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Outcome prediction value of National Early Warning Score in septic patients with community-acquired pneumonia in emergency department: A single-center retrospective cohort study

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World Journal of Emergency Medicine 2020年第4期11卷 206-215页

作者： Hai-jiang Zhou Tian-fei Lan shu-bin guo Emergency Medicine Clinical Research Center Beijing Chao-yang HospitalCapital Medical University&Beijing Key Laboratory of Cardiopulmonary Cerebral ResuscitationBeijingChina Department of Allergy Beijing Shijitan HospitalCapital Medical UniversityBeijingChina

BACKGROUND:To evaluate the accuracy of National Early Warning Score(NEWS)in predicting clinical outcomes(28-day mortality,intensive care unit[ICU]admission,and mechanical ventilation use)for septic patients with community-acquired pneumonia(CAP)compared with other commonly used severity scores(CURB65,Pneumonia Severity Index[PSI],Sequential Organ Failure Assessment[SOFA],quick SOFA[qSOFA],and Mortality in Emergency Department Sepsis[MEDS])and admission lactate ***:Adult patients diagnosed with CAP admitted between January 2017 and May 2019 with admission SOFA≥2 from baseline were *** characteristics were *** primary outcome was the 28-day mortality after admission,and the secondary outcome included ICU admission and mechanical ventilation *** prediction value of parameters above was compared using receiver operating characteristics(ROC)*** regression analyses were carried out to determine the risk factors for the 28-day ***-Meier survival curves were plotted and compared using optimal cut-off values of qSOFA and ***:Among the 340 enrolled patients,90 patients were dead after a 28-day follow-up,62 patients were admitted to ICU,and 84 patients underwent mechanical *** single predictors,NEWS achieved the largest area under the receiver operating characteristic(AUROC)curve in predicting the 28-day mortality(0.861),ICU admission(0.895),and use of mechanical ventilation(0.873).NEWS+lactate,similar to MEDS+lactate,outperformed other combinations of severity score and admission lactate in predicting the 28-day mortality(AUROC 0.866)and ICU admission(AUROC 0.905),while NEWS+lactate did not outperform other combinations in predicting mechanical ventilation(AUROC 0.886).Admission lactate only improved the predicting performance of CURB65 and qSOFA in predicting the 28-day mortality and ICU ***:NEWS could be a valuable predictor in septic patients with CAP in emergency depa

关键词： Community-acquired pneumonia Sepsis National Early Warning Score(NEWS) Intensive care unit Emergency departments

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Empyema and mediastinal abscess in pyriform sinus f istula: A case report

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World Journal of Emergency Medicine 2019年第4期10卷 244-247页

作者： Hai-jiang Zhou Wen-peng Yin Tian-fei Lan shu-bin guo Department of Emergency Medicine Beijing Chao-yang HospitalCapital Medical UniversityBeijing 100020China Department of Allergy Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China

Dear editor,Though notorious for its tendency to induce recurrent neck abscess,pyriform sinus fistula is of importance despite its *** usually presents diagnostic and therapeutic *** of post-infectious fi brosis,the embryologic origin of pyriform sinus fi stula is diffi cult to appreciate in certain *** we present a case with empyema and mediastinal abscess caused by pyriform sinus fi stula and share our experience in the treatment of this patient.

关键词： Empyema mediastinal abscess pyriform sinus fistula

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Nutritional status and prognostic factors for mortality in patients admitted to emergency department observation units:a national multi-center study in China

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World Journal of Emergency Medicine 2023年第1期14卷 17-24页

作者： Hai-jiang Zhou Dong-jing Zuo Da Zhang Xin-hua He shu-bin guo Nutrition School of Education College of Chinese Emergency Medicine Beijing Key Laboratory of Cardio-pulmonary Cerebral ResuscitationEmergency Medicine Clinical Research CenterBeijing Chao-yang HospitalCapital Medical UniversityBeijing 100020China

BACKGROUND:Nutritional risk is common among patients admitted to the emergency department and is associated with adverse clinical *** its large population,few comprehensive studies have been conducted in China concerning the nutritional status of patients admitted to emergency department observation units(EDOUs).METHODS:Patients admitted to EDOUs of 90 tertiary hospitals in China between June 2020 and December 2020 were *** information,laboratory parameters,nutritional support therapies,and 28-day mortality were *** factors for mortality were examined using multi-variateadjusted logistic regression *** operating characteristic(ROC)curves for each predictor of mortality were plotted,and the area under the ROC(AUROC)curves was ***:A total of 2,005 eligible patients were finally *** the 28-day follow-up,1,911 patients survived,and 94 *** group with a Nutritional Risk Screening 2002(NRS 2002)score of 3-4 points was the largest(52.01%).The number of patients receiving oral nutritional supplements,enteral nutrition(EN),parenteral nutrition(PN),and the combination of EN and PN was 425,314,853,and 413,*** the total,77.55%of patients had nutritional risk(NRS 2002≥3).The proportion of patients with high nutritional risk(NRS2002≥5)in the age group>80 years was significantly higher than that in the age group 66-80 years(29.00%vs.23.93%,P=0.032),but not significantly higher than that in the age group 18-65 years(29.00%vs.26.54%,P=0.449).Logistic regression analysis revealed that heart failure(odds ratio[OR]1.856,95%confidence interval[CI]1.087-3.167,P=0.023),consciousness(OR 2.967,95%CI 1.894-4.648,P<0.001),Acute Physiology and Chronic Health Evaluation II(APACHE II)score(OR 1.037,95%CI 1.017-1.058,P<0.001),NRS 2002 score(OR 1.286,95%CI 1.115-1.483,P=0.001),and Mini Nutritional Assessment-Short Form score(OR 0.946,95%CI 0.898-0.997,P=0.039)were all independent risk factors for 28-day m

关键词： Nutritional risk Malnutrition Nutritional Risk Screening 2002 Mini Nutritional Assessment-Short Form

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Lipocalin-2 Test in Distinguishing Acute Lung Injury Cases from Septic Mice Without Acute Lung Injury

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Chinese Medical Sciences Journal 2014年第2期29卷 65-77页

作者： Gao Zeng Cong-wei Jia Jie Liu shu-bin guo Department of Emergency Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Department of Pathology Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College

Objective To explore whether the amount of lipocalin-2 in the biofluid could reflect the onset of sepsis-induced acute lung injury(ALI) in mice. Methods Lipopolysaccharide(LPS, 10 mg/kg) injection or cecal ligation and puncture(CLP) was performed to induce severe sepsis and ALI in C57 BL/6 male mice randomly divided into 5 groups(n=10 in each group): group A(intraperitoneal LPS injection), group B(intravenous LPS injection via tail vein), group C(CLP with 25% of the cecum ligated), group D(CLP with 75% of the cecum ligated), and the control group(6 sham-operation controls plus 4 saline controls). All the mice received volume resuscitation. Measurements of pulmonary morphological and functional alterations were used to identify the presence of experimental ALI. The expressions of lipocalin-2 and interleukin(IL)-6 in serum, bronchoalveolar lavage fluid(BALF), and lung tissue were quantified at both protein and mRNA levels. The overall abilities of lipocalin-2 and IL-6 tests to diagnose sepsis-induced ALI were evaluated by generating receiver operator characteristic curves(ROC) and computing area under curve(AUC). Results In both group B and group D, most of the "main features" of experimental ALI were reproduced in mice, while group A and group C showed septic syndrome without definite evidence for the presence of ALI. Compared with septic mice without ALI(group A+group C), lipocalin-2 protein expression in septic mice with ALI(group B+group D) was significantly up-regulated in BALF(P<0.01) and in serum(P<0.01), and mRNA expression boosted in lung tissues(all P<0.05). Lipocalin-2 tests performed better than IL-6 tests in recognizing sepsis-induced ALI cases, evidenced by the larger AUC of the former(BALF tests, 0.8800 versus 0.6625; serum tests, 0.8500 versus 0.7000). Using a dual cutoff system to diagnose sepsis-induced ALI, BALF lipocalin-2 test exhibited the highest positive likelihood ratio(13.000) and the lowest negative likelihood ratio(0.077) among the tests of

关键词： lipocalin-2 acute lung injury biomarker sepsis neutrophil gelatinase associatedlipocalin

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Effect of Nitrate on Activities and Transcript Levels of Nitrate Reductase and Glutamine Synthetase in Rice

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Pedosphere 2008年第5期18卷 664-673页

作者： CAO Yun FAN Xiao-Rong SUN shu-bin XU guo-Hua HU Jiang SHEN Qi-Rong College of Resources and Environmental Sciences Nanjing Agricultural University Nanjing 210095 （China）.

Real-time polymerase chain reaction analysis was used to compare the effect of NO3^- on the activities of nitrate reductase （NR） and glutamine synthetase （GS）, and the transcript levels of two NR genes, OsNial and OsNia2, two cytosolic GS1 genes, OsGln1;1 and OsGln1;2, and one plastid GS2 gene OsGln2, in two rice （Oryza sativa L.） cultivars Nanguang （NG） and Yunjing （Y J）. Both cultivars achieved greater biomass and higher total N concentration when grown in a mixed N supply than in sole NH4^＋ nutrition. Supply of NO3^- increased NR activity in both leaves and roots. Expression of both NR genes was also substantially enhanced and transcript levels of OsNia2 were significantly higher than those of OsNial. NO3 also caused an increase in GS activity, but had a complex effect on the expression of the three GS genes. In roots, the OsGln1;1 transcript increased, but OsGln1;2 decreased. In leaves, NO3^- had no effect on the GS1 expression, but the transcript for OsGln2 increased both in the leaves and roots of rice with a mixed supply of N. These results suggested that the increase in GS activity might be a result of the complicated regulation of the various GS genes. In addition, the NO3-induced increase of biomass, NR activity, GS activity, and the transcript levels of NR and GS genes were proportionally higher in NG than in Y J, indicating a stronger response of NG to NO3^- nutrition than YJ.

关键词： ammonium glutamine synthetase nitrate nitrate reductase Oryza sativa L.

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Pheochromocytoma with abdominal aortic aneurysm presenting as recurrent dyspnea,hemoptysis,and hypotension:A case report

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World Journal of Clinical Cases 2021年第18期9卷 4754-4759页

作者： Hai-Yang Zhao Yong-Zhen Zhao Yu-Mei Jia Xue Mei shu-bin guo Emergency Medicine Clinical Research Center Beijing Chaoyang HospitalCapital Medical University&Beijing Key Laboratory of Cardiopulmonary Cerebral ResuscitationBeijing 100020China Department of Endocrinology Beijing Chaoyang HospitalCapital Medical UniversityBeijing 100020China

BACKGROUND Pheochromocytomas are rare endocrine tumors with various clinical manifestations,and few of them might present with profound,life-threatening *** SUMMARY We report the case of a 65-year-old man who complained of sudden dyspnea and hemoptysis for half a *** was no obvious cause for the patient to have dyspnea,coughing,or coughing up to approximately 100 mL of fresh ***,he was diagnosed with pheochromocytoma crisis(PCC),coexisting with an abdominal aortic aneurysm(AAA).CONCLUSION We report a case of pheochromocytoma presenting with recurrent hemoptysis,dyspnea and hypotension coexisting with an *** not only proved the uncommon manifestations of pheochromocytoma but also directed clinicians to consider PCC among the possible diagnoses when meeting similar ***,surgical excision is the most beneficial method for the treatment of pheochromocytoma coexisting with AAA when the situation is stable.

关键词： Emergency Hemoptysis Hypotension Pheochromocytoma crisis Abdominal aortic aneurysm Case report

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Lipopolysaccharide Challenge Induces Long Pentraxin 3 Expression in Mice Independently from Acute Lung Injury

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Chinese Medical Sciences Journal 2015年第1期30卷 7-17页

作者： Gao Zeng Jie Liu Ning Wu Cong-wei Jia shu-bin guo Department of Emergency Medicine Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Department of Pathology Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College Department of Thoracic Surgery Huashan Hospital Fudan University

Objective To determine whether the onset of acute lung injury （ALl） induces the up-regulation of pentraxin 3 （PTX3） expression in mice and whether PTX3 concentration in the biofluid can help recognizing sepsis-induced ALI. Methods Wild-type C57BL/6 mice （12-14 weeks old） were randomly divided into 3 groups. Mice in the group 1 （n=12） and group 2 （n=12） were instilled with lipopolysaccharide via intratracheal or intraperitoneal routes, respectively. Mice in the group 3 （n=8） were taken as blank controls. Pulmonary morphological and functional alterations were measured to determine the presence of experimental ALl. PTX3 expression in the lung was quantified at both protein and mRNA levels. PTX3 protein concentration in blood and bronchoalveolar lavage fluid was measured to evaluate its ability to diagnose sepsis-induced ALI by computing area under receiver operator characteristic curve （AUROCC）. Results ALl was commonly confirmed in the group 1 but never in the other groups. PTX3 expression was up-regulated indiscriminately among lipopolysaccharide-challenged mice. PTX3 protein concentration in the biofluid was unable to diagnose sepsis-induced ALl evidenced by its small AUROCC. PTX3 concentration in bronchoalveolar lavage fluid did not correlate with that in serum. Conclusions Lipopolysaccharide challenges induced PTX3 expression in mice regardless of the presence ofALI. PTX3 may act as an indicator of inflammatory response instead of organ injury per se.

关键词： long pentraxin 3 acute lung injury biomarker sepsis lipopolysaccharide

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Clinical Characteristics and Current Interventions in Shock Patients in Chinese Emergency Departments： A Multicenter Prospective Cohort Study

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Chinese Medical Journal 2017年第10期130卷 1146-1154页

作者： shu-bin guo Yun-Xia Chen Xue-Zhong Yu Emergency Department Beijing Chao-Yang Hospital Affiliated to Capital Medical University Beijing 100020 China Emergency Department Peki'ng Union Medical College Hospital Beijing 100730 China

Background： Shock is a life-threatening condition in emergency departments （EDs） and is associated with a high mortality： however, its clinical characteristics and current interventions in China are seldom reported. This study investigated the clinical characteristics and current interventions of shock patients in Chinese EDs. Methods： This multicenter prospective cohort study was conducted in the EDs of 33 academic hospitals in 16 Chinese provinces. Adult shock patients were enrolled from December 2013 to April 2014. Age, sex, comorbidities, shock subtype, and vital signs were recorded on ED an＇ival; details of subsequent interventions and treatments were added. We compared those data between survivors and nonstu＇vivors. All patients were lbllowed tip for 3 days. The primary outcome was 3-day mortality. binary logistic regression analysis identified the independent predictors of that mortality. Results： We enrolled 1095 shock patients. The 3-day mortality was 27.5%, 36.3%, and 29.0%, respectively, in the whole cohort and for cardiogenic and septic shock. Within the first 24 11, 1039 patients （94.9%） were admitted to the Intensive Care Unit. Use of bicarbonate, epinephrine, and dopamine is an independent predictor lbr mortality. Hemorrhage and trauma （39.1%）, along with sepsis （40.4%） were the most commonly observed causes of shock in the ED. In nondiabetic patients with cardiogenic shock, 3-day mortality was 69.2% for patients needing glucose control -- much higher than in those not needing glucose control （30.0%, P- 0.01 ）. Hydroxyethyl starch （HES） was applied in 29.6% of septic shock patients, and the mortality of septic patients who received HES was much higher than those who did not （38.2% vs. 25. 1%, P = 0.006）. Conclusions： In China, short-term mortality of shock patients in EDs is still high, especially among those with cardiogenic and septic shock. HES application needs to be restricted -- particularly in septic shock patients.

关键词： Emergencies: Mortality Sepsis: Shock: Therapeutics

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Contribution of Quick Sequential Organ Failure Assessment Score Combined with Electrocardiography in Risk Stratification of Patients with Acute Pulmonary Embolism

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Chinese Medical Journal 2018年第20期131卷 2395-2401页

作者： Fei Teng Yun-Xia Chen Xin-Hua He shu-bin guo Department of Emergency Beijing Chao-Yang Hospital Capital Medical University Beijing 100020 China Department of Infection and Microbiology Beijing Chao-Yang Hospital Capital Medical University Beijing 100020 China

Background： The quick Sequential Organ Failure Assessment （qSOFA） score emerged recently. We investigated its contribution to risk stratification in acute pulmonary embolism （PE） by combining with electrocardiography （ECG）. Methods： Acute PE patients diagnosed in Beijing Chao-Yang Hospital, Capital Medical University, from 2008 to 2018 were retrospectively studied and divided into high- and low-risk groups by imaging and biomarkers. The ECG scores consisted oftachycardia, McGinn-White sign （S1Q3T3）, right bundle branch block, and T-wave inversion of leads V1-V3. A new combination of qSOFA scores and ECG scores by logistic regression for predicting high-risk stratification patients with acute PE was evaluated by a receiver operating characteristic curve. Results： Totally 1318 patients were enrolled, including 271 in the high-risk group and 1047 in the low-risk group. A combination predictive scoring system named qSOFA-ECG = qSOFA score ＋ ECG score was created. The optimal cutoffvalue for qSOFA-ECG was 2, and the sensitivity, specificity, positive predictive value, and negative predictive value were 81.5%, 72.3%, 43.2%, and 93.8%, respectively. For predicting high-risk stratification and reperfusion therapy, the qSOFA-ECG is superior to PE Severity Index （PESI） and simplified PESI. Conclusions： The qSOFA score contributes to identify acute PE patients with potentially hemodynamic decompensation that need monitoring and possible reperfusion therapy at the emergency department arrival when used in combination with ECG score.

关键词： Electrocardiography Emergency Pulmonary Embolism Quick Sequential Organ Failure Assessment

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Neutrophil Dysfunction in Sepsis

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Chinese Medical Journal 2016年第22期129卷 2741-2744页

作者： Fang Zhang An-Lei Liu shuang Gao shui Ma shu-bin guo Department of Emergency Medicine Peking Union Medical College Hospital Beijing 100730 China Department of Intensive Care Medicine Beijing Jishuitan Hospital Beijing 100035 China Department of Emergency Medicine Beijing Chaoyang Hospital Beijing 100020 China

Objective：Sepsis is defined as life-threatening organ dysfunction due to a dysregulated host response to *** this article,we reviewed the correlation between neutrophil dysfunction and *** Sources：Articles published up to May 31,2016,were selected from the PubMed databases,with the keywords of＂neutrophil function＂,＂neutrophil dysfunction＂,and ＂sepsis＂.Study Selection：Articles were obtained and reviewed to analyze the neutrophil function in infection and neutrophil dysfunction in ***：We emphasized the diagnosis of sepsis and its *** mechanisms involve a generalized circulatory,immune,coagulopathic,and/or neuroendocrine response to *** studies focused on neutrophil burst or *** activation,impairment ofneutrophil migration,and endothelial lesions are involved in this *** of cytokines,chemokines,and other mediators contribute to neutrophil dysfunction in ***：Sepsis represents a severe derangement of the immune response to infection,resulting in neutrophil *** dysfunction promotes sepsis and even leads to organ *** studies,clinical practice,and strategies to interrupt dysregulated neutrophil function in sepsis are desperately needed.

关键词： Migration Neutrophil Dysfunction Neutrophil Function Sepsis

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