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Establishment of a Rat Model of Capillary Leakage Syndrome Induced by Cardiopulmonary Resuscitation After Cardiac Arrest

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当代医学科学(英文) 2023年第4期43卷 708-715页

作者： Xiao-lei ZHANG Ye CHENG Chun-lin XING Jia-yun YING Xue YANG Xiao-di CAI Guo-ping LU department of Pediatric emergency medicine and critical care medicine Children's Hospital of Fudan UniversityShanghai 201102China department of Pediatric critical care medicine Children's Hospital of Chongqing Medical UniversityChongqing 400014China

Objective:Cardiopulmonary resuscitation(CPR)after cardiac arrest(CA)is one of the main causes of capillary leakage syndrome(CLS).This study aimed to establish a stable CLS model following the CA and cardiopulmonary resuscitation(CA-CPR)model in Sprague-Dawley(SD)rats.Methods:We conducted a prospective,randomized,animal model study.All adult male SD rats were randomly divided into a normal group(group N),a sham operation group(group S),and a cardiopulmonary resuscitation group(group T).The SD rats of the three groups were all inserted with 24-G needles through their left femoral arteries and right femoral veins.In group S and group T,the endotracheal tube was intubated.In group T,CA induced by asphyxia(AACA)was caused by vecuronium bromide with the endotracheal tube obstructed for 8 min,and the rats were resuscitated with manual chest compression and mechanical ventilation.Preresuscitation and postresuscitation measurements,including basic vital signs(BVS),blood gas analysis(BG),routine complete blood count(CBC),wet-to-dry ratio of tissues(W/D),and the HE staining results after 6 h were evaluated.Results:In group T,the success rate of the CA-CPR model was 60%(18/30),and CLS occurred in 26.6%(8/30)of the rats.There were no significant differences in the baseline characteristics,including BVS,BG,and CBC,among the three groups(P>0.05).Compared with pre-asphyxia,there were significant differences in BVS,CBC,and BG,including temperature,oxygen saturation(SpO_(2)),mean arterial pressure(MAP),central venous pressure(CVP),white blood cell count(WBC),hemoglobin,hematocrit,pH,pCO_(2),pO_(2),SO_(2),lactate(Lac),base excess(BE),and Na+(P<0.05)after the return of spontaneous circulation(ROSC)in group T.At 6 h after ROSC in group T and at 6 h after surgery in groups N and S,there were significant differences in temperature,heart rate(HR),respiratory rate(RR),SpO_(2),MAP,CVP,WBC,pH,pCO_(2),Na+,and K+among the three groups(P<0.05).Compared with the other two groups,the rats in group T showed a significantly increased W/D weight r

关键词： cardiac arrest cardiopulmonary resuscitation capillary leakage model

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Validation of the Japan Coma Scale for the prediction of mortality in children:analysis of a nationwide trauma database

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World Journal of Pediatric Surgery 2022年第2期5卷 23-28页

作者： Yuki Enomoto Yusuke Tsutsumi Asuka Tsuchiya Takahiro Kido Koji Ishigami Masahito Togo Susumu Yasuda Yoshiaki Inoue Department of Emergency and Critical Care Medicine University of TsukubaTsukubaIbarakiJapan Department of Emergency and Critical Care Medicine Mito Medical CenterMitoIbarakiJapan Department of Emergency and Critical Care Medicine Tokai University School of Medicine Graduate School of MedicineIseharaKanagawaJapan department of Clinical Epidemiology and Health Economics The University of TokyoBunkyo-kuTokyoJapan department of Pediatrics University of Tsukuba HospitalTsukubaIbarakiJapan

Objective The Japan Coma Scale(JCS)is widely used in clinical practice to evaluate levels of consciousness in Japan.There have been several studies on the usefulness of JCS in adults.However,its usefulness in evaluating children has not been reported.Therefore,this study aimed to assess the usefulness of the JCS for the prediction of mortality in children.Methods This is a multicenter cohort study which used data from a national trauma registry(Japan Trauma Data Bank).This study included patients under 16 years of age who were treated between 2004 and 2015.The primary outcome measure was in-hospital mortality.Two models were used to examine each item of the Glasgow Coma Scale(GCS)and the JCS.Model A included the discrete levels of each index.In model B,data regarding age,sex,vital signs on arrival to hospital,the Injury Severity Score,and blunt trauma were added to each index.The effectivity of the JCS score was then evaluated using the area under the curve(AUC)for discrimination,a calibration plot,and the Hosmer-Lemeshow test for calibration.Results A total of 9045 patients were identified.The AUCs of the GCS and JCS were 0.929(95%confidence interval(CI)0.904 to 0.954)and 0.930(95%CI 0.906 to 0.954)in model A and 0.975(95%CI 0.963 to 0.987)and 0.974(95%CI 0.963 to 0.985)in model B,respectively.The results of the Hosmer-Lemeshow test were 0.00(p=1.00)and 0.00(p=1.00)in model A and 4.14(p=0.84)and 8.55(p=0.38)in model B for the GCS and JCS,respectively.Conclusions We demonstrated that the JCS is as valid as the GCS for predicting mortality.The findings of this study indicate that the JCS is a useful and relevant tool for pediatric trauma care and future research.

关键词： Glasgow prediction nationwide

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Effects of viral infection and microbial diversity on patients with sepsis:A retrospective study based on metagenomic next-generation sequencing

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World Journal of emergency medicine 2021年第1期12卷 29-35页

作者： Li-wei Duan Jin-long Qu Jian Wan Yong-hua Xu Yi Shan Li-xue Wu Jin-hao Zheng Wei-wei Jiang Qi-tong Chen Yan Zhu Jian Zhou Wen-bo Yu Lei Pei Xi Song Wen-fang Li Zhao-fen Lin Department of Emergency and Critical Care Medicine Changzheng Hospitalthe Second Military Medical UniversityShanghai 200003China Department of Emergency and Critical Care Medicine Pudong New Area People’s HospitalShanghai 201299China

BACKGROUND: The study aims to investigate the performance of a metagenomic next-generationsequencing (NGS)-based diagnostic technique for the identifi cation of potential bacterial and viral infectionsand eff ects of concomitant viral infection on the survival rate of intensive care unit (ICU) sepsis patients.METHODS: A total of 74 ICU patients with sepsis who were admitted to our institution from February1, 2018 to June 30, 2019 were enrolled. Separate blood samples were collected from patients for bloodcultures and metagenomic NGS when the patients’ body temperature was higher than 38 °C. Patients’demographic data, including gender, age, ICU duration, ICU scores, and laboratory results, were recorded.The correlations between pathogen types and sepsis severity and survival rate were evaluated.RESULTS: NGS produced higher positive results (105 of 118;88.98%) than blood cultures(18 of 118;15.25%) over the whole study period. Concomitant viral infection correlated closelywith sepsis severity and had the negative effect on the survival of patients with sepsis. However,correlation analysis indicated that the bacterial variety did not correlate with the severity of sepsis.CONCLUSIONS: Concurrent viral load correlates closely with the severity of sepsis and thesurvival rate of the ICU sepsis patients. This suggests that prophylactic administration of antiviraldrugs combined with antibiotics may be benefi cial to ICU sepsis patients.

关键词： Sepsis Metagenomic next-generation sequencing Viral infections Bacterial infections Microbial diversity

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A case of Rickettsia felis infection-induced encephalitis in a pregnant woman

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World Journal of emergency medicine 2024年第2期15卷 150-152页

作者： Jinghua Qiu Hui Feng Lijun Liu Jianjun Zhu Department of Emergency and Critical Care Medicine the Second Affiliated Hospital of Soochow UniversitySuzhou 215004China

Rickettsia felis is an exclusively cytozoic Gram-negative prokaryote with cat fleas as the major vectors.[1]As early as 1918,Rickettsia felis was detected in cat fleas in Europe and named Rickettsia ctenocephali.[2]Symptoms of fever,malaise,headache,maculopapular rash and eschar are observed in patients with Rickettsia felis infection.

关键词： encephalitis headache infection

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Therapeutic Effects of Shenfu Injection in Shock

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Chinese Journal of Integrative medicine 2023年第12期29卷 1142-1146页

作者： ZHANG Ming-qing LI Chun-sheng department of emergency medicine Beijing Jishuitan HospitalBeijing(100035)China department of emergency medicine Critical Care CenterCapital Medical University Affiliated Beijing Friendship HospitalBeijing(100050)China

Shock is the clinical manifestation of acute circulatory failure,which results in inadequate utilization of cellular oxygen.It is a common condition with high mortality rates in intensive care units.The intravenous administration of Shenfu Injection(SFI)may attenuate inflammation,regulate hemodynamics and oxygen metabolism;inhibit ischemia-reperfusion responses;and have adaptogenic and antiapoptotic effects.In this review,we have discussed the clinical applications and antishock pharmacological effects of SFI.Further in-depth and large-scale multicenter clinical studies are warranted to determine the therapeutic effects of SFI on shock.

关键词： pathophysiology shock Chinese medicine Shenfu Injection

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Over-expression of programmed death-ligand 1 and programmed death-1 on antigen-presenting cells as a predictor of organ dysfunction and mortality during early sepsis: a prospective cohort study

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World Journal of emergency medicine 2023年第3期14卷 179-185页

作者： Jia-bao Li Miao-rong Xie Mei-li Duan Ya-nan Yu Chen-chen Hang Zi-ren Tang Chun-sheng Li department of critical care medicine Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China emergency and critical care Center Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China department of emergency medicine Beijing Chaoyang HospitalCapital Medical UniversityBeijing 100020China

BACKGROUND:This study aimed to explore the changes of programmed death-ligand 1(PDL1)and programmed death-1(PD-1)expression on antigen-presenting cells(APCs)and evaluate their association with organ failure and mortality during early sepsis.METHODS:In total,40 healthy controls and 198 patients with sepsis were included in this study.Peripheral blood was collected within the first 24 h after the diagnosis of sepsis.The expression of PDL1 and PD-1 was determined on APCs,such as B cells,monocytes,and dendritic cells(DCs),by flow cytometry.Cytokines in plasma,such as interferon-γ(IFN-γ),tumor necrosis factor-α(TNF-α),interleukin-4(IL-4),IL-6,IL-10,and IL-17A were determined by Luminex assay.RESULTS:PD-1 expression decreased significantly on B cells,monocytes,myeloid DCs(mDCs),and plasmacytoid DCs(pDCs)as the severity of sepsis increased.PD-1 expression was also markedly decreased in non-survivors compared with survivors.In contrast,PD-L1 expression was markedly higher on mDCs,pDCs,and monocytes in patients with sepsis than in healthy controls and in non-survivors than in survivors.The PD-L1 expression on APCs(monocytes and DCs)was weakly related to organ dysfunction and infl ammation.The area under the receiver operating characteristic curve(AUC)of the PD-1 percentage of monocytes(monocyte PD-1%)+APACHE II model(0.823)and monocyte PD-1%+SOFA model(0.816)had higher prognostic value than other parameters alone.Monocyte PD-1%was an independent risk factor for 28-day mortality.CONCLUSION:The severity of sepsis was correlated with PD-L1 or PD-1 over-expression on APCs.PD-L1 in monocytes and DCs was weakly correlated with infl ammation and organ dysfunction during early sepsis.The combination of SOFA or APACHE II scores with monocyte PD-1%could improve the prediction ability for mortality.

关键词： Infl ammation Programmed death-ligand 1 Programmed death-1 Antigen-presenting cells

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Trends in point-of-care ultrasound protocols in the emergency department and intensive care unit:a review

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emergency and critical care medicine 2023年第2期3卷 64-69页

作者： Xinhui Fan Yuan Bian Guoying Wang Weikang Liu Luyao Gao Yuhui Pan Shengchuan Cao Qiuhuan Yuan Shujian Wei Feng Xu Yuguo Chen department of emergency and Chest Pain Center Shandong Provincial Clinical Research Center for Emergency and Critical Care MedicineInstitute of Emergency and Critical Care Medicine of Shandong UniversityKey Laboratory of Emergency and Critical Care Medicine of Shandong ProvinceKey Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong ProvinceQilu Hospital of Shandong UniversityJinanChina.

Together with the development of the focused assessment with sonography for trauma protocol for ultrasound in trauma patients,point-of-care ultrasound is widely used in the field of emergency and critical care medicine.Researchers have established several classic operating protocols for different diseases,such as acute respiratory failure,shock,and cardiac arrest,in the emergency department and intensive care unit.With further development in the portability and popularity of ultrasonic equipment,it is expected to be used as a new type of technology for physical examination,including inspection,palpation,percussion,auscultation,and insonation,which will improve the clinical medicine practice in the future.

关键词： Auscultation and insonation Inspection Palpation Percussion Point-of-care ultrasound Protocol Seven-point and nineplane protocol

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emergency and critical care medicine:the launch of a new medical journal

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emergency and critical care medicine 2021年第1期1卷 1-1页

作者： Yuguo Chen department of emergency and Chest Pain Center Clinical Research Center for Emergency and Critical Care Medicine of Shandong ProvinceInstitute of Emergency and Critical Care Medicine of Shandong UniversityKey Laboratory of Emergency and Critical Care Medicine of Shandong ProvinceKey Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong ProvinceQilu HospitalCheeloo College of MedicineShandong UniversityJinanShandongChina

After careful preparation and collective efforts,we are honored to announce the launch of the first issue of emergency and criticalcaremedicine.This journal offers a new opportunity to cross professional boundaries,track research hotspots,and produce innovative medical research results in the fields of emergency and critical care medicine.

关键词： journal collective care

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The “July Effect” in the intensive care units revisited:A bi-institutional 6-year experience of 57,160 patients

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World Journal of emergency medicine 2022年第3期13卷 215-218页

作者： Leon Naar Ander D.Gallastegi Raghu R.Seethala B.Christian Renne Michael E.Billington Jasmine Kannikal Haytham M.A.Kaafarani Jarone Lee Division of Trauma Emergency Surgery&Surgical Critical CareDepartment of SurgeryMassachusetts General HospitalHarvard Medical SchoolBoston 02114-2696USA Division of emergency critical care medicine Department of Emergency MedicineBrigham and Women's HospitalHarvard Medical SchoolBoston 02115-6195USA department of emergency medicine Massachusetts General HospitalHarvard Medical SchoolBoston 02115-6195USA

July coincides with the beginning of the academic year in teaching hospitals across the United States of America (USA).The increased responsibility assumed by trainees transitioning to a higher role in the healthcare team is hypothesized to lead to poorer patient outcomes,termed the“July Effect”.The consequence of a“July Effect”might be more severe in critical care settings,where the complexity of patients requires a higher level of experience and training.The only studies evaluating the“July Effect”in the ICU were published in the early 2000’s.;Since that time,several resident work-hour regulations have been implemented by the Accreditation Council for Graduate Medical Education (ACGME).;These regulations have resulted in more frequent sign-outs,reduced continuity of care,and less clinical time for trainees,which in theory could increase the risk of errors among young trainees at the time they are most vulnerable.

关键词： sized academic assumed

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Expert consensus on blood pressure management in critically ill patients

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Journal of Intensive medicine 2023年第3期3卷 185-203页

作者： Yuetian Yu Ye Gong Bo Hu Bin Ouyang Aijun Pan Jinglun Liu Fen Liu Xiu-Ling Shang Xiang-Hong Yang Guowei Tu Changsong Wang Shaolin Ma Wei Fang Ling Liu Jiao Liu Dechang Chen department of critical care medicine Renji HospitalSchool of MedicineShanghai Jiao Tong UniversityShanghai 200001China department of critical care medicine Huashan HospitalFudan UniversityShanghai 200040China department of critical care medicine Zhongnan Hospital of Wuhan UniversityWuhan 430071HubeiChina department of critical care medicine The First Affiliated Hospital of SunYatsen UniversityGuangzhou 510080GuangdongChina department of critical care medicine The First Affiliated Hospital of USTCDivision of Life Science and MedicineUniversity of Science and Technology of ChinaHefei 230001AnhuiChina department of emergency medicine and critical care medicine The First Affiliated Hospital of Chongqing Medical UniversityChongqing 400016China department of critical care medicine The First Affiliated Hospital of Nanchang UniversityNanchang 330000JiangxiChina department of critical care medicine Fujian Provincial HospitalShengli Clinical Medical College of Fujian Medical UniversityFujian Provincial Center for Critical Care MedicineFujian Provincial Key Laboratory of Critical Care MedicineFuzhou 350001 FujianChina department of Intensive care Unit Emergency&Intensive Care Unit CenterZhejiang Provincial People's HospitalAffiliated People's HospitalHangzhou Medical CollegeHangzhou 310014 ZhejiangChina Cardiac Intensive care Center Zhongshan HospitalFudan UniversityShanghai 200032China department of critical care medicine the First Affiliated Hospital of Harbin Medical UniversityHarbin 150001HeilongjiangChina department of critical care medicine Shanghai East HospitalTongji University School of MedicineShanghai 200120China department of critical care medicine Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityShandong First Medical UniversityJinan250014 ShandongChina department of critical care medicine Jiangsu Provincial Key Laboratory of Critical Care MedicineZhongda HospitalSchool of MedicineSoutheast UniversityNanjing210009 JiangsuChina Depart

Introduction For critically ill patients with unstable hemodynamics,goal‑directed therapy for arterial blood pressure is needed with continuous daily bedside monitoring.The prevalence of hypertension in Chinese adults is 25.2%,of which 1–2%of patients may experience a hypertensive emergency,with a mortality rate of 6.9%in the acute phase.The mortality and readmission rates within 90 days of onset are as high as 11%.[1]Furthermore,the mortality rate for patients who experience hypertensive emergencies can reach 50%within 12 months of the incident.[2]The incidence of perioperative hypertension in patients undergoing cardiac surgery is approximately 50%,with this figure dropping to 25%for non-cardiac surgery.Surgery may increase the incidence of perioperative cardio-cerebrovascular adverse events by 3–5%.[3]

关键词： patients mortality hypertensive

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