Background:Sepsis patients face a high risk of new-onset atrial fibrillation (NOAF), which increases mortality. Thus, it is significant to construct a risk prediction model for early risk stratification. Objective:To construct and validate a risk prediction model for NOAF in sepsis. Methods:A total of 423 sepsis patients were randomly divided into training (n=299) and validation (n=124) cohorts. Predictors were selected using least absolute shrinkage and selection operator (LASSO) regression, and independent risk factors were identified by multivariate logistic regression to construct a nomogram. Model performance was assessed by the area under the receiver operating characteristic curve (AUC), Hosmer-Lemeshow test, and calibration curves. Clinical utility was evaluated using decision curve analysis (DCA) and clinical impact curves (CIC). Results:Log interleukin-6 (Log IL-6), blood urea nitrogen (BUN), and heart rate (HR) were identified as independent risk factors for NOAF. The nomogram demonstrated strong discriminative ability, with AUCs of 0.925 in the training cohort and 0.866 in the validation cohort. Calibration was good in both cohorts, and DCA and CIC indicated favorable clinical utility across a range of threshold probabilities. Conclusion:A risk prediction model incorporating Log IL-6, BUN, and HR effectively could predict NOAF in sepsis patients, with good discrimination, calibration, and potential clinical applicability for early risk identification. However, prior to further clinical application, additional multicenter, prospective studies are required for external validation.

目的 探讨哮喘-慢性阻塞性肺疾病重叠综合征(ACO)患者血清微量元素与病情严重程度的关系.方法 选择2019年2月至2020年10月新疆医科大学第一附属医院收治的42例ACO患者为研究对象,根据第1秒用力呼气量(FEV1)将患者分为轻中度组(n=17)和重度/极重度组(n=25).检测患者肺功能指标及呼出气一氧化氮(FeNO).采用串联质谱法测定患者血清镁、锰、铅、锌、铁、铜等微量元素水平.利用流式细胞仪检测外周血T淋巴细胞亚群.根据慢性阻塞性肺疾病评估测试(CAT)、咳嗽临床症状评分(CCSS)和改良的医学研究理事会呼吸困难量表(mMRC)3份问卷对患者健康状况进行评估.结果 重度/极重度组患者血清镁、FeNO、CD8+低于轻中度组(P<0.05).重度/极重度组患者CD4+/CD8+、CAT、mMRC(P<0.05).血清镁分别与FEV1％、FVC、FEV1/FVC、FeNO、CD8+呈正相关,与CD4+/CD8+、CAT、mMRC呈负相关(P<0.05).与高FeNO患者相比,低FeNO患者血清镁浓度显著降低(P<0.05).结论 ACO患者血清镁与肺功能、FeNO、T淋巴细胞亚群、健康状况有关,可能成为反映ACO病情严重程度的指标.

Mini-CEX是一种简短的用于评价住院医师临床能力的方法,主要内容包括观察和评价住院医师的知识、技能、态度和带教老师的适时反馈,根据住院医师对患者病史采集和进行体格检查的能力来评估其问诊技能和临床判断.由于急诊科工作繁忙,往往需要快速评估病情,因此问卷调查是一种非常实用的方法.人们在不同的临床环境中对mini-CEX评价进行了广泛的研究,证明其在医学培训中具有较高的可接受性[1],本研究旨在探讨mini-CEX在急诊科临床实践教学中的应用价值.

Chinese emergency department (ED) staff encountered significant mental stress while fighting the coronavirus disease 2019 (COVID-19) pandemic. We sought to investigate the prevalence and associated factors for depressive symptoms among ED staff (including physicians, nurses, allied health, and auxiliary ED staff). A cross-sectional national survey of ED staff who were on duty and participated in combating the COVID-19 pandemic was conducted March 1–15, 2020. A total of 6,588 emergency medical personnel from 1,060 hospitals responded to this survey. A majority of respondents scored above 10 points on the PHQ-9 standardized test, which is associated with depressive symptoms. Those aged 31–45, those working in the COVID-19 isolation unit, and those with relatives ≤ 16 or ≥70 years old at home all had statistically significant associations with scoring >10 points. Depressive symptoms among Chinese emergency medical staff were likely quite common during the response to the COVID-19 pandemic and reinforce the importance of targeted ED staff support during future outbreaks.

Objective:To investigate the relationship between previous bleeding history and poor prognosis of patients with acute upper gastrointestinal bleeding.Methods:This study was a prospective multicentre real-world study (Acute Upper Gastrointestinal Real-word study, AUGUR study). The data of patients with UGIB who were admitted to the emergency department of 20 tertiary hospitals in China from June 30, 2020 to February 10, 2021 were collected. According to the number of previous bleeding history, the patients were divided into three groups (0 time, 1-3 times, and≥4 times). Based on the patient’s demographic data, clinical characteristics, laboratory data, treatment, and outcomes, univariate and logistic regression analysis were performed to investigate the correlation between the number of previous bleeding and the 90-day mortality and rebleeding of patients with gastrointestinal bleeding.Results:A total of 1 072 patients with acute UGIB were included in this study. The all-cause mortality and rebleeding rate of all patients were 10.9% (117/1 072) and 11.8% (129/1 072), respectively. Among them, 712 patients (66.42%) had no previous bleeding, 297 patients (27.71%) had previous bleeding 1-3 times, and 63 patients (5.88%) had previous bleeding≥4 times. In univariate analysis, age, vital signs and consciousness on admission, history of liver cirrhosis, onset with hematemesis, admission hemoglobin, varicose veins bleeding, peptic ulcer bleeding, red blood cell infusion, tracheal intubation and the use of vasopressors after admission were risk factors for the 90-day mortality and rebleeding rate. Multivariate logistic regression analysis showed that patients with previous bleeding≥4 times had a higher risk of the 90-day mortality ( OR=2.17, 95% CI: 1.04-4.57, P=0.040) and rebleeding ( OR=2.32, 95% CI: 1.19-4.53, P=0.013). Conclusions:The history of previous bleeding≥ 4 times can be used as an independent risk factor for the 90-day mortality and rebleeding in patients with acute UGIB.

Background: Chinese emergency medical staff have great mental and work pressure in fighting the coronavirus disease 2019 (COVID-19) pandemic, and it is necessary to understand the prevalenece and influencing factors for depression. Methods: A cross-sectional national survey of general emergency medical staff who were on duty and participated in COVID-19 anti-pandemic from November 2019 to April 2020 was conducted and we used the scale of Patient Health Questionnaire-9 (PHQ-9) to assess depression symptom. Univariate analysis and multivariable logistic-regression models assessed for the associations of influencing PHQ-9 scores. Results: 6588 emergncy medical staff from 1060 hospitals responded to the survey. The average PHQ-9 score of all medical staff was 10.94±5.1. We use PHQ-9≥10 as the cut-off value to define major depression, the prevalence of major depression was 57.60%.The results of univariate analysis showed that demographic factors(gender, age, occupation, relationship status, living with childen ≤16 years-old or adults≥70 years- old), work factors (direct contact with confirmed COVID-19 patients or working in an isolation unit with COVID-19 patients), and forced isolation in the hospital all had an increased risk of major depression. In addition, multivariate logistic regression analysis indicated that main factors associated with major depression symptom were direct contact with confirmed COVID-19 patient (OR 1.153), working in a COVID-19 isolation ward (OR 1.366), age between 31-45 years old (OR 1.139), and living with children ≤16 years old(OR 1.126) or adults≥70 years old (OR 1.325). Working in Hubei province (the epicenter of the outbreak) during COVID-19 had no correlation with depression. Conclusion: Chinese emergency medical staff experienced depression burden during COVID-19 period, particularly, those aged 31-45,those working in isolation unit COVID-19, those living with children or older people These results reinforce the value of effective, targeted staff support during the COVID-19 or future outbreaks.Funding Statement: The authors state that there is no funding for this article.Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: The study has been approved by the Ethics Committee of Peking Union Medical College Hospital, and all the participants provided informed consent.

目的 通过研究急性呼吸窘迫综合征(Acute respiratory distress syndrome,ARDS)患者早期血浆去甲肾上腺素(noradrenaline,NE)与TNF-α、IL-1β、IL-9、IL-15水平,探讨交感神经兴奋和炎症反应对ARDS早期病情发展影响的相关因素,为预测和干预早期ARDS患者预后提供理论依据,以期降低死亡率、提高救治率.方法 采用回顾性分析2013.6-2015.11收治于新疆医科大学第一附属医院急救中心的ARDS患者48例,根据发病后第3天是否存活,将其分为存活组(n=28)和死亡组(n=20).分别统计两组患者的年龄、性别、发病第一天的血清NE、TNF-α、IL-1β、IL-9、IL-15、血常规、血气、凝血及生化指标,并分析其与患者早期预后的关系.统计学分析使用SPSS17.0软件进行分析.结果 单因素分析后死亡组与存活组之间年龄、性别、APACHEII评分、PaO2/FiO2、IL-9、降钙素原、血清葡萄糖、乳酸、肝功能、肌酐、钾、钠、氯、淋巴细胞比例、血小板计数之间差异无统计学意义(P>0.05);死亡组与存活组之间NE、TNF-α、IL-1β、IL-15、C反应蛋白、尿素、钙离子、白细胞总数、血红蛋白差异具有统计学意义(P<0.05).多因素分析后发现高水平NE、TNF-α、IL-1β、IL-15、C反应蛋白、尿素和钙离子水平降低是影响中重度ARDS早期预后的独立性危险因素.结论 在中重度ARDS早期的临床诊疗中应密切关注交感神经兴奋性、炎症反应程度及尿素水平、钙离子水平,并采取适当的治疗措施,以降低ARDS的病死率,提高生存率.

目的 通过研究中重度急性呼吸窘迫综合征(ARDS)患者第1天与第3天血清去甲肾上腺素(NE)水平与TNF-α、IL-1β、IL-9、IL-15水平的关系,探讨ARDS的神经免疫相关发病机制.方法 选择2013-06～2015-11新疆医科大学第一附属医院急诊科中重度ARDS患者28例为病例组,随访28 d,根据预后是否存活分为死亡组(n=15)和存活组(n=13).选择22例健康体检者作为对照组,分别检测病例组发病第1天、第3天及对照组第1天的血清NE、TNF-α、IL-1β、IL-9、IL-15水平,进行数据统计分析.结果 病例组第1天及第3天TNF-α、IL-1β、IL-9、IL-15、NE水平均高于对照组(P＜0.05).相关性分析中病例组第1天NE与TNF-α、IL-1β、IL-9呈正相关(P＜0.05,r＞0),与IL-15呈负相关(P ＜0.05,r＜0);第3天TNF-α与NE呈正相关(P ＜0.05,r＞0).发病第1天死亡组IL-9(4.45±0.51)、IL-15(115.37±18.59)和NE(18.45±3.23) pg/mL水平高于存活组[3.88±0.33、88.69±12.35、(17.97±3.35)pg/mL,P＞0.05],死亡组TNF-α(219.57±35.36)和IL-1β(197.16±32.27)水平明显高于存活组[168.42±21.96,138.05±24.73,P＜0.05].Logistic回归分析,TNF-α(OR=1.004,95％CI2.18～10.25,P=0.003)和IL-1β(OR=1.005,95％ CI 1.79～8.69,P=0.013)是影响ARDS预后的危险因素.结论 在中重度ARDS早期交感神经递质释放与炎症反应程度基本一致,因此在临床抗炎治疗诊疗过程中应重视交感神经活性的变化.

目的 比较去甲肾上腺素(NE)和特利加压素(TP)对急性呼吸窘迫综合征(ARDS)合并感染性休克患者血流动力学、容量反应性及肾功能的影响.方法 选择2014年2月—2018年2月新疆医科大学第一附属医院急救创伤中心收治ARDS合并感染性休克患者76例作为研究对象.按随机数字表法分为TP组(38例)和NE组(38例),在给予抗感染、抗休克、机械通气、对症支持等常规治疗的基础上,分别应用TP和NE作为缩血管药物.比较2组患者治疗前后的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心指数(CI)和氧合指数(PaO2/FiO2),治疗后患者的液体输入量、尿量和容量反应性情况,治疗前后的乳酸、血肌酐(SCr)水平和乳酸清除率(LCR),并记录不良反应情况.结果 与治疗前比较,治疗后TP组、NE组的MAP和PaO2/FiO2升高(F=39.731、24.329、29.013、12.356,P均=0.000),HR和CVP降低(F=7.099、15.144、4.162、12.077,P均=0.000),而CI无明显变化(P>0.05);治疗48 h后,TP组HR和CVP低于NE组(t=2.103、2.504,P=0.039、0.014),MAP和PaO2/FiO2高于NE组(t=2.357、1.999,P=0.021、0.049),而CI无统计学差异(P>0.05).治疗后,TP组、NE组患者的液体输入量和尿量情况均有改善(F=74.322、45.934、61.412、23.195,P均=0.000),其中治疗48 h后TP组明显优于NE组(F=4.958、5.669,P=0.028、0.019);2组治疗后的容量反应阳性率均明显升高(χ2=14.976、5.811,P=0.001、0.005),其中,TP组明显高于NE组(χ2=4.212,P=0.040).治疗后TP组SCr较治疗前明显降低(F=2.778,P=0.028),而NE组无明显变化(P>0.05).治疗后,2组的乳酸水平降低(F=29.929、12.411,P=0.000、0.007),LCR升高(F=245.711、151.032,P均=0.000),且TP组治疗72 h后较NE组改善更显著(F=27.710、55.381,P=0.000、0.000).2组患者不良反应发生率比较差异无统计学意义(7.89％vs.10.53％,χ2=0.560,P=0.377).结论 与去甲肾上腺素相比,应用特利加压素治疗ARDS合并感染性休克,能够有效改善血流动力学指标,更有效持久地维持血压,明显提高氧合指数和容量反应性,改善代谢水平和肾功能.

Objective: This study is aimed to explore the functions of TNF-alpha IL-1 beta, IL-9, and IL-15 cytokines in the pathogenesis of acute respiratory distress syndrome (ARDS). Methods: A total of 28 patients with ARDS diagnostic criteria from the Emergency Department from June 2013 to July 2014 were selected as the ARDS group, and 22 healthy subjects were designated as the control. Clinical parameters were collected. Based on the 2012 Berlin criteria, the ARDS patients were categorised into moderate (18 cases) and severe (10 cases) groups. A total of 3 ml of peripheral venous blood was drawn from the fasted control and ARDS groups on the mornings of days one and three. ELISA was used to measure the serum concentrations of TNF-alpha, IL-1 beta, IL-9, and IL-15 in both groups. The serum concentrations of TNF-alpha, IL-1 beta, IL-9, and IL-15 were compared across all groups and time points. At the 28-day follow-up, patients were recategorised into survival (13 cases) and nonsurvival (15 cases) groups based on their prognostic situations. Results: On the first day of diagnosis, no significant differences in age, gender, APACHE II score, procalcitonin, hs-CRP, white blood cell count, lactic acid, or albumin values were observed between the survival and nonsurvival ARDS groups (P > 0.05). The pH values in the nonsurvival group were significantly lower than that in the survival group (P < 0.05). The serum levels of TNF-alpha, IL-1 beta, IL-9, and IL-15 in the ARDS group were significantly higher than those in the control group (P < 0.05). The serum TNF-alpha level in the moderate group were significantly lower than that in the severe group (P < 0.05). Three days after ARDS diagnosis, the serum levels of TNF-alpha, IL-1 beta, IL-9, and IL-15 in the moderate group were significantly lower than those in the severe group (P < 0.05). On day three, the serum levels of TNF-alpha, IL-1 beta, IL-9, and IL-15 in the nonsurvival group were significantly higher than those in the control group (P < 0.05). Conclusion: During the early stages of ARDS, the serum levels of TNF-alpha, IL-1 beta, IL-9, and IL-15 can be used to evaluate ARDS severity and make a prognosis.

Objective To investigate the predictive value of IL-9 cytokines in the patients with acute respiratory distress syndrome (ARDS).Methods According to Berlin definition of ARDS published in 2012,data of 28 patients with ARDS and another 22 healthy subjects as control were collected for prospective study from June,2013 to July,2014.Of them,there were 23 patients with severe pneumonia,1 patient with acute mercury poisoning,2 patients with severe acute pancreatitis,2 patients with acute paraquat poisoning.The survivors of ARDS patients were followed up.The ARDS patients were divided into moderate group (n =18) and severe group (n =10) as per the severity of the disease diagnosed at the first day after admission.And the ARDS patients were also divided into non-survival group (n =15) and survival group (n =13) according to the ARDS patients survived for 28 days.Three mLs of peripheral venous blood were collected in the early morning from fasted ARDS patients on the first and the third day after diagnosis of ARDS confirmed,and those of healthy subjects were collected on the first day after admission.The IL-9 cytokine level of peripheral venous blood detected by using enzyme linked immunosorbent assay (ELISA).The comparisons of levels of IL-9 cytokine were carried out between ARDS group and control group on the first day after diagnosis of ARDS established,between moderate group and severe group on the first day and the third day,and between survival group and non-survival group.The receiver operating characteristic (ROC) curve was used to evaluate the performance of IL-9 as a prognostic indicator in the early stage of ARDS.Data were analyzed by using SPSS 19.0 software.Results On the first day after diagnosis of ARDS,there were no statistically significant differences in age,APACHE Ⅱ score,procalcitonin (PCT),C-reactive protein (CRP),white blood cell count,lactate,and albumin between survival group and non-survival group (P ＞ 0.05).PH value in non-survival group was significantly lower than that in survival group (P＜0.05).IL-9 cytokine level of peripheral venous serum in ARDS group was significantly higher than that in healthy control group (P ＜ 0.05).There were no statistically significant differences in IL-9 level of peripheral venous serum both between moderate group and severe group and between survival group and non-survival group (P ＞ 0.05).On the third day,IL-9 level in severe group was significantly higher than that in moderate group (P ＜ 0.05),and that in survival group was significantly lower than that in non-survival group (P ＜ 0.05).The ROC of IL-9 at the first day for predicting mortality had all area under curve (AUC) to be 0.579 (95％ CI 0.361-0.798,P ＞ 0.05).The ROC of IL-9 on the third day for predicting mortality had AUC of 0.769 (95％ CI 0.592-0.947,P ＜ 0.05).When the cut-off value of IL-9 for the death followed up for 28 day' s was 2.88 pg/mL,the sensitivity was 86.7％,and the specificity was 61.5％.Conclusions IL-9 levels of in patients with ARDS were significantly higher,and IL-9 level can be helpful for the assessment of ARDS severity in the early stage,and for prognosis as well.