On the basis of the data obtained from a field survey, the relationship between land use and soil nutrients was evaluated in Qingzhou County, Shandong Province, China, through a statistical analysis of differences in ...On the basis of the data obtained from a field survey, the relationship between land use and soil nutrients was evaluated in Qingzhou County, Shandong Province, China, through a statistical analysis of differences in 17 nutrients in five types of cultivated land. The results showed significant effects (P < 0.05 or P < 0.01) of land-use type on soil organic matter and concentration of macronutrients, secondary nutrients, and micronutrients, as well as total salt and soil pH. In vegetable land, because of the large amounts of fertilizer applied to vegetable crops, the concentrations of most soil nutrients, with exception of available Si and micronutrients, were higher than those in grain cropland. Grain cropland had a significantly lower total salt content (P < 0.01) and tended to have a higher soil pH than vegetable land. Within subtypes of land use, dry land, irrigable land, and open-air vegetable land had the highest coefficient of variation (CV) for available P, whereas protected vegetable land had the highest CV for total N and available S. In general, land-use types had greater impact on macronutrients than on secondary nutrients and micronutrients.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
Unplanned intensive care unit(ICU)admissions(UP-ICU)following initial general ward placement are associated with poor patient outcomes and represent a key quality indicator for healthcare facilities.Healthcare facilit...Unplanned intensive care unit(ICU)admissions(UP-ICU)following initial general ward placement are associated with poor patient outcomes and represent a key quality indicator for healthcare facilities.Healthcare facilities have employed numerous predictive models,such as physiological scores(e.g.,Acute Physiology and Chronic Health Evaluation II,Revised Trauma Score,and Mortality Probability Model II at 24 hours)and anatomical scores(Injury Severity Score and New Injury Severity Score),to identify high-risk patients.Although physiological scores frequently surpass anatomical scores in predicting mortality,their specificity for trauma patients is limited,and their clinical applicability may be limited.Initially proposed for ICU readmission prediction,the stability and workload index for the transfer score has demonstrated inconsistent validity.Machine learning offers a promising alternative.Several studies have shown that machine learning models,including those that use electronic health records(EHR)data,can more accurately predict trauma patients’deaths and admissions to the ICU than traditional scoring systems.These models identify unique predictors that are not captured by existing methods.However,challenges remain,including integration with EHR systems and data entry complexities.Critical care outreach programs and telemedicine can help reduce UP-ICU admissions;however,their effectiveness remains unclear because of costs and implementation challenges,respectively.Strategies to reduce UP-ICU admissions include improving triage systems,implementing evidence-based protocols for ICU patient management,and prioritizing prehospital intervention and stabilization to optimize the“golden hour”of trauma care.To improve patient outcomes and reduce the burden of UPICU admissions,further studies are required to validate and implement these strategies and refine machine learning models.展开更多
BACKGROUND Newborns are immediately admitted to the neonatal intensive care unit(NICU)after birth,and thus mothers suffer from the pain of mother-infant separation.Some mothers worry about alterations in their child’...BACKGROUND Newborns are immediately admitted to the neonatal intensive care unit(NICU)after birth,and thus mothers suffer from the pain of mother-infant separation.Some mothers worry about alterations in their child’s condition and the uncertainty and high medical costs of possible sequelae,which frequently cause anxiety,depression,and other adverse emotions.AIM To investigate the anxiety and depression status of mothers of children in the NICU and its related factors.METHODS A convenient sampling method is adopted.The research objects included the mothers of 191 children in the NICU of Suzhou Ninth Hospital Affiliated with Suzhou University from January 2023 to July 2024.The general information questionnaire,personal control scale,self-rating anxiety scale,and self-rating depression scale were utilized for investigation.Anxiety and depression status in mothers of children in the NICU and its related factors were analyzed.RESULTS The incidences of maternal anxiety and depression among 191 hospitalized children in the NICU were 32.98%(63/191)and 23.56%(45/191),respectively.Single-factor analysis reveals that family monthly income,individual sense of control,gestational age of the child,and the number of diseases in the child are associated with the anxiety and depression experienced by the mother of the child in the NICU(P<0.05).Multivariate logistic regression analysis revealed that family monthly income of<5000 yuan(RMB),poor individual control,gestational age of<32 weeks,and the number of diseases of≥3 kinds are all related factors for anxiety and depression in mothers of children admitted to the NICU(P<0.05).CONCLUSION Mothers of children admitted to the NICU demonstrated high anxiety and depression incidences.The nursing staff in the neonatal department established intervention measures for each related factor,strengthened communication and communication with the mother of the child,and did a good job in psychological counseling.展开更多
Intensivists are often plagued with the challenges of managing critically ill patients in the neurocritical intensive care unit(neuro ICU);one such challenge is the level of illness and the need for sedation,inhibitin...Intensivists are often plagued with the challenges of managing critically ill patients in the neurocritical intensive care unit(neuro ICU);one such challenge is the level of illness and the need for sedation,inhibiting the provider’s ability to adequately assess the patient.Most sedatives alter neurological and physical exam findings,only compounding potential barriers to providing the best care for each patient.It is important to emphasize that even in the altered mentation of these patients,physical and neurological exams reign supreme as diagnostic tools and should be used in conjunction with multimodal neuromonitoring methods,rather than labs or imaging alone.Additionally,selecting the appropriate analgesic(s)and sedative(s)based on these findings are highly important when determining the best course of individualized management.Thus,providers in the neuro ICU should be highly familiar with the appropriate analgesic and sedative options available in order to determine not only which may be best for each patient,but to also better understand how each drug may impact assessment findings.This comprehensive review aims to provide a structured overview of the pertinent sedatives commonly used in neuro ICUs,their risks and benefits,and how providers can best utilize each in practice to further improve patient outcomes.The novel contribution of this work provides comparative drug tables,dosing guidance for pediatric and very elderly(>85-years-old)populations,and an exploration into the future possibilities of utilizing artificial intelligence and the human gut microbiome to further enhance the prospects of precision medicine.展开更多
BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevanc...BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevance in patients with septic shock remains uncertain.AIM To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.METHODS In the present retrospective single-center study,a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University,between August 1,2018,and May 31,2023,were analyzed.Patients were categorized based on the timing of hypernatremia occurrence into the IAH group(n=62),the non-IAH group(n=41),and the normonatremia group(n=54).RESULTS In the present study,there was a significant association between the high serum sodium concentrations,excessive persistent inflammation,immunosuppression and catabolism syndrome and chronic critical illness,while rapid recovery had an apparent association with normonatremia.Moreover,multivariable analyses revealed the following independent risk factors for IAH:Total urinary output over the preceding three days[odds ratio(OR)=1.09;95%CI:1.02–1.17;P=0.014],enteral nutrition(EN)sodium content of 500 mg(OR=2.93;95%CI:1.13–7.60;P=0.027),and EN sodium content of 670 mg(OR=6.19;95%CI:1.75–21.98;P=0.005)were positively correlated with the development of IAH.Notably,the area under the curve for total urinary output over the preceding three days was 0.800(95%CI:0.678–0.922,P=0.001).Furthermore,maximum serum sodium levels,the duration of hypernatremia,and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients(P<0.05).CONCLUSION The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU.It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.展开更多
Assessment of SDG11.3.1 indicator of the United Nations Sustainable Development Goals(SDGs)is a valuable tool for policymakers in urban planning.This study aims to enhance the accuracy of the SDG11.3.1 evaluation and ...Assessment of SDG11.3.1 indicator of the United Nations Sustainable Development Goals(SDGs)is a valuable tool for policymakers in urban planning.This study aims to enhance the accuracy of the SDG11.3.1 evaluation and explore the impact of varying precision levels in urban built-up area on the indicator’s assessment outcomes.We developed an algorithm to generate accurate urban built-up area data products based on China’s Geographical Condition Monitoring data with a 2 m resolution.The study evaluates urban land-use efficiency in China from 2015 to 2020 across different geographical units using both the research product and data derived from other studies utilizing medium and low-resolution imagery.The results indicate:(1)A significant improvement in the accuracy of our urban built-up area data,with the SDG11.3.1 evaluation results demonstrating a more precise reflection of spatiotemporal characteristics.The indicator shows a positive correlation with the accuracy level of the built-up area data;(2)From 2015 to 2020,Chinese prefecture-level cities have undergone faster urbanization in terms of land expansion relative to population growth,leading to less optimal land resource utilization.Only in extra-large cities does urban population growth show a relatively balanced pattern.However,urban popula tion growth in other regions and cities of various sizes lags behind land urbanization.Notably,Northeast China and small to medium cities encounter significant challenges in urban population growth.The comprehensive framework developed for evaluating SDG11.3.1 with high-precision urban built-up area data can be adapted to different national regions,yielding more accurate SDG11.3.1 outcomes.Our urban area and built-up area data products provide crucial inputs for calculating at least four indicators related to SDG11.展开更多
BACKGROUND Stress-induced hyperglycemia(SIH)is common in critically ill patients and has been associated with adverse cardiovascular outcomes.Intensive insulin therapy(IIT)has been proposed to mitigate these risks by ...BACKGROUND Stress-induced hyperglycemia(SIH)is common in critically ill patients and has been associated with adverse cardiovascular outcomes.Intensive insulin therapy(IIT)has been proposed to mitigate these risks by achieving tighter glycemic control.AIM To evaluate the efficacy of IIT for managing SIH in critically ill patients and to explore its potential effect on cardiac function.METHODS A retrospective study was conducted at our hospital from January 2021 to December 2024,adhering to STROBE guidelines.A total of 186 critically ill pa-tients were divided into normal glycemia(n=85)and SIH(n=101)groups.The SIH cohort was further subdivided into conventional treatment(n=50)and IIT(n=51)groups.Hemodynamic parameters-including right atrial pressure(RAP),pulmonary artery pressure(PAP),pulmonary capillary wedge pressure(PAWP),cardiac output(CO),cardiac index(CI),and B-type natriuretic peptide(BNP)-were measured at baseline and post-treatment.Clinical outcomes such as intensive care unit(ICU)length of stay,mechanical ventilation requirements,and mortality were also recorded.Statistical analyses were conducted using inde-pendent samples t-tests and χ^(2)/Fisher’s exact tests.RESULTS SIH markedly worsened haemodynamics versus normal glycaemia:RAP 9.8±5.1 vs 6.1±3.5 mmHg,PAP 35.2±16.0 vs 26.2±10.3 mmHg,PAWP 16.0±7.0 vs 8.6±6.4 mmHg,CO 3.3±2.3 vs 6.0±3.3 L/min,CI 1.88±0.24 vs 2.70±0.50 L/min/m2,BNP 465±250 vs 180±53 pg/mL(all P<0.001).Within the SIH cohort,IIT outperformed conventional therapy:RAP 7.0±2.2 vs 8.3±3.9 mmHg(P=0.04),PAP 21.6±3.7 vs 29.3±6.5 mmHg(P<0.001),PAWP 10.2±5.4 vs 13.8±5.3 mmHg(P=0.001),CO 4.9±2.2 vs 4.0±1.4 L/min(P=0.022),CI 2.58±0.32 vs 2.11±0.31 L/min/m2,P<0.001),BNP 202±62 vs 346±171 pg/mL(P<0.001).Clinically,IIT shortened ICU stay(10.3±3.4 vs 14.5±2.6 days,P<0.001),reduced ventilator use(56.9%vs 76.0%,P=0.042),and lowered mortality(23.5%vs 42.0%,P=0.048).CONCLUSION IIT significantly reduced cardiac filling pressures,improved cardiac function,and was associated with favorable clinical outcomes in SIH patients,suggesting potential benefits of stricter glycaemic control in critically ill patients.However,given the retrospective design and absence of glucose-variability monitoring,these findings should be interpreted with caution.展开更多
Transferring patients with critical illnesses from general wards to intensive care units (ICUs) is a crucial and time-sensitive process. This article presents strategies for improving the efficiency of patient transfe...Transferring patients with critical illnesses from general wards to intensive care units (ICUs) is a crucial and time-sensitive process. This article presents strategies for improving the efficiency of patient transfers, particularly in hospitals where intensive care units are located in buildings separate from general wards. Patient transfers comprise several steps: physicians issue orders, relatives are notified, equipment is prepared, and medical staff coordinate. We identified three factors that influence transfer time: preparation time for bed transfer, time required for shift handovers, and time required for between-ward patient movement. Unfamiliarity with transfer routes and long elevator wait times were factors that also influenced transfer time. The following strategies were proposed: develop a standardized material checklist, design key notes for patient transfers, and optimize transfer routes. These strategies reduced transfer times by 40% to 43%. This study demonstrates that by addressing logistical challenges and streamlining relevant procedures, hospitals can enhance safety and quality of care during patient transfers.展开更多
Acute cholangitis(AC)is a heterogeneous disease with considerable variation in clinical presentation and high medical costs.Although the overall mortality rate is decreasing.However,the mortality in severe AC ranged f...Acute cholangitis(AC)is a heterogeneous disease with considerable variation in clinical presentation and high medical costs.Although the overall mortality rate is decreasing.However,the mortality in severe AC ranged from 10%-30%due to sepsis,multi-organ failure,and systemic inflammatory response syndrome.Assessing the predictors of poor outcomes,including mortality,intensive care unit(ICU)admission,and hospital stay,is vital for early and effective intervention.We assessed the predictors of mortality and ICU admission in patients with AC.We conducted a literature search in PubMed/MEDLINE,Google Scholar,and Cochrane Library for relevant articles.The keywords used were acute cholangitis,biliary cholangitis,predictors,mortality,ICU admission,and Hospital stay.In addition,we assessed the role of early vs late endoscopic retrograde cholangiopancreatography on the outcomes.Old age,end-organ failure,red cell distribution width to albumin ratio,neutrophil-to-lymphocyte ratio,platelet-lymphocyte ratio,the need for ventilator support,diabetes,electrolyte imbalance,procalcitonin-to-albumin ratio,C-reactive protein-to-albumin,Glasgow Coma Scale,and systolic hypertension are predictors of poor outcomes in AC of varying etiology,and concurrent acute pancreatitis was not associated with ICU admission.展开更多
Intensive care unit(ICU)acquired sarcopenia and myosteatosis are increasingly recognized complications of critical illness,characterized by a rapid loss of ske-letal muscle mass,quality,and function.These conditions r...Intensive care unit(ICU)acquired sarcopenia and myosteatosis are increasingly recognized complications of critical illness,characterized by a rapid loss of ske-letal muscle mass,quality,and function.These conditions result from a complex interplay of systemic inflammation,immobilization,catabolic stress,mitochon-drial dysfunction,and immune dysregulation,often culminating in impaired recovery,prolonged hospitalization,and increased long-term mortality.First identified in survivors of sepsis and prolonged mechanical ventilation,these muscle abnormalities were initially described using computed tomography-based assessments of muscle area and density.Subsequent advances in imaging,biomarker discovery,and functional testing have enabled earlier detection and risk stratification across diverse ICU populations.While nutritional optimization and early mobilization form the cornerstone of current prevention and treatment strategies,the emergence of novel approaches,including automated artificial intelligence-based screening,neuromuscular electrical stimulation,and targeted pharmacologic therapies,has broadened the clinical scope of interventions.Despite their significant prognostic implications,ICU-acquired sarcopenia and myosteatosis remain under-recognized in routine critical care practice.This mini-review aims to synthesize current knowledge regarding their pathophysiology,available diagnostic modalities,prognostic relevance,and the evolving landscape of therapeutic strategies for long-term functional recovery in critically ill patients.展开更多
In order to enhance the guidance for Yuluxiang pear cultivation in hilly and mountainous regions, this study provides a comprehensive introduction to various aspects, including the establishment of high-standard orcha...In order to enhance the guidance for Yuluxiang pear cultivation in hilly and mountainous regions, this study provides a comprehensive introduction to various aspects, including the establishment of high-standard orchards and the reinforcement of integrated management techniques, in order to offer a valuable reference for fruit farmers engaged in scientific planting practices.展开更多
Objective To explore the relationship between serum chloride levels and prognosis in patients with hepatic coma in the intensive care unit(ICU).Methods We analyzed 545 patients with hepatic coma in the ICU from the Me...Objective To explore the relationship between serum chloride levels and prognosis in patients with hepatic coma in the intensive care unit(ICU).Methods We analyzed 545 patients with hepatic coma in the ICU from the Medical Information Mart for Intensive Care IV(MIMIC-IV)database.Associations between serum chloride levels and 28-day and 1-year mortality rates were assessed using restricted cubic splines(RCSs),Kaplan-Meier(KM)curves,and Cox regression.Subgroup analyses,external validation,and mechanistic studies were also performed.Results A total of 545 patients were included in the study.RCS analysis revealed a U-shaped association between serum chloride levels and mortality in patients with hepatic coma.The KM curves indicated lower survival rates among patients with low chloride levels(<103 mmol/L).Low chloride levels were independently linked to increased 28-day and 1-year all-cause mortality rates.In the multivariate models,the hazard ratio(HR)for 28-day mortality in the low-chloride group was 1.424(95%confidence interval[CI]:1.041–1.949),while the adjusted hazard ratio for 1-year mortality was 1.313(95%CI:1.026–1.679).Subgroup analyses and external validation supported these findings.Cytological experiments suggested that low chloride levels may activate the phosphorylation of the NF-κB signaling pathway,promote the expression of pro-inflammatory cytokines,and reduce neuronal cell viability.Conclusion Low serum chloride levels are independently associated with increased mortality in patients with hepatic coma.展开更多
BACKGROUND Colorectal cancer(CRC)is one of the most common cancers and CRC patients are among the most common intensive care unit(ICU)admitted cancer patients.However,their prognosis and evaluation methods are rarely ...BACKGROUND Colorectal cancer(CRC)is one of the most common cancers and CRC patients are among the most common intensive care unit(ICU)admitted cancer patients.However,their prognosis and evaluation methods are rarely studied.AIM To determine the short-term mortality outcome and identify the potential prognostic factors of CRC cancer patients admitted to the ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at the ICU departments of 37 cancer specialized hospitals in China,and included patients aged≥14 years with ICU duration≥24 hours.Clinical records of patients with a primary CRC diagnosis were reviewed.Patients were separated into groups according to 90-day survival.Characteristics between groups were compared.Univariate and multivariate regression tests were used to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS In total,189 CRC patients were included in the study.The 90-day mortality was 12.2%.Patients who died showed differences compared to patients who survived mostly in terms of disease severity and ICU complications.It appears that patients admitted to the ICU from a clinical ward due to emergencies may have a higher risk of mortality while surgical management was associated with better survival.In multivariate analysis,only chemotherapy,elective surgery and conventional oxygen therapy were identified as independently correlated with 90-day mortality.Sequential organ failure assessment and acute physiology and chronic health evaluation II scores had moderate accuracy in predicting short-term mortality.CONCLUSION ICU admitted CRC patients appear to have low short-term mortality which requires further confirmation in prospective studies.The prognostic tools for these patients need further optimization.展开更多
BACKGROUND Analgesia and sedation are commonly prescribed therapies within the intensive care unit(ICU)for patients receiving mechanical ventilation.Current guidelines recommend utilizing an analgesia-first approach t...BACKGROUND Analgesia and sedation are commonly prescribed therapies within the intensive care unit(ICU)for patients receiving mechanical ventilation.Current guidelines recommend utilizing an analgesia-first approach to initially reach appropriate pain control,while potentially achieving sedation goals concurrently.Our system employs a guideline-based ICU sedation order-set that features an electronic medical record(EMR)integrated ICU checklist that combines analgesia and sedation.AIM To identify systems-based factors that are associated with the use of continuous midazolam infusion administration in mechanically ventilated patients.METHODS We extracted EMR data from patients who received mechanical ventilation between January 1,2021,and December 31,2023.Subjects included were 18 years or older who received mechanical ventilation.“R”version 4.3.2 was used for data processing and statistical analysis.We performed a multivariable regression analysis to predict the administration of a continuous midazolam infusion with modified Sequential Organ Failure Assessment score,Charlson comorbidity index,and critical care medicine(CCM)primary service.RESULTS Of 3805 patients that underwent mechanical ventilation,62%were male,with a mean age of 66.9 years.3429 patients were treated by a provider team with a CCM attending,and 376 patients were managed by a non-CCM primary team with CCM consultative services.A midazolam infusion was used in 187 of 3429(5%)patients with CCM as primary and in 166 of 376(56%)patients with non-CCM primary(χ2598.23,P<0.001).Of the patients who received continuous midazolam,117(21%)died vs 236(7%)survived hospitalization.Continuous midazolam was associated with more days with coma and more days with delirium(P<0.0001).CONCLUSION Continuous midazolam infusion was more likely in patients admitted to the ICU under an open unit with a non-CCM physician with an intensivist consult available,despite guided order-sets and checklists integrated into the EMR.展开更多
Desmopressin(1-deamino-8-D-arginine vasopressin,DDAVP)is a synthetic analogue of arginine vasopressin,the body’s natural antidiuretic hormone.It acts selectively on V2 receptors,promoting renal water reabsorption and...Desmopressin(1-deamino-8-D-arginine vasopressin,DDAVP)is a synthetic analogue of arginine vasopressin,the body’s natural antidiuretic hormone.It acts selectively on V2 receptors,promoting renal water reabsorption and stimulating the release of von Willebrand factor(vWF)and factor VIII,while exerting minimal vasoconstrictive effects through V1 receptors.Developed in the late 1960s and introduced clinically in the early 1970s for the management of central diabetes insipidus,desmopressin was engineered to provide a longer duration of action and reduced cardiovascular side effects compared to native vasopressin.Its haemostatic potential was later recognized when it was observed to enhance endogenous levels of vWF and factor VIII,leading to its incorporation into the treatment of mild haemophilia A and von Willebrand disease(vWD).This unique combination of antidiuretic and prohemostatic properties has broadened its therapeutic role across various clinical settings.In critical care,desmopressin has emerged as a potentially valuable agent in managing complex scenarios such as uremic platelet dysfunction,trauma-associated coagulopathy,intracranial hemorrhage,vWD,and central diabetes insipidus.However,despite its mechanistic appeal and broad pharmacologic utility,the full scope of desmopressin’s applications in the intensive care unit(ICU)remains underrecognized.This review aims to provide a comprehensive examination of desmopressin’s pharmacological characteristics,evidence-based indications in critically ill patients,therapeutic efficacy,safety profile,and practical considerations for dosing in the ICU setting.展开更多
This letter provides commentary on the manuscript“Intensive care unit outcomes and prognostic factors of colorectal cancer”.The study is the first to present multicenter data on the 90-day mortality of patients with...This letter provides commentary on the manuscript“Intensive care unit outcomes and prognostic factors of colorectal cancer”.The study is the first to present multicenter data on the 90-day mortality of patients with colorectal cancer admitted to the intensive care unit,and identifies chemotherapy history,elective surgery,and conventional oxygen therapy as independent prognostic factors.We propose three refinements to enhance the study’s clinical utility:Clarify chemotherapy details,including regimen and treatment phase,along with the surgical approach(curative vs palliative)and how preoperative tumor staging influences prognosis;elucidate the relationship between intensive care unit admission etiologies and prognosis;and incorporate colorectal cancer-specific biomarkers to optimize prognostic scoring systems.The study’s core contribution is substantial,and refinement of the details will further enhance its clinical translational relevance.展开更多
Intensive farming practices,aimed at maximizing crop yields through substantial inputs of labour,technology,and chemical fertilizers,have significantly transformed modern agriculture.However,these methods have raised ...Intensive farming practices,aimed at maximizing crop yields through substantial inputs of labour,technology,and chemical fertilizers,have significantly transformed modern agriculture.However,these methods have raised serious concerns regarding soil health,environmental sustainability,and long-term agricultural viability.This study examines the ecological impact of intensive farming on soil health in the KB Asifabad District of Telangana,India,where traditional and modern farming techniques coexist.The objectives include analysing socio-economic factors influencing farming methods,evaluating the impact of tilling techniques and fertilizer use on soil health,and promoting sustainable practices through education and policy recommendations.Findings reveal a strong reliance on chemical fertilizers,with 98.3% of farmers using them exclusively due to their perceived efficiency and rapid results.However,this overdependence has led to soil degradation,reduced microbial diversity,and environmental pollution.Conversely,despite its ecological benefits,natural manure remains underutilized due to scepticism and economic constraints.Mechanical tilling methods,while effective,have negatively impacted soil structure and fertility.The study highlights the necessity of transitioning to sustainable practices,integrating organic inputs,and adopting conservation techniques to restore soil health and ecosystem balance.This research provides practical pathways for achieving sustainable agriculture by integrating traditional knowledge with modern practices.It is particularly relevant for policymakers,agricultural extension services,and farming communities as it highlights the need for educational initiatives,financial incentives,and regulatory measures to ensure long-term soil fertility,environmental stewardship,and improved farmer livelihoods.展开更多
Objective:To determine the incidence,risk factors,antibiotic resistance patterns,and outcomes of various nosocomial infections in Intensive Care Unit(ICU)patients.Methods:The present prospective observational study wa...Objective:To determine the incidence,risk factors,antibiotic resistance patterns,and outcomes of various nosocomial infections in Intensive Care Unit(ICU)patients.Methods:The present prospective observational study was conducted in the multidisciplinary ICU of a tertiary care hospital for 6 months.Incidence,risk factors,and outcome parameters were calculated using Mann Whitney U test,Chi-square test,and stepwise univariate and multivariate logistic regression analysis.Results:The overall incidence of nosocomial infections was 23.5%(74/314).Ventilator-associated pneumonia was the most common infection(54.1%,52/96),followed by catheter-related bloodstream infections(22.9%,22/96).Stress ulcer prophylaxis(aOR 7.691,95%CI 2.202-26.860,P=0.001),endotracheal intubation(aOR 3.251,95%CI 1.251-8.420,P=0.015),Foley’s catheter(aOR 11.917,95%CI 1.335-106.410,P=0.027),and ICU stay>7 days(aOR 30.915,95%CI 10.062-94.980,P=0.001)were statistically significant risk factors associated with nosocomial infection in ICU patients.Gram-negative bacteria showed a high degree of resistance to most of antibiotics except colistin and tigecycline.Infected group's mortality was significantly greater than the uninfected group(21.62%vs.5.83%P<0.001)and had considerably longer ICU length of stay[21(12)vs.7(4)days,P<0.001]and duration of mechanical ventilation[20(11)days vs.0(5)days,P<0.001].Conclusions:This study highlights the high incidence rate of ventilator-associated pneumonia,with extensive drug resistance in ICU patients,highlighting the need for an optimized antimicrobial stewardship program to develop effective strategies for the management of nosocomial infections.Multifaceted interventions targeting modifiable risk factors are essential to reduce the occurences of these nosocomial infections in ICU patients.展开更多
Objective:To investigate the impact of early initiation of intensive lipid-lowering therapy on the postoperative efficacy and inflammatory factors in patients with acute coronary syndrome(ACS)undergoing percutaneous c...Objective:To investigate the impact of early initiation of intensive lipid-lowering therapy on the postoperative efficacy and inflammatory factors in patients with acute coronary syndrome(ACS)undergoing percutaneous coronary intervention(PCI).Methods:A total of 100 ACS patients undergoing PCI admitted to our hospital were selected as the study subjects.They were randomly divided into a control group(treated with statin combined with ezetimibe,n=41),a study group 1(initiated with statin combined with PCSK9 inhibitor immediately after surgery,n=32),and a study group 2(routinely administered oral statin and initiated with combined PCSK9 inhibitor before discharge,n=27).The therapeutic efficacy,inflammatory factor levels,and incidence of adverse events were compared and analyzed among the three groups.Results:The therapeutic regimen in study group 1 demonstrated the optimal efficacy and impact on inflammatory factors,followed by study group 2,while the control group showed relatively weaker efficacy,with statistically significant differences(p<0.05).The overall incidence of adverse reactions was 30.00%in the control group,5.00%in study group 1,and 10.00%in study group 2,with statistically significant differences among the groups(p<0.05),with the lowest incidence observed in study group 1.Conclusion:Early intensive lipid-lowering therapy can effectively improve lipid metabolism,suppress inflammatory responses,and reduce cardiovascular events in ACS patients after PCI,suggesting its pleiotropic cardiovascular protective effects.展开更多
基金Project supported by the National Natural Science Foundation of China (No. 40571160)the Experimental Program of Cultivated Land Fertility Investigation and Quality Evaluation of the Agricultural Department of China (No. 2002-23).
文摘On the basis of the data obtained from a field survey, the relationship between land use and soil nutrients was evaluated in Qingzhou County, Shandong Province, China, through a statistical analysis of differences in 17 nutrients in five types of cultivated land. The results showed significant effects (P < 0.05 or P < 0.01) of land-use type on soil organic matter and concentration of macronutrients, secondary nutrients, and micronutrients, as well as total salt and soil pH. In vegetable land, because of the large amounts of fertilizer applied to vegetable crops, the concentrations of most soil nutrients, with exception of available Si and micronutrients, were higher than those in grain cropland. Grain cropland had a significantly lower total salt content (P < 0.01) and tended to have a higher soil pH than vegetable land. Within subtypes of land use, dry land, irrigable land, and open-air vegetable land had the highest coefficient of variation (CV) for available P, whereas protected vegetable land had the highest CV for total N and available S. In general, land-use types had greater impact on macronutrients than on secondary nutrients and micronutrients.
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Unplanned intensive care unit(ICU)admissions(UP-ICU)following initial general ward placement are associated with poor patient outcomes and represent a key quality indicator for healthcare facilities.Healthcare facilities have employed numerous predictive models,such as physiological scores(e.g.,Acute Physiology and Chronic Health Evaluation II,Revised Trauma Score,and Mortality Probability Model II at 24 hours)and anatomical scores(Injury Severity Score and New Injury Severity Score),to identify high-risk patients.Although physiological scores frequently surpass anatomical scores in predicting mortality,their specificity for trauma patients is limited,and their clinical applicability may be limited.Initially proposed for ICU readmission prediction,the stability and workload index for the transfer score has demonstrated inconsistent validity.Machine learning offers a promising alternative.Several studies have shown that machine learning models,including those that use electronic health records(EHR)data,can more accurately predict trauma patients’deaths and admissions to the ICU than traditional scoring systems.These models identify unique predictors that are not captured by existing methods.However,challenges remain,including integration with EHR systems and data entry complexities.Critical care outreach programs and telemedicine can help reduce UP-ICU admissions;however,their effectiveness remains unclear because of costs and implementation challenges,respectively.Strategies to reduce UP-ICU admissions include improving triage systems,implementing evidence-based protocols for ICU patient management,and prioritizing prehospital intervention and stabilization to optimize the“golden hour”of trauma care.To improve patient outcomes and reduce the burden of UPICU admissions,further studies are required to validate and implement these strategies and refine machine learning models.
文摘BACKGROUND Newborns are immediately admitted to the neonatal intensive care unit(NICU)after birth,and thus mothers suffer from the pain of mother-infant separation.Some mothers worry about alterations in their child’s condition and the uncertainty and high medical costs of possible sequelae,which frequently cause anxiety,depression,and other adverse emotions.AIM To investigate the anxiety and depression status of mothers of children in the NICU and its related factors.METHODS A convenient sampling method is adopted.The research objects included the mothers of 191 children in the NICU of Suzhou Ninth Hospital Affiliated with Suzhou University from January 2023 to July 2024.The general information questionnaire,personal control scale,self-rating anxiety scale,and self-rating depression scale were utilized for investigation.Anxiety and depression status in mothers of children in the NICU and its related factors were analyzed.RESULTS The incidences of maternal anxiety and depression among 191 hospitalized children in the NICU were 32.98%(63/191)and 23.56%(45/191),respectively.Single-factor analysis reveals that family monthly income,individual sense of control,gestational age of the child,and the number of diseases in the child are associated with the anxiety and depression experienced by the mother of the child in the NICU(P<0.05).Multivariate logistic regression analysis revealed that family monthly income of<5000 yuan(RMB),poor individual control,gestational age of<32 weeks,and the number of diseases of≥3 kinds are all related factors for anxiety and depression in mothers of children admitted to the NICU(P<0.05).CONCLUSION Mothers of children admitted to the NICU demonstrated high anxiety and depression incidences.The nursing staff in the neonatal department established intervention measures for each related factor,strengthened communication and communication with the mother of the child,and did a good job in psychological counseling.
文摘Intensivists are often plagued with the challenges of managing critically ill patients in the neurocritical intensive care unit(neuro ICU);one such challenge is the level of illness and the need for sedation,inhibiting the provider’s ability to adequately assess the patient.Most sedatives alter neurological and physical exam findings,only compounding potential barriers to providing the best care for each patient.It is important to emphasize that even in the altered mentation of these patients,physical and neurological exams reign supreme as diagnostic tools and should be used in conjunction with multimodal neuromonitoring methods,rather than labs or imaging alone.Additionally,selecting the appropriate analgesic(s)and sedative(s)based on these findings are highly important when determining the best course of individualized management.Thus,providers in the neuro ICU should be highly familiar with the appropriate analgesic and sedative options available in order to determine not only which may be best for each patient,but to also better understand how each drug may impact assessment findings.This comprehensive review aims to provide a structured overview of the pertinent sedatives commonly used in neuro ICUs,their risks and benefits,and how providers can best utilize each in practice to further improve patient outcomes.The novel contribution of this work provides comparative drug tables,dosing guidance for pediatric and very elderly(>85-years-old)populations,and an exploration into the future possibilities of utilizing artificial intelligence and the human gut microbiome to further enhance the prospects of precision medicine.
基金Supported by The National Natural Science Foundation of China,No.82072130Key Medical Research Projects in Jiangsu Province,No.ZD2022021Suzhou Clinical Medical Center for Anesthesiology,No.Szlcyxzxj202102。
文摘BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevance in patients with septic shock remains uncertain.AIM To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.METHODS In the present retrospective single-center study,a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University,between August 1,2018,and May 31,2023,were analyzed.Patients were categorized based on the timing of hypernatremia occurrence into the IAH group(n=62),the non-IAH group(n=41),and the normonatremia group(n=54).RESULTS In the present study,there was a significant association between the high serum sodium concentrations,excessive persistent inflammation,immunosuppression and catabolism syndrome and chronic critical illness,while rapid recovery had an apparent association with normonatremia.Moreover,multivariable analyses revealed the following independent risk factors for IAH:Total urinary output over the preceding three days[odds ratio(OR)=1.09;95%CI:1.02–1.17;P=0.014],enteral nutrition(EN)sodium content of 500 mg(OR=2.93;95%CI:1.13–7.60;P=0.027),and EN sodium content of 670 mg(OR=6.19;95%CI:1.75–21.98;P=0.005)were positively correlated with the development of IAH.Notably,the area under the curve for total urinary output over the preceding three days was 0.800(95%CI:0.678–0.922,P=0.001).Furthermore,maximum serum sodium levels,the duration of hypernatremia,and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients(P<0.05).CONCLUSION The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU.It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.
基金funded by the National Key Research and De-velopment Program of China(Grant No.2023YFC3804001)the Natural Resources Planning and Management Project(Grant No.A2417,A2418)the Fundamental Scientific Research Funds for Central Public Wel-fare Research Institutes(Grant No.AR2409).
文摘Assessment of SDG11.3.1 indicator of the United Nations Sustainable Development Goals(SDGs)is a valuable tool for policymakers in urban planning.This study aims to enhance the accuracy of the SDG11.3.1 evaluation and explore the impact of varying precision levels in urban built-up area on the indicator’s assessment outcomes.We developed an algorithm to generate accurate urban built-up area data products based on China’s Geographical Condition Monitoring data with a 2 m resolution.The study evaluates urban land-use efficiency in China from 2015 to 2020 across different geographical units using both the research product and data derived from other studies utilizing medium and low-resolution imagery.The results indicate:(1)A significant improvement in the accuracy of our urban built-up area data,with the SDG11.3.1 evaluation results demonstrating a more precise reflection of spatiotemporal characteristics.The indicator shows a positive correlation with the accuracy level of the built-up area data;(2)From 2015 to 2020,Chinese prefecture-level cities have undergone faster urbanization in terms of land expansion relative to population growth,leading to less optimal land resource utilization.Only in extra-large cities does urban population growth show a relatively balanced pattern.However,urban popula tion growth in other regions and cities of various sizes lags behind land urbanization.Notably,Northeast China and small to medium cities encounter significant challenges in urban population growth.The comprehensive framework developed for evaluating SDG11.3.1 with high-precision urban built-up area data can be adapted to different national regions,yielding more accurate SDG11.3.1 outcomes.Our urban area and built-up area data products provide crucial inputs for calculating at least four indicators related to SDG11.
文摘BACKGROUND Stress-induced hyperglycemia(SIH)is common in critically ill patients and has been associated with adverse cardiovascular outcomes.Intensive insulin therapy(IIT)has been proposed to mitigate these risks by achieving tighter glycemic control.AIM To evaluate the efficacy of IIT for managing SIH in critically ill patients and to explore its potential effect on cardiac function.METHODS A retrospective study was conducted at our hospital from January 2021 to December 2024,adhering to STROBE guidelines.A total of 186 critically ill pa-tients were divided into normal glycemia(n=85)and SIH(n=101)groups.The SIH cohort was further subdivided into conventional treatment(n=50)and IIT(n=51)groups.Hemodynamic parameters-including right atrial pressure(RAP),pulmonary artery pressure(PAP),pulmonary capillary wedge pressure(PAWP),cardiac output(CO),cardiac index(CI),and B-type natriuretic peptide(BNP)-were measured at baseline and post-treatment.Clinical outcomes such as intensive care unit(ICU)length of stay,mechanical ventilation requirements,and mortality were also recorded.Statistical analyses were conducted using inde-pendent samples t-tests and χ^(2)/Fisher’s exact tests.RESULTS SIH markedly worsened haemodynamics versus normal glycaemia:RAP 9.8±5.1 vs 6.1±3.5 mmHg,PAP 35.2±16.0 vs 26.2±10.3 mmHg,PAWP 16.0±7.0 vs 8.6±6.4 mmHg,CO 3.3±2.3 vs 6.0±3.3 L/min,CI 1.88±0.24 vs 2.70±0.50 L/min/m2,BNP 465±250 vs 180±53 pg/mL(all P<0.001).Within the SIH cohort,IIT outperformed conventional therapy:RAP 7.0±2.2 vs 8.3±3.9 mmHg(P=0.04),PAP 21.6±3.7 vs 29.3±6.5 mmHg(P<0.001),PAWP 10.2±5.4 vs 13.8±5.3 mmHg(P=0.001),CO 4.9±2.2 vs 4.0±1.4 L/min(P=0.022),CI 2.58±0.32 vs 2.11±0.31 L/min/m2,P<0.001),BNP 202±62 vs 346±171 pg/mL(P<0.001).Clinically,IIT shortened ICU stay(10.3±3.4 vs 14.5±2.6 days,P<0.001),reduced ventilator use(56.9%vs 76.0%,P=0.042),and lowered mortality(23.5%vs 42.0%,P=0.048).CONCLUSION IIT significantly reduced cardiac filling pressures,improved cardiac function,and was associated with favorable clinical outcomes in SIH patients,suggesting potential benefits of stricter glycaemic control in critically ill patients.However,given the retrospective design and absence of glucose-variability monitoring,these findings should be interpreted with caution.
文摘Transferring patients with critical illnesses from general wards to intensive care units (ICUs) is a crucial and time-sensitive process. This article presents strategies for improving the efficiency of patient transfers, particularly in hospitals where intensive care units are located in buildings separate from general wards. Patient transfers comprise several steps: physicians issue orders, relatives are notified, equipment is prepared, and medical staff coordinate. We identified three factors that influence transfer time: preparation time for bed transfer, time required for shift handovers, and time required for between-ward patient movement. Unfamiliarity with transfer routes and long elevator wait times were factors that also influenced transfer time. The following strategies were proposed: develop a standardized material checklist, design key notes for patient transfers, and optimize transfer routes. These strategies reduced transfer times by 40% to 43%. This study demonstrates that by addressing logistical challenges and streamlining relevant procedures, hospitals can enhance safety and quality of care during patient transfers.
文摘Acute cholangitis(AC)is a heterogeneous disease with considerable variation in clinical presentation and high medical costs.Although the overall mortality rate is decreasing.However,the mortality in severe AC ranged from 10%-30%due to sepsis,multi-organ failure,and systemic inflammatory response syndrome.Assessing the predictors of poor outcomes,including mortality,intensive care unit(ICU)admission,and hospital stay,is vital for early and effective intervention.We assessed the predictors of mortality and ICU admission in patients with AC.We conducted a literature search in PubMed/MEDLINE,Google Scholar,and Cochrane Library for relevant articles.The keywords used were acute cholangitis,biliary cholangitis,predictors,mortality,ICU admission,and Hospital stay.In addition,we assessed the role of early vs late endoscopic retrograde cholangiopancreatography on the outcomes.Old age,end-organ failure,red cell distribution width to albumin ratio,neutrophil-to-lymphocyte ratio,platelet-lymphocyte ratio,the need for ventilator support,diabetes,electrolyte imbalance,procalcitonin-to-albumin ratio,C-reactive protein-to-albumin,Glasgow Coma Scale,and systolic hypertension are predictors of poor outcomes in AC of varying etiology,and concurrent acute pancreatitis was not associated with ICU admission.
文摘Intensive care unit(ICU)acquired sarcopenia and myosteatosis are increasingly recognized complications of critical illness,characterized by a rapid loss of ske-letal muscle mass,quality,and function.These conditions result from a complex interplay of systemic inflammation,immobilization,catabolic stress,mitochon-drial dysfunction,and immune dysregulation,often culminating in impaired recovery,prolonged hospitalization,and increased long-term mortality.First identified in survivors of sepsis and prolonged mechanical ventilation,these muscle abnormalities were initially described using computed tomography-based assessments of muscle area and density.Subsequent advances in imaging,biomarker discovery,and functional testing have enabled earlier detection and risk stratification across diverse ICU populations.While nutritional optimization and early mobilization form the cornerstone of current prevention and treatment strategies,the emergence of novel approaches,including automated artificial intelligence-based screening,neuromuscular electrical stimulation,and targeted pharmacologic therapies,has broadened the clinical scope of interventions.Despite their significant prognostic implications,ICU-acquired sarcopenia and myosteatosis remain under-recognized in routine critical care practice.This mini-review aims to synthesize current knowledge regarding their pathophysiology,available diagnostic modalities,prognostic relevance,and the evolving landscape of therapeutic strategies for long-term functional recovery in critically ill patients.
文摘In order to enhance the guidance for Yuluxiang pear cultivation in hilly and mountainous regions, this study provides a comprehensive introduction to various aspects, including the establishment of high-standard orchards and the reinforcement of integrated management techniques, in order to offer a valuable reference for fruit farmers engaged in scientific planting practices.
文摘Objective To explore the relationship between serum chloride levels and prognosis in patients with hepatic coma in the intensive care unit(ICU).Methods We analyzed 545 patients with hepatic coma in the ICU from the Medical Information Mart for Intensive Care IV(MIMIC-IV)database.Associations between serum chloride levels and 28-day and 1-year mortality rates were assessed using restricted cubic splines(RCSs),Kaplan-Meier(KM)curves,and Cox regression.Subgroup analyses,external validation,and mechanistic studies were also performed.Results A total of 545 patients were included in the study.RCS analysis revealed a U-shaped association between serum chloride levels and mortality in patients with hepatic coma.The KM curves indicated lower survival rates among patients with low chloride levels(<103 mmol/L).Low chloride levels were independently linked to increased 28-day and 1-year all-cause mortality rates.In the multivariate models,the hazard ratio(HR)for 28-day mortality in the low-chloride group was 1.424(95%confidence interval[CI]:1.041–1.949),while the adjusted hazard ratio for 1-year mortality was 1.313(95%CI:1.026–1.679).Subgroup analyses and external validation supported these findings.Cytological experiments suggested that low chloride levels may activate the phosphorylation of the NF-κB signaling pathway,promote the expression of pro-inflammatory cytokines,and reduce neuronal cell viability.Conclusion Low serum chloride levels are independently associated with increased mortality in patients with hepatic coma.
文摘BACKGROUND Colorectal cancer(CRC)is one of the most common cancers and CRC patients are among the most common intensive care unit(ICU)admitted cancer patients.However,their prognosis and evaluation methods are rarely studied.AIM To determine the short-term mortality outcome and identify the potential prognostic factors of CRC cancer patients admitted to the ICU.METHODS A multicenter cross-sectional study was performed from May 10,2021 to July 10,2021 at the ICU departments of 37 cancer specialized hospitals in China,and included patients aged≥14 years with ICU duration≥24 hours.Clinical records of patients with a primary CRC diagnosis were reviewed.Patients were separated into groups according to 90-day survival.Characteristics between groups were compared.Univariate and multivariate regression tests were used to analyze the correlated factors of ICU outcomes.Predictive values of disease severity scores were assessed using receiver operating characteristic curve analysis.RESULTS In total,189 CRC patients were included in the study.The 90-day mortality was 12.2%.Patients who died showed differences compared to patients who survived mostly in terms of disease severity and ICU complications.It appears that patients admitted to the ICU from a clinical ward due to emergencies may have a higher risk of mortality while surgical management was associated with better survival.In multivariate analysis,only chemotherapy,elective surgery and conventional oxygen therapy were identified as independently correlated with 90-day mortality.Sequential organ failure assessment and acute physiology and chronic health evaluation II scores had moderate accuracy in predicting short-term mortality.CONCLUSION ICU admitted CRC patients appear to have low short-term mortality which requires further confirmation in prospective studies.The prognostic tools for these patients need further optimization.
文摘BACKGROUND Analgesia and sedation are commonly prescribed therapies within the intensive care unit(ICU)for patients receiving mechanical ventilation.Current guidelines recommend utilizing an analgesia-first approach to initially reach appropriate pain control,while potentially achieving sedation goals concurrently.Our system employs a guideline-based ICU sedation order-set that features an electronic medical record(EMR)integrated ICU checklist that combines analgesia and sedation.AIM To identify systems-based factors that are associated with the use of continuous midazolam infusion administration in mechanically ventilated patients.METHODS We extracted EMR data from patients who received mechanical ventilation between January 1,2021,and December 31,2023.Subjects included were 18 years or older who received mechanical ventilation.“R”version 4.3.2 was used for data processing and statistical analysis.We performed a multivariable regression analysis to predict the administration of a continuous midazolam infusion with modified Sequential Organ Failure Assessment score,Charlson comorbidity index,and critical care medicine(CCM)primary service.RESULTS Of 3805 patients that underwent mechanical ventilation,62%were male,with a mean age of 66.9 years.3429 patients were treated by a provider team with a CCM attending,and 376 patients were managed by a non-CCM primary team with CCM consultative services.A midazolam infusion was used in 187 of 3429(5%)patients with CCM as primary and in 166 of 376(56%)patients with non-CCM primary(χ2598.23,P<0.001).Of the patients who received continuous midazolam,117(21%)died vs 236(7%)survived hospitalization.Continuous midazolam was associated with more days with coma and more days with delirium(P<0.0001).CONCLUSION Continuous midazolam infusion was more likely in patients admitted to the ICU under an open unit with a non-CCM physician with an intensivist consult available,despite guided order-sets and checklists integrated into the EMR.
文摘Desmopressin(1-deamino-8-D-arginine vasopressin,DDAVP)is a synthetic analogue of arginine vasopressin,the body’s natural antidiuretic hormone.It acts selectively on V2 receptors,promoting renal water reabsorption and stimulating the release of von Willebrand factor(vWF)and factor VIII,while exerting minimal vasoconstrictive effects through V1 receptors.Developed in the late 1960s and introduced clinically in the early 1970s for the management of central diabetes insipidus,desmopressin was engineered to provide a longer duration of action and reduced cardiovascular side effects compared to native vasopressin.Its haemostatic potential was later recognized when it was observed to enhance endogenous levels of vWF and factor VIII,leading to its incorporation into the treatment of mild haemophilia A and von Willebrand disease(vWD).This unique combination of antidiuretic and prohemostatic properties has broadened its therapeutic role across various clinical settings.In critical care,desmopressin has emerged as a potentially valuable agent in managing complex scenarios such as uremic platelet dysfunction,trauma-associated coagulopathy,intracranial hemorrhage,vWD,and central diabetes insipidus.However,despite its mechanistic appeal and broad pharmacologic utility,the full scope of desmopressin’s applications in the intensive care unit(ICU)remains underrecognized.This review aims to provide a comprehensive examination of desmopressin’s pharmacological characteristics,evidence-based indications in critically ill patients,therapeutic efficacy,safety profile,and practical considerations for dosing in the ICU setting.
文摘This letter provides commentary on the manuscript“Intensive care unit outcomes and prognostic factors of colorectal cancer”.The study is the first to present multicenter data on the 90-day mortality of patients with colorectal cancer admitted to the intensive care unit,and identifies chemotherapy history,elective surgery,and conventional oxygen therapy as independent prognostic factors.We propose three refinements to enhance the study’s clinical utility:Clarify chemotherapy details,including regimen and treatment phase,along with the surgical approach(curative vs palliative)and how preoperative tumor staging influences prognosis;elucidate the relationship between intensive care unit admission etiologies and prognosis;and incorporate colorectal cancer-specific biomarkers to optimize prognostic scoring systems.The study’s core contribution is substantial,and refinement of the details will further enhance its clinical translational relevance.
文摘Intensive farming practices,aimed at maximizing crop yields through substantial inputs of labour,technology,and chemical fertilizers,have significantly transformed modern agriculture.However,these methods have raised serious concerns regarding soil health,environmental sustainability,and long-term agricultural viability.This study examines the ecological impact of intensive farming on soil health in the KB Asifabad District of Telangana,India,where traditional and modern farming techniques coexist.The objectives include analysing socio-economic factors influencing farming methods,evaluating the impact of tilling techniques and fertilizer use on soil health,and promoting sustainable practices through education and policy recommendations.Findings reveal a strong reliance on chemical fertilizers,with 98.3% of farmers using them exclusively due to their perceived efficiency and rapid results.However,this overdependence has led to soil degradation,reduced microbial diversity,and environmental pollution.Conversely,despite its ecological benefits,natural manure remains underutilized due to scepticism and economic constraints.Mechanical tilling methods,while effective,have negatively impacted soil structure and fertility.The study highlights the necessity of transitioning to sustainable practices,integrating organic inputs,and adopting conservation techniques to restore soil health and ecosystem balance.This research provides practical pathways for achieving sustainable agriculture by integrating traditional knowledge with modern practices.It is particularly relevant for policymakers,agricultural extension services,and farming communities as it highlights the need for educational initiatives,financial incentives,and regulatory measures to ensure long-term soil fertility,environmental stewardship,and improved farmer livelihoods.
文摘Objective:To determine the incidence,risk factors,antibiotic resistance patterns,and outcomes of various nosocomial infections in Intensive Care Unit(ICU)patients.Methods:The present prospective observational study was conducted in the multidisciplinary ICU of a tertiary care hospital for 6 months.Incidence,risk factors,and outcome parameters were calculated using Mann Whitney U test,Chi-square test,and stepwise univariate and multivariate logistic regression analysis.Results:The overall incidence of nosocomial infections was 23.5%(74/314).Ventilator-associated pneumonia was the most common infection(54.1%,52/96),followed by catheter-related bloodstream infections(22.9%,22/96).Stress ulcer prophylaxis(aOR 7.691,95%CI 2.202-26.860,P=0.001),endotracheal intubation(aOR 3.251,95%CI 1.251-8.420,P=0.015),Foley’s catheter(aOR 11.917,95%CI 1.335-106.410,P=0.027),and ICU stay>7 days(aOR 30.915,95%CI 10.062-94.980,P=0.001)were statistically significant risk factors associated with nosocomial infection in ICU patients.Gram-negative bacteria showed a high degree of resistance to most of antibiotics except colistin and tigecycline.Infected group's mortality was significantly greater than the uninfected group(21.62%vs.5.83%P<0.001)and had considerably longer ICU length of stay[21(12)vs.7(4)days,P<0.001]and duration of mechanical ventilation[20(11)days vs.0(5)days,P<0.001].Conclusions:This study highlights the high incidence rate of ventilator-associated pneumonia,with extensive drug resistance in ICU patients,highlighting the need for an optimized antimicrobial stewardship program to develop effective strategies for the management of nosocomial infections.Multifaceted interventions targeting modifiable risk factors are essential to reduce the occurences of these nosocomial infections in ICU patients.
文摘Objective:To investigate the impact of early initiation of intensive lipid-lowering therapy on the postoperative efficacy and inflammatory factors in patients with acute coronary syndrome(ACS)undergoing percutaneous coronary intervention(PCI).Methods:A total of 100 ACS patients undergoing PCI admitted to our hospital were selected as the study subjects.They were randomly divided into a control group(treated with statin combined with ezetimibe,n=41),a study group 1(initiated with statin combined with PCSK9 inhibitor immediately after surgery,n=32),and a study group 2(routinely administered oral statin and initiated with combined PCSK9 inhibitor before discharge,n=27).The therapeutic efficacy,inflammatory factor levels,and incidence of adverse events were compared and analyzed among the three groups.Results:The therapeutic regimen in study group 1 demonstrated the optimal efficacy and impact on inflammatory factors,followed by study group 2,while the control group showed relatively weaker efficacy,with statistically significant differences(p<0.05).The overall incidence of adverse reactions was 30.00%in the control group,5.00%in study group 1,and 10.00%in study group 2,with statistically significant differences among the groups(p<0.05),with the lowest incidence observed in study group 1.Conclusion:Early intensive lipid-lowering therapy can effectively improve lipid metabolism,suppress inflammatory responses,and reduce cardiovascular events in ACS patients after PCI,suggesting its pleiotropic cardiovascular protective effects.
