BACKGROUND:Out-of-hospital cardiac arrest (OHCA) in China has a high incidence and poor survival, highlighting an urgent need for rapid identification of reversible aetiologies. Conventional transthoracic echocardiography during resuscitation can be limited by imaging quality and prolonged chest compression interruptions. Transoesophageal echocardiography (TEE) is a feasible alternative that allows for continuous real-time imaging during compressions, but its utility in Chinese OHCA patients remains uncertain. METHODS:This prospective, single-centre exploratory study enrolled 45 consecutive selected adults with non-traumatic OHCA (NT-OHCA) of unclear aetiology who were eligible for TEE. Of all enrolled patients, 43 completed standardised TEE image acquisition, while 2 cases with TEE-unrecognisable aetiology were excluded from aetiological analysis. The per-protocol analysis finally included 41 patients in whom TEE was successfully completed. Certified emergency physicians performed simplified TEE examinations (five standard views) during active resuscitation. Door-to-TEE interval, diagnostic yield, TEE-guided interventions and clinical outcomes were recorded according to Utstein guidelines. RESULTS:TEE yielded diagnostic-quality images in all patients (43/43), with a median door-to-TEE time of 13 min (IQR: 6.5-22). Reversible aetiologies were identified in 39.0% (16/41), most commonly acute aortic dissection (50.0%, 8/16), followed by massive pulmonary embolism (25.0%), hypertrophic cardiomyopathy (18.8%) and hypovolaemia (6.3%). TEE guided interventions in 56.3% (9/16) of identified cases. Return of spontaneous circulation (ROSC) and 28-day survival rates were 41.5% and 12.2%, respectively, with no significant differences between aetiology-identified and unidentified groups (ROSC: 37.5% vs 44.0%, p>0.05; 28-day survival: 6.3% vs 16.0%, p>0.05). Sensitivity analysis of the 43-case complete imaging cohort and the total 45 enrolled cases further verified the stability and reliability of the diagnostic results. CONCLUSIONS:During mechanical cardiopulmonary resuscitation, TEE rapidly identified suspected aetiologies in 39% (16/41) of NT-OHCA cases, notably revealing frequent acute aortic dissections. Lacking a comparator group, TEE's feasibility as a complementary tool requires further controlled investigation.

急性胰腺炎(acute pancreatitis,AP)是一种以胰腺组织水肿和坏死为主要病理特征的急腹症.约11％～32％的初发AP患者会发展为复发性急性胰腺炎(recurrent acute pancreatitis,RAP)[1-2],远期危害较大[3-5].高脂血症性急性胰腺炎(hyperlipidemic acute pancreatitis,HLAP)发病率逐年升高[6-7],较其他病因所致的AP更年轻化[8]、重症化[9-10],且合并症多[8],易发展为复发性高脂血症性急性胰腺炎(recurrent hyperlipidemic acute pancreatitis,R-HLAP)[3,11].如果能在初发HLAP患者中甄别出复发高风险人群,及时采取有效防治措施,则可能避免RAP发生.故本文回顾性分析本院诊治且能随访跟踪的初发HLAP患者临床资料,探讨发生R-HLAP的影响因素,构建预测R-HLAP的列线图并验证及评价,为临床早期筛选高风险复发人群制定防治策略.

The High-flow nasal cannula (HFNC) oxygen therapy has received attention as an alternative to respiratory support in critically ill patients. It gives you a continuous flow of fresh gas at high flow rates replacing or washing out the patient's pharyngeal deadspace. Every breath that the patient now breathes will be cleared of carbon dioxide and replaced with an oxygen-rich gas, which improves breathing efficiency. Although the use of HFNC in adults who are critically ill has been dramatically increasing, the advantages and disadvantages of each element have not been well discussed. Although the use of HFNC in critically ill adults has increased dramatically, its advantages and disadvantages have not been well discussed. The pathophysiological mechanism of AHF caused by dyspnea and hypoxia is different from the primary respiratory disease, the indications, timing and efficacy of HFNC in AHF treatment are not satisfactory. This paper reviews related research in recent years to improve the AHF respiratory support level with reasonable use of HFNC. Practical Application: HFNC has a unique advantage in the treatment of AHF with hypoxemia due to the ability to produce a certain level of PEEP, providing humidified warming and stable oxygen concentration and oxygen flow, reducing respiratory work and comfort. This paper reviews related research in recent years to improve the AHF respiratory support level with reasonable use of HFNC.

Objective:To establish an early prediction model with multiple indicators to predict the risk of severe acute pancreatitis (SAP) in hyperlipidemic acute pancreatitis (HLAP).Methods:The clinical data of 92 patients with HLAP admitted to the Emergency Department of our hospital from March 2018 to February 2020 were analyzed retrospectively. Among them, 29 cases deteriorated to SAP and 63 cases did not. Univariate analysis was used to screen predictive indicators related to hyperlipidemic severe acute pancreatitis (HL-SAP), and logistic regression analysis was used to screen independent predictive indicators related to HL-SAP. Then a prediction model was established. The area under (AUC) the receiver operating curve (ROC) was used to evaluate the predictive ability of each predictive indicator and the model for HL-SAP. Bootstrap resampling technology was used to validate the predictive ability of the model.Results:Univariate analysis showed that procalcitonin, D-dimer, C-reactive protein, albumin, cholesterol and CT grade had influence on the progression of HLAP to SAP ( P<0.05). Logistic regression analysis showed that D-dimer ( OR=2.112, 95% CI: 1.022-4.366; P<0.05), CT grade ( OR=5.818, 95% CI: 2.481-13.643; P<0.01) and cholesterol ( OR=1.146, 95% CI: 1.004-1.308; P<0.05) were independent risk factor of HL-SAP. The AUC of D-dimer, CT grade, cholesterol and the model were 0.802, 0.875, 0.665 and 0.927, respectively. Internal validation of the predictive ability of the model showed that the C-index was 0.927. Conclusions:In the early phase, application of the prediction model that composes D-dimer, CT grade and cholesterol has a good predictive effect on HL-SAP.

目的 对比经鼻高流量氧疗和无创正压通气在急诊科抢救老年慢性阻塞性肺疾病急性发作并发Ⅱ型呼吸衰竭的治疗效果.方法 选取我院急诊抢救室2018年7月—2019年7月慢性阻塞性肺疾病急性发作合并呼吸衰竭老年患者66例,随机分为经鼻高流量氧疗30例和无创正压通气36例.2组患者在常规抗感染、使用支气管扩张剂、祛痰及维持水电解质平衡等基础上,分别采用经鼻高流量氧疗和无创正压通气.观察2组患者治疗前后的心率、呼吸频率、血氧饱和度、血气分析指标、治疗启用时间、患者舒适度及不良反应.结果经治疗2 h后,2组心率、呼吸频率、血氧饱和度、血气分析指标均有明显改善,与治疗前比较差异有统计学意义(P<0.01),2组间对比差异无统计学意义(P>0.05);经鼻高流量氧疗启用时间较无创正压通气时间短,且舒适度更高(P<0.05);2组均未见明显不良反应.结论 两种呼吸支持模式在抢救老年慢性阻塞性肺疾病急性发作并发呼吸衰竭都有较好的效果,经鼻高流量氧疗启用时间短,舒适度高、耐受性好.

肺奴卡菌病是由奴卡菌侵犯肺部引起的亚急性、慢性局限性或播散性化脓性或肉芽肿性疾病,可经血源播散至皮肤或中枢神经系统、肾脏等部位或器官.由于是一种少见病,且临床和影像学表现缺乏特异性,故容易误诊或漏诊而延误治疗或治疗不规范而影响预后.本文报道 1 例肺奴卡菌病伴发脑梗死病例,并复习相关文献,希望有助于提高对奴卡菌病的认识.

脓毒症(sepsis)是宿主对感染的特异性反应失调导致的危及生命的器官功能损害,是重症监护病房(ICU)患者的主要死亡原因.生物标志物在早期识别诊断脓毒症、病情评价、指导抗生素应用及预后评估方面具有重要意义.不同于降钙素原(PCT)、白细胞介素-6(IL-6)、C-反应蛋白(CRP)等炎症标志物,近来发现的一种新型生物标志物可溶性CD14亚型(Presepsin)在脓毒症的诊断及评价中显示了良好的临床意义,具有良好的临床应用前景.

一、概述 机械通气的撤离(weaning from mechanical ventilation,简称撤机)一直是临床上的一个研究热点,自主呼吸试验(spontaneous breathing trial,SBT)作为撤机前的常规检查,是评估有创通气患者能否成功拔管的主要诊断试验.多方面因素影响撤机的成败,撤机导致的心功能不全是撤机失败的常见原因,早期发现心功能不全对指导撤机过程有重要意义.B型钠尿肽(B-type natriuretic peptide,BNP)及N端前脑钠肽(N-terminal pro-brain natriuretic peptide,NT-proBNP)作为心脏标志物,近年来得到越来越多的关注.最近的研究结果表明,BNP可以预测机械通气患者的撤机结果,有助于提高拔管成功率;NT-proBNP有助于鉴别撤机失败的原因是否为心源性因素.BNP水平在撤机过程中的动态变化,在指导撤机过程、鉴别撤机失败的原因、提高撤机成功率方面的应用价值值得深入研究.

目的:构建含大鼠TCR Vβ5.2-HSP70和TCR Vβ8.2-HSP70基因的重组真核表达质粒,并检测其在体内外的表达。方法:实验于2005-10/2006-09在首都医科大学免疫学系实验室完成。①以自主构建的重组表达载体pTARGET-TCR Vβ5.2和pTARGET-TCR Vβ8.2为模板,将结核杆菌HSP70的一段保守序列P111-125设计到引物中,通过PCR的方法得到TCR Vβ5.2-HSP70和TCR Vβ8.2-HSP70基因片段,将其插入到真核表达载体pTARGET中,构建重组表达载体pTARGET-TCR Vβ5.2/8.2-HSP70。②将BALB/c小鼠48只随机分为4组,pTARGET-TCR Vβ 5.2-HSP70组、pTARGET-TCR Vβ8.2-HSP70组和空质粒组肌注相应的质粒DNA100μg/次,PBS组注射PBS缓冲液100μL/次。共注射3次,每次间隔2周。于末次免疫后3d取注射部位的肌肉,用RT-PCR及免疫组化染色法检测TCR Vβ5.2/8.2-HSP70基因在注射部位的转录和表达。③将COS-7细胞分为pTARGET-TCR Vβ5.2-HSP70组、pTARGET-TCR Vβ8.2-HSP70组、空质粒组和未转染细胞组,进行相应质粒转染,24h后收集细胞,用免疫细胞化学染色法检测靶基因在真核细胞内的表达。结果:①TCR Vβ5.2/8.2-HSP70基因已被正确插入到pTARGET载体中。②pTARGET-TCR Vβ5.2-HSP70组、pTARGET-TCR Vβ8.2-HSP70组小鼠免疫处的肌肉组织RT-PCR检测显示,在500～600bp和400～500bp处出现特异的扩增带,分别与TCR Vβ5.2-HSP70和TCR Vβ8.2-HSP70基因片段的大小相符,而注射空质粒组和PBS组均未见此条带。③免疫组化结果显示转染重组质粒pTARGET-TCR Vβ5.2/8.2-HSP70的COS-7细胞的胞质及胞膜都有明显的着染。结论:成功构建了重组真核表达质粒pTARGET-TCR Vβ5.2/8.2-HSP70,并在体内外检测到其转录和表达,为进一步进行TCR DNA疫苗治疗胶原诱导性关节炎的实验研究奠定了基础。