Background: To determine whether Pcv-aCO2/Ca-cvO2 combined with Pcv-aCO2 could predict the outcomes in patients complicated with abdominal infection and sepsis after abdominal tumor operation. ...Methods: Total 92 patients admitted to our hospital from January 2017 to December 2020 who underwent abdominal tumor operation were enrolled. Blood gas analysis of artery and central vein, various laboratory indexes, SOFA score, hemodynamic parameters at different time points and treatment outcome were recorded. Results: ROC curve analysis showed that hemodynamic parameter alone could not predict ICU treatment outcome and mortality of patients, but 72-hour SOFA score could predict treatment outcome of patients (AUC = 0.930, 95% CI: 0.803-1.000, p = 0.019). The significant hemodynamic parameter for evaluating treatment outcome and prognosis of patients was Pcv-aCO2 + Ratio of T3. KaplanMeier univariate survival curve and Log-rank suggested that patients who had higher combined predictive parameter of T3 Ratio + T3 Pcv-aCO2 still had ischemia and hypoxia of tissues and organs after standard fluid resuscitation, and treatment outcome was not good. In subgroup analysis, patients with higher Ratio had higher lactate, higher T72 SOFA score, and poor treatment outcome. Conclusion: The combination of Ratio and Pcv-aCO2 could evaluate clinical treatment outcome of patients complicated with abdominal infection and sepsis after abdominal tumor operation. Keywords: ratio, Pcv-aCO2, Ca-cvO2, sepsis, hemodynamic, abdominal tumor
The purposes of this survey were to show the current situation of oncology critical care medicine in China by questionnaire, to understand the resource distribution of oncology critical care ...medicine, and to analyze and evaluate the existing resources and reserve capacity of oncology critical care medicine in China.
We conducted the survey mainly in the form of an online questionnaire. The Committee of Cancer Critical Care Medicine of the Chinese Anticancer Association (CACA) initiated the survey on November 1st, 2017, and 36 member hospitals nationwide participated in the survey. The questionnaire included ten items: investigator information, hospital information, general information of oncology critical care department, staffing of oncology critical care department, management in oncology critical care department, technical skills in oncology critical care department, patient source in oncology critical care department, equipment configuration in oncology critical care department, special skills in oncology critical care department and summary of the information.
The survey results included information from 28 member units, all of which were tertiary hospitals, distributed in 20 provinces and 4 direct-controlled municipalities. The results are as follows. (1) The total ratio of beds in the oncology critical care department to hospital beds was 1.06%, and the average number of beds in the oncology critical care department was 16.36. (2) The ratio of physicians in the oncology critical care department to beds was approximately 0.62:1, and the ratio of nurses to beds was approximately 1.98:1. (3) According to the census of the population and gross domestic product (GDP) of different regions conducted by the State Statistics Bureau in 2017, the ratio of beds in the oncology critical care department for tumor patients to population was 4.55 beds per 10 million people, and the ratio of beds in the oncology critical care department to GDP was 8.00 beds per RMB 100 billion, on average. (4) According to the requirements of the guidelines for the development and management of critical care medicine in China, the facilities in departments of oncology critical care medicine meet the requirements, and the technical skills of medical staff are competent.
The development of oncology critical care in China is becoming better, but there is still a certain gap compared with the intensive care unit (ICU) standards in China and the average level of the nationwide. The development of oncology critical care medicine is urgent.
To evaluate the value of central venous pressure (CVP), central venous oxygen saturation (ScvO₂) and venous-arterial carbon dioxide partial pressure gradient (Pv-aCO₂)) in the diagnosis of septic ...shock-induced left ventricular dysfunction.
Consecutive patients with septic shock were enrolled from September 2013 to September 2014 in ICU at Peking Union Medical College Hospital. The data of CVP, Pv-aCO₂) and ScvO₂) were recorded and analyzed. According to the left ventricular ejection fraction (LVEF) tested by bedside echocardiography, the patients were divided into two groups: new onset of left ventricular dysfunction (LVEF < 50%) group and non-left ventricular dysfunction (LVEF ≥ 50%) group. A diagnostic model was created by logistic regression. The diagnostic performance and cut-off values of CVP, Pv-aCO₂, ScvO₂) were determined using receiver operating characteristic (ROC) curve analysis.
Among 93 patients enrolled, 39 were diagnosed with left ventricular dysfunction. In the new onset group, CVP (12.5 ± 3.
Longitudinal changes in the white matter/functional brain networks of semantic dementia (SD), as well as their relations with cognition remain unclear. Using a graph‐theoretic method, we examined the ...neuroimaging (T1, diffusion tensor imaging, functional MRI) network properties and cognitive performance in processing semantic knowledge of general and six modalities (i.e., object form, color, motion, sound, manipulation and function) from 31 patients (at two time points with an interval of 2 years) and 20 controls (only at baseline). Partial correlation analyses were carried out to explore the relationships between the network changes and the declines of semantic performance. SD exhibited aberrant general and modality‐specific semantic impairment, and gradually worsened over time. Overall, the brain networks showed a decreased global and local efficiency in the functional network organization but a preserved structural network organization with a 2‐year follow‐up. With disease progression, both structural and functional alterations were found to be extended to the temporal and frontal lobes. The regional topological alteration in the left inferior temporal gyrus (ITG.L) was significantly correlated with general semantic processing. Meanwhile, the right superior temporal gyrus and right supplementary motor area were identified to be associated with color and motor‐related semantic attributes. SD manifested disrupted structural and functional network pattern longitudinally. We proposed a hub region (i.e., ITG.L) of semantic network and distributed modality‐specific semantic‐related regions. These findings support the hub‐and‐spoke semantic theory and provide targets for future therapy.
We explored the topological alterations in structural/functional brain networks in 31 patients with semantic dementia with 2‐year follow‐up. We proposed a hub region (i.e., left inferior temporal gyrus) and suggested that color attribute was stored in the right superior temporal gyrus and motor‐related attribute was stored in the right supplementary motor area.
Abstract Objective It is well known that glucose and lipid metabolism disorders and insulin resistance are common in sepsis, which affect the occurrence and prognosis of multiple organ dysfunction in ...septic patients. Previous study reported the predictive value of triglyceride-glucose index (TyG), a clinical indicator for insulin resistance, in postoperative delirium patients. However, it remains unclear whether the TyG index is a novel predictive biomarker for sepsis-associated delirium. The aim of this study is to explore the relationship between TyG index and the risk of delirium in patients with sepsis. Methods Adult septic patients were identified from the MIMIC-IV database and divided into four groups based on the mean value of TyG. The primary outcome was the incidence of delirium. The association between TyG and the risk of developing delirium was evaluated by restricted cubic spline (RCS), multivariate logistic regression and subgroup analysis. Propensity Score Matching (PSM) method was used to balance the baseline data. Results A total of 3,331 septic patients were included in the analysis, and further divided into four groups: Q1 (TyG ≤ 8.67), Q2 (8.67 < TyG ≤ 9.08), Q3 (9.08 < TyG ≤ 9.61), and Q4 (TyG > 9.61). The RCS curves demonstrated a non-linear positive relationship between TyG index and the risk of developing delirium, and an optimal cut-of value 9.09 was recommended. After balancing the baseline information by PSM, patients in the TyG > 9.09 group had a significant higher incidence of delirium compared with those in the TyG ≤ 9.09 group. In logistic regression analysis, TyG > 9.09 was significantly associated with lower risk of developing delirium in both original cohort (OR 1.54–1.78, all P < 0.001) and the PSM cohort (OR 1.41–1.48, all P < 0.001). No association was found between the TyG index and mortality (all P > 0.05). In subgroup analysis, our findings were consistent (all OR > 1 in all subgroups). Conclusion Our study demonstrated an independent association between TyG index and increased risk of delirium in septic patients, indicating that TyG index can serve as a biomarker for delirium in sepsis.
Approximately 40 to 60% of patients with sepsis develop sepsis-induced cardiomyopathy (SIC), which is associated with a substantial increase in mortality. We have found that molecular hydrogen (H
) ...inhalation improved the survival rate and cardiac injury in septic mice. However, the mechanism remains unclear. This study aimed to explore the regulatory mechanism by which hydrogen modulates autophagy and its role in hydrogen protection of SIC.
Cecal ligation and puncture (CLP) was used to induce sepsis in adult C57BL/6J male mice. The mice were randomly divided into 4 groups: Sham, Sham + 2% hydrogen inhalation (H
), CLP, and CLP + H
group. The 7-day survival rate was recorded. Myocardial pathological scores were calculated. Myocardial troponin I (cTnI) levels in serum were detected, and the levels of autophagy- and mitophagy-related proteins in myocardial tissue were measured. Another four groups of mice were also studied: CLP, CLP + Bafilomycin A1 (BafA1), CLP + H
, and CLP + H
+ BafA1 group. Mice in the BafA1 group received an intraperitoneal injection of the autophagy inhibitor BafA1 1 mg/kg 1 h after operation. The detection indicators remained the same as before.
The survival rate of septic mice treated with H
was significantly improved, myocardial tissue inflammation was improved, serum cTnI level was decreased, autophagy flux was increased, and mitophagy protein content was decreased (P < 0.05). Compared to the CLP + H
group, the CLP + H
+ BafA1 group showed a decrease in autophagy level and 7-day survival rate, an increase in myocardial tissue injury and cTnI level, which reversed the protective effect of hydrogen (P < 0.05).
Hydrogen exerts protective effect against SIC, which may be achieved through the promotion of autophagy and mitophagy.
Objective
Acinetobacter baumannii
is one of the most important pathogenic bacteria causing nosocomial infections and has a high mortality rate. Assessment of the microbiological characteristics and ...risk factors on prognosis associated with
A.baumannii
is essential. In this study, we aimed to investigate the clinical characteristics and prognostic risk factors of patients with
A.baumannii
bacteremia.
Patients and Methods
This study retrospectively analyzed the antibiotic resistance of pathogens based on the clinical data of
A.baumannii
bacteremia patients presented in a tertiary teaching hospital from 2017 to 2022. Logistic regression and decision tree identified the prognostic risk factors for patients with baumannemia. Kaplan-Meier method was used for survival analysis between MDR and Non-MDR groups. The area under receiver-operating characteristic curve (ROC curve) was used to compare the predictive value of the APACHE II score and Sequential Organ Failure Assessment (SOFA) score.
Results
A total of 110 patients with positive
A. Baumannii
blood cultures were included. Most of the patients were from intensive care unit (ICU) wards. The drug sensitivity results showed that the resistance rate of
A. baumannii
to colistin was the lowest (1.1%), followed by tigecycline (3.6%).
The survival time of MDR group was significantly shorter than that of Non-MDR group. Multivariate analysis showed that, APACHE II score and SOFA score were independent risk factors affecting the prognosis of 28 days of
A.baumannii
bacteremia. And both scores displayed excellent AUROCs (SOFA: 0.909, APACHE II: 0.895 in predicting 28-day mortality). The two scoring systems were highly correlated and predicted no significant difference (
r
2
= 0.4410,
P
< 0.001). We found that SOFA > 7 and APACHE II > 21 are associated with significantly higher mortality rates.
Conclusion
A.baumannii
bacteremia have the highest incidence in the ICU, with high drug resistance and mortality rates. The survival time of patients with MDR
A. Baumannii
bacteremia was significantly shortened. The SOFA score and APACHE II score can reflect the severity of
A.baumannii
bacteremia patients and evaluate the 28-day prognosis. In addition, for the convenience of calculation, the SOFA score may be more clinically useful than the APACHE II score in predicting the mortality rate of
A.baumannii
bacteremia.
Gordon Holmes Syndrome (GDHS) is a hereditary neurodegenerative disease mainly associated with mutations of RNF216. We established a human induced pluripotent stem cell (hiPSC) line, FDHSi003-A, ...derived from PBMC of a patient baring a mutation of RNF216 c.1948G > T, who shows typical symptoms of GDHS. The generated FDHSi003-A expresses pluripotency markers, displays a normal karyotype, and has the potency to differentiate into all three germ layers. Thus, FDHSi003-A is an ideal model to investigate the mechanism of RNF216 in GDHS.
This study aimed to evaluate the clinical value of dynamic monitoring of neutrophil/lymphocyte ratio (NLR), APACHE II (Acute Physiology and Chronic Health Evaluation II) score, and Sequential Organ ...Failure Assessment (SOFA) score in predicting 28-day prognosis and drug resistance in patients with bloodstream infection with
complex (Abc complex).
In this research, individuals admitted to Tianjin Medical University General Hospital from January 2017 to March 2023 with bloodstream infections and a minimum of one Abc complex positive blood culture were chosen. The risk factors for the 28-day prognosis and drug resistance were analyzed using logistic regression. The NLR, APACHE II score, and SOFA score were evaluated for predicting 28-day prognosis and drug resistance using an ROC curve analysis. The data were analyzed using R Studio to find correlations and conduct survival analysis with the Kaplan-Meier method.
The final statistical analysis included a total of 129 patients with bloodstream infections caused by Abc complex. Independent risk factors predicting mortality within 28 days were identified as follows: the SOFA score and APACHE II scores at 24 h, and APACHE II scores at 72 h after the onset of blood infection (
< 0.05). NLR, SOFA score, and APACHE II score did not predict drug resistance. Patients with Carbapenem-resistant
complex (CRAB) had shorter survival times than those with carbapenem-sensitive strains (40.77 days vs. 47.65 days, respectively,
= 0.0032).
The prognosis of Abc complex bloodstream infection is affected by both SOFA and APACHE II scores. Both scoring systems have similar prognostic values at different time points after infection, but for computational convenience, it is recommended to use the SOFA score. NLR exhibits limited effectiveness in predicting mortality within 28 days. Carbapenem-resistant individuals with Abc complex experience significantly reduced survival time. None of the three factors-SOFA score, APACHE II score, and NLR-can early predict the occurrence of CRAB infections effectively.
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