between the FCS,FC values of the different brain regions and clinical variables such as fasting blood glucose(FPG),glycosylated hemoglobin(HbA1c),thyroid hormone(TSH)levels,as well as the scores of mini mental state examination(MMSE),Montreal cognitive assessment(MoCA),clock drawing test(CDT),Hamilton Depression Rating Scale(HAMD-24)and Hamilton Anxiety Scale(HAMA).Results Compared with control group,the HAMD-24 and HAMA scores in T2DM group significantly increased(P<0.01),while the MoCA scores decreased(P<0.05);In T2DM group,the FCS value of the right middle temporal gyrus increased(GRF correction,voxel level P<0.001,clustering level P<0.05),and the FC value of the right middle temporal gyrus-left anterior cingulate cortex decreased(GRF correction,voxel level P<0.001,clustering level P<0.05).Correlation analysis showed that the FC value of right middle temporal gyrus-left anterior cingulate cortex in T2DM patients was negatively correlated with HAMD-24 score(r=-0.395,P=0.003),HbA1c level(r=-0.303,P=0.023),and positively correlated with TSH level(r=0.324,P=0.017).Conclusions The increase of FCS value in the right middle temporal gyrus and the decrease of FC value in the right middle temporal gyrus-left anterior cingulate cortex may be important neuroimaging features of brain function damage in T2DM patients.HbA1c may play an important role in the process of brain damage in T2DM patients.
