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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 ***: 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 ***: 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 ***: 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 treatm

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

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 ***: 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 ***: 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 ***: 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 th

关键词： Emergency medicine Medical education Simulation China

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 ***: 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 ***: 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： Emergency Venous thromboembolism Staff knowledge Emergency doctor Emergency nurse

Comparison of the anterior and posterior approach in treating four-level cervical spondylotic myelopathy

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Chinese Medical Journal 2020年第23期133卷 2816-2821页

作者： Ji-Liang Zhai shi-gong guo Li Nie Jian-Hua Hu Department of Orthopedic Surgery Peking Union Medical College HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijing 100730China Department of Rehabilitation Medicine University Hospital of Wales CardiffUK Department of Research and Education Beijing Centers of Disease Prevention and ControlBeijing 102206China

Background:The optimal surgical approach for four-level cervical spondylotic myelopathy remains *** purpose of this study was to compare clinical and radiological outcomes and complications between the anterior and posterior approaches for four-level cervical spondylotic ***:A total of 19 patients underwent anterior decompression and fusion and 25 patients underwent posterior laminoplasty and instrumentation in this *** information,intraoperative blood loss,clinical and radiological outcomes,and complications were *** Orthopedic Association(JOA)score,36-item short form survey(SF-36)score and cervical alignment were ***:There were no significant differences in JOA scores between the anterior and posterior group preoperatively(11.6±1.6 vs.12.1±1.5),immediately postoperatively(14.4±1.1 vs.13.8±1.3),or at the last follow-up(14.6±1.0 vs.14.2±1.1)(P>0.05).The JOA scores significantly improved immediately postoperatively and at the last follow-up in both groups compared with their preoperative *** recovery rate was significantly higher in the anterior group both immediately postoperatively and at the last *** SF-36 score was significantly higher in the anterior group at the last follow-up compared with the preoperative value(69.4 vs.61.7).Imaging revealed that there was no significant difference in the Cobb angle at C2-C7 between the two groups preoperatively(-2.0°±7.3°vs.-1.4°±7.5°).The Cobb angle significantly improved immediately postoperatively(12.3°±4.2°vs.9.2°±3.6°)and at the last follow-up(12.4°±3.5°vs.9.0°±2.6°)in both groups compared with their preoperative values(P=0.00).Three patients had temporary dysphagia in the anterior group and four patients had persistent axial symptoms in the posterior ***:Both the anterior and posterior approaches were effective in treating four-level cervical spondylotic myelopathy in terms of neurological clinical outcomes and radiol

关键词： Four-level cervical spondylotic myelopathy Multilevel cervical spondylotic myelopathy Anterior cervical corpectomy and fusion Anterior cervical discectomy and fusion Laminoplasty

Effect of Resveratrol on Preventing Steroid-induced Osteonecrosis in a Rabbit Model

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Chinese Medical Journal 2016年第7期129卷 824-830页

作者： Ji-Liang Zhai Xi-Sheng Weng Zhi-Hong Wu shi-gong guo Department of Orthopaedic Surgery Peking Union Medical College Hospital Chinese Academy of Medical Science and Peking Union Medical College Beijing 100730 China Department of Orthopaedic Surg'ery Charingcross Hospital London W6 8RF UK

Background： Prevention of osteonecrosis （ON） has seldom been addressed. The purpose of this study was to evaluate the effect of resveratrol on preventing steroid-induced ON in rabbits. Methods： Seventy-two rabbits were divided into four groups：（l） NEC （ON） group： thirty rabbits were treated with lipopolysaccharide （LPS） once, then with methylprednisolone （MPS） daily for 3 days; （2） PRE （prevention） group： thirty rabbits were given one dose of LPS, then MPS daily for 3 days, and resveratrol on day 0 and daily for 2 weeks：（3） RES （resveratrol） group： six rabbits were given resveratrol for 2 weeks but without LPS/MPS; （4） CON （control） group： six rabbits were given alcohol for 2 weeks but without LPS/MPS. Levels of plasma tissue-type plasminogen activator （t-PAL plasminogen activator inhibitor 1 （PAl-1）, thrombomodulin （TM）, vascular endothelial growth factor （VEGF）, maximum enhancement （ME） by magnetic resonance imaging, and ON incidence were evaluated. Results： The PRE group had a lower ON incidence than the NEC group, but with no significant differences at 2 weeks and 12 weeks. Tile RES and CON groups did not develop ON. TM and VEGF were significantly higher in the NEC group compared with the PRE group at weeks 1, 2, and 4 （TM： 1 week, P= 0.029; 2 weeks, P= 0.005; and 4 weeks, P = 0.047; VEGF： 1 week, P= 0.039; 2 weeks, P= 0.021; 4 weeks. P = 0.014） but the difference disappeared at 12 weeks. The levels of t-PA and PAl-I were not significantly different between the NEC and PRE groups. The TM, t-PA, PAl-l, and VEGF concentrations in the RES and CON groups did not change over time. Compared to the baseline, ME in the NEC group decreased significantly （P = 0.025） at week 1, increased significantly （P = 0.021） at week 2, and was decreased at week 12. The variance was insignificant in the PRE group. Conclusions： Resveratrol may improve blood supply to bone in a rabbit model of ON of the femoral head via anti-inflammatory effects to protect the vascular endothelium and

关键词： Contrast-enhanced Magnetic Resonance Imaging Dynamic Femoral Head Necrosis Osteonecrosis Resveratrol

Surgical Fixation of Fourth and Fifth Metacarpal Shaft Fractures with Flexible Intramedullary Absorbable Rods： Early Clinical Outcomes and Implications

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Chinese Medical Journal 2015年第21期128卷 2851-2855页

作者： Ge Xiong Zi-Run Xiao shi-gong guo Wei Zheng Lu-Fei Dai Department of Hand Surgery Beijing Jishuitan Hospital Beijing 100035 China Department of Trauma and Orthopaedic Surgery Lister Hospital Stevenage UK

Background： To avoid the irritation of tendons and soft tissues as well as hardware-related problems, we designed an intramedullary fixation with bioabsorbable rods for the treatment of the metacarpal shaft fractures. Methods： Five patients with nine shaft fractures of the fourth and fifth metacarpi were treated with intramedullary absorbable implants and followed up with an average of 4.2 months postoperatively. Results： At final follow-up, all patients achieved fracture union with no signs of inflammatory or subcutaneous effusion. There was no shortening, angulatory, or rotatory deformity. There was almost full active extension range of motion （ROM） of the metacarpophalangeal joints while the active flexion ROM of these joints was 80.7 ± 9.6°. hand was 94.0 ± 9.6%. X-rays showed that the arch of the second Compared with the contralateral hand, the grip strength of the injured to fifth metacarpal heads was smooth. There were no intramedullary lytic changes and soft tissue swellings. Conclusion： The intramedullary absorbable implants are a safe, simple, and practical treatment for fourth and filth metacarpal fractures with good early clinical outcomes and no significant complications.

关键词： Absorbable Implant Follow-up: Intramedullary Fixation Metacarpal Fracture

Role of corticotrophin releasing hormone in cerebral infarction-related gastrointestinal barrier dysfunction

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World Journal of Emergency Medicine 2011年第1期2卷 59-65页

作者： Ye-cheng Liu Zhi-wei Qi shi-gong guo Zhong Wang Xuc-zhong Yu Sui Ma Emergency Medicine Department Peking Union Medical College Hospital Beijing 100730 China China-Japan Friendship Hospital Beijing 100029 China Weston General Hospital UK

BACKGROUND： Corticotrophin releasing hormone （CRH） is believed to mediate stress-induced behaviors, implying a broader, integrative role for the hormone in the psychological stress response, and studies on CRH in physical stress are few. This study was undertaken to investigate whether CRH plays an important role in cerebral infarction-related gastrointestinal barrier ***： Thirty male Wistar rats were randomly divided into a pseudo-operation group （group C, n=10）, a cerebral infarction group （group I, n=10）, and a cerebral infarction ＋ ic α-helical-CRH （9-41） group （group Aic, n=10）. Urine samples were collected to determine the levels of epinephrine, norepinephrine, cortisol, and sucrose. At 24 hours after establishment of the models, blood samples were taken to determine the activity of diamine oxidase （DAO） and the concentration of D-lactic acid （D-lac）. The stomach was taken to determine gastric Guth score, and the hypothalamus was also taken to determine tissue CRH protein expression using Western ***： The hypothalamus CRH protein, the indicators of stress, the plasma DAO activity and plasma D-lac, urine sucrose exertion and gastric Guth score in group I were higher than those in groups Aic and ***： After cerebral infarction, CRH in the hypothalamus was increased, the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system were activated, gastrointestinal permeability was increased, and gastrointestinal barrier function was destroyed. CRH receptor antagonist alleviated the gastrointestinal barrier function.

关键词： Corticotrophin releasing hormone Cerebral infarction Gastrointestinal barrier Stress

Multiple Tin Compounds Modified Carbon Fibers to Construct Heterogeneous Interfaces for Corrosion Prevention and Electromagnetic Wave Absorption

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Nano-Micro Letters 2025年第1期17卷 507-527页

作者： Zhiqiang guo Di Lan Zirui Jia Zhenguo Gao Xuetao shi Mukun He Hua guo Guanglei Wu Pengfei Yin College of Science Sichuan Agricultural UniversityYa’an 625014People’s Republic of China School of Materials Science and Engineering Hubei University of Automotive TechnologyShiyan 442002People’s Republic of China Institute of Materials for Energy and Environment State Key Laboratory of Bio‑Fibers and Eco‑TextilesCollege of Materials Science and EngineeringQingdao UniversityQingdao 266071People’s Republic of China Shaanxi Key Laboratory of Macromolecular Science and Technology School of Chemistry and Chemical EngineeringNorthwestern Polytechnical UniversityXi’anShaanxi 710072People’s Republic of China

Currently,the demand for electromagnetic wave(EMW)absorbing materials with specific functions and capable of withstanding harsh environments is becoming increasingly ***-component interface engineering is considered an effective means to achieve high-efficiency EMW ***,interface modulation engineering has not been fully discussed and has great potential in the field of EMW *** this study,multi-component tin compound fiber composites based on carbon fiber(CF)substrate were prepared by electrospinning,hydrothermal synthesis,and high-temperature thermal *** utilizing the different properties of different substances,rich heterogeneous interfaces are *** effectively promotes charge transfer and enhances interfacial polarization and conduction *** prepared SnS/SnS_(2)/SnO_(2)/CF composites with abundant heterogeneous interfaces have and exhibit excellent EMW absorption properties at a loading of 50 wt%in epoxy *** minimum reflection loss(RL)is−46.74 dB and the maximum effective absorption bandwidth is 5.28 ***,SnS/SnS_(2)/SnO_(2)/CF epoxy composite coatings exhibited long-term corrosion resistance on Q235 steel ***,this study provides an effective strategy for the design of high-efficiency EMW absorbing materials in complex and harsh environments.

关键词： Electrostatic spinning Component regulation Heterogeneous interfaces Electromagnetic wave absorption Corrosion protection

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兔膝关节置换术后感染模型的建立

中华实验外科杂志 2010年第2期27卷 258-260页

作者：王志酬曹力龚时国曾赟刘阳新疆医科大学第一附属医院骨科中心乌鲁木齐830054

目的建立兔膝关节置换（TKA）术后感染模型.方法设计制作兔膝关节假体,新西兰兔48只行右膝TKA,4周后随机分为4组：对照组膝关节腔内接种无菌0.45%NaCl溶液,实验A、B、C组分别接种5×10^3、5×10^5、5×10^7CFU耐甲氧西林金葡菌（MRSA... 详细信息

目的建立兔膝关节置换（TKA）术后感染模型.方法设计制作兔膝关节假体,新西兰兔48只行右膝TKA,4周后随机分为4组：对照组膝关节腔内接种无菌0.45%NaCl溶液,实验A、B、C组分别接种5×10^3、5×10^5、5×10^7CFU耐甲氧西林金葡菌（MRSA）;监测血沉（ESR）、C-反应蛋白（CRP）,4周后处死,取材行细菌培养和血培养.结果感染率：对照组0（0/12）;实验A组58.3%（7/12）;B组100.0%（12/12）;C组100.0%（12/12）.血培养阳性率：对照组0（0/12）;实验A组0（0/12）;B组0（0/12）;C组41.7%（5/12）.实验组CRP、ESR显著升高,分别于第3、7天达峰值并维持在较高水平.结论兔TKA术后4周接种5×10^5CFU的MRSA可成功建模.

关键词：关节置换耐甲氧西林金葡菌模型,动物