OBJECTIVE: To investigate the efficacy and safety of Chinese herbal medicine in treating sepsis patients with bloodstream infection.METHODS: A 6-year retrospective study was carried out at a university hospital in China. Adult sepsis patients with bloodstream infection were included. The primary outcome was 28-day mortality after admission.Propensity score method was used to adjust for possible confounding. 28-day mortality was estimated by KaplanMeier analysis and compared using the log-rank test. Cox regression analysis was carried out to identify factors impacting in-hospital mortality outcomes.RESULTS: Following the application of the propensity score method, a total of 176 patients were included. The all-cause 28-day mortality in the control group and Chinese herbal medicine group was 21.6% and 14.8%,respectively. Kaplan-Meier survival analysis showed that Chinese herbal medicine was associated with a lower hazard ratio(HR) in all-cause 28-day death compared with the control group [HR = 0.44, 95% CI(0.22, 0.90), P < 0.05]. The complications were similar between the two groups(P > 0.05). Blood-activating and stasis-eliminating herb administration was associated with reduced inhospital mortality among sepsis patients with bloodstream infection [HR = 0.54, 95% CI(0.34, 0.94), P < 0.05].CONCLUSIONS: Chinese herbal medicine, especially the blood-activating and stasis-eliminating herb, might have certain efficacy and safety in treating sepsis patients with bloodstream infection. Clinicians should prescribe blood-activating and stasis-eliminating herb in treating these two coalescent critical diseases as long as no contraindications exist. However, further studies are needed to validate our results.

Background: Serum amyloid A has been widely reported as a useful biochemical marker in the diagnoses of acute appendicitis. The aim of this study was to appraise the diagnostic accuracy of serum amyloid A in the diagnosis of acute appendicitis.Methods: A systematic search of several databases was conducted. The search time was from the beginning of the databases creation to March 1, 2021, and the languages were restricted to English and Chinese. Clinical studies using serum amyloid A for the diagnosis of acute appendicitis were included. The overall sensitivity and specificity were calculated by using a bivariable mixed effects model. Heterogeneity was tested using I-2 statistics. This study has been registered on the International Prospective Register of Systematic Reviews (PROSPERO; no. CRD42021241343).Results: Five studies comprising 668 participants were eligible for inclusion. The overall sensitivity and specificity of serum amyloid A in diagnosing acute appendicitis were 0.87 (95% confidence interval [CI], 0.79-0.92) and 0.74 (95% CI, 0.59-0.85), respectively. The positive and negative likelihood were 3.3 (95% CI, 2.1-5.4) and 0.18 (95% CI, 0.11-0.28), respectively. The area under the summary receiver operating characteristic curves was 0.89 (95% CI, 0.86-0.91). The heterogeneity was significant (I-2 = 82%; 95% CI [63%-100%]).Conclusions: Serum amyloid A has good diagnostic accuracy for acute appendicitis. It is expected that serum amyloid A could be helpful in the early clinical diagnosis of acute appendicitis.

《温热论》是温病学经典名著之一,其中治疗理念至今对温病的诊治仍有指导意义.而脓毒症是临床常见的急危重症之一,其发病率和死亡率较高,预后不良.脓毒症的发病及演变过程类似于温病.《温热论》一些条文与现代脓毒症的核心治疗理念十分契合,主要体现在护肺清温,拒邪于表;截断扭转,逆转病势;泻热存阴,顾护津液;培补中焦,顾护胃气;宣通阳气,利尿逐湿;紧急干预,防治变证六个方面,《温热论》这些理念与现代脓毒症治疗的早期筛查和治疗、抗感染治疗、液体复苏、营养支持、肾脏替代治疗、积极防治多脏器功能障碍/衰竭等核心治疗理念相契合.由此可见,汲古求新,开创新知,《温热论》仍对脓毒症的诊治具有重要指导意义,加强《温热论》相关条文学习有助于认识及治疗脓毒症.

目的:探讨血流感染脓毒症患者临床特征、中医证素分布及其与预后的相关性.方法:根据687例血流感染脓毒症患者住院期间预后分为存活组和病死组,分析两组临床特征的差异,并采用Cox回归分析影响预后的相关因素.结果:687例血流感染脓毒症患者中男性、老年人比例较高,常合并多种基础疾病,感染的病原体以革兰阴性菌(G-菌)多见;中医证素以气虚证、热证、痰证、血瘀证及湿证比例最高.多因素Cox回归分析结果提示,年龄、热证、湿证、水饮证和阳虚证是血流感染脓毒症患者住院期间死亡的独立危险因素(均P<0.05).结论:血流感染脓毒症患者的临床特点和预后有一定规律,当患者年龄较大,或者出现热证、湿证、水饮证或者阳虚证时,可能预后不良.

Introduction: Ischaemia-modified albumin (IMA) is a new, sensitive marker of ischaemic diseases that has been approved for diagnosing myocardial ischaemia. However, the accuracy of IMA in the diagnosis of stroke remains to be clarified. The study’s purpose is to assess the potential role of IMA as a diagnostic indicator in stroke. Methods: We carried out a systematic search in Medline, the Cochrane Library, Embase, Scopus, Science Direct, ISI Web of Knowledge, and the reference lists of relevant articles from the databases’ inception to September 1, 2019. Studies that appraised the diagnostic accuracy of IMA for acute stroke patients were included in our study. Two reviewers extracted data independently and assessed the quality of the retrieved studies, and disagreements were resolved through discussions with a third reviewer. Sensitivities and specificities were pooled by using bivariate diagnostic meta-analysis. We calculated I2 to test the heterogeneity and used meta-regression to identify potential sources of heterogeneity. This systematic review and meta-analysis is registered in international prospective register of systematic reviews (number CRD42020149174). Results: Six studies with 605 patients were eligible for inclusion. Our meta-analysis produced the following outcomes: the mean sensitivity of IMA in diagnosing acute stroke was 0.80 (95% confidence interval [CI], 0.69–0.88) and the specificity was 0.80 (95% CI, 0.71–0.87). The area under the receiver operating characteristic curve was 0.86 (95% CI, 0.83–0.89), and the pooled diagnostic odds ratio was 16 (95% CI, 8–33). There was obvious heterogeneity between studies (I2 = 78%, 95% CI, 53–100). Sensitivity analysis and meta-regression could account for the heterogeneity. Conclusion: IMA is a helpful marker for consideration in the early diagnosis of stroke.

目的 探讨内科脓毒症患者的中医证素分布规律.方法 基于医院信息系统回顾性收集2013年1月1日至2018年12月31日在广东省中医院住院的内科脓毒症患者的病例资料,主要包括患者性别、民族、年龄、入院诊断等一般资料,以及患者入院时症状、体征、四诊资料.由2名住院医师(执业年限≥3年)进行证素辨证,并将高频证素采用关联分析法及聚类分析法探讨各证素的分布规律. 结果 共纳入内科脓毒症患者4833例,排名前3位的症状为神倦、纳差、气促,舌象为暗舌、淡舌、红舌,苔象为腻苔、黄苔、白苔,脉象为弦脉、滑脉、细脉.最常累及的脏腑为肺、心、脾(频率分别为56.51％、55.43％、50.84％),证素分布前3位分别为气虚证、痰证和火热证(频率分别为79.43％、43.06％、35.30％).关联分析提示,痰证-气虚证组合支持度最高,为0.431,湿证-痰证-气虚证组合的置信度较高,为0.952.聚类分析提示,气虚证是脓毒症患者独立证素分类. 结论 气虚证、痰证是内科脓毒症的关键证素,若脓毒症病情演变,可发展为腑实证、血瘀证、阳虚证等.

We read the innovative article by Ohlsson et al.,1Ohlsson M.A. Kennedy L.M.A. Juhlin T. et al.Risk prediction of future cardiac arrest by evaluation of a genetic risk score alone and in combination with traditional risk factors.Resuscitation. 2020; 146: 74-79https://doi.org/10.1016/j.resuscitation.2019.11.005Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar the authors should be commended for combining polygenetic genetic risk scores with traditional risk factors to form a novel composite risk score to help identify individuals who will suffer cardiac arrest (CA). Though this study sounds scientific, some critical issues should be discussed. First, in the study by Ohlsson et al.,1Ohlsson M.A. Kennedy L.M.A. Juhlin T. et al.Risk prediction of future cardiac arrest by evaluation of a genetic risk score alone and in combination with traditional risk factors.Resuscitation. 2020; 146: 74-79https://doi.org/10.1016/j.resuscitation.2019.11.005Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar some variables were included and adjusted in their multivariate cox proportional model, however, anemia had not been included. Actually, anemia is closely correlated with CA, a Korean cohort study containing 494,948 subjects indicated that 1-unit decrease in hemoglobin was associated with 21–24% increase in the risk of sudden CA,2Kim I.J. Yang P.S. KimF T.H et al.Relationship between anemia and the risk of sudden cardiac arrest – a nationwide cohort study in South Korea.Circ J. 2018; 82: 2962-2969https://doi.org/10.1253/circj.CJ-18-0046Crossref PubMed Scopus (9) Google Scholar hence, anemia is an independent risk factor of CA and should not be ignored. Second, in the commented paper,1Ohlsson M.A. Kennedy L.M.A. Juhlin T. et al.Risk prediction of future cardiac arrest by evaluation of a genetic risk score alone and in combination with traditional risk factors.Resuscitation. 2020; 146: 74-79https://doi.org/10.1016/j.resuscitation.2019.11.005Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar factors like smoking, diabetes mellitus, hypertension, serum lipid, obesity were included and adjusted without checking the interactions between these covariates, nevertheless, these covariates might be correlated with each other,3Knol M.J. Egger M. Scott P. et al.When one depends on the other: reporting of interaction in case–control and cohort studies.Epidemiology. 2009; 20: 161-166https://doi.org/10.1097/EDE.0b013e318186651Crossref PubMed Scopus (0) Google Scholar the authors had better check the multicollinearity of these variables. Third, Table 1 showed that both systolic blood pressure (BP) and diastolic BP both distributed statistically differently between the control group and cardiac origin arrest group. As we all know, BP can be divided into 3 categories: hypertension, hypotension and normal BP. But in the study by Ohlsson et al.,1Ohlsson M.A. Kennedy L.M.A. Juhlin T. et al.Risk prediction of future cardiac arrest by evaluation of a genetic risk score alone and in combination with traditional risk factors.Resuscitation. 2020; 146: 74-79https://doi.org/10.1016/j.resuscitation.2019.11.005Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar only hypertension was chosen as covariate, in practice, hypotension or shock was more frequent in CA patients and shock was verified to be an independent risk factor of CA patients,4Siriphuwanun V. Punjasawadwong Y. Saengyo S. et al.Incidences and factors associated with perioperative cardiac arrest in trauma patients receiving anesthesia.Risk Manag Healthc Policy. 2018; 11: 177-187https://doi.org/10.2147/RMHPS178950Crossref PubMed Google Scholar thus we suggest BP should be divided into 3 groups – hypertension group, hypotension group and normal BP group to reduce biases. Fourth, Ohlsson et al. tried to develop a novel composite risk score model for patients with future cardiac arrest, however, the events of cardiac origin CA (n = 181) and non-cardiac origin CA (n = 71) were so small which could result in non-significant statistical values and subsequent biases. Furthermore, internal and external validity procedures should be performed to check the comprehensive validity of this model to make the results more precise.5Steyerberg E.W. Vergouwe Y. Towards better clinical prediction models: seven steps for development and an ABCD for validation.Eur Heart J. 2014; 35: 1925-1931https://doi.org/10.1093/eurheartj/ehu207Crossref PubMed Scopus (836) Google Scholar In a word, the results of this innovative study should be interpreted prudently and more work should be done in the future. None declared. Guanghua Tang and Xianshi Zhou are funded by Guangdong Provincial Key Laboratory of Research on Emergency in TCM (No. 2017B030314176). The funders had no role in writing the manuscript or the decision to submit. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

目的 探讨基于数据挖掘的中医药治疗小儿惊风处方用药规律.方法 对中国期刊全文数据库(CNKI)、维普中文科技期刊数据库(VIP)和万方数据知识服务平台建库至2018年8月关于中医治疗小儿惊风的文献进行检索,通过数据筛选清理,将符合要求的文献建立数据库,采取频数分析方法对方剂中使用药物种类、归经以及选药规律进行分析.结果 共搜集文献处方64个,使用药物共计263味,使用频次最高的前5位:钩藤、僵蚕、连翘、甘草、白芍.所用药物的主要功效:清热解毒、疏散风热、息风定惊、清热平肝、息风止痉.所用药物归经:肺、肝、心.药物平均剂量:约成人的四分之一.常用及最佳药对组合:僵蚕与钩藤.结论 小儿惊风的方剂以清热息风,平肝定惊止痉为主,用药针对性较强.基于"古今医案云平台"的数据挖掘可以反映中医治疗小儿惊风的用药规律,对临床和用药传承及交流具有重要指导作用.

We read the fascinating article by Alkhalil et al1Alkhalil M Kearney A Hegarty M et al.Eosinopenia as an adverse marker of clinical outcomes in patients presenting with acute myocardial infarction.Am J Med. 2019; 132: e827-e834Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar in a recent issue of The American Journal of Medicine. Although the study sounds scientific, we have identified some critical methodological issues. First, the study was conducted between January 2014 and January 2015. However, in the methods section, Alkhalil et al claimed that they treated the enrolled subjects according to a guideline that was published in 2018.2Ibanez B James S Agewall S et al.2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC).Eur Heart J. 2018; 39: 119-177Crossref PubMed Scopus (4624) Google Scholar We believe the authors should provide a more detailed explanation for how this was possible. Second, although the study presented and compared some clinical factors in the low and normal eosinophil groups, it did not present the door-to-balloon time because door-to-balloon time is closely correlated with the mortality of patients with ST-elevation myocardial infarction (STEMI). A previous study that involved 43,801 patients with STEMI showed that longer door-to-balloon times were correlated with a higher adjusted risk of mortality in the hospital; the corresponding increased adjusted mortality for patients with door-to-balloon times within 30 minutes, 60 minutes, 90 minutes, 120 minutes, 150 minutes, and 180 minutes were 3.0%, 3.5%, 4.3%, 5.6%, 7.0%, and 8.4%, respectively (P <0.001).3Rathore SS Curtis JP Chen J et al.Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: national cohort study.BMJ. 2009; 338: b1807Crossref PubMed Scopus (338) Google Scholar Given the promising ability of door-to-balloon times to predict the mortality of patients with STEMI, we believe Alkhalil et al should have presented and analyzed door-to-balloon times as a factor. Third, Alkhalil et al used Kaplan-Meier curves and the log-rank test to determine the differences in groups of low and normal eosinophil. However, the log-rank test does not take into consideration confounding variables.4Tolles J Lewis RJ Time-to-event analysis.JAMA. 2016; 315: 1046-1047Crossref PubMed Scopus (20) Google Scholar As Table 1 showed, some clinical factors, like age, proportion of normal renal function, and troponin concentration, were differently distributed between the low and normal eosinophil groups. These unbalanced covariates could result in biased results and conclusions and should have been adjusted. Therefore, rather than the log-rank test, more accurate and appropriate statistical methods should be chosen and applied. In summary, the results of Alkhalil et al's study should be interpreted cautiously, and more work should be conducted in the future.

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal

We read with great interest the article in an issue of The American Journal of Medicine by Simonaviius et al.1Simonavičius J Sanders van-Wijk S Rickenbacher P et al.Prognostic significance of longitudinal clinical congestion pattern in chronic heart failure: insights from TIME-CHF Trial.Am J Med. 2019; 132: e679-e692Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar The article concluded that severe congestion was accompanied by early death, and clinical decongestion treatment could result in improved outcome. Though this study sounds scientific, some critical methodological issues should be discussed. First, Simonaviius et al applied log-rank test to analyze survival outcomes among groups by Kaplan-Meier curves. However, Cox proportional hazards model should not be applied until both of 2 important assumptions are satisfied. The first assumption is that data censoring has no relationships in the outcome of interest, and the second assumption is that hazard functions should be proportional to each other for all patient groups.2Tolles J Lewis RJ Time-to-event analysis.JAMA. 2016; 315: 1046-1047Crossref PubMed Scopus (21) Google Scholar Apparently, as shown in their Figures 2 and 3, several survival curves crossed each other, which suggests that the proportionality assumption might have been violated.2Tolles J Lewis RJ Time-to-event analysis.JAMA. 2016; 315: 1046-1047Crossref PubMed Scopus (21) Google Scholar There are other statistical methods, such as Gehan's generalized Wilcoxon test, that the authors could have used to analyze their data instead of a log-rank test. Second, in multivariable regression models, choosing an appropriate number of variables is crucial; as a matter of fact, the ratio of the number of the least common outcomes to the maximum number of independent variables (least outcomes/maximum variables) should be at least 10.3Stoltzfus JC Logistic regression: a brief primer.Acad Emerg Med. 2011; 18: 1099-1104Crossref PubMed Scopus (398) Google Scholar As the group whose clinical congestion index (CCI) = 0 contained only 36 patients, the number of variables included in the study should be no more than 4 (36/10 = 3.6); however, according to their Table 4,1Simonavičius J Sanders van-Wijk S Rickenbacher P et al.Prognostic significance of longitudinal clinical congestion pattern in chronic heart failure: insights from TIME-CHF Trial.Am J Med. 2019; 132: e679-e692Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar there were 8 variables included in the multivariable regression model. Hence, this multivariable regression model might be overfit. Third, apart from the 8 adjusted variables, many other variables (including body mass index, diabetes, anemia, etc.) were differently distributed, quite significantly, among the 3 groups, which could result in biased results. Thus, we must ask why the authors did not adjust these unbalanced variables. Fourth, the article found that clinical congestion index showed the potential to be an independent predictor of mortality for patients with chronic heart failure;1Simonavičius J Sanders van-Wijk S Rickenbacher P et al.Prognostic significance of longitudinal clinical congestion pattern in chronic heart failure: insights from TIME-CHF Trial.Am J Med. 2019; 132: e679-e692Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar however, it was a study of a clinical prediction model, and thus, the calibration and discrimination of the model should be assessed. Furthermore, the model should be internally and externally validated to make the results more rigorous.4Steyerberg EW Vergouwe Y Towards better clinical prediction models: seven steps for development and an ABCD for validation.Eur Heart J. 2014; 35: 1925-1931Crossref PubMed Scopus (853) Google Scholar

We read the intriguing paper by Wood et al. ([1][1]) in a recent issue of the Journal . Though their study appears sound, some critical methodological issues should not be ignored. First, Wood et al. claimed that their study was a randomized trial, but the randomization was stratified by the

An article in a recent issue of The American Journal of Medicine by Chang et al1Chang SH Wu CV Yeh YH et al.Efficacy and safety of oral anticoagulants in patients with atrial fibrillation and stages 4 or 5 chronic kidney disease.Am J Med. 2019; 132: 1335-1343Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar indicated high risks of major bleeding in prescribing anticoagulants in patients with atrial fibrillation and stage 4 or 5 chronic kidney disease.1Chang SH Wu CV Yeh YH et al.Efficacy and safety of oral anticoagulants in patients with atrial fibrillation and stages 4 or 5 chronic kidney disease.Am J Med. 2019; 132: 1335-1343Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar Though the study is professional in general, there are some critical methodological issues requiring further discussion. First, Chang et al tried to compare the risks of stroke and major bleeding of 3 groups: nonvitamin K antagonist oral anticoagulant (NOAC), warfarin, and no oral anticoagulation (No OAC). Therefore, medications, such as aspirin, clopidogrel, and ticagrelor, were provided and adjusted in their Cox proportional hazard models. However, some important parameters reflecting body functions of thrombosis, bleeding, and hemostasis were not provided and adjusted; thus, we propose that the authors should further include several critical laboratory parameters, like prothrombin time, activated partial thromboplastin time, platelet count, hemoglobin concentration, and international normalized ratio, and adjust them for more accurate results. Second, Chang et al applied the Kaplan-Meier and Cox proportional hazard model in their analysis without checking whether the proportionality assumption was met. A valid proportionality assumption is 1 of the 2 basic preconditions for the application of proportional hazards models;2In J Lee DK Survival analysis: part I - analysis of time-to-event.Korean J Anesthesiol. 2018; 71: 182-191Crossref PubMed Scopus (18) Google Scholar it is then inappropriate to apply this model with an invalid proportionality assumption that can be manifested as crossed survival curves.3Tolles J Lewis RJ Time-to-event analysis.JAMA. 2016; 315: 1046-1047Crossref PubMed Scopus (20) Google Scholar As seen from Figure 2 in Chang et al,1Chang SH Wu CV Yeh YH et al.Efficacy and safety of oral anticoagulants in patients with atrial fibrillation and stages 4 or 5 chronic kidney disease.Am J Med. 2019; 132: 1335-1343Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar several survival curves cross each other, which suggests that the proportionality assumption might have been violated;3Tolles J Lewis RJ Time-to-event analysis.JAMA. 2016; 315: 1046-1047Crossref PubMed Scopus (20) Google Scholar hence, the Cox proportional hazard model is improper here. Third, though the total sample size reached a high value of 3771, the number of events of 2 primary outcomes in this study, ischemic stroke/systemic embolism and major bleeding, in the NOAC group were only 3 and 18, respectively. We believe that the precision of results might be limited by the small number of events. Fourth, in addition to the several limitations referred by the authors, this study was also limited by deeming all patients taking NOAC as a whole without individual discrepancies. In fact, the categories, brands, doses, frequency, and cumulative treatment course of NOAC medicine could exert different efficacies and harms to the patients, which should apply to the warfarin group as well. In sum, the results of this study should be taken with prudence and further work should be done.

背景 肺部感染合并脓毒症患者在临床上较为棘手,而准确评估患者病情和预后、及时调整治疗策略对改善患者预后具有重要意义.目的 探究肺炎合并内科脓毒症患者预后的影响因素,旨在寻找能预警肺炎合并内科脓毒症患者预后的临床指标.方法 本研究为回顾性研究,选取2013—2018年广东省中医院收治的肺炎合并内科脓毒症患者2855例,脓毒症符合Sepsis 2.0诊断标准.收集患者的临床资料及预后指标.肺炎合并内科脓毒症患者住院期间预后的影响因素分析采用多元Cox回归分析,肺炎合并内科脓毒症患者住院7、28、90 d内预后的影响因素分析采用多因素Logistic回归分析.结果 多元Cox回归分析结果显示,年龄、序贯器官衰竭估计(SOFA)评分、查尔森合并症指数(CCI)评分、行心肺复苏术、输红细胞、输血浆、使用肾上腺素、降钙素原(PCT)及血乳酸(Lac)是肺炎合并内科脓毒症患者住院期间预后的独立影响因素(P<0.05).多因素Logistic回归分析结果显示,SOFA评分、行心肺复苏术、输红细胞、输血浆、使用肾上腺素及Lac是肺炎合并内科脓毒症患者住院7 d内预后的独立影响因素(P<0.05);年龄、SOFA评分、行无创通气、行有创通气、行心肺复苏术、输血浆、使用去甲肾上腺素、使用肾上腺素及Lac是肺炎合并内科脓毒症患者住院28 d内预后的独立影响因素(P<0.05);年龄、行无创通气、行有创通气、行心肺复苏术、输红细胞、输血浆、使用肾上腺素及Lac是肺炎合并内科脓毒症患者住院90 d内预后的独立影响因素(P<0.05).结论 行心肺复苏术、输血浆、使用肾上腺素及Lac升高是肺炎合并内科脓毒症患者预后的危险因素,而年龄、SOFA评分、CCI评分、行无创通气、行有创通气、输红细胞、使用去甲肾上腺素及PCT是患者特定时间段预后的影响因素.

We read the intriguing paper by Wood et al. ([1][1]) in a recent issue of the Journal . Though their study appears sound, some critical methodological issues should not be ignored. First, Wood et al. claimed that their study was a randomized trial, but the randomization was stratified by the

Surgical InfectionsVol. 20, No. 3 Letter to the EditorThe Wide Gap between the Knowledge of Adult and Pediatric SepsisXiaobin Yao, Xianshi Zhou, and Fanwei WuXiaobin YaoGuangzhou University of Chinese Medicine, Guangzhou, China.Search for more papers by this author, Xianshi ZhouEmergency Department, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China.Search for more papers by this author, and Fanwei WuAddress correspondence to: Dr. Fanwei Wu, Famous Doctor Hall, Bao'an TCM Hospital Group, Number 25, 2nd Yu'an Road, Bao'an District, Shenzhen 518133, China E-mail Address: wfwiso9000@126.comTCM Hospital Group, Shenzhen, China.Search for more papers by this authorPublished Online:2 Apr 2019https://doi.org/10.1089/sur.2018.197AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"The Wide Gap between the Knowledge of Adult and Pediatric Sepsis." Surgical Infections, 20(3), p. 251FiguresReferencesRelatedDetails Volume 20Issue 3Apr 2019 InformationCopyright 2019, Mary Ann Liebert, Inc., publishersTo cite this article:Xiaobin Yao, Xianshi Zhou, and Fanwei Wu.The Wide Gap between the Knowledge of Adult and Pediatric Sepsis.Surgical Infections.Apr 2019.251-251.http://doi.org/10.1089/sur.2018.197Published in Volume: 20 Issue 3: April 2, 2019Online Ahead of Print:December 27, 2018PDF download

室性心动过速是常见的室性心律失常,可分为非持续性或持续性室速.多数情况下,非持续性、非结构性心脏病的室性心动过速病人经治疗预后较好,而部分室性心动过速,如左室特发性室性心动过速,因QRS波时限较短,体表心电图常有一定迷惑性,较难与室上性室性心动过速伴差异传导相鉴别,延误治疗.对于伴有临床症状、药物治疗效果不佳或运动诱发的室性心动过速,射频消融是其主要的治疗策略.射频消融被认为是一种安全有效的终止室性心动过速的方式,手术成功率可达90.9％[1],而手术相关的严重并发症较低,术后死亡病例更是少有报道.本研究报道 1例左室后间隔室性心动过速并行射频消融术后死亡病例资料如下.

We read with interest the paper by Dahl et al. [(1)][1], who found a high prevalence (26%) of definite infective endocarditis (IE) in patients with Enterococcus faecalis bacteremia. Though the research sounds scientific, we still have some different viewpoints to address. First, 2 of the 10

目的 了解公众对自救互救知识和技能的掌握情况及相关需求,为开展自救互救知识和技能培训提供参考和依据.方法 通过问卷星网站平台发放调查问卷,调查广东省内和部分省外各地区公众自救互救知识和技能的掌握现状与需求.问卷内容包括被调查者的基本信息、急救互救技能培训现状和培训需求三部分,共计30个条目.结果 共收到有效问卷1 018份,其中广东省内占74.36%,省外占25.64%;参加过急救科普培训者285名(占28.0%);在接受过急救科普培训者中,以20～29岁、30～39岁人群最多,占50.53%(144名),60～69岁人群仅占1.40%(4名).培训项目方面,曾接受过心肺复苏(CPR)培训[264名(92.63%)]、止血包扎[170名(占59.65%)]、伤口处理[143名(占50.18%)]者较多.培训方式主要是学校或单位组织讲座[163名(占57.19%)]、医护人员专业培训[146名(占51.23%)],但自评价为熟悉掌握相关知识者仅74名(占25.96%);未参加过科普培训的原因主要是没有培训机会[654名(占89.22%)].对不同受教育程度、不同职业人群接受急救培训的现状进行分析显示,学历越高,接受急救科普培训率越高,政府机构人员[40.48%(17/42)]、教师[37.74%(40/106)]和学生[32.54%(96/295)]接受急救科普培训率较高,退休老人[15.00%(6/40)]、农民[9.09%(1/11)]和商人[6.38%(3/47)]接受急救科普培训率较低.自救互救知识和技能培训需求方面,公众更希望在医疗单位或社区等场所接受来自于医疗单位、医学院校等专业机构和专业人员的培训,更倾向现场理论+实践操作的培训方式,更希望掌握CPR等10个项目的自救互救知识和技能.根据本次调查,公众参加急救培训的目的主要是帮助家人[883名(86.74%)]、帮助他人[873名(85.76%)]和救自己[843名(82.81%)].被调查者均表示,不能提供现场急救的主要原因是无实战经验[780名(76.62%)]、能力不足[770名(75.64%)]、无法律保障[421名(占41.36%)].95.87%(976名)的人表示,如果通过培训掌握相关急救知识和技能愿意提供现场急救措施.结论 我国公众急救知识仍皇现"双低一失衡"现象,公众自救互救知识和技能亟需加强,需搭建自救互救科普教育平台,全面提升公众自救互救能力和水平.