Cardiopulmonary prognosis of prophylactic endotracheal intubation in patients with upper gastrointestinal bleeding undergoing endoscopy

BACKGROUND:It is controversial whether prophylactic endotracheal intubation(PEI)protects the airway before endoscopy in critically ill patients with upper gastrointestinal bleeding(UGIB).The study aimed to explore the predictive value of PEI for cardiopulmonary outcomes and identify high-risk patients with UGIB undergoing endoscopy.METHODS:Patients undergoing endoscopy for UGIB were retrospectively enrolled in the eICU Collaborative Research Database(eICU-CRD).The composite cardiopulmonary outcomes included aspiration,pneumonia,pulmonary edema,shock or hypotension,cardiac arrest,myocardial infarction,and arrhythmia.The incidence of cardiopulmonary outcomes within 48 h after endoscopy was compared between the PEI and non-PEI groups.Logistic regression analyses and propensity score matching analyses were performed to estimate effects of PEI on cardiopulmonary outcomes.Moreover,restricted cubic spline plots were used to assess for any threshold effects in the association between baseline variables and risk of cardiopulmonary outcomes(yes/no)in the PEI group.RESULTS:A total of 946 patients were divided into the PEI group(108/946,11.4%)and the non-PEI group(838/946,88.6%).After propensity score matching,the PEI group(n=50)had a higher incidence of cardiopulmonary outcomes(58.0%vs.30.3%,P=0.001).PEI was a risk factor for cardiopulmonary outcomes after adjusting for confounders(odds ratio[OR]3.176,95%confidence interval[95%CI]1.567-6.438,P=0.001).The subgroup analysis indicated the similar results.A shock index>0.77 was a predictor for cardiopulmonary outcomes in patients undergoing PEI(P=0.015).The probability of cardiopulmonary outcomes in the PEI group depended on the Charlson Comorbidity Index(OR 1.465,95%CI 1.079-1.989,P=0.014)and shock index>0.77(compared with shock index≤0.77[OR 2.981,95%CI 1.186-7.492,P=0.020,AUC=0.764]).CONCLUSION:PEI may be associated with cardiopulmonary outcomes in elderly and critically ill patients with UGIB undergoing endoscopy.Furthermore,a shock index greater than 0.77 could be used as a predictor of a worse prognosis in patients undergoing PEI.

A comparison of maternal fear of childbirth,labor pain intensity and intrapartum analgesic consumption between primiparas and multiparas:A cross-sectional study

Objectives:To describe and compare fear of childbirth and in-labor pain intensity between primiparas and multiparas and explore the association between the amount of actual pain relief and fear of childbirth.Methods:A convenience sampling method was used.A total of 260 women undergoing spontaneous or induced labor,including 97 primiparas and 163 multiparas,were recruited in a large academic specialized hospital in Guangzhou,China,from February 2018 to August 2019.The clinical data of maternal and neonatal were extracted from a structured electronic medical record system.Other demographic information,such as employment and family monthly income,was collected by a questionnaire.The Numeric Rating Scale(NRS)and the Chinese version of the Childbirth Attitude Questionnaire(C-CAQ)were applied to assess maternal in-labor pain intensity and fear of childbirth.The analgesic consumption and the frequency of manual boluses as rescue analgesia were stored and collected from the analgesia pump.Results:Eighty-two(84.5%)primiparas and ninety-nine(60.7%)multiparas received epidural analgesia(P<0.001).In the epidural subgroup,the primiparous average fear of childbirth(36.46±10.93)was higher than that of the multiparas(32.06±10.23)(P¼0.007).However,multiparas reported more intense in-labor pain[8.0(8.0,9.0)vs.8.0(7.0,8.0)],had more successful manual boluses per hour[2.68(1.65,3.85)vs.1.77(0.90,2.47)],more hourly analgesic consumption[23.00(16.00,28.25)vs.17.24(11.52,21.36)mL]and more average analgesic consumption[0.35(0.24,0.45)vs.0.26(0.19,0.35)mL/(h$kg)]than the primiparas(P<0.05).Spearman’s correlation analysis showed that the maximum in-labor pain was weakly positively correlated with fear of childbirth(r¼0.09)(P<0.05),hourly analgesic consumption(r¼0.16)(P<0.01)and average analgesic consumption(r¼0.17)(P<0.05).No statistically significant association was uncovered between analgesic consumption and maternal fear of childbirth.Conclusions:Fear of childbirth is a potential predictor of labor pain intensity.Further study is needed to explore its role and value in pain management during delivery.Parity is not a determinant of pain relief use and should not be a preconceived preference of obstetric care team members to determine the distribution of epidural analgesia,especially when analgesia resources are insufficient.

Spectral analysis of new black hole candidate AT2019wey observed by NuSTAR

AT2019 wey is a new galactic X-ray binary that was first discovered as an optical transient by the Asteroid Terrestrial-impact Last Alert System(ATLAS)on December 7,2019.AT2019 wey consists of a black hole candidate as well as a low-mass companion star(M_(star)≤1.0 M_(■))and is likely to have a short orbital period(P_(orb)≤16h).Although AT2019 wey began activation in the X-ray band on March 8,2020,it did not enter the soft state during almost the entire outburst.In this study,we present a detailed spectral analysis of AT2019 wey in the low/hard state during its X-ray outburst on the basis of Nuclear Spectroscopic Telescope Array(Nu S T AR)observations.We obtain tight constraints on several of its important physical parameters by applying the state of the art relxill relativistic reflection model family.In particular,we determine that the measured inner radius of the accretion disk is most likely to have extended to the innermost stable circular orbit(ISCO)radius,i.e.,R_(in)=1.38^(+0.23)_(-0.16)R_(ISCO).Hence,assuming R_(in)=R_(ISCO),we find the spin of AT2019 wey to be a*~0.97,which is close to the extreme and an inner disk inclination angle of i~22°.Additionally,according to our adopted models,AT2019 wey tends to have a relatively high iron abundance of AFe~5A_(Fe,■)and a high disk ionization state of logξ~3.4.