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Low dose of hydroxychloroquine reduces fatality of critically ill patients with COVID-19

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Science China(Life Sciences) 2020年第10期63卷 1515-1521页

作者： Bo Yu Chenze Li Peng Chen Ning Zhou Luyun Wang Jia Li Hualiang Jiang Dao-Wen Wang Division of Cardiology Department of Internal Medicine and Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological DisordersTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China State Key Laboratory of Drug Research Shanghai Institute of Materia MedicaChinese Academy of SciencesShanghai 201203China Shanghai Institute for Advanced Immunochemical Studies and School of Life Science and Technology Shanghai Tech UniversityShanghai 201210China

Coronavirus disease 2019(COVID-19)is a pandemic with no specific drugs and high *** most urgent need is to find effective *** sought to determine whether hydroxychloroquine(HCQ)application may reduce the death risk of critically ill COVID-19 *** this retrospective study,we included 550 critically ill COVID-19 patients who need mechanical ventilation in Tongji Hospital,Wuhan,from February 1,2020 to April 4,*** 550 patients received comparable basic treatments including antiviral drugs and antibiotics,and 48 of them were treated with oral HCQ treatment(200 mg twice a day for 7–10 days)in addition to the basic *** endpoint is fatality of patients,and inflammatory cytokine levels were compared between HCQ and non-hydroxychloroquine(NHCQ)*** found that fatalities are 18.8%(9/48)in HCQ group,which is significantly lower than 47.4%(238/502)in the NHCQ group(Pcritically ill patients of COVID-19 through attenuation of inflammatory cytokine ***,HCQ should be prescribed as a part of treatment for critically ill COVID-19 patients,with possible outcome of saving lives.

关键词： patients drugs critically

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The influence of metabolic imbalances and oxidative stress on the outcome of critically ill polytrauma patients: a review

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Burns & Trauma 2017年第1期5卷 17-23页

作者： Alexandru Florin Rogobete Dorel Sandesc Marius Papurica Emil Robert Stoicescu Sonia Elena Popovici Lavinia Melania Bratu Corina Vernic Adriana Mariana Sas Adrian Tudor Stan Ovidiu Horea Bedreag Faculty of Medicine Victor Babes University of Medicine and PharmacyStr.Eftimie Murgu Nr.2Timisoara300041TimisRomania Clinic of Anaesthesia and Intensive Care Emergency County Hospital“PiusBrinzeu”Bd.Liviu Rebreanu Nr.156Timisoara300736TimisRomania

The critically ill polytrauma patient presents with a series of associated pathophysiologies secondary to the traumatic injuries. The most important include systemic inflammatory response syndrome (SIRS), sepsis, oxidative stress (OS), metabolic disorders, and finally multiple organ dysfunction syndrome (MODS) and death. The poor outcome of these patients is related to the association of the aforementioned pathologies. The nutrition of the critically ill polytrauma patient is a distinct challenge because of the rapid changes in terms of energetic needs associated with hypermetabolism, sepsis, SIRS, and OS. Moreover, it has been proven that inadequate nutrition can prolong the time spent on a mechanical ventilator and the length of stay in an intensive care unit (ICU). A series of mathematical equations can predict the energy expenditure (EE), but they have disadvantages, such as the fact that they cannot predict the EE accurately in the case of patients with hypermetabolism. Indirect calorimetry (IC) is another method used for evaluating and monitoring the energy status of critically ill patients. In this update paper, we present a series of pathophysiological aspects associated with the metabolic disaster affecting the critically ill polytrauma patient. Furthermore, we present different non-invasive monitoring methods that could help the intensive care physician in the adequate management of this type of patient.

关键词： critically ill Energy expenditure Indirect calorimetry Metabolic disaster Oxidative stress Overfeeding Underfeeding Polytrauma

Vocal repertoire of the critically endangered whiteheaded langur(Trachypithecus leucocephalus): Call types, acoustic structures, and related social-ecological contexts

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Zoological Research 2022年第5期43卷 875-879页

作者： Peng-Lai Fan Jia-Xing Li Li-Ting Yang Tao Sun Shi-Jun Wu Cyril CGrueter Cheng-Ming Huang Qi-Hai Zhou Ming Li CAS Key Lab Animal Ecology&Conservation Biology Institute of ZoologyChinese Academy of SciencesBeijing 100101China Key Laboratory of Ecology of Rare and Endangered Species and Environmental Protection(Guangxi Normal University) Ministry of EducationGuilinGuangxi 541006China Guangxi Key Laboratory of Rare and Endangered Animal Ecology College of Life SciencesGuangxi Normal UniversityGuilinGuangxi 541006China Guangxi Chongzuo White-headed Langur National Nature Reserve ChongzuoGuangxi 532200China Department of Anatomy Physiologyand Human BiologySchool of Human SciencesUniversity of Western AustraliaPerth WA 6009Australia Centre for Evolutionary Biology School of Biological SciencesUniversity of Western AustraliaPerth WA 6009Australia International Center of Biodiversity and Primate Conservation Dali UniversityDaliYunnan 671003China Center for Excellence in Animal Evolution and Genetics Chinese Academy of SciencesKunmingYunnan 650223China

DEAR EDITOR,We examined the vocal repertoire of the critically endangered white-headed langur(Trachypithecus leucocephalus)inhabiting karst limestone forests in *** identified 17 call types across all age/sex classes based on human auditory perception,spectrogram assessment,and quantitative analysis of 25 acoustic parameters extracted from 409 high-quality *** total,11 types of calls produced by adults corresponded to the simple one-male multi-female social groups of white-headed langurs.

关键词： white critically karst

The Maximum Size and Related Extremal Graphs of critically h-Edge-Connected Graphs

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数学进展 1989年第2期 249-250页

作者：徐俊明 University of Science and Technology of China

Let G be a simple *** edge-connectivity of G is denoted by λ（G）. For a given positive integer h,G is said to be critically h-edge-connected ifλ（G）=h and λ（G-χ）h（p）and denotefh（p）=max{|E（G）|∶G∈（?）h... 详细信息

关键词： integer vertex connected connectivity union smallest critically trivial equality holds

Predictive accuracy of Sepsis-3 definitions for mortality among adult critically ill patients with suspected infection

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Chinese Medical Journal 2019年第10期132卷 1147-1153页

作者： Qi-Hong Chen Jun Shao Wei-Li Liu Hua-Ling Wang Lei Liu Xiao-Hua Gu Rui-Qiang Zheng Department of Critical Care Medicine Jiangdu People's Hospital of YangzhouJiangdu People's Hospital Affiliated to Medical College of Yangzhou University Yangzhou Jiangsu 225001 China Department of Critical Care Medicine Northern Jiangsu People's Hospital Clinical Medical College Yangzhou University Yangzhou Jiangsu 225001 China Department of Intensive Care Unit Affiliated Hospital of Yangzhou University Yangzhou University Yangzhou Jiangsu 225001 China Department of Cardiology Northern Jiangsu People's Hospital Clinical Medical College of Yangzhou University Yangzhou Jiangsu 225001 China

Background: Sepsis-3 definitions have been published recently;however, their diagnostic value remains controversial. This study was to assess the accuracy of Sepsis-3 definitions compared to Sepsis-1 definitions by stratifying mortality among adult critically ill patients with suspected infection. Methods: A multicenter, prospective cohort study was conducted from November 10, 2017 to October 10, 2018, in five Intensive Care Units (ICUs) at four teaching hospitals. Thirty-day mortality was compared across categories for both Sepsis-3 definitions and Sepsis-1 definitions, which were evaluated by logistic regression analysis followed by measurement of the area under the receiver operating characteristic curve (AUROC) for predicting 30-day mortality rates. Results: Of the 749 enrolled patients, 644 (85.9%) were diagnosed with sepsis according to the Sepsis-1 definitions. Among those patients, 362 were diagnosed with septic shock (362/749, 48.3%). However, according to the Sepsis-3 definitions, there were 483 patients with a diagnosis of sepsis (483/749, 64.5%), among whom 299 patients were diagnosed with septic shock (299/749, 39.9%). According to the Sepsis-3 definitions, sepsis (sepsis and septic shock) patients had higher 30-day mortality (41.8%) than sepsis patients according to the Sepsis-1 definitions (31.8%,χ^2 = 5.552, P = 0.020). The AUROC of systemic inflammatory response syndrome (SIRS) and quick sequential organ failure assessment (qSOFA) scores with regard to 30-day mortality rates were 0.609 (0.566-0.652) and 0.694 (0.654-0.733), respectively. However, the AUROC of SOFA scores (0.828 [0.795-0.862]) were significantly higher than that of SIRS or qSOFA scores (P critically ill patients with suspected infection, the Sepsis-3 definitions were relatively accurate in stratifying mortality and were superior to the Sepsis-1 definitions.

关键词： Infection critically ill patients Sepsis-3 Septic shock Mortality

Expert consensus on the use of human serum albumin in critically ill patients

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Chinese Medical Journal 2021年第14期134卷 1639-1654页

作者： Yue-Tian Yu Jiao Liu Bo Hu Rui-Lan Wang Xiang-Hong Yang Xiu-Ling Shang Gang Wang Chang-Song Wang Bai-Ling Li Ye Gong Sheng Zhang Xin Li Lu Wang Min Shao Mei Meng Feng Zhu You Shang Qiang-Hong Xu Zhi-Xiong Wu De-Chang Chen Department of Critical Care Medicine Ren Ji HospitalShanghai Jiao Tong University School of MedicineShanghai 200001China Department of Critical Care Medicine Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghai 200025China Department of Critical Care Medicine Zhongnan Hospital of Wuhan UniversityWuhanHubei 430071China Department of Critical Care Medicine Shanghai General HospitalShanghai Jiaotong University School of MedicineShanghai 201620China Department of Critical Care Medicine Zhejiang Provincial People’s Hospital(People’s Hospital of Hangzhou Medical College)HangzhouZhejiang 310014China Department of Critical Care Medicine Fujian Provincial HospitalShengli Clinical Medical College of Fujian Medical UniversityFuzhouFujian 350001China Department of Critical Care Medicine The Second Affiliated Hospital of Xi’an Jiaotong UniversityXi’anShaanxi 710004China Department of Critical Care Medicine Harbin Medical University Cancer HospitalHarbinHeilongjiang 150081China Department of Cardiovascular Surgery Changhai HospitalNaval Military Medical University(The Second Military Medical University)Shanghai 200433China Department of Critical Care Medicine Department of NeurosurgeryHuaShan HospitalFudan UniversityShanghai 200040China Department of Cardiovascular Surgery Zhongshan HospitalFudan UniversityShanghai 200032China Department of Critical Care Medicine Renmin Hospital of Wuhan UniversityWuhanHubei 430060China Department of Critical Care Medicine The First Affiliated Hospital of Anhui Medical UniversityHefeiAnhui 230022China Department of Burn and Trauma Intensive Care Unit The First Affiliated HospitalNaval Medical UniversityShanghai 200433China Department of Critical Care Medicine Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei 430022China Department of Critical Care Medicine Zhejiang HospitalHangzhouZhejiang 310013China Department of Critical Care Medicine Huadong HospitalFudan UniversityShanghai 20

Introduction Human serum albumin(HSA)is a non-glycosylated,negatively charged,single-chain polypeptide composed of 585 amino acid residues with a relative molecular mass of 66.438 *** is synthesized by the liver at a rate of approximately 200 mg·kg^(-1)·day^(-1),with a half-life of 21 days,and subjected to catabolism in the muscles,liver,and kidneys at a rate of 4%per day.[1]Albumin,accounting for 60%of the total plasma protein,has various physiological functions,[2]such as maintaining 70%to 80%of effective plasma colloid osmotic pressure,coordinating vascular endothelial integrity,anti-oxidant and anti-inflammatory activities,maintaining the acidbase balance,and participating in the transport,distribution,and metabolism of a variety of endogenous and exogenous substances.

关键词： metabolism endogenous critically

Glycemic variability in critically ill patients:risk factors and association with mortality

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Chinese Medical Journal 2020年第10期133卷 1255-1256页

作者： Chien-Wei Hsu Shu-Fen Sun Huey-Shyan Lin Department of Chest Medicine Kaohsiung Veterans General HospitalKaohsiung CityTaiwan 81362China School of Medicine National Yang-Ming UniversityTaipei CityTaiwan 11221China Department of Physical Medicine and Rehabilitation Kaohsiung Veterans General HospitalKaohsiung CityTaiwan 81362China School of Nursing Fooyin UniversityStatistical Consultant of Research and DevelopmentDepartment of HealthKaohsiung City GovernmentKaohsiung CityTaiwan 80203China.

To the Editor:Glycemic variability(GV)has a significant influence on the outcome in critically ill patients.1'4|Diabetic status of the patient affects the relationship between GV and mortality;increased GV is a more potent risk factor for mortality among patients without diabetes mellitus(DM)than among patients with DM.[5]This retrospective study of 1234 intensive care unit(ICU)patients was conducted to determine the significant factors that contribute to high GV and to assess the association between GV and outcome in critically ill patients.

关键词： patients mortality critically

Fluid and electrolyte overload in critically ill patients: An overview

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World Journal of Critical Care Medicine 2015年第2期4卷 116-129页

作者： Bruno Adler Maccagnan Pinheiro Besen André Luiz Nunes Gobatto Lívia Maria Garcia Melro Alexandre Toledo Maciel Marcelo Park Intensive Care Unit Department of Medical Emergencies Hospital das Clínicas University of Sao Paulo Medical School Imed Research Group Intensive Care Unit Hospital Sao Camilo Pompéia

Fluids are considered the cornerstone of therapy for many shock states, particularly states that are associated with relative or absolute hypovolemia. Fluids are also commonly used for many other purposes, such as renalprotection from endogenous and exogenous substances, for the safe dilution of medications and as "maintenance" fluids. However, a large amount of evidence from the last decade has shown that fluids can have deleterious effects on several organ functions, both from excessive amounts of fluids and from their non-physiological electrolyte composition. Additionally, fluid prescription is more common in patients with systemic inflammatory response syndrome whose kidneys may have impaired mechanisms of electrolyte and free water excretion. These processes have been studied as separate entities(hypernatremia, hyperchloremic acidosis and progressive fluid accumulation) leading to worse outcomes in many clinical scenarios, including but not limited to acute kidney injury, worsening respiratory function, higher mortality and higher hospital and intensive care unit lengthof-stays. In this review, we synthesize this evidence and describe this phenomenon as fluid and electrolyte overload with potentially deleterious effects. Finally, we propose a strategy to safely use fluids and thereafter wean patients from fluids, along with other caveats to be considered when dealing with fluids in the intensive care unit.

关键词： Fluid therapy critically Ill Oliguria Waterelectrolyte balance Central venous pressure Resuscitation Acute kidney injury Diuretics Multiple organ dysfunction syndrome Systemic inflammatory response syndrome

Association between infections caused by multidrug-resistant gram-negative bacteria and mortality in critically ill patients

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World Journal of Critical Care Medicine 2016年第2期5卷 111-120页

作者： Elisabeth Paramythiotou Christina Routsi Second Department of Critical Care Medical School University of Athens Attikon University Hospital First Department of Critical Care Medica School University of Athens Evangelismos Hospital

The incidence of gram-negative multidrug-resistant(MDR) bacterial pathogens is increasing in hospitals and particularly in the intensive care unit(ICU) setting. The clinical consequences of infections caused by MDR pathogens remain controversial. The purpose of this review is to summarize the available data concerning the impact of these infections on mortality in ICU patients. Twenty-four studies, conducted exclusively in ICU patients, were identified through Pub Med search over the years 2000-2015. Bloodstream infection was the only infection examined in eight studies, respiratory infections in four and variable infections in others. Comparative data on the appropriateness of empirical antibiotic treatment were provided by only seven studies. In ten studies the presence of antimicrobial resistance was not associated with increased mortality; on the contrary, in other studies a significant impact of antibiotic resistance on mortality was found, though, sometimes, mediated by inappropriate antimicrobial treatment. Therefore, a direct association between infections due to gram-negative MDR bacteria and mortality in ICU patients cannot be confirmed. Sample size, presence of multiple confounders and other methodological issues may influence the results. These data support the need for further studies to elucidate the real impact of infections caused by resistant bacteria in ICU patients.

关键词： critically ill patients Infections Multidrug resistance Gram-negative pathogens Mortality