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Distribution and drug resistance of pathogenic bacteria in emergency patients

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World Journal of Clinical Cases 2019年第20期7卷 3175-3184页

作者： Wei Huai qing-bian ma Jia-Jia Zheng Yang Zhao Qiang-Rong Zhai Emergency Department Third Clinical Medical CollegePeking UniversityBeijing 100191China Laboratory Department Third Clinical Medical CollegePeking UniversityBeijing 100191China

BACKGROUND Antibiotic resistance has become a global threat for human health,calling for rational use of *** To analyze the distribution and drug resistance of the bacteria,providing the prerequisite for use of antibiotics in emergency *** A total of 2048 emergency patients from 2013 to 2017 were *** clinical examination specimens were collected,followed by isolation of *** bacterial identification and drug susceptibility testing were carried *** A total of 3387 pathogens were *** top six pathogens were Acinetobacter baumannii(660 strains),Staphylococcus aureus(436 strains),Klebsiella pneumoniae(347 strains),Pseudomonas aeruginosa(338 strains),Escherichia coli(237 strains),and Candida albicans(207 strains).The isolation rates of these pathogens decreased year by year except Klebsiella pneumoniae,which increased from 7.1%to 12.1%.Acinetobacter baumannii is a widely-resistant strain,with multiple resistances to imipenem,ciprofloxacin,minocycline and *** Staphylococcus aureus had high resistance rates to levofloxacin,penicillin G,and *** the susceptibility of it to vancomycin and tigecycline were 100%.Klebsiella pneumoniae had high resistance rates to imipenem,cefoperazone/sulbactam,amikacin,and ciprofloxacin,with the lowest resistance rate to *** resistance rates of Pseudomonas aeruginosa to cefoperazone/sulbactam and imipenem were higher,with the resistance rate to amikacin below 10%.Besides,Escherichia coli had high resistance rates to ciprofloxacin and cefoperazone/sulbactam and low resistance rates to imipenem,amikacin,and *** The pathogenic bacteria isolated from the emergency patients were mainly Acinetobacter baumannii,Staphylococcus aureus,Klebsiella pneumoniae,Pseudomonas aeruginosa,Escherichia coli,and Candida *** detection rates of drugresistant bacteria were high,with different bacteria having multiple drug resistances to commonly

关键词： Distribution Drug resistance Bacteria Emergency department

Angiotensin converting enzymes inhibitors or angiotensin receptor blockers should be continued in COVID-19 patients with hypertension

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World Journal of Clinical Cases 2021年第1期9卷 47-60页

作者： Ci Tian Nan Li Yi Bai Han Xiao Shu Li qing-Gang Ge Ning Shen qing-bian ma Department of Emergency Medicine Peking University Third HospitalBeijing 100191China Research Center of Clinical Epidemiology Peking University Third HospitalBeijing 100191China Department of Cardiology and Institute of Vascular Medicine Peking University Third HospitalBeijing 100191China Department of Critical Care Medicine Peking University Third HospitalBeijing 100191China Department of Pulmonary and Critical Care Medicine Department of MedicinePeking University Third HospitalBeijing 100191China

BACKGROUND Recent studies have revealed that sustained ingestion of angiotensin converting enzymes inhibitors or angiotensin receptor blockers(ACEIs/ARBs)had no harmful effects on coronavirus disease 2019(COVID-19)patients complicated with *** To investigate the impact on COVID-19 patients complicated with hypertension who discontinued using ACEIs/*** All COVID-19 patients complicated with hypertension admitted to our isolated unit were consecutively recruited in this *** patients switched from ACEIs/ARBs to calcium channel blocker(CCBs)after admission,while others continued using non-ACEIs/*** compared characteristics and clinical outcomes between these two groups of *** A total of 53 patients were enrolled,27 patients switched from ACEIs/ARBs to CCBs while 26 patients continued with non-ACEIs/*** controlling potential confounding factors using the Cox proportional hazards model,hospital stay was longer in patients who discontinued ACEIs/ARBs,with a hazard ratio of 0.424(95%confidence interval:0.187-0.962;P=0.040),upon discharge than patients using other anti-hypertensive drugs.A sub-group analysis showed that the effect of discontinuing use of ACEIs/ARBs was stronger in moderate cases[hazard ratio=0.224(95%confidence interval:0.005-0.998;P=0.0497)].CONCLUSION Patients in the discontinued ACEIs/ARBs group had longer hospital *** findings suggest that COVID-19 patients complicated with hypertension should continue to use ACEIs/ARBs.

关键词： COVID-19 Hypertension Angiotensin converting enzymes inhibitors Angiotensin receptor blockers Angiotensin-converting enzyme-2 Prognosis

Comparison of intraosseous access and central venous catheterization in Chinese adult emergency patients: A prospective, multicenter, and randomized study

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World Journal of Emergency Medicine 2021年第2期12卷 105-110页

作者： Yan-yan Liu Yu-peng Wang Ling-yun Zu Kang Zheng qing-bian ma Ya-an Zheng Wei Gao Department of Cardiology and Institute of Vascular Medicine Peking University Third HospitalNHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory PeptidesKey Laboratory of Molecular Cardiovascular SciencesMinistry of EducationBeijing Key Laboratory of Cardiovascular Receptors ResearchBeijing 100191China Department of Emergency Medicine Peking University Third HospitalBeijing 100191China

BACKGROUND: It is challenging to establish peripheral intravenous access in adult critically patients. This study aims to compare the success rate of the first attempt, procedure time, operator satisfaction with the used devices, pain score, and complications between intraosseous(IO) access and central venous catheterization(CVC) in critically ill Chinese ***: In this prospective clustered randomized controlled trial, eight hospitals were randomly divided into either the IO group or the CVC group. Patients who needed emergency vascular access were included. From April 1, 2017 to December 31, 2018, each center included 12 patients. We recorded the data mentioned ***: A total of 96 patients were enrolled in the study. There were no statistically significant differences between the two groups regarding sex, age, body mass index, or operator satisfaction with the used devices. The success rates of the first attempt and the procedure time were statistically significant between the IO group and the CVC group(91.7% vs. 50.0%, P<0.001;52.0 seconds vs. 900.0 seconds, P<0.001). During the study, 32 patients were conscious. There was no statistically significant difference between the two groups regarding the pain score associated with insertion. There were statistically significant differences between the two groups regarding the pain score associated with IO or CVC infusion(1.5 vs. 0.0, P=0.044). Complications were not observed in the two ***: IO access is a safe, rapid, and effective technique for gaining vascular access in critically ill adults with inaccessible peripheral veins in the emergency departments.

关键词： Intraosseous access Central venous catheterization Success rates Procedure time Pain score

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World Journal of Clinical Cases 2020年第20期8卷 4807-4815页

作者： Ci Tian Yang Lv Shu Li Dai-Dai Wang Yi Bai Fang Zhou qing-bian ma Department of Emergency Medicine Peking University Third HospitalBeijing 100191China Department of Orthopedics Peking University Third HospitalBeijing 100191China

BACKGROUND Acute traumatic spinal cord injury(ATSCI)usually results in disability,yet data on contemporary national trends of ATSCI incidence are *** To provide a systematic and basic theoretical basis for improving the treatment of acute spinal cord *** Data from the Peking University Third Hospital Inpatient Sample databases were analyzed.A total of 304 patients with ATSCI were included from 2012 to *** epidemiological data,treatment,complications and clinical outcomes of these patients were *** Of the 304 patients,257(84.5%)were male,and 75%of the patients were 55 years old or younger.135 patients had improved follow-up American Spinal Injury Association(ASIA)grades(44.4%).Only 14 patients with ASIA grade A improved.A statistically significant difference in prognosis between patients who underwent surgery within 72 h and those who underwent surgery after 72 h was observed(Pmanagement strategy are *** improvements in treatment planns are needed in order to obtain more reliable functional outcomes.

关键词： Acute spinal cord injury Trauma Surgery American Spinal Injury Association Steroids Prognosis

Correlation between the warning symptoms and prognosis of cardiac arrest

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World Journal of Clinical Cases 2022年第22期10卷 7738-7748页

作者： Kang Zheng Yi Bai Qiang-Rong Zhai Lan-Fang Du Hong-Xia Ge Guo-Xing Wang qing-bian ma Department of Emergency Medicine Peking University Third HospitalBeijing 100191China Department of Emergency Medicine Beijing Friendship HospitalBeijing 100050China

BACKGROUND A low survival rate in patients with cardiac arrest is associated with failure to recognize the condition in its initial ***,recognizing the warning symptoms of cardiac arrest in the early stage may play an important role in *** To investigate the warning symptoms of cardiac arrest and to determine the correlation between the symptoms and *** We included all adult patients with all-cause cardiac arrest who visited Peking University Third Hospital or Beijing Friendship Hospital between January 2012 and December *** on population,symptoms,resuscitation parameters,and outcomes were *** Of the 1021 patients in the study,65.9%had symptoms that presented before cardiac arrest,25.2%achieved restoration of spontaneous circulation(ROSC),and 7.2%survived to *** patients with symptoms had higher rates of an initial shockable rhythm(12.2%vs 7.5%,P=0.020),ROSC(29.1%vs 17.5%,P=0.001)and survival(9.2%vs 2.6%,P=0.001)than patients without *** with the out-of-hospital cardiac arrest(OHCA)without symptoms subgroup,the OHCA with symptoms subgroup had a higher rate of calls before arrest(81.6%vs 0.0%,Pmales,whereas dyspnea(54.9%vs 45.9%,P=0.029)and a non-cardiac etiology(53.3%vs 41.7%,P=0.003)were mor

关键词： Cardiac arrest Warning symptoms Immediate recognition Etiology Cardiopulmonary resuscitation Prognosis

Cardiac arrhythmias and cardiac arrest related to mushroom poisoning: A case report

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World Journal of Clinical Cases 2019年第16期7卷 2330-2335页

作者： Shu Li qing-bian ma Ci Tian Hong-Xia Ge Yang Liang Zhi-Guo Guo Cheng-Duo Zhang Bei Yao Jia-Ning Geng Fran Riley Department of Emergency Medicine Peking University Third HospitalBeijing 100191China Department of Cardiology Peking University Third HospitalBeijing 100191China Department of Laboratory Medicine Peking University Third HospitalBeijing 100191China Beijing Institute of Genomics Chinese Academy of SciencesBeijing 100101China Department of Emergency Medicine Maimonides Medical CenterBrooklynNY 11219United States

BACKGROUND Mushroom exposure is a global health *** manifestations of mushroom poisoning (MP) may *** species have been reported as rhabdomyolytic,hallucinogenic,or gastrointestinal *** or even fatal MPs are mostly attributable to Amanita phalloides,with the development of severe liver or renal *** injury and even cases mimicking ST-segment elevation myocardial infarction (STEMI) have been previously reported,while cardiac arrhythmia or cardiac arrest is not commonly *** SUMmaRY We report a 68-year-old woman with MP who suffered from delirium,seizure,long QT syndrome on electrocardiogram (ECG),severe cardiac arrhythmias of multiple origins,and cardiac *** was intubated and put on blood *** kidney and liver functions were intact;creatine kinase-MB was mildly elevated,and then fell within normal range during her hospital *** sent the mushrooms she left for translation elongation factor subunit 1α,ribosomal RNA gene sequence,and internal transcribed spacer sequence *** were four kinds of mushrooms identified,two of which were found to be *** This is the first time that we found cardiac toxicity caused by Panaeolus subbalteatus and Conocybe lactea,which were believed to be toxic to the liver,kidney,and *** suggest that intensive monitoring and ECG follow-up are essential to diagnose prolonged QT interval and different forms of tachycardia in MP patients,even without the development of severe liver or renal *** mechanisms need to be further investigated and clarified based on animal experiments and molecular signal pathways.

关键词： Mushroom poisoning Arrhythmia Cardiac arrest Seizure Case report

Performance of Simplified Acute Physiology Score 3 in Predicting Hospital Mortality in Emergency Intensive Care Unit

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Chinese Medical Journal 2017年第13期130卷 1544-1551页

作者： qing-bian ma Yuan-Wei Fu Lu Feng Qiang-Rong Zhai Yang Liang Meng Wu Ya-An Zheng Department of Emergency Medicine Peking University Third Hospital Beijing 100091 China

Background： Since the 1980s, severity of illness scoring systems has gained increasing popularity in Intensive Care Units （ICUs）. Physicians used them for predicting mortality and assessing illness severity in clinical trials. The objective of this study was to assess the performance of Simplified Acute Physiology Score 3 （SAPS 3） and its customized equation for Australasia （Australasia SAPS 3, SAPS 3 [AUS]） in predicting clinical prognosis and hospital mortality in emergency ICU （EICU）. Methods： A retrospective analysis of the EICU including 463 patients was conducted between January 2013 and December 2015 in the EICU of Peking University Third Hospital. The worst physiological data of enrolled patients were collected within 24 h after admission to calculate SAPS 3 score and predicted mortality by regression equation. Discrimination between survivals and deaths was assessed by the area under the receiver operator characteristic curve （AUC）. Calibration was evaluated by Hosmer-Lemeshow goodness-of fit test through calculating the ratio of observed-to-expected numbers of deaths which is known as the standardized mortality ratio （SMR）. Results： A total of 463 patients were enrolled in the study, and the observed hospital mortality was 26.1% （121/463）. The patients enrolled were divided into survivors and nonsurvivors. Age, SAPS 3 score, Acute Physiology and Chronic Health Evaluation Score 11 （APACHE 11）, and predicted mortality were significantly higher in nonsurvivors than survivors （P 〈 0.05 or P 〈 0.01 ）. The AUC （95% confidence intervals [C/s]） for SAPS 3 score was 0.836 （0.796-0.876）. The maximum of Youden＇s index, cutoff, sensitivity, and specificity of SAPS 3 score were 0.526%, 70.5 points, 66.9%, and 85.7%, respectively. The Hosmer-Lemeshow goodness-of-fit test for SAPS 3 demonstrated a Chi-square test score of 10.25, P = 0.33, SMR （95% CI） = 0.63 （0.52 0.76）. The Hosmer-Lemeshow goodness-of fit test tbr SAPS 3 （AUS） demonstrated a Chi-square test score of 9.5

关键词： Hosmer-Lemeshow Good-of-fit Test Independent Risk Factor Probability of Hospital Mortality Prognosis ReceiverOperating Characteristic Simplified Acute Physiology Score 3 Standardized Mortality Ratio

A Case of Clozapine Toxicity Leading to Acute Respiratory Distress Syndrome（ARDS）

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A Case of Clozapine Toxicity Leading to Acute Respiratory Di...

Differential diagnosis of coronavirus disease 2019 from pneumonias caused by other etiologies in a fever clinic in Beijing

2016年中国药学大会暨第十六届中国药师周

作者： Meng-jia Ge Wei Liu Shuo Li Shu Li qing-bian ma Department of Pharmacy Peking University Third Hospital Department Of Pharmacy Administration and Clinical Pharmacy School of Pharmaceutical SciencePeking University Department of Emergency Peking University Third Hospital

Clozapine is a second-generation antipsychotic reserved for the management of treatment-resistant schizophrenia. FDA had required black box warnings of clozapine-induced agranulocytosis because of several reported deaths. Therefore clozapine is dispensed only under rigid guidelines. Case reports of overdose have been rare. The lung is a site of active transport and accumulation for clozapine and a toxic clozapine ingestion leads to the impairment of the lung, resulting in the ARDS. We report a case of intentional clozapine intoxication of 2500 mg and rapidly progressed to ARDS. Successful recovery followed effective management with anti-inflammation therapy.

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Chinese Medical Journal 2020年第20期133卷 2504-2506页

作者： Ying Liang Jing-Jin Liang qing-Tao Zhou Xiao-Guang Li Fei Lin Zhong-Hua Deng Bi-Ying Zhang Lu Li Xiao-Hua Wang Hong Zhu qing-bian ma Xiao-Mei Tong Jie Xu Yong-Chang Sun Department of Respiratory and Critical Care Medicine Peking University Third HospitalBeijing 100191China Department of Infectious Diseases Peking University Third HospitalBeijing 100191China Department of Radiology Peking University Third HospitalBeijing 100191China Emergency Department Peking University Third HospitalBeijing 100191China Department of Pediatrics Peking University Third HospitalBeijing 100191China

Coronavirus disease 2019(COVID-19)is an acute respiratory infectious disease caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).111 Fever clinics in general hospitals were requested to reinforce surveillance of this highly contagious *** with body temperatures≥37.3℃ were asked to firstly visit fever clinics,where a triage strategy was implemented,and probable or possible cases were identified by experts or expert panels,and samples were sent for quick viral detection.

关键词： acute diagnosis fever