IntroductionDelirium is a common acute cognitive impairment characterised by confusion, disorientation and attention deficits, particularly prevalent in intensive care unit (ICU) settings. Given its significant impact on patients, caregivers and healthcare resources, preventing delirium in patients in the ICU is of paramount importance. This is the first randomised-controlled trial designed to evaluate the effects of a virtual reality-based sensory stimulation intervention on preventing delirium in ICU patients.Methods and analysisWe employed a paired randomisation method to match eligible participants based on a validated delirium risk scoring model for patients in the ICU. The study will commence in September 2024 and conclude in June 2026. A consecutive sample of 324 patients in the ICU admitted to the study setting will be recruited. Eligible participants will be randomly allocated to receive either virtual reality-based sensory stimulation in addition to usual care or usual care alone. The virtual reality-based sensory stimulation intervention will last for up to 14 days, with all interventions administered by a research team. We define delirium-free days over a 14-day period as the primary outcome. The secondary outcomes will include delirium incidence, duration and severity; patients’ psychological well-being (post-traumatic stress disorder, sleep quality and ICU memory); patients’ clinical outcomes and other outcomes (quality of life, independence and cognitive function). Data will be collected at baseline, post-intervention and 6 months post-intervention. Two independent t-tests or Wilcoxon-Mann-Whitney tests will be used for continuous variables, while χ2or Fisher’s exact tests will be employed for categorical variables. The analysis will adhere to both the intention-to-treat and per-protocol principles. Additionally, mixed-effects models and subgroup analysis will be planned.Ethics and disseminationThis protocol was approved by the Research Ethics Committee of Shenzhen Hospital of Southern Medical University (NYSZYYEC20230068). All participants or their family caregivers will provide written informed consent. Results will be disseminated through scientific publications, and presentations at local and international conferences.Trial registration numberClinicalTrials.govNCT06153472. Trial registration date: 22 November 2023.

Purpose: Voriconazole (VOR) is combined with atorvastatin (ATO) to treat fungal infections in patients with dyslipidemia in clinical practice. However, the pharmacokinetic interactions and potential mechanisms between them are unknown. Therefore, this study aimed to investigate the pharmacokinetic interactions and potential mechanisms between ATO and VOR.Patients and methods: We collected plasma samples from three patients using ATO and VOR. Rats were administered either VOR or normal saline for 6 days, followed by a single dose of 2 mg/kg ATO, and then plasma samples were collected at different time points. The incubation models of human liver microsomes or HepG2 cells were constructed in vitro. A high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) system was developed to determine the concentration of ATO, 2-hydroxy-ATO, 4-hydroxy-ATO, and VOR.Results: In patients, VOR significantly reduced the metabolism of ATO and slowed the formation of 2-hydroxy- and 4-hydroxy-ATO. In rats pretreated with orally administered VOR for 6 days or normal saline given a single dose of 2 mg/kg ATO administered orally on Day 6, the t1/2 of ATO was significantly prolonged from 3.61 to 6.43 h, and the area under the concentration-time curve (AUC0–24h) values of ATO increased from 53.86 to 176.84 h μg.L−1. However, the pharmacokinetic parameters of VOR (20 mg/kg) with or without pretreatment with ATO (2 mg/kg) only slightly changed. In vitro studies indicated that VOR inhibited the metabolism of ATO and testosterone, and the IC50 values were 45.94 and 49.81 μM. However, no significant change in transporter behaviors of ATO was observed when VOR or transporter inhibitors were co-administered.Conclusion: Our study demonstrated that VOR has significant interactions with ATO, probably due to VOR’s inhibition of the CYP3A4-mediated metabolism of ATO. Based on the clinical cases and potential interactions, the basic data obtained in our study are expected to help adjust the dose of ATO and promote the design of rational dosage regimens for pharmacotherapy for fungal infections in patients with dyslipidemia.

Bongkrekic acid (BA) poisoning can progress rapidly and lead to the failure of multiple organs, such as brain, liver and kidney. The mortality of BA poisoning is 40-100%. Little information is available on the toxicokinetic parameters of BA in human. Although hemodialysis is widely utilized for patients with severe BA poisoning, the exact amount of BA removed by hemodialysis is poorly documented. We analyzed toxicokinetic parameters, endogenous clearance and hemodialysis clearance in a patient with BA poisoning. A 27-year-old male developed symptoms of severe diarrhea, nausea, vomiting and weakness after eating rice noodles for more than one day. The patient developed multiple organ failures, especially the liver. Initial serum BA concentration was 0.5μg/mL. He received plasmapheresis, routing, and Oxiris-based Continuous Renal Replacement Therapy (CRRT). The whole blood, serum, urine and dialysate BA concentrations were collected and analyzed hourly. Toxicokinetic parameters relationships were determined using noncompartmental analysis. The clearances were determined using standard pharmacokinetic calculations. The disposition of BA was characterized by a long half-life (t1/2 of 102) and high max plasma (CL of 129,000 L/h/kg) following ingestion of contaminated food. The average serum clearance of BA during PE is remarkable higher than CRRT and the endogenous clearance. In contrast, the rates of decline in blood levels during the CRRT treatments were similar to the natural rate of decline. The total amount of BA removed by Plasmapheresis was 5.51mg. However, most CRRT failed to eliminate BA. We report a rare case of BA poisoning with a complication of liver failure and acute kidney damage. The patient expired, even with supportive care, plasmapheresis and hemodialysis. Analysis of whole blood, serum, urine and dialysate concentrations showed limited efficacy of CRRT in removing BA from blood. In contrast, there was significant extraction of BA from Plasmapheresis.

BackgroundRabies is a highly fatal disease. Once symptoms develop, death usually occurs within days. Survivors were occasionally reported in the literatures. Ante-mortem diagnosis remains a challenge in most rabies endemic countries. A novel, accurate diagnostic assay is highly desirable.MethodsWe used metagenomic next-generation sequencing (mNGS) to examine the cerebrospinal fluid (CSF) samples of a 49-year-old patient with rabies and validated the results by TaqMan PCR and RT-PCR/Sanger sequencing.ResultsMetagenomic next-generation sequencing identified sequence reads uniquely aligned to the rabies virus (RABV). PCR confirmed the presence of the partial RABV N gene in the CSF. Phylogenetic analysis showed that the RABV grouped as an Asian clade, which is the most broadly distributed clade in China.ConclusionMetagenomic next-generation sequencing may be a useful screening tool for the etiological diagnosis of rabies, especially in the absence of timely rabies laboratory testing or in patients with no exposure history.

目的 探讨高渗盐水(HS)液体复苏对重症急性胰腺炎(SAP)的临床价值.方法 采用前瞻性、多中心、随机对照临床试验方法,纳入2018年8月至2022年2月期间3家医院重症医学科(ICU)收治的40例SAP患者,随机分为HS组(n=19)和林格液(LR)组(n=21),观察并比较两组患者液体复苏24 h后的血流动力学变化、前3 d液体复苏量、第7天脏器功能评分和炎症指标,治疗期间机械通气、血液净化治疗、血管活性药物和外科手术等治疗干预情况,胰腺坏死和继发感染发生率,以及ICU住院天数、总住院天数、住院病死率、不良反应发生率,并采用二元Logistic回归分析观察影响患者第7天脏器衰竭的相关因素.结果 HS和LR液体复苏24 h后,两组心率和血乳酸水平较基线值下降(P<0.05).HS组较LR组前3 d所需液体复苏量更少(mL:12287±3083 vs.14494±4475,P<0.05),第7天改良Marshall评分<2分比例更高(47.36％vs.9.52％),急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分(分:4.83±3.22 vs.7.91±4.84)和序贯器官衰竭评分(SOFA)[分:2(1.75,3.5)vs.4(3.5,7.5)]更低,总胆红素[mmol/L:17.40(12.10,25.25)vs.38.70(19.75,91.95)]、C-反应蛋白[mg/L:62.50(15.67,145.30)vs.164.00(68.15,204.50)]和降钙素原[ng/L:0.40(0.17,0.68)vs.0.91(0.35,1.67)]更低(均P<0.05),但血肌酐(Cr)和白细胞介素-6(IL-6)比较差异无统计学意义(P>0.05);HS组较LR组需要机械通气比例(26.32％vs.66.67％)和血管活性药物治疗干预比例(5.26％vs.38.10％)更低,ICU住院天数更短[d:6.11(4.67,10.89)vs.11.81(7.28,16.62)],且均P<0.05,但需要血液净化治疗和外科手术干预、胰腺坏死和继发感染、总住院天数和住院病死率等比较差异无统计学意义(P>0.05).二元Logistic回归分析显示,HS是影响SAP患者第7天脏器衰竭的独立保护因素(OR=0.105,95％CI 0.19～0.591,P<0.05).HS组液体复苏后,第2天血钠离子(Na+)水平较基线值升高[mmol/L:140(134～150)vs.136(128～158),P<0.05].结论 与LR比较,HS液体复苏能够减少SAP患者输液量、减轻炎症反应、减少血管活性药物和机械通气的使用,并且安全性良好,还改善SAP患者早期阶段脏器功能,并减少ICU住院时间等预后指标.

BACKGROUND The exact definition of Acute kidney injury (AKI) for patients with traumatic brain injury (TBI) is unknown. AIM To compare the power of the “Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease” (RIFLE), Acute Kidney Injury Network (AKIN), Creatinine kinetics (CK), and Kidney Disease Improving Global Outcomes (KDIGO) to determine AKI incidence/stage and their association with the in-hospital mortality rate of patients with TBI. METHODS This retrospective study collected the data of patients admitted to the intensive care unit for neurotrauma from 2001 to 2012, and 1648 patients were included. The subjects in this study were assessed for the presence and stage of AKI using RIFLE, AKIN, CK, and KDIGO. In addition, the propensity score matching method was used. RESULTS Among the 1648 patients, 291 (17.7%) had AKI, according to KDIGO. The highest incidence of AKI was found by KDIGO (17.7%), followed by AKIN (17.1%), RIFLE (12.7%), and CK (11.5%) (P = 0.97). Concordance between KDIGO and RIFLE/AKIN/CK was 99.3%/99.1%/99.3% for stage 0, 36.0%/91.5%/44.5% for stage 1, 35.9%/90.6%/11.3% for stage 2, and 47.4%/89.5%/36.8% for stage 3. The in-hospital mortality rates increased with the AKI stage in all four definitions. The severity of AKI by all definitions and stages was not associated with in-hospital mortality in the multivariable analyses (all P > 0.05). CONCLUSION Differences are seen in AKI diagnosis and in-hospital mortality among the four AKI definitions or stages. This study revealed that KDIGO is the best method to define AKI in patients with TBI.

Background The clinical and imaging features of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections that progressed to coronavirus disease 2019 (COVID-19) have been explored in numerous studies. However, little is known about these features in patients who received negative respiratory nucleic acid test results after the infections resolved. In this study, we aim to describe these features in a group of Chinese patients. Methods This retrospective study includes 51 patients with mild-to-moderate COVID-19 (median age: 34.0 years and 47.1% male) between January 31 and February 28, 2020. Demographic, clinical, laboratory, and computed tomography (CT) imaging data were collected before and after two consecutive negative respiratory SARS-CoV-2 tests. Results Following a negative test result, the patients' clinical symptoms continued to recover, but abnormal imaging findings were observed in all moderate cases. Specifically, 77.4% of patients with moderate COVID-19 exhibited multi-lobar lung involvement and lesions were more frequently observed in the lower lobes. The most common CT imaging manifestations were ground-glass opacities (51.6%) and fibrous stripes (54.8%%). Twelve of the 31 patients with moderate COVID-19 underwent repeated chest CT scans after a negative SARS-CoV-2 test. Among them, the ground-glass opacities decreased by > 60% within 1 week in seven patients (58.3%), but by < 5% in four patients (13.8%). Conclusions Following a positive and subsequent negative SARS-CoV-2 tests, patients with COVID-19 continued to recover despite exhibiting persistent clinical symptoms and abnormal imaging findings.

Abstract Purpose: The aim of the present study was to assess whether SARS-CoV-2 can be detected in the expressed prostatic secretion (EPS) of patients with corona virus disease 2019 (COVID-19). Methods: 18 cases of COVID-19, and 5 suspected cases, were selected from three medical centers to detect the RNA expression of SARS-CoV-2 in their EPS with RT-PCR. Results: Results were negative in all EPS samples for SARS-CoV-2 of suspected and confirmed patients. Conclusions: No SARS-CoV-2 was expressed in EPS of patients with COVID-19.

China has a shocking number of tetanus cases in the world, but little research has investigated doctors? knowledge of and practices in tetanus prophylaxis, especially tetanus vaccination. To this end, we conducted a pilot study on 197 emergency doctors using a mixed method of web-based (163; 82.8%) and paper-based (34; 17.2%) surveys. There was no difference between the two groups except for the percentage of doctors receiving a tetanus booster in the past 10 years and the responses to question 11. Surprisingly, only 28.9% of doctors had received formal training on tetanus immunization and only 21.3% had themselves received a tetanus vaccine booster in the past 10 years. Furthermore, only 14.2% of the respondents confirmed the availability of the tetanus vaccine in their respective institutions. Finally, the correct rates and Tetanus-immune-globulin (TIG)-only option rates for questions 11?15 were unsatisfactory. Our results showed that most emergency doctors? knowledge and practices strayed from the recommendations of Advisory Committee on Immunization Practices (ACIP): 1) TIG alone for most trauma patients instead of vaccine was an overused treatment approach. 2) Most of the emergency doctors lacked formal training on and knowledge of tetanus vaccination. 3) Even the emergency doctors themselves were not properly vaccinated. 4) The tetanus vaccine was only available in a small number of the respondents? institutions. The findings of this study suggest an urgent need to improve this dire situation.

目的:探讨改良POSSUM评分系统对外科重症患者术后不良事件的预测价值.方法:采用回顾性研究方法,对2016年1月至2017年1月入住重症医学科的79例外科重症患者进行分析,按照术后28天预后分为预后良好组(n=62)和预后不良组(n=17).分析两组改良POSUUM评分系统、CCI、APACHE II评分.结果:预后良好组改良POSUUM评分系统、CCI、APACHE II评分均显著低于预后不良组(P<0.05).P?PSOUUM评分系统、CCI、APACHE II评分ROC曲线下面积分别为0.859(95%CI:0.778-0.939)、0.806(95%CI:0.675-0.938)、0.818(95%CI:0.715-0.921).P?PSOUUM评分系统和APACHE II评分分别取35.5和11.5为最佳临界值时,序列试验的诊断效能优于平行试验.结论:P?PSOUUM评分系统和APACHE II评分进行序列试验可以提高预测外科重症患者术后不良事件的特异度.

Objective: To investigate whether high platelets:red blood cell (RBC) ratios during massive transfusion for trauma decrease mortality. Methods:A systemic review of the published literature for massive blood transfusions in trauma was performed. Patients were categorised into groups based on plasma:RBC transfusion ratios. Studies were included regardless of type, patient age, sample size or duration of patient follow-up. Results: RCT studies reporting outcomes for 856 patients were included in this meta-analysis. Three studies were from civilian environments and one from a military setting. Ratio cut-offs at 1:1 were the most commonly reported. No significant differences in mortality were detected at 24 hours (RR 1.00,[95% CI, 0.48 to 2.07) or at 28 days (RR 1.45,[95%CI, 0.67 to 3.10). Conclusions:No additional survivalbenefits of high platelets:RBC resuscitation ratioswere identified although with more patients achieved hemostasis and fewer patients died of exsanguination.

目的 探讨液体复苏对创伤致严重脓毒症和脓毒性休克患者心肌损伤的影响.方法 选取严重脓毒症和脓毒性休克患者26例,均给予液体复苏治疗.根据预后分为2组,治疗3d后存活患者21例为存活组,治疗3d后死亡患者5例为死亡组；根据患者指标达标情况将存活组分为2组,达标患者13例(中心静脉压为8～ 12 mmHg(1 mmHg =0.133kPa),平均动脉压为65 ～ 90 mmHg,混合静脉血氧饱和度为70％以上)为达标组.未达标患者8例为未达标组,分析各组患者间血流动力学指标、组织灌注指标、心肌损伤指标.结果 液体复苏治疗后,患者肺动脉楔压、心指数、体循环血管阻力指数、左心室每搏工作指数、右心室每搏工作指数均显著升高,患者肺循环血管阻力指数、血乳酸浓度、血二氧化碳分压均显著下降(P均＜0.05).存活组与死亡组患者心肌肌钙蛋白Ⅰ、N末端-心室利钠肽前体均显著下降(P均＜0.05).死亡组患者心肌肌钙蛋白Ⅰ、N末端-心室利钠肽前体均明显高于存活组(P均＜0.05).未达标组患者心肌肌钙蛋白Ⅰ、N末端-心室利钠肽前体均明显高于达标组(P均＜0.05).结论 液体复苏可显著改善严重脓毒症和脓毒性休克患者的心肌功能,心肌肌钙蛋白Ⅰ和N末端-心室利钠肽前体等心肌损伤指标与患者的预后有着密切联系.

睾丸横过异位(transverse testicular ectopia,TTE)临床十分罕见,特征性表现为一侧睾丸移位至对侧腹股沟管,常合并腹股沟疝.我院在2008年收治一例,治疗后经4年随访患者恢复良好,现报告如下. 1 临床资料 6岁男性患儿,因右侧腹股沟疝在外院行疝囊高位结扎术,术后半月发现右侧阴囊空虚在我院就诊.体格检查:患儿体型及阴茎发育良好,双侧阴囊发育不良,右侧明显,左侧腹股沟外环上方可触及类圆形包块,大小约2 cm×2 cm×1.5 cm,右侧腹股沟区陈旧手术瘢痕,阴囊及腹股沟区未触及包块.B超检查提示右侧腹股沟、盆腔及腹膜后未发现包块,左侧腹股沟外环处可见睾丸样结构两枚,一枚位于腹股沟浅环处大小正常,一枚位于深环处,大小约1.5 cm× 1.5 cm×1.0 cm.生化检查正常,性激素正常,HCG及AFP检查正常.进一步行盆腔MR与B超检查结果一致,初步考虑为左侧隐睾伴腹股沟斜疝,右侧易位睾丸决定行手术探查.

目的:以内毒素(lipopolysaccharide,LPS)诱导法建立大鼠急性肺损伤(acute lung injury,ALI)模型,探讨不同剂量的硫辛酸(lipoic acid,LA)处理对大鼠ALI的保护作用.方法:选择健康SD大鼠90只,其中72只SD大鼠腹腔注射LPS 25 mg/kg,构建大鼠ALI模型,再按不同干预方法将72只大鼠分为LA阴性对照组(腹腔注射等量0.9％氯化钠液)、LA大剂量组[腹腔注射LA 120 mg/(kg·d)]、LA中剂量组[腹腔注射LA 60 mg/(kg·d)]、LA小剂量组[腹腔注射LA 30 mg/(kg·d)],每组18只;其余18只大鼠,仅腹腔注射等量0.9％氯化钠液(正常组).检测各组大鼠处理24、48、72 h后肺组织中核因子κB (NF-kappa B,NF-κB)、白细胞介素1(interleukin 1,IL-1)、NO合成酶(NO synthetase,NOS)、NO、肿瘤坏死因子(tumor necrosis factor α,TNF-α)的水平.结果:LPS诱导后,LA阴性对照组大鼠肺组织中NF-κB、IL-1、NOS、NO、TNF-α在72 h时最高.与正常组大鼠比较,其余各组NOS、NO、TNF-α的水平均较高,差异有统计学意义(P＜0.05);与LA阴性对照组比较,处理24、48、72 h后LA大剂量组IL-1、NF-κB、NOS、NO、TNF-α的水平明显下降(P均＜0.05),LA中剂量组在处理24 h后的NOS、NO水平以及处理72 h的NO水平也明显下降(P均＜0.05).结论:LA对ALI大鼠的治疗效果以大剂量组最为明显,其机制可能与LA抑制NF-κB激活以及下调肺组织中IL-1、NOS、NO、TNF-a的表达有关.

急性脑血管病变是一种常见且发病迅猛的危重症,该疾病引起的并发症如颅内压升高,急性肾功能衰竭未得到有效的控制,极易引发脑疝,严重者可导致患者死亡[1].因甘露醇可在急性发作期迅速降低颅内压,缓解脑水肿,故将其作为首选治疗方法.但研究发现应用剂量的不当会损伤肾脏,引起体内电解质紊乱,严重者可出现急性肾功能衰竭(ARF)甚至死亡[ 2].

<正>脓毒症的发病率大约是0.3%,病死率大约25%,如并发感染性休克患者的病死率可高达80%[1]。因此,加强对脓毒症发病机制的探索,研究具有拮抗脓毒症的药物或治疗措施,对救治脓毒血患者具有重要的意义。

目的:探讨院前急救中昏迷查因患者的急救思维及处置;方法:选择我院2010年1月~2011年12月昏迷出诊患者的院前急救记录、抢救记录、住院病历等资料进行回顾性分析.结果:298例院前急救昏迷查因患者中脑血管意外82例(27.51%),外伤性昏迷66例(22.14%),糖尿病昏迷46例(15.43%),中毒43例(14.43%),心跳、呼吸停止36例(12.08%),其他25例(8.38%).结论:昏迷患者要作出准确的病因诊断,确保救治成功,除应用先进的检测手段、掌握各科的专业理论知识及急救技能外,更重要的是全面科学合理的院前急救思维方法.

目的 研究大黄鼻饲联合扩肛对危重患者肠道功能的影响.方法 将180例ICU患者随机分为三组:常规治疗组、大黄治疗组和大黄联合扩肛治疗组,每组60例.观察每组患者腹胀发生率、48 h排便率、肠内营养中断率、MODS发生率及转出率(5 d和10 d)等指标.结果 与常规治疗组相比,大黄组及大黄联合扩肛组腹胀发生率、肠内营养中断率、MODS发生率显著下降;48 h排便率及转出率(5 d和10 d)显著上升,差异有统计学意义(P＜0.05).与大黄组比较,大黄联合扩肛组腹胀发生率、肠内营养中断率、MODS发生率显著下降;48 h排便率及转出率(5 d和10 d)显著上升,差异有统计学意义(P＜0.05).结论 大黄鼻饲联合扩肛能改善危重患者肠道功能;扩肛治疗及大黄鼻饲可增加危重患者对肠道营养的耐受性,从而使危重患者易于接受肠内营养,改善危重患者的预后,两种方法联合使用效果更理想.

Objective To evaluate and analyze the application value of continuous Acute Physiology and Chronic Health EvaluationⅢ(APACHEⅢ)apply on critically ill patients in the intense care unit.MethodsBy collecting and sorting out the data of 320 cases of serious patients,the prognosis of patients were evaluated by APACHEⅢfor 3 days in continuation and tracking the results in the end.ResultsThere was a significant correlation between the score of APACHEⅢ and the actual mortality.The mortality increased remarkably when the score was>90.It is helpful that judging the result of serious patients by using continuous APACHEⅢ.ConclusionsAPACHEⅢ score system can be used to evaluate state of an illness and prognosis.It is the basis of medical quality and reasonable application of ICU source.