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Speckle-tracking echocardiography for detecting myocardial dysfunction in sepsis and septic shock patients:A single emergency department study

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World Journal of Emergency Medicine 2022年第3期13卷 175-181页

作者： Xuan Fu Xue Lin Samuel Seery Li-na Zhao hua-dong zhu Jun Xu Xue-zhong Yu Emergency Department State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijing 100730China Department of Cardiology Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China Faculty of Health and Medicine Division of Health ResearchLancaster UniversityLancaster LAI 4YWUnited Kingdom

BACKGROUND:Septic cardiomyopathy(SCM)occurs in the early stage of sepsis and septic shock,which has implications for treatment strategies and prognosis.Additionally,myocardial involvement in the early stages of sepsis is difficult to identify.Here,we assess subclinical myocardial function using laboratory tests and speckle-tracking echocardiography(STE).METHODS:Emergency department patients diagnosed with sepsis or septic shock were included for analysis.Those with other causes of acute or pre-existing cardiac dysfunction were excluded.Transthoracic echocardiography(TTE),including conventional echocardiography and STE,were performed for all patients three hours after initial resuscitation.Samples for laboratory tests were taken around the time of TTE.RESULTS:Left ventricular functions of 60 patients were analyzed,including 21 septic shock patients and 39 sepsis patients.There was no significant difference in global longitudinal strain(GLS),global circumferential strain(GCS),or global radical strain(GRS)between patients with sepsis and septic shock(all with P>0.05).However,GLS and GCS were significantly less negative in patients with abnormal troponin levels or in patients with abnormal left ventricular ejection fraction(LVEF)values(all with P<0.05).There were also moderate correlations between GLS and levels of cTnI(r=0.40,P=0.002)or N-terminal pro-B-type natriuretic peptide(NT-proBNP)(r=0.44,P=0.001)in sepsis and septic shock patients.CONCLUSION:Myocardial dysfunction,e.g.,lower LVEF or less negative GLS in patients with sepsis or septic shock,is more affected by myocardial injury.GLS could be incorporated into mainstream clinical practice as a supplementary LVEF parameter,especially for those with elevated troponin levels.

关键词： Sepsis Septic shock Speckle-tracking echocardiography Global longitudinal strain Global circumferential strain

Nonpharmaceutical interventions eff ectively reduced infl uenza spread during the COVID-19 pandemic

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World Journal of Emergency Medicine 2023年第3期14卷 224-226页

作者： Yuan Yuan Yan Li Jiang-shan Wang Ye-cheng Liu Jun Xu hua-dong zhu Lu-zhao Feng Emergency Department State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijing 100005China School of Population Medicine&Public Health Chinese Academy of Medical Sciences/Peking Union Medical CollegeBeijing 100730China

Seasonal infl uenza,which is transmitted by droplets and direct contact,is a global public health issue that causes an average of 2.5 excess infl uenza-like illness(ILI)consultations per 1,000 person-years in China.[1]Nonpharmaceutical interventions(NPIs)against droplet and direct contact transmission,including social distancing measures and personal protective measures,are recommended to reduce the spread of disease.Social distancing measures comprised isolating ill persons,quarantining exposed persons,school and workplace closures,and avoiding crowds.Personal protective measures included hygiene,respiratory etiquette,and face masks.[2]In December 2019,coronavirus disease 2019(COVID-19)started to spread,and China introduced NPIs to address the pandemic in January 2020.These NPIs could also help reduce the spread of other respiratory diseases,such as seasonal influenza.[3]In the second half of 2020,the COVID-19 pandemic was gradually brought under control.Production,transport,and schools were returning to normal,while citizens were still required to wear masks in public.Cases of influenza also reappeared.This study compared the ILI percentage(ILI%),laboratory(LAB)-positive rate,incidence rate,and effective reproductive number(Rt)of infl uenzas from 2019 to 2022 to clarify the change in seasonal infl uenza spread after the COVID-19 outbreak.

关键词： protective measures spread

Is rosuvastatin protective against sepsis-associated encephalopathy? A secondary analysis of the SAILS trial

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World Journal of Emergency Medicine 2022年第5期13卷 367-372页

作者： Shi-yuan Yu Zeng-zheng Ge Jun Xiang Yan-xia Gao Xin Lu Joseph Harold Walline Mu-bing Qin hua-dong zhu Yi Li Emergency Department State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijing 100730China General Medicine Department of Jingnan Medical Center General Hospital of PLABeijing 100039China Emergency Department the First Affi liated Hospital of Zhengzhou UniversityZhengzhou 450052China Department of Emergency Medicine Penn State HealthMilton S.Hershey Medical CenterHershey 17033USA

BACKGROUND:Sepsis is a common cause of death in emergency departments and sepsis-associated encephalopathy(SAE)is a major complication.Rosuvastatin may play a neuroprotective role due to its protective effects on the vascular endothelium and its anti-inflammatory functions.Our study aimed to explore the potential protective function of rosuvastatin against SAE.METHODS:Sepsis patients without any neurological dysfunction on admission were prospectively enrolled in the“Rosuvastatin for Sepsis-Associated Acute Respiratory Distress Syndrome”study(SAILS trial,ClinicalTrials.gov number:NCT00979121).Patients were divided into rosuvastatin and placebo groups.This is a secondary analysis of the SAILS dataset.Baseline characteristics,therapy outcomes,and adverse drug events were compared between groups.RESULTS:A total of 86 patients were eligible for our study.Of these patients,51 were treated with rosuvastatin.There were significantly fewer cases of SAE in the rosuvastatin group than in the placebo group(32.1%vs.57.1%,P=0.028).However,creatine kinase levels were significantly higher in the rosuvastatin group than in the placebo group(233[22-689]U/L vs.79[12-206]U/L,P=0.034).CONCLUSION:Rosuvastatin appears to have a protective role against SAE but may result in a higher incidence of adverse events.

关键词： Rosuvastatin calcium Sepsis-associated encephalopathy Anti-infl ammatory agents Sepsis Adverse reactions

A survey of ventilation strategies during cardiopulmonary resuscitation

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World Journal of Emergency Medicine 2019年第4期10卷 222-227页

作者： Ye-cheng Liu Yan-meng Qi Hui Zhang Joseph Walline hua-dong zhu Department of Emergency Medicine Peking Union Medical College HospitalBeijingChina Accident and Emergency Medicine Academic Unit Prince of Wales HospitalThe Chinese University of Hong KongHong KongChina

BACKGROUND:Many controversies still exist regarding ventilator parameters during cardiopulmonary resuscitation(CPR).This study aimed to investigate the CPR ventilation strategies currently being used among physicians in Chinese tertiary hospitals.METHODS:A survey was conducted among the cardiac arrest team physicians of 500 tertiary hospitals in China in August,2018.Surveyed data included physician and hospital information,and preferred ventilation strategy during CPR.RESULTS:A total of 438(88%)hospitals completed the survey,including hospitals from all 31 Chinese mainland provinces.About 41.1%of respondents chose delayed or no ventilation during CPR,with delayed ventilations all starting within 12 minutes.Of all the respondents who provided ventilation,83.0%chose to strictly follow the 30:2 strategy,while 17.0%chose ventilations concurrently with uninterrupted compressions.Only 38.3%respondents chose to intubate after initiating CPR,while 61.7%chose to intubate immediately when resuscitation began.During bagvalve-mask ventilation,only 51.4%of respondents delivered a frequency of 10 breaths per minute.In terms of ventilator settings,the majority of respondents chose volume control(VC)mode(75.2%),tidal volume of 6–7 mL/kg(72.1%),PEEP of 0–5 cmH2O(69.9%),and an FiO2 of 100%(66.9%).However,62.0%of respondents had mistriggers after setting the ventilator,and 51.8%had high pressure alarms.CONCLUSION:There is a great amount of variability in CPR ventilation strategies among cardiac arrest team physicians in Chinese tertiary hospitals.Guidelines are needed with specific recommendations on ventilation during CPR.

关键词： Cardiopulmonary resuscitation Ventilation strategy Questionnaire survey Cardiac arrest team

Development of an intensive simulating training program in emergency medicine for medical students in China

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World Journal of Emergency Medicine 2022年第1期13卷 23-26页

作者： Xin Lu Shi Feng Shi-gong Guo Mu-bing Qin Xiang-ning Liu Shi-yuan Yu Li-na Zhao Zeng-zheng Ge Jing-jing Chai Sheng-yong Xu Di Shi Ji-hai Liu hua-dong zhu Yi Li Emergency Department State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalPeking Union Medical CollegeChinese Academy of Medical SciencesBeijing 100730China Department of Rehabilitation Medicine Southmead HospitalBristol BS105NBUnited Kingdom

BACKGROUND: A national standardized emergency medicine(EM) curriculum for medical students, including specific competencies in procedural skills, are absent in many countries. The development of an intensive simulating training program in EM, based on a tight schedule, is anticipated to enhance the competency of medical students.METHODS: A 3-day intensive EM training program, consisting of four procedural skills and 8-hour case-based learning(CBL), was developed by experienced physicians from the EM department in Peking Union Medical College Hospital(PUMCH). Medical students from Peking Union Medical College(PUMC) and Tsinghua University(THU) participated in the training. Three written tests were cautiously designed to examine the short-term(immediately after the program) and long-term(6 months after the program) efficacy of the training. After completion of the training program, an online personal appraisal questionnaire was distributed to the students on WeChat(a mobile messaging App commonly used in China) to achieve anonymous self-evaluation.RESULTS: Ninety-seven out of 101 students completed the intensive training and took all required tests. There was a significant increase in the average score after the intensive simulating training program(pre-training 13.84 vs. 15.57 post-training, P<0.001). Compared with the pre-training test, 63(64.9%) students made progress. There was no significant difference in scores between the tests taken immediately after the program and 6 months later(15.57±2.22 vs. 15.38±2.37, P=0.157). Students rated a higher score in all diseases and procedural skills, and felt that their learning was fruitful.CONCLUSIONS: The introduction of a standardized intensive training program in EM focusing on key competencies can improve clinical confidence, knowledge, and skills of medical students toward the specialty. In addition, having such a program can also enhance student’s interest in EM as a career choice which may enhance recruitment into the specialty and workplace planning.

关键词： Emergency medicine Medical education Simulation China

Utility and Safety of Intrathecal Methotrexate Treatment in Severe Anti-N-methyI-D-aspartate Receptor Encephalitis： A Pilot Study

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Chinese Medical Journal 2018年第2期131卷 156-160页

作者： Xun-Zhe Yang hua-dong zhu Hai-Tao Ren Yi-Cheng zhu Bin Peng Li-Ying Cui Hong-Zhi Guan Department of Neurology Peking Union Medical College Hospital Chinese Academy of Medical Sciences Beijing 100730 China Department of Emergency Peking Union Medical College Hospital Chinese Academy of Medical Sciences Beijing 100730 China Center of Neuroscience Chinese Academy of Medical Sciences Beijing 100730 China

Background： Anti-N-methyl-D-aspartate receptor （anti-NMDAR） encephalitis is a treatable autoimmune neurologic syndrome that occurs with or without tumor association. However, some severe cases are refractory to systemic immunotherapy. This pilot study aimed to evaluate the utility and safety of intrathecal methotrexate injection for severe patients with anti-NMDAR encephalitis who did not respond to first-line immunotherapy. Methods： Intrathecal injections with methotrexate and dexamethasone were performed weekly in four legible patients within consecutive 4 weeks. Cerebrospinal fluid （CSF） was collected at baseline and each time of intrathecal injection lbr identification of anti-NMDAR antibody titers. Results： Significant clinical improvement was observed in three patients associated with a stepwise decrease of CSF anti-NMDAR antibody titers （maximum： 1/320 to minimum： 1/10）. After 2 months of follow-up, they were able to follow simple commands and had appropriate interactions with people （modified Rankin scale [mRS] of 0-2）. At 12 months of follow-up, they all had returned to most activities of daily life （.mRS of 0）, and no relapses were reported. One patient showed no clinical improvement and died of neurologic complications. Conclusions： lntrathecal treatment may be a potentially useful supplementary therapy in severely affected patients with anti-NMDAR encephalitis. Further large cohort study and animal experiment may help us elaborate the utility of intrathecal injection of methotrexate and its mechanism of action.

关键词： Anti-N-methyl-D-aspartate Receptor Encephalitis Injections Methotrexate

Tension hydropneumothorax in a Boerhaave syndrome patient:A case report

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World Journal of Emergency Medicine 2021年第3期12卷 235-237页

作者： Chun-ting Wang Hui Jiang Joseph Walline Yan Li Jian Wang Jun Xu hua-dong zhu Emergency Department Peking Union Medical College HospitalBeijing 100730China Emergency Department Civil Aviation General HospitalBeijing 100123China Accident and Emergency Medicine Academic Unit the Chinese University of Hong KongHong Kong 999077China Department of Radiology Peking Union Medical College HospitalBeijing 100730China

Dear editor,Boerhaave syndrome,firstly described by Hermann Boerhaave in 1724,is a rare and life-threatening condition characterized by spontaneous transmural tear of the oesophagus.[1]The early diagnosis of Boerhaave syndrome is extremely important since a delay in the diagnosis can increase the mortality rate.[2]Here,we reported a Boerhaave syndrome patient combined with tension hydropneumothorax.

关键词： diagnosis patient mortality

Venous thromboembolism in the emergency department:A survey of current best practice awareness in physicians and nurses in China

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World Journal of Emergency Medicine 2019年第1期10卷 5-13页

作者： Wen-hua Zhou Jian-qiang He Shi-gong Guo Joseph Walline Xiao-ying Liu Li-yuan Tian hua-dong zhu Xue-zhong Yu Yi Li Emergency Department Peking Union Medical College Hospital Oxford Centre for Enablement Nuffi eld Orthopaedic Centre Accident and Emergency Medicine Academic Unit Prince of Wales Hospital The Chinese University of Hong Kong

BACKGROUND: For emergency department(ED) patients, risk assessment, prophylaxis, early diagnosis and appropriate treatment of venous thromboembolism(VTE) are essential for preventing morbidity and mortality. This study aimes to investigate knowledge amongst emergency medical staff in the management of VTE. METHODS: We designed a questionnaire based on multiple scales. The questionnaire was distributed to the medical and nursing clinical staff in the large urban ED of a medical center in Northern China. Data was described with percentages and the Kruskal-Wallis test was used to compare ranked data between different groups. The statistical analysis was done using the SPSS 22.0 software.RESULTS: In this survey, 180 questionnaires were distributed and 174 valid responses(response rate of 96.67%) were collected and analyzed. In scores of VTE knowledge, no signifi cant differences were found with respect to job(doctor vs. nurse), the number of years working in clinical medicine, education level, and current position, previous hospital experience and nurses' current work location within the ED. However, in pair wise comparison, we found participants who worked in ED for more than 5 years(n=83) scored signifi cantly higher on the questionnaire than those under 5 years(n=91)(95.75 vs. 79.97, P=0.039). There was a signifi cant difference in some questions based on gender, age, job, and nurse work location, number of working years, education level, and different ED working lifetime.CONCLUSION: Our survey has shown defi ciencies among ED medical staff in knowledge and awareness of the management of VTE. We recommend several changes be considered, such as the introduction of an interdisciplinary workshop for medical staff; the introduction of a standardized VTE protocol; a mandatory study module on VTE for new physicians and nurses; the introduction of a mandatory reporting system for adverse events(including VTE).

关键词：小学英语课外阅读阅读材料

Efficacy and safety of corticosteroids in immunocompetent patients with septic shock

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World Journal of Emergency Medicine 2021年第2期12卷 124-130页

作者： Xin Lu Wei Han Yan-xia Gao Shi-gong Guo Shi-yuan Yu Xue-zhong Yu hua-dong zhu Yi Li Emergency Department State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China Department of Epidemiology and Biostatistics Institute of Basic Medical Sciences Chinese Academy of Medical Sciences/School of Basic Medicine Peking Union Medical CollegeBeijing 100005China Emergency Department the First Affi liated Hospital of Zhengzhou UniversityZhengzhou 450052China Department of Rehabilitation Medicine Southmead HospitalBristolUnited Kingdom

BACKGROUND: The use of corticosteroids in septic shock has been studied for many decades but yielded conflicting results. We conducted a systematic review to evaluate the efficacy and the safety of corticosteroids in immunocompetent patients with septic shock.METHODS: Medline via Pub Med, Cochrane Central Register of Controlled Trials(CENTRAL) in the Cochrane Library, and EMBASE were searched from inception to March 2020. Two reviewers independently identified randomized controlled trials(RCTs) comparing corticosteroids with a control group for immunocompetent patients with septic shock. Data were abstracted and reported following the Cochrane Handbook for Systematic Review of Intervention and Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) statement. The efficacy outcome included mortality and shock reversal. The safety outcomes were infection, gastrointestinal bleeding, and hyperglycemia.RESULTS: Nine RCTs with a total of 1,298 patients were included. Compared with the control group, corticosteroid group did not lower the short-term(28 or 30 days) mortality(risk ratio [RR] 0.95, 95% confidence interval(CI) 0.85 to 1.06, inconsistency [I2]=0%, trial sequential analysis [TSA]-adjusted CI 0.83 to 1.09, moderate-certainty evidence). Corticosteroids significantly shortened the time to shock reversal compared with the control group(mean difference [MD] –21.56 hours;95% CI –32.95 to –10.16, I2=0%;TSA-adjusted CI –33.33 to –9.78, moderate-certainty evidence). The corticosteroid treatment was associated with an increased risk of hyperglycemia but not the infection or gastrointestinal bleeding.CONCLUSIONS: The corticosteroid treatment is not associated with lower short-or longterm mortality compared with placebo in immunocompetent patients with septic shock. However, corticosteroids significantly shorten the time to shock reversal without increasing the risk of infection. The patient's immune status should also be considered during clinical treatment and clinical trials in future.

关键词： Corticosteroids Septic shock Immunocompetent patients Systematic review Meta-analysis