BACKGROUND:Pulse indicated continuous cardiac output(PiCCO)has largely replaced Swan-Ganz catheterization in shock patients.However,whether PiCCO monitoring can improve outcomes of shock patients,such as mortality,len...BACKGROUND:Pulse indicated continuous cardiac output(PiCCO)has largely replaced Swan-Ganz catheterization in shock patients.However,whether PiCCO monitoring can improve outcomes of shock patients,such as mortality,length of hospital stay,duration of mechanical ventilation,or laboratory parameters,remains unknown.METHODS:This retrospective cohort study included patients with shock in the intensive care unit(ICU)from January 2013 to January 2020.Patients were divided into PiCCO group and non-PiCCO group based on treatment with PiCCO monitoring or not.Demographic characteristics,Acute Physiology and Chronic Health Evaluation(APACHE)II scores,quick Sequential Organ Failure Assessment(qSOFA)scores,14-day mortality,and N-terminal pro-B-type natriuretic peptide(NT-proBNP)levels at 0,1,3 and 7 days after onset of shock,duration of mechanical ventilation,length of hospital stay and hospitalization costs were compiled and analyzed using propensity score matching(PSM).RESULTS:Real-world analysis of 1,583 ICU patients suff ering shock after propensity score matching revealed that 14-day mortality did not differ between PiCCO and non-PiCCO groups(36.2%vs.32.6%,P=0.343).Duration of mechanical ventilation,hospital stay,and hospitalization costs were also similar between the two groups(P>0.05).No diff erences in changes of NT-proBNP levels on days 0,1,3,and 7 as compared to baseline were noted between the two groups(P>0.05).CONCLUSIONS:The results of our real-world indicate that PiCCO monitoring may not shorten the duration of mechanical ventilation,length of hospital stay,or reduce hospitalization costs,nor will it bring survival benefi ts to ICU patients suff ering shock.展开更多
Objective There is a large population of patients classified as complex higher-risk and indicated patients(CHIPs)in China with a poor prognosis.The treatment of these patients is complex and challenging,especially whe...Objective There is a large population of patients classified as complex higher-risk and indicated patients(CHIPs)in China with a poor prognosis.The treatment of these patients is complex and challenging,especially when acute cardiac events occur,such as acute coronary syndrome(ACS)or heart failure.Pharmacotherapy and some mechanical circulatory support(MCS)therapeutic devices can provide stable hemodynamic support for CHIPs-percutaneous coronary intervention(PCI).LDL-C is an important pathogenic factor in atherosclerosis,and the target of blood lipid control.Recent studies have revealed that lipoprotein(a)[Lp(a)],which is formed when a covalent bond between apolipoprotein(a)and apolipoprotein B-100 is made,produces an LDL-like particle.This particle is an independent risk factor for the development of atherosclerosis,and is closely correlated to stent thrombosis and restenosis.Furthermore,this requires active intervention.PCSK9 inhibitors have been used in lipid-lowering treatment,and preventing atherosclerosis.The present study explores the efficacy of PCSK9 inhibitors in CHIPs-ACS,and the association between the change in Lp(a)and survival after 2 years of follow-up.Methods The present real-world,prospective control study enrolled 321 CHIPs-ACS who underwent emergency PCI from August 2019 to November 2020,and these patients were followed up for 2 years.These patients were divided into two groups:PCSK9 group(n=161)given the combined PCSK9 inhibitor(140 mg of evolocumab every 2 weeks)and statins-based therapy,and SOC group(n=160)treated with statin-based lipid-lowering therapy alone.Then,the change in lipid index was measured,and the cardiovascular(CV)event recurrence rate was evaluated after one month and 2 years.Afterwards,the contribution of serum lipid parameters,especially the Lp(a)alteration,in patients with earlier initiation of the PCSK9 inhibitor to the CV outcome was analyzed.Results The LDL-C level was significantly reduced in both groups:52.3%in the PCSK9 group and 32.3%(P<0.001)in the SOC group.It is noteworthy that the Lp(a)level decreased by 13.2%in the PCSK9 group,but increased by 30.3%in the SOC group(P<0.001).Furthermore,the number of CV events was not significantly different between the PCSK9 and SOC groups after the 2-year follow-up period.In the PCSK9 group,the Lp(a)reduction was associated with the baseline Lp(a)levels of the patients(r2=−0.315,P<0.001).Moreover,the decrease in Lp(a)contributed to the decline in CV events in patients who received ACS CHIPs-PCI,and the decrease in Lp(a)level was independent of the LDL-C level reduction.Conclusion The early initiation of PCSK9 inhibitors can significantly reduce the LDL-C and Lp(a)levels in ACS CHIPs-PCI.However,further studies are needed to confirm whether PCSK9 inhibitors can reduce the incidence of CV disease in CHIPs.展开更多
Objective: We aimed to compare the perinatal outcomes in late preterm spontaneous and indicated birth neonates. Methods: We studied 289 late preterm births, classified as either aspontaneous late preterm birth (sLPTB)...Objective: We aimed to compare the perinatal outcomes in late preterm spontaneous and indicated birth neonates. Methods: We studied 289 late preterm births, classified as either aspontaneous late preterm birth (sLPTB) group (preterm labor with intact membranes and preterm premature rupture of membranes) or an indicated late preterm birth (iLPTB) group (hypertensive disorder in pregnancy, placental causes, and maternal diseases), according to the delivery indication. We then compared the maternal and neonatal characteristics and perinatal outcomes, including the Apgar score, admission to the neonatal intensive care unit (NICU) or special care nursery (SCN), duration of NICU stay, and the rate of composite morbidity (antibiotic use, hypoglycemia, hypocalcemia, hyperbilirubinemia requiring phototherapy, respiratory support, and respiratory distress syndrome). Results: A total of 198 neonates were in the sLPTB group and 91 were in the iLPTB group. In spite of greater gestational age at the time of delivery in the iLPTB group, the mean birth weight was lower than that in the sLPTB group. Additionally, the iLPTB group showed lower Apgar scores, and higher rates of NICU or SCN admission, respiratory support, and hypoglycemia, but there was no difference in the rate of composite morbidity between the two groups. Conclusion: iLPTB neonates had lower birth weights despite greater gestational age than those in the sLPTB group, but there was no difference in the rate of composite morbidity between the two groups.展开更多
Complex higher-risk and indicated patients (CHIPs) refers to patients with severe coronary artery disease (CAD) needing revascularization. However, these patients are at an increased risk for this procedure.[1] The CH...Complex higher-risk and indicated patients (CHIPs) refers to patients with severe coronary artery disease (CAD) needing revascularization. However, these patients are at an increased risk for this procedure.[1] The CHIP population is attracting much interest in the field of interventional cardiology, since it was introduced in 2016 by Kirtane et al,[1] and the optimal treatment strategies for this population were fiercely discussed in almost every interventional forum at home and abroad. First of all, a comprehensive risk assessment must be conducted to determine which patients with CAD should undergo revascularization based on clinical presentation, functional tests, and anatomic characteristics. Percutaneous coronary intervention (PCI) might be a beneficial option when complete revascularization can be achieved, especially for patients are either inoperable or at higher surgical risk.[2,3] To treat these high-risk patients safely and effectively with PCI, well-trained interventionalists exhibiting both technical and cognitive skills are needed.展开更多
BACKGROUND Inappropriate selection of patients with early gastric cancer(EGC)for endoscopic submucosal dissection(ESD)may lead to non-curative resection,necessitating additional gastrectomy.Conversely,inappropriate se...BACKGROUND Inappropriate selection of patients with early gastric cancer(EGC)for endoscopic submucosal dissection(ESD)may lead to non-curative resection,necessitating additional gastrectomy.Conversely,inappropriate selection for gastrectomy may result in overtreatment,adversely affecting patients’quality of life.Few have systematically evaluated the concordance between therapeutic indications under current Japanese guidelines and pathological criteria in EGC.To minimize noncurative resection risks while sparing unnecessary surgery for low-risk patients’,we specifically assess the suitability of Japanese guidelines in non-Japanese populations.This work aims to optimize clinical practice by refining endoscopic treatment criteria for adoption beyond Japan.AIM To evaluate EGC clinical decision accuracy by comparing therapeutic indication with postoperative pathological criteria and analyzing factors influencing discrepancies.METHODS A retrospective analysis was conducted on 796 EGC cases diagnosed at Peking University Third Hospital between January 2010 and December 2022.Cases were categorized into three groups:Same-estimated(preoperative therapeutic indication with postoperative pathological criteria matched),underestimated(preoperative ESD indication but postoperative surgical criteria),and overestimated(preoperative surgical indication but postoperative ESD criteria).The rate of discrepancy and associated risk factors were assessed.RESULTS The accuracy rates of preoperative evaluation for ESD and gastrectomy indications were 73.0%(321/430)and 76.0%(278/366),respectively.The overall discrepancy rate was 25.6%(204/796).Multivariate analysis identified tumor location in the upper-third stomach(odds ratio=2.158,95%confidence interval:1.373-3.390,P=0.001)was significantly associated with a higher likelihood of being underestimated and undifferentiated histologic type on preoperative biopsy(odds ratio=2.005,95%confidence interval:1.036-3.879,P=0.039)was more likely to be overestimated.Significant differences were observed in tumor diameter(P<0.001),depth of infiltration(P<0.001),ulcerative findings(P<0.001),and histologic type(P<0.001)between preoperative and postoperative evaluations.CONCLUSION The accuracy of preoperative EGC indications is 74.4%.Upper-third stomach and undifferentiated histology are primary discrepancy predictors.Upper-third tumors are prone to underestimation,while undifferentiated tumors are prone to overestimation.展开更多
We used solidification/stabilization methods to remediate highly concentrated Zn^(2+)-contaminated soil.An industrial waste mixture of red mud,carbide slag,and phosphogypsum is combined with cement as the curing agent...We used solidification/stabilization methods to remediate highly concentrated Zn^(2+)-contaminated soil.An industrial waste mixture of red mud,carbide slag,and phosphogypsum is combined with cement as the curing agent.The mixing ratios of the four materials are determined by comparing the strength,permeability coefficient,pH,and Zn^(2+)-leaching concentration of the solidified soil.Microscopic characteristics of the solidified uncontaminated soil and solidified Zn^(2+)-contaminated soil were observed using scanning electron microscopy,X-ray diffraction,and Fourier-transform infrared spectroscopy.Furthermore,the heavy metals speciation in both pure cement and mixed-material solidified soil was examined,demonstrating the beneficial role of the mixed-type curing agent in stabilizing heavy metals.The research results indicate that Zn^(2+)degrade the strength of the solidified soil by up to 90%.The permeability coefficient,pH,and Zn^(2+)-leaching concentration of the solidified soil easily meet standard,especially with Zn^(2+)leaching concentration well below the environmental protection limit.Furthermore,most Zn^(2+)exists in forms with lower biological and chemical reactivity.Both the solidified Zn^(2+)-contaminated soil and uncontaminated soil resulted in the formation of hydrated products containing elements such as silicon,aluminum,calcium,and sulfur.Additionally,the solidified Zn^(2+)-contaminated soil produced zinc-containing compounds and a large amount of rod-shaped ettringite.展开更多
The indications and contraindications of parenteral nutrition(PN)are discussed in view of recent clinical find-ings.For decades,PN has been restricted to patients unable to tolerate enteral nutrition(EN)intake owing t...The indications and contraindications of parenteral nutrition(PN)are discussed in view of recent clinical find-ings.For decades,PN has been restricted to patients unable to tolerate enteral nutrition(EN)intake owing to the perceived risk of severe side-effects.The evolution of the PN substrate composition and delivery of nutrition via all-in-one bags has dramatically improved the application prospects of PN.Recent studies show similar compli-cation rates of nutrition therapy administered through enteral and intravenous routes.Therefore,indications of PN have,based on evidence,extended beyond complete gastrointestinal(GI)failure to include conditions such as insufficient EN generating persistent negative energy balance and insufficient protein intakes,malabsorption,or specific needs that are impossible to cover with EN feeds.展开更多
Wetland degradation is an escalating global challenge with profound impacts on animal diversity,particularly during successional processes.Birds,as highly mobile and environmentally sensitive organisms,serve as effect...Wetland degradation is an escalating global challenge with profound impacts on animal diversity,particularly during successional processes.Birds,as highly mobile and environmentally sensitive organisms,serve as effective indicators of ecological change.While previous studies have primarily focused on local community structures and species diversity during a specific season,there is a need to extend the research timeframe and explore broader spatial variations.Additionally,expanding from simple species diversity indices to more multidimensional diversity indices would provide a more comprehensive understanding of wetland health and resilience.To address these gaps,we investigated the effects of wetland degradation on bird diversity across taxonomic,phylogenetic,and functional dimensions in the Zoige Wetland,a plateau meadow wetland biodiversity hotspot.Surveys were conducted during both breeding(summer)and overwintering(winter)seasons across 20 transects in 5 sampling areas,representing 4 degradation levels(pristine,low,medium,and high).Our study recorded a total of 106 bird species from 32 families and 14 orders,revealing distinct seasonal patterns in bird community composition and diversity.Biodiversity indices were significantly higher in pristine and low-degraded wetlands,particularly benefiting waterfowl(Anseriformes,Ciconiiformes)and wading birds(Charadriiformes)in winter,when these areas provided superior food resources and habitat conditions.In contrast,medium and highly degraded wetlands supported increased numbers of terrestrial birds(Passeriformes)and raptors(Accipitriformes,Falconiformes).Seasonal differences in taxonomic,phylogenetic,and functional diversity indices highlighted the contrasting ecological roles of wetlands during breeding and overwintering periods.Furthermore,indicator species analysis revealed key species associated with specific degradation levels and seasons,providing valuable insights into wetland health.This study underscores the importance of spatiotemporal dynamics in understanding avian responses to wetland degradation.By linking seasonal patterns of bird diversity to habitat conditions,our findings contribute to conservation efforts and provide a framework for assessing wetland degradation and its ecological impacts.展开更多
Cardiovascular diseases(CVDs)remain the leading cause of morbidity and mortality worldwide,necessitating innovative diagnostic and prognostic strategies.Traditional biomarkers like C-reactive protein,uric acid,troponi...Cardiovascular diseases(CVDs)remain the leading cause of morbidity and mortality worldwide,necessitating innovative diagnostic and prognostic strategies.Traditional biomarkers like C-reactive protein,uric acid,troponin,and natriuretic peptides play crucial roles in CVD management,yet they are often limited by sensitivity and specificity constraints.This narrative review critically examines the emerging landscape of cardiac biomarkers and advocates for a multiple-marker approach to enhance early detection,prognosis,and risk stratification of CVD.In recent years,several novel biomarkers have shown promise in revolutionizing CVD diagnostics.Gamma-glutamyltransferase,microRNAs,endothelial microparticles,placental growth factor,trimethylamine N-oxide,retinol-binding protein 4,copeptin,heart-type fatty acid-binding protein,galectin-3,growth differentiation factor-15,soluble suppression of tumorigenicity 2,fibroblast growth factor 23,and adrenomedullin have emerged as significant indicators of CV health.These biomarkers provide insights into various pathophysiological processes,such as oxidative stress,endothelial dysfunction,inflammation,metabolic disturbances,and myocardial injury.The integration of these novel biomarkers with traditional ones offers a more comprehensive understanding of CVD mechanisms.This multiple-marker approach can improve diagnostic accuracy,allowing for better risk stratification and more personalized treatment strategies.This review underscores the need for continued research to validate the clinical utility of these biomarkers and their potential incorporation into routine clinical practice.By leveraging the strengths of both traditional and novel biomarkers,precise therapeutic plans can be developed,thereby improving the management and prognosis of patients with CVDs.The ongoing exploration and validation of these biomarkers are crucial for advancing CV care and addressing the limitations of current diagnostic tools.展开更多
The advent of precision medicine has underscored the importance of biomarkers in predicting therapy response for bladder cancer,a malignancy marked by considerable heterogeneity.This review critically examines the cur...The advent of precision medicine has underscored the importance of biomarkers in predicting therapy response for bladder cancer,a malignancy marked by considerable heterogeneity.This review critically examines the current landscape of biomarkers to forecast treatment outcomes in bladder cancer patients.We explore a range of biomarkers,including genetic,epigenetic,proteomic,and transcriptomic indicators,from multiple sample sources,including urine,tumor tissue and blood,assessing their efficacy in predicting responses to chemotherapy,immunotherapy,and targeted therapies.Despite promising developments,the translation of these biomarkers into clinical practice faces significant challenges,such as variability in biomarker performance,the necessity for large-scale validation studies,and the integration of biomarker testing into routine clinical workflows.We also highlight the need for standardized methodologies and robust assays to ensure consistency and reliability.Future directions point towards longitudinal studies and the development of combination biomarker panels to enhance predictive accuracy.This review emphasizes the transformative potential of predictive biomarkers in improving patient outcomes and advocates for continued collaborative efforts to overcome existing barriers in this rapidly evolving field.展开更多
BACKGROUND Type 2 diabetes mellitus(T2DM),a chronic metabolic disease with a high global incidence,has become a serious public health challenge.China has the largest number of T2DM patients worldwide,imposing a signif...BACKGROUND Type 2 diabetes mellitus(T2DM),a chronic metabolic disease with a high global incidence,has become a serious public health challenge.China has the largest number of T2DM patients worldwide,imposing a significant economic burden on the healthcare system.T2DM is closely associated with insulin resistance,impaired pancreatic B cell function,and disordered glucose and lipid metabolism,which can lead to various complications,reducing patients'quality of life and increasing the risk of disability and death.Thus,finding effective preventive and intervention measures is crucial.Exercise therapy,a key part of diabetes management,has gained attention in recent years,with many studies indicating its benefits for blood glucose control and other aspects in diabetic patients.AIM To assess the effectiveness of combined resistance and aerobic exercise interventions on blood glucose control and metabolic indicators in patients with T2DM and to explore their application in diabetes management.METHODS Systematic searches were conducted using PubMed,EMBASE,Cochrane Library,and Chinese databases for relevant randomized controlled trials(RCTs).The inclusion criteria were participants aged≥18 years with T2DM and the intervention involved combined resistance and aerobic exercise for≥8 weeks.The primary outcome indicators were fasting blood glucose,low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),triglycerides(TG),glycated hemoglobin A1c(HbA1c),and total cholesterol(TC)levels.Data analysis was performed using RevMan software,and the interventional effects were assessed using weighted mean differences or standardized mean differences(SMD).RESULTS Six RCTs meeting the inclusion criteria were included,with a total sample size of 366 participants.The meta-analysis results showed that combined resistance and aerobic exercise significantly improved several metabolic indicators in patients with T2DM.Specific results were as follows:(1)For fasting blood glucose,combined exercise was more effective than aerobic exercise alone[SMD=1.22;95%confidence interval(95%CI):0.70,1.74;P<0.00001];(2)LDL-C levels were significantly reduced by the combined intervention(SMD=1.45;95%CI:1.18-1.72;P<0.00001);(3)The combined intervention significantly increased HDL-C levels(SMD=1.42;95%CI:0.98-1.87;P<0.00001);(4)The combined intervention significantly reduced TG levels(SMD=1.12;95%CI:0.85-1.39;P<0.00001;(5)No statistically significant difference was observed in HbA1c between the combined and the aerobic exercise group(SMD=-0.03;95%CI:-1.09 to 1.04;P<0.00001);and(6)The combined exercise intervention group significantly reduced TC levels(SMD=2.66;95%CI:1.93-3.38;P<0.00001).The subgroup analysis results suggest that the effect of exercise interventions may be influenced by various factors,including the patient's age,baseline blood glucose levels,and exercise intensity.CONCLUSION Combined resistance and aerobic exercise intervention significantly improved fasting blood glucose,LDL-C,HDL-C,TG,and TC levels in patients with T2DM,especially in terms of blood glucose control and cardiovascular risk,demonstrating better outcomes than aerobic exercise alone.展开更多
BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU ad...BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality.Two different types of unplanned ICU admissions include upgrades(patients admitted to the floor then moved to the ICU)and bounce backs(patients admitted to the ICU,discharged to the floor,and then readmitted to the ICU).Previous studies have shown that geriatric trauma patients are at higher risk for unfavorable outcomes.AIM To analyze the characteristics,management and outcomes of trauma patients who had an unplanned ICU admission during their hospitalization.METHODS This institutional review board approved,retrospective cohort study examined 203 adult trauma patients with unplanned ICU admission at an urban level 1 trauma center over a six-year period(2017-2023).This included 134 upgrades and 69 bounce backs.Analyzed variables included:(1)Age;(2)Sex;(3)Comorbidities;(4)Mechanism of injury(MOI);(5)Injury severity score(ISS);(6)Glasgow Coma Scale(GCS);(7)Type of injury;(8)Transfusions;(9)Consultations;(10)Timing and reason for unplanned admission;(11)Intubations;(12)Surgical interventions;(13)ICU and hospital lengths of stay;and(14)Mortality.RESULTS Unplanned ICU admissions comprised 4.2%of total ICU admissions.Main MOI was falls.Mean age was 70.7 years,ISS was 12.8 and GCS was 13.9.Main injuries were traumatic brain injury(37.4%)and thoracic injury(21.7%),and main reason for unplanned ICU admission was respiratory complication(39.4%).The 47.3%underwent a surgical procedure and 46.8%were intubated.Average timing for unplanned ICU admission was 2.9 days.Bounce backs occurred half as often as upgrades,however had higher rates of transfusions(63.8%vs 40.3%,P=0.002),consultations(4.8 vs 3.0,P<0.001),intubations(63.8%vs 38.1%%,P=0.001),longer ICU lengths of stay(13.2 days vs 6.4 days,P<0.001)and hospital lengths of stay(26.7 days vs 13.0 days,P<0.001).Mortality was 25.6%among unplanned ICU admissions,31.9%among geriatric unplanned ICU admissions and 11.9%among all trauma ICU patients.CONCLUSION Unplanned ICU admissions constituted 4.2%of total ICU admissions.Respiratory complications were the main cause of unplanned ICU admissions.Bounce backs occurred half as often as upgrades,but were associated with worse outcomes.展开更多
Succinylcholine(SC)is a widely used depolarizing muscle relaxant,but improper use can lead to arrhythmias and,in severe cases,pose a life-threatening risk.Additionally,some criminals exploit SC for illicit activities....Succinylcholine(SC)is a widely used depolarizing muscle relaxant,but improper use can lead to arrhythmias and,in severe cases,pose a life-threatening risk.Additionally,some criminals exploit SC for illicit activities.Therefore,rapid SC detection is paramount for clinical practice and public safety.Currently,however,limited methods are available for the rapid detection of SC.A fluorescent indicator displacement assay sensor based on molecular recognition of an amide naphthotube was developed.This sensor enabled the rapid fluorescent detection of SC through competitive binding between SC and methylene blue with the amide naphthotube.The sensor exhibited exceptional sensitivity with a detection limit as low as 1.1μmol/L and a detection range of 1.1~60μmol/L,coupled with outstanding selectivity and robust stability.Furthermore,this sensor accurately determined SC levels in biological samples such as serum.In summary,this research provides a new solution for the rapid and accurate sensing of SC in complex matrices and offers new insights for the swift identification and detection of toxins.展开更多
In order to accurately forecast the main engine fuel consumption and reduce the Energy Efficiency Operational Indicator(EEOI)of merchant ships in polar ice areas,the energy transfer relationship between ship-machine-p...In order to accurately forecast the main engine fuel consumption and reduce the Energy Efficiency Operational Indicator(EEOI)of merchant ships in polar ice areas,the energy transfer relationship between ship-machine-propeller is studied by analyzing the complex force situation during ship navigation and building a MATLAB/Simulink simulation platform based on multi-environmental resistance,propeller efficiency,main engine power,fuel consumption,fuel consumption rate and EEOI calculation module.Considering the environmental factors of wind,wave and ice,the route is divided into sections,the calculation of main engine power,main engine fuel consumption and EEOI for each section is completed,and the speed design is optimized based on the simulation model for each section.Under the requirements of the voyage plan,the optimization results show that the energy efficiency operation index of the whole route is reduced by 3.114%and the fuel consumption is reduced by 9.17 t.展开更多
Objectives:We systematically reviewed the rational use of medicines using the World Health Organization/International Network of Rational Use of Drugs(WHO/INRUD)core drug use indicators.We also assessed the impact of ...Objectives:We systematically reviewed the rational use of medicines using the World Health Organization/International Network of Rational Use of Drugs(WHO/INRUD)core drug use indicators.We also assessed the impact of the coronavirus disease 2019 pandemic and the National Drug Policy(NDP)2005 on the rational use of medicines.Methods:Searches were conducted in PubMed,Scopus,and Google Scholar databases to identify studies that met our eligibility criteria.Assessment of the quality of studies was conducted using the Joanna Briggs Institute criteria for analytical studies.We reported and compared the median values of WHO/INRUD core drug use indicators with standard thresholds.Data were presented with median,interquartile range(IQR),and percentages.MannWhitney and Kruskal-Wallis tests were conducted to assess for statistical significance(P<0.05)across variables.Results:Thirty-one studies were included in the review,comprising 50,931 patient encounters across 268 health facilities.Within prescribing indicators,average number of medicines per patient encountered[3.4(IQR:3.0to 4.0)],percentage of medicines prescribed by generic[50.4%(IQR:47.4%to 65.0%)],percentage of encounters with antibiotic prescribed[40.2%(IQR:30.5%to 52.7%)],percentage of encounters with injection prescribed[18%(IQR:3.2%to 30.0%)]and the percentage of medicines prescribed from essential medicines list[82.0%(IQR:66.4%to 89.3%)].The median percentage of encounters with antibiotics(P=0.04)and the median percentage of medicines prescribed by generics(P=0.03)increased during and after the COVID-19 pandemic.Prescribing indicators were worse in primary and secondary health facilities,with significant differences in the median percentage of encounters with antibiotics(P=0.007)and injections(P=0.0002)across primary,secondary,and tertiary health facilities.There were improvements across all prescribing indicators after the implementation of NDP 2005.Conclusions:Core drug use indicators in Nigerian health facilities deviated from the WHO/INRUD thresholds,with noticeable improvement after the implementation of NDP 2005.More efforts are needed to improve rational drug use in Nigerian hospitals.展开更多
BACKGROUND Nutritional and inflammatory indicators are crucial in assessing the nutritional health and immune function of patients with cancer,which are factors closely associated with the diagnosis and treatment of c...BACKGROUND Nutritional and inflammatory indicators are crucial in assessing the nutritional health and immune function of patients with cancer,which are factors closely associated with the diagnosis and treatment of colorectal cancer(CRC).AIM To explore the relationship between nutritional and inflammatory indicators and microsatellite stability(MSS)status in CRC.METHODS The clinical data of 56 patients who underwent surgical treatment for CRC were collected.Furthermore,the expressions of nutritional(levels of serum albumin,triglycerides,serum cholesterol,and body mass index)and inflammatory response indicators(absolute neutrophil count,absolute lymphocyte count,absolute monocyte count,neutrophil-to-lymphocyte ratio,and lymphocyte-to-monocyte ratio)as well as their correlation with microsatellite instability(MSI)status were investigated in patients with CRC.RESULTS Compared to the patients with MSS tumors,those with MSI tumors demonstrated significantly lower levels of two nutritional indicators,namely serum albumin and body mass index(P<0.05).Moreover,patients in the MSI group demonstrated significantly lower absolute lymphocyte counts and higher neutrophil-to-lymphocyte ratio than those in the MSS group(P<0.05),indicating pronounced differences in inflammatory responses and immune states between the two groups.CONCLUSION Certain nutritional and inflammatory indicators exhibit significant differences among patients with MSI and MSS CRC,highlighting their potential role in the clinical treatment and health management of this specific population.展开更多
The amount of impervious surface area increases with rapid urbanization.Remote sensing indices are used to detect impervious surface areas quickly,cheaply and accurately.This study used Landsat-OLI and Sentiel-2A MSI ...The amount of impervious surface area increases with rapid urbanization.Remote sensing indices are used to detect impervious surface areas quickly,cheaply and accurately.This study used Landsat-OLI and Sentiel-2A MSI images in the province of Ankara to compare six impervious surface extraction indices:Normalized Difference Builtup Index(NDBI),Combinational Biophysical Composition Index(CBCI),Normalized Impervious Surface Index(NISI),Urban Index(UI),Index-based Built-up Index(IBI),Enhanced Normalized Difference Impervious Surfaces Index(ENDISI).Spectral discrimination index(SDI)and error matrix were used to evaluate the performance of the indexes.In addition,a visual evaluation of the performance of the indices was made on different surface areas in the study area.展开更多
Understanding the active tectonic processes in the Nandakini Watershed is imperative for evaluating geological hazards and seismic risks,as well as for informing land-use planning and natural resource management strat...Understanding the active tectonic processes in the Nandakini Watershed is imperative for evaluating geological hazards and seismic risks,as well as for informing land-use planning and natural resource management strategies in the region.Tectonic geomorphology serves as a vital tool for characterizing recent tectonic movements.This research employs GIS techniques to elucidate tectonic activity and its influence on drainage patterns in the Nandakini Watershed,utilizing morphometric parameters derived from SRTM DEM data.Morphometric indices are employed to assess the tectonic movement within drainage basins,capturing both areal and linear factors such as drainage density,texture,circulatory and bifurcation ratios,and stream length ratios.The linear and areal morphometric indices are categorized into three classes representing varying degrees of active tectonic activity.These classifications are then utilized to compute the relative active tectonic index(IRAT).In addition,geomorphic parameters include hypsometric integral,stream length-gradient index,normalized steepness index,chi gradient index,and swath profiles.The majority of the studied region is in an extremely high to moderately active tectonic zone.Large-scale faults and thrusts within the basins are closely correlated with these zones that have been identified.The integrated methodology of GIS-based morphometric analysis and geomorphic study enables the identification of deformed landforms associated with ongoing tectonic activity.Furthermore,these results offer valuable insights for informing watershed management strategies and promoting sustainable land use planning initiatives.展开更多
文摘BACKGROUND:Pulse indicated continuous cardiac output(PiCCO)has largely replaced Swan-Ganz catheterization in shock patients.However,whether PiCCO monitoring can improve outcomes of shock patients,such as mortality,length of hospital stay,duration of mechanical ventilation,or laboratory parameters,remains unknown.METHODS:This retrospective cohort study included patients with shock in the intensive care unit(ICU)from January 2013 to January 2020.Patients were divided into PiCCO group and non-PiCCO group based on treatment with PiCCO monitoring or not.Demographic characteristics,Acute Physiology and Chronic Health Evaluation(APACHE)II scores,quick Sequential Organ Failure Assessment(qSOFA)scores,14-day mortality,and N-terminal pro-B-type natriuretic peptide(NT-proBNP)levels at 0,1,3 and 7 days after onset of shock,duration of mechanical ventilation,length of hospital stay and hospitalization costs were compiled and analyzed using propensity score matching(PSM).RESULTS:Real-world analysis of 1,583 ICU patients suff ering shock after propensity score matching revealed that 14-day mortality did not differ between PiCCO and non-PiCCO groups(36.2%vs.32.6%,P=0.343).Duration of mechanical ventilation,hospital stay,and hospitalization costs were also similar between the two groups(P>0.05).No diff erences in changes of NT-proBNP levels on days 0,1,3,and 7 as compared to baseline were noted between the two groups(P>0.05).CONCLUSIONS:The results of our real-world indicate that PiCCO monitoring may not shorten the duration of mechanical ventilation,length of hospital stay,or reduce hospitalization costs,nor will it bring survival benefi ts to ICU patients suff ering shock.
基金the Translational Medicine and Interdisciplinary Research Joint Fund of Zhongnan Hospital of Wuhan University(No.ZNLH-201907)the Hubei Province Health and Family Planning Scientific Research Project(No.WJ2019Q041)the Chinese Academy of Medical Science Innovation Fund for Medical Sciences(No.2021-I2M-1-009).
文摘Objective There is a large population of patients classified as complex higher-risk and indicated patients(CHIPs)in China with a poor prognosis.The treatment of these patients is complex and challenging,especially when acute cardiac events occur,such as acute coronary syndrome(ACS)or heart failure.Pharmacotherapy and some mechanical circulatory support(MCS)therapeutic devices can provide stable hemodynamic support for CHIPs-percutaneous coronary intervention(PCI).LDL-C is an important pathogenic factor in atherosclerosis,and the target of blood lipid control.Recent studies have revealed that lipoprotein(a)[Lp(a)],which is formed when a covalent bond between apolipoprotein(a)and apolipoprotein B-100 is made,produces an LDL-like particle.This particle is an independent risk factor for the development of atherosclerosis,and is closely correlated to stent thrombosis and restenosis.Furthermore,this requires active intervention.PCSK9 inhibitors have been used in lipid-lowering treatment,and preventing atherosclerosis.The present study explores the efficacy of PCSK9 inhibitors in CHIPs-ACS,and the association between the change in Lp(a)and survival after 2 years of follow-up.Methods The present real-world,prospective control study enrolled 321 CHIPs-ACS who underwent emergency PCI from August 2019 to November 2020,and these patients were followed up for 2 years.These patients were divided into two groups:PCSK9 group(n=161)given the combined PCSK9 inhibitor(140 mg of evolocumab every 2 weeks)and statins-based therapy,and SOC group(n=160)treated with statin-based lipid-lowering therapy alone.Then,the change in lipid index was measured,and the cardiovascular(CV)event recurrence rate was evaluated after one month and 2 years.Afterwards,the contribution of serum lipid parameters,especially the Lp(a)alteration,in patients with earlier initiation of the PCSK9 inhibitor to the CV outcome was analyzed.Results The LDL-C level was significantly reduced in both groups:52.3%in the PCSK9 group and 32.3%(P<0.001)in the SOC group.It is noteworthy that the Lp(a)level decreased by 13.2%in the PCSK9 group,but increased by 30.3%in the SOC group(P<0.001).Furthermore,the number of CV events was not significantly different between the PCSK9 and SOC groups after the 2-year follow-up period.In the PCSK9 group,the Lp(a)reduction was associated with the baseline Lp(a)levels of the patients(r2=−0.315,P<0.001).Moreover,the decrease in Lp(a)contributed to the decline in CV events in patients who received ACS CHIPs-PCI,and the decrease in Lp(a)level was independent of the LDL-C level reduction.Conclusion The early initiation of PCSK9 inhibitors can significantly reduce the LDL-C and Lp(a)levels in ACS CHIPs-PCI.However,further studies are needed to confirm whether PCSK9 inhibitors can reduce the incidence of CV disease in CHIPs.
文摘Objective: We aimed to compare the perinatal outcomes in late preterm spontaneous and indicated birth neonates. Methods: We studied 289 late preterm births, classified as either aspontaneous late preterm birth (sLPTB) group (preterm labor with intact membranes and preterm premature rupture of membranes) or an indicated late preterm birth (iLPTB) group (hypertensive disorder in pregnancy, placental causes, and maternal diseases), according to the delivery indication. We then compared the maternal and neonatal characteristics and perinatal outcomes, including the Apgar score, admission to the neonatal intensive care unit (NICU) or special care nursery (SCN), duration of NICU stay, and the rate of composite morbidity (antibiotic use, hypoglycemia, hypocalcemia, hyperbilirubinemia requiring phototherapy, respiratory support, and respiratory distress syndrome). Results: A total of 198 neonates were in the sLPTB group and 91 were in the iLPTB group. In spite of greater gestational age at the time of delivery in the iLPTB group, the mean birth weight was lower than that in the sLPTB group. Additionally, the iLPTB group showed lower Apgar scores, and higher rates of NICU or SCN admission, respiratory support, and hypoglycemia, but there was no difference in the rate of composite morbidity between the two groups. Conclusion: iLPTB neonates had lower birth weights despite greater gestational age than those in the sLPTB group, but there was no difference in the rate of composite morbidity between the two groups.
基金This work was supported by grants from the National Key Research and Development Program of China(2017YFC0908800)Beijing Municipal Administration of Hospitals5 Ascent Plan(DFL20150601)+1 种基金 Mission Plan(SML20180601) Beijing Municipal Health Commission "Project of Science and Technology Innovation Center"(PXM2019_026272_000006)(PXM2019_026272_000005).
文摘Complex higher-risk and indicated patients (CHIPs) refers to patients with severe coronary artery disease (CAD) needing revascularization. However, these patients are at an increased risk for this procedure.[1] The CHIP population is attracting much interest in the field of interventional cardiology, since it was introduced in 2016 by Kirtane et al,[1] and the optimal treatment strategies for this population were fiercely discussed in almost every interventional forum at home and abroad. First of all, a comprehensive risk assessment must be conducted to determine which patients with CAD should undergo revascularization based on clinical presentation, functional tests, and anatomic characteristics. Percutaneous coronary intervention (PCI) might be a beneficial option when complete revascularization can be achieved, especially for patients are either inoperable or at higher surgical risk.[2,3] To treat these high-risk patients safely and effectively with PCI, well-trained interventionalists exhibiting both technical and cognitive skills are needed.
基金Supported by China Health&Medical Development Foundation,No.M2021551.
文摘BACKGROUND Inappropriate selection of patients with early gastric cancer(EGC)for endoscopic submucosal dissection(ESD)may lead to non-curative resection,necessitating additional gastrectomy.Conversely,inappropriate selection for gastrectomy may result in overtreatment,adversely affecting patients’quality of life.Few have systematically evaluated the concordance between therapeutic indications under current Japanese guidelines and pathological criteria in EGC.To minimize noncurative resection risks while sparing unnecessary surgery for low-risk patients’,we specifically assess the suitability of Japanese guidelines in non-Japanese populations.This work aims to optimize clinical practice by refining endoscopic treatment criteria for adoption beyond Japan.AIM To evaluate EGC clinical decision accuracy by comparing therapeutic indication with postoperative pathological criteria and analyzing factors influencing discrepancies.METHODS A retrospective analysis was conducted on 796 EGC cases diagnosed at Peking University Third Hospital between January 2010 and December 2022.Cases were categorized into three groups:Same-estimated(preoperative therapeutic indication with postoperative pathological criteria matched),underestimated(preoperative ESD indication but postoperative surgical criteria),and overestimated(preoperative surgical indication but postoperative ESD criteria).The rate of discrepancy and associated risk factors were assessed.RESULTS The accuracy rates of preoperative evaluation for ESD and gastrectomy indications were 73.0%(321/430)and 76.0%(278/366),respectively.The overall discrepancy rate was 25.6%(204/796).Multivariate analysis identified tumor location in the upper-third stomach(odds ratio=2.158,95%confidence interval:1.373-3.390,P=0.001)was significantly associated with a higher likelihood of being underestimated and undifferentiated histologic type on preoperative biopsy(odds ratio=2.005,95%confidence interval:1.036-3.879,P=0.039)was more likely to be overestimated.Significant differences were observed in tumor diameter(P<0.001),depth of infiltration(P<0.001),ulcerative findings(P<0.001),and histologic type(P<0.001)between preoperative and postoperative evaluations.CONCLUSION The accuracy of preoperative EGC indications is 74.4%.Upper-third stomach and undifferentiated histology are primary discrepancy predictors.Upper-third tumors are prone to underestimation,while undifferentiated tumors are prone to overestimation.
基金Funded by the National Natural Science Foundation of China(Nos.52378360,51978438)。
文摘We used solidification/stabilization methods to remediate highly concentrated Zn^(2+)-contaminated soil.An industrial waste mixture of red mud,carbide slag,and phosphogypsum is combined with cement as the curing agent.The mixing ratios of the four materials are determined by comparing the strength,permeability coefficient,pH,and Zn^(2+)-leaching concentration of the solidified soil.Microscopic characteristics of the solidified uncontaminated soil and solidified Zn^(2+)-contaminated soil were observed using scanning electron microscopy,X-ray diffraction,and Fourier-transform infrared spectroscopy.Furthermore,the heavy metals speciation in both pure cement and mixed-material solidified soil was examined,demonstrating the beneficial role of the mixed-type curing agent in stabilizing heavy metals.The research results indicate that Zn^(2+)degrade the strength of the solidified soil by up to 90%.The permeability coefficient,pH,and Zn^(2+)-leaching concentration of the solidified soil easily meet standard,especially with Zn^(2+)leaching concentration well below the environmental protection limit.Furthermore,most Zn^(2+)exists in forms with lower biological and chemical reactivity.Both the solidified Zn^(2+)-contaminated soil and uncontaminated soil resulted in the formation of hydrated products containing elements such as silicon,aluminum,calcium,and sulfur.Additionally,the solidified Zn^(2+)-contaminated soil produced zinc-containing compounds and a large amount of rod-shaped ettringite.
文摘The indications and contraindications of parenteral nutrition(PN)are discussed in view of recent clinical find-ings.For decades,PN has been restricted to patients unable to tolerate enteral nutrition(EN)intake owing to the perceived risk of severe side-effects.The evolution of the PN substrate composition and delivery of nutrition via all-in-one bags has dramatically improved the application prospects of PN.Recent studies show similar compli-cation rates of nutrition therapy administered through enteral and intravenous routes.Therefore,indications of PN have,based on evidence,extended beyond complete gastrointestinal(GI)failure to include conditions such as insufficient EN generating persistent negative energy balance and insufficient protein intakes,malabsorption,or specific needs that are impossible to cover with EN feeds.
基金supported by the Southwest Minzu University Research Startup Funds (No.16011221038,RQD2022021)Double World-Class Project (No.CX2023010)。
文摘Wetland degradation is an escalating global challenge with profound impacts on animal diversity,particularly during successional processes.Birds,as highly mobile and environmentally sensitive organisms,serve as effective indicators of ecological change.While previous studies have primarily focused on local community structures and species diversity during a specific season,there is a need to extend the research timeframe and explore broader spatial variations.Additionally,expanding from simple species diversity indices to more multidimensional diversity indices would provide a more comprehensive understanding of wetland health and resilience.To address these gaps,we investigated the effects of wetland degradation on bird diversity across taxonomic,phylogenetic,and functional dimensions in the Zoige Wetland,a plateau meadow wetland biodiversity hotspot.Surveys were conducted during both breeding(summer)and overwintering(winter)seasons across 20 transects in 5 sampling areas,representing 4 degradation levels(pristine,low,medium,and high).Our study recorded a total of 106 bird species from 32 families and 14 orders,revealing distinct seasonal patterns in bird community composition and diversity.Biodiversity indices were significantly higher in pristine and low-degraded wetlands,particularly benefiting waterfowl(Anseriformes,Ciconiiformes)and wading birds(Charadriiformes)in winter,when these areas provided superior food resources and habitat conditions.In contrast,medium and highly degraded wetlands supported increased numbers of terrestrial birds(Passeriformes)and raptors(Accipitriformes,Falconiformes).Seasonal differences in taxonomic,phylogenetic,and functional diversity indices highlighted the contrasting ecological roles of wetlands during breeding and overwintering periods.Furthermore,indicator species analysis revealed key species associated with specific degradation levels and seasons,providing valuable insights into wetland health.This study underscores the importance of spatiotemporal dynamics in understanding avian responses to wetland degradation.By linking seasonal patterns of bird diversity to habitat conditions,our findings contribute to conservation efforts and provide a framework for assessing wetland degradation and its ecological impacts.
文摘Cardiovascular diseases(CVDs)remain the leading cause of morbidity and mortality worldwide,necessitating innovative diagnostic and prognostic strategies.Traditional biomarkers like C-reactive protein,uric acid,troponin,and natriuretic peptides play crucial roles in CVD management,yet they are often limited by sensitivity and specificity constraints.This narrative review critically examines the emerging landscape of cardiac biomarkers and advocates for a multiple-marker approach to enhance early detection,prognosis,and risk stratification of CVD.In recent years,several novel biomarkers have shown promise in revolutionizing CVD diagnostics.Gamma-glutamyltransferase,microRNAs,endothelial microparticles,placental growth factor,trimethylamine N-oxide,retinol-binding protein 4,copeptin,heart-type fatty acid-binding protein,galectin-3,growth differentiation factor-15,soluble suppression of tumorigenicity 2,fibroblast growth factor 23,and adrenomedullin have emerged as significant indicators of CV health.These biomarkers provide insights into various pathophysiological processes,such as oxidative stress,endothelial dysfunction,inflammation,metabolic disturbances,and myocardial injury.The integration of these novel biomarkers with traditional ones offers a more comprehensive understanding of CVD mechanisms.This multiple-marker approach can improve diagnostic accuracy,allowing for better risk stratification and more personalized treatment strategies.This review underscores the need for continued research to validate the clinical utility of these biomarkers and their potential incorporation into routine clinical practice.By leveraging the strengths of both traditional and novel biomarkers,precise therapeutic plans can be developed,thereby improving the management and prognosis of patients with CVDs.The ongoing exploration and validation of these biomarkers are crucial for advancing CV care and addressing the limitations of current diagnostic tools.
文摘The advent of precision medicine has underscored the importance of biomarkers in predicting therapy response for bladder cancer,a malignancy marked by considerable heterogeneity.This review critically examines the current landscape of biomarkers to forecast treatment outcomes in bladder cancer patients.We explore a range of biomarkers,including genetic,epigenetic,proteomic,and transcriptomic indicators,from multiple sample sources,including urine,tumor tissue and blood,assessing their efficacy in predicting responses to chemotherapy,immunotherapy,and targeted therapies.Despite promising developments,the translation of these biomarkers into clinical practice faces significant challenges,such as variability in biomarker performance,the necessity for large-scale validation studies,and the integration of biomarker testing into routine clinical workflows.We also highlight the need for standardized methodologies and robust assays to ensure consistency and reliability.Future directions point towards longitudinal studies and the development of combination biomarker panels to enhance predictive accuracy.This review emphasizes the transformative potential of predictive biomarkers in improving patient outcomes and advocates for continued collaborative efforts to overcome existing barriers in this rapidly evolving field.
基金Supported by Research Project of Zhejiang Provincial Science and Technology Plan for Traditional Chinese Medicine,No.2024ZL753and Research Project of Zhejiang Provincial Medical and Health Science and Technology Plan,No.2024KY1406.
文摘BACKGROUND Type 2 diabetes mellitus(T2DM),a chronic metabolic disease with a high global incidence,has become a serious public health challenge.China has the largest number of T2DM patients worldwide,imposing a significant economic burden on the healthcare system.T2DM is closely associated with insulin resistance,impaired pancreatic B cell function,and disordered glucose and lipid metabolism,which can lead to various complications,reducing patients'quality of life and increasing the risk of disability and death.Thus,finding effective preventive and intervention measures is crucial.Exercise therapy,a key part of diabetes management,has gained attention in recent years,with many studies indicating its benefits for blood glucose control and other aspects in diabetic patients.AIM To assess the effectiveness of combined resistance and aerobic exercise interventions on blood glucose control and metabolic indicators in patients with T2DM and to explore their application in diabetes management.METHODS Systematic searches were conducted using PubMed,EMBASE,Cochrane Library,and Chinese databases for relevant randomized controlled trials(RCTs).The inclusion criteria were participants aged≥18 years with T2DM and the intervention involved combined resistance and aerobic exercise for≥8 weeks.The primary outcome indicators were fasting blood glucose,low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),triglycerides(TG),glycated hemoglobin A1c(HbA1c),and total cholesterol(TC)levels.Data analysis was performed using RevMan software,and the interventional effects were assessed using weighted mean differences or standardized mean differences(SMD).RESULTS Six RCTs meeting the inclusion criteria were included,with a total sample size of 366 participants.The meta-analysis results showed that combined resistance and aerobic exercise significantly improved several metabolic indicators in patients with T2DM.Specific results were as follows:(1)For fasting blood glucose,combined exercise was more effective than aerobic exercise alone[SMD=1.22;95%confidence interval(95%CI):0.70,1.74;P<0.00001];(2)LDL-C levels were significantly reduced by the combined intervention(SMD=1.45;95%CI:1.18-1.72;P<0.00001);(3)The combined intervention significantly increased HDL-C levels(SMD=1.42;95%CI:0.98-1.87;P<0.00001);(4)The combined intervention significantly reduced TG levels(SMD=1.12;95%CI:0.85-1.39;P<0.00001;(5)No statistically significant difference was observed in HbA1c between the combined and the aerobic exercise group(SMD=-0.03;95%CI:-1.09 to 1.04;P<0.00001);and(6)The combined exercise intervention group significantly reduced TC levels(SMD=2.66;95%CI:1.93-3.38;P<0.00001).The subgroup analysis results suggest that the effect of exercise interventions may be influenced by various factors,including the patient's age,baseline blood glucose levels,and exercise intensity.CONCLUSION Combined resistance and aerobic exercise intervention significantly improved fasting blood glucose,LDL-C,HDL-C,TG,and TC levels in patients with T2DM,especially in terms of blood glucose control and cardiovascular risk,demonstrating better outcomes than aerobic exercise alone.
文摘BACKGROUND The need for an emergency upgrade of a hospitalized trauma patient from the floor to the trauma intensive care unit(ICU)is an unanticipated event with possible life-threatening consequences.Unplanned ICU admissions are associated with increased morbidity and mortality and are an indicator of trauma service quality.Two different types of unplanned ICU admissions include upgrades(patients admitted to the floor then moved to the ICU)and bounce backs(patients admitted to the ICU,discharged to the floor,and then readmitted to the ICU).Previous studies have shown that geriatric trauma patients are at higher risk for unfavorable outcomes.AIM To analyze the characteristics,management and outcomes of trauma patients who had an unplanned ICU admission during their hospitalization.METHODS This institutional review board approved,retrospective cohort study examined 203 adult trauma patients with unplanned ICU admission at an urban level 1 trauma center over a six-year period(2017-2023).This included 134 upgrades and 69 bounce backs.Analyzed variables included:(1)Age;(2)Sex;(3)Comorbidities;(4)Mechanism of injury(MOI);(5)Injury severity score(ISS);(6)Glasgow Coma Scale(GCS);(7)Type of injury;(8)Transfusions;(9)Consultations;(10)Timing and reason for unplanned admission;(11)Intubations;(12)Surgical interventions;(13)ICU and hospital lengths of stay;and(14)Mortality.RESULTS Unplanned ICU admissions comprised 4.2%of total ICU admissions.Main MOI was falls.Mean age was 70.7 years,ISS was 12.8 and GCS was 13.9.Main injuries were traumatic brain injury(37.4%)and thoracic injury(21.7%),and main reason for unplanned ICU admission was respiratory complication(39.4%).The 47.3%underwent a surgical procedure and 46.8%were intubated.Average timing for unplanned ICU admission was 2.9 days.Bounce backs occurred half as often as upgrades,however had higher rates of transfusions(63.8%vs 40.3%,P=0.002),consultations(4.8 vs 3.0,P<0.001),intubations(63.8%vs 38.1%%,P=0.001),longer ICU lengths of stay(13.2 days vs 6.4 days,P<0.001)and hospital lengths of stay(26.7 days vs 13.0 days,P<0.001).Mortality was 25.6%among unplanned ICU admissions,31.9%among geriatric unplanned ICU admissions and 11.9%among all trauma ICU patients.CONCLUSION Unplanned ICU admissions constituted 4.2%of total ICU admissions.Respiratory complications were the main cause of unplanned ICU admissions.Bounce backs occurred half as often as upgrades,but were associated with worse outcomes.
文摘Succinylcholine(SC)is a widely used depolarizing muscle relaxant,but improper use can lead to arrhythmias and,in severe cases,pose a life-threatening risk.Additionally,some criminals exploit SC for illicit activities.Therefore,rapid SC detection is paramount for clinical practice and public safety.Currently,however,limited methods are available for the rapid detection of SC.A fluorescent indicator displacement assay sensor based on molecular recognition of an amide naphthotube was developed.This sensor enabled the rapid fluorescent detection of SC through competitive binding between SC and methylene blue with the amide naphthotube.The sensor exhibited exceptional sensitivity with a detection limit as low as 1.1μmol/L and a detection range of 1.1~60μmol/L,coupled with outstanding selectivity and robust stability.Furthermore,this sensor accurately determined SC levels in biological samples such as serum.In summary,this research provides a new solution for the rapid and accurate sensing of SC in complex matrices and offers new insights for the swift identification and detection of toxins.
文摘In order to accurately forecast the main engine fuel consumption and reduce the Energy Efficiency Operational Indicator(EEOI)of merchant ships in polar ice areas,the energy transfer relationship between ship-machine-propeller is studied by analyzing the complex force situation during ship navigation and building a MATLAB/Simulink simulation platform based on multi-environmental resistance,propeller efficiency,main engine power,fuel consumption,fuel consumption rate and EEOI calculation module.Considering the environmental factors of wind,wave and ice,the route is divided into sections,the calculation of main engine power,main engine fuel consumption and EEOI for each section is completed,and the speed design is optimized based on the simulation model for each section.Under the requirements of the voyage plan,the optimization results show that the energy efficiency operation index of the whole route is reduced by 3.114%and the fuel consumption is reduced by 9.17 t.
文摘Objectives:We systematically reviewed the rational use of medicines using the World Health Organization/International Network of Rational Use of Drugs(WHO/INRUD)core drug use indicators.We also assessed the impact of the coronavirus disease 2019 pandemic and the National Drug Policy(NDP)2005 on the rational use of medicines.Methods:Searches were conducted in PubMed,Scopus,and Google Scholar databases to identify studies that met our eligibility criteria.Assessment of the quality of studies was conducted using the Joanna Briggs Institute criteria for analytical studies.We reported and compared the median values of WHO/INRUD core drug use indicators with standard thresholds.Data were presented with median,interquartile range(IQR),and percentages.MannWhitney and Kruskal-Wallis tests were conducted to assess for statistical significance(P<0.05)across variables.Results:Thirty-one studies were included in the review,comprising 50,931 patient encounters across 268 health facilities.Within prescribing indicators,average number of medicines per patient encountered[3.4(IQR:3.0to 4.0)],percentage of medicines prescribed by generic[50.4%(IQR:47.4%to 65.0%)],percentage of encounters with antibiotic prescribed[40.2%(IQR:30.5%to 52.7%)],percentage of encounters with injection prescribed[18%(IQR:3.2%to 30.0%)]and the percentage of medicines prescribed from essential medicines list[82.0%(IQR:66.4%to 89.3%)].The median percentage of encounters with antibiotics(P=0.04)and the median percentage of medicines prescribed by generics(P=0.03)increased during and after the COVID-19 pandemic.Prescribing indicators were worse in primary and secondary health facilities,with significant differences in the median percentage of encounters with antibiotics(P=0.007)and injections(P=0.0002)across primary,secondary,and tertiary health facilities.There were improvements across all prescribing indicators after the implementation of NDP 2005.Conclusions:Core drug use indicators in Nigerian health facilities deviated from the WHO/INRUD thresholds,with noticeable improvement after the implementation of NDP 2005.More efforts are needed to improve rational drug use in Nigerian hospitals.
基金Supported by Grants of the Suzhou Medical Key Discipline,No.SZXK202109Suzhou Clinical Key Disease Project,No.LCZX202111Suzhou Promoting Health through Science and Education Research Project,No.KJXW2021028.
文摘BACKGROUND Nutritional and inflammatory indicators are crucial in assessing the nutritional health and immune function of patients with cancer,which are factors closely associated with the diagnosis and treatment of colorectal cancer(CRC).AIM To explore the relationship between nutritional and inflammatory indicators and microsatellite stability(MSS)status in CRC.METHODS The clinical data of 56 patients who underwent surgical treatment for CRC were collected.Furthermore,the expressions of nutritional(levels of serum albumin,triglycerides,serum cholesterol,and body mass index)and inflammatory response indicators(absolute neutrophil count,absolute lymphocyte count,absolute monocyte count,neutrophil-to-lymphocyte ratio,and lymphocyte-to-monocyte ratio)as well as their correlation with microsatellite instability(MSI)status were investigated in patients with CRC.RESULTS Compared to the patients with MSS tumors,those with MSI tumors demonstrated significantly lower levels of two nutritional indicators,namely serum albumin and body mass index(P<0.05).Moreover,patients in the MSI group demonstrated significantly lower absolute lymphocyte counts and higher neutrophil-to-lymphocyte ratio than those in the MSS group(P<0.05),indicating pronounced differences in inflammatory responses and immune states between the two groups.CONCLUSION Certain nutritional and inflammatory indicators exhibit significant differences among patients with MSI and MSS CRC,highlighting their potential role in the clinical treatment and health management of this specific population.
文摘The amount of impervious surface area increases with rapid urbanization.Remote sensing indices are used to detect impervious surface areas quickly,cheaply and accurately.This study used Landsat-OLI and Sentiel-2A MSI images in the province of Ankara to compare six impervious surface extraction indices:Normalized Difference Builtup Index(NDBI),Combinational Biophysical Composition Index(CBCI),Normalized Impervious Surface Index(NISI),Urban Index(UI),Index-based Built-up Index(IBI),Enhanced Normalized Difference Impervious Surfaces Index(ENDISI).Spectral discrimination index(SDI)and error matrix were used to evaluate the performance of the indexes.In addition,a visual evaluation of the performance of the indices was made on different surface areas in the study area.
文摘Understanding the active tectonic processes in the Nandakini Watershed is imperative for evaluating geological hazards and seismic risks,as well as for informing land-use planning and natural resource management strategies in the region.Tectonic geomorphology serves as a vital tool for characterizing recent tectonic movements.This research employs GIS techniques to elucidate tectonic activity and its influence on drainage patterns in the Nandakini Watershed,utilizing morphometric parameters derived from SRTM DEM data.Morphometric indices are employed to assess the tectonic movement within drainage basins,capturing both areal and linear factors such as drainage density,texture,circulatory and bifurcation ratios,and stream length ratios.The linear and areal morphometric indices are categorized into three classes representing varying degrees of active tectonic activity.These classifications are then utilized to compute the relative active tectonic index(IRAT).In addition,geomorphic parameters include hypsometric integral,stream length-gradient index,normalized steepness index,chi gradient index,and swath profiles.The majority of the studied region is in an extremely high to moderately active tectonic zone.Large-scale faults and thrusts within the basins are closely correlated with these zones that have been identified.The integrated methodology of GIS-based morphometric analysis and geomorphic study enables the identification of deformed landforms associated with ongoing tectonic activity.Furthermore,these results offer valuable insights for informing watershed management strategies and promoting sustainable land use planning initiatives.
