A novel predictor of unsustained return of spontaneous circulation in cardiac arrest patients through a combination of capnography and pulse oximetry: a multicenter observational study

BACKGROUND:Unsustained return of spontaneous circulation(ROSC)is a critical barrier to survival in cardiac arrest patients.This study examined whether end-tidal carbon dioxide(ETCO_(2))and pulse oximetry photoplethysmogram(POP)parameters can be used to identify unsustained ROSC.METHODS:We conducted a multicenter observational prospective cohort study of consecutive patients with cardiac arrest from 2013 to 2014.Patients’general information,ETCO_(2),and POP parameters were collected and statistically analyzed.RESULTS:The included 105 ROSC episodes(from 80 cardiac arrest patients)comprised 51 sustained ROSC episodes and 54 unsustained ROSC episodes.The 24-hour survival rate was significantly higher in the sustained ROSC group than in the unsustained ROSC group(29.2%vs.9.4%,P<0.05).The logistic regression analysis showed that the difference between after and before ROSC in ETCO_(2)(ΔETCO_(2))and the difference between after and before ROCS in area under the curve of POP(ΔAUCp)were independently associated with sustained ROSC(odds ratio[OR]=0.931,95%confi dence interval[95%CI]0.881-0.984,P=0.011 and OR=0.998,95%CI 0.997-0.999,P<0.001).The area under the receiver operating characteristic curve ofΔETCO_(2),ΔAUCp,and the combination of both to predict unsustained ROSC were 0.752(95%CI 0.660-0.844),0.883(95%CI 0.818-0.948),and 0.902(95%CI 0.842-0.962),respectively.CONCLUSION:Patients with unsustained ROSC have a poor prognosis.The combination ofΔETCO_(2) andΔAUCp showed signifi cant predictive value for unsustained ROSC.

The Chinese guideline for management of snakebites

In 2009,the World Health Organization included snakebite on the list of neglected tropical diseases,acknowledging it as a common occupational hazard for farmers,plantation workers,and others,causing tens of thousands of deaths and chronic physical disabilities every year.This guideline aims to provide practical information to help clinical professionals evaluate and treat snakebite victims.These recommendations are based on clinical experience and clinical research evidence.This guideline focuses on the following topics:snake venom,clinical manifestations,auxiliary examination,diagnosis,treatments,and prevention.

The effect of prophylactic antibiotics in acute upper gastrointestinal bleeding patients in the emergency department

BACKGROUND: Currently, prophylactic antibiotics are recommended only for cirrhotic patients with acute upper gastrointestinal bleeding(AUGIB);however, the benefit for other AUGIB patients remains undetermined. We aimed to compare the clinical outcomes between patients with AUGIB with and without prophylactic antibiotics to identify the population that requires this therapy.METHODS: Patients with AUGIB admitted between 1st January 2019 and 31st December 2021 in the Emergency Department of Peking Union Medical College Hospital were enrolled. Patients were divided into the antibiotic and non-antibiotic groups. The primary outcome was in-hospital mortality, and the secondary outcome was the onset of new infection. The risk factors for mortality and infection were analyzed, and stratification analysis of prophylactic antibiotics was performed. Continuous data were analyzed using the t-test or nonparametric rank sum test, and categorical data were analyzed using the Chi-square test or Fisher's exact test. Indicators with significant differences between the groups were included for logistic regression analysis. A P-value <0.05 was considered statistically significant. RESULTS: A total of 392 individuals were included, among them, 281 patients received prophylactic antibiotics, and 111 patients did not receive prophylactic antibiotics. The mortality rates were significantly lower in the antibiotic group than in the non-antibiotics group(6.41% vs. 17.12%, P=0.001). The risk factors for infection were varicose veins(P=0.045) and endotracheal intubation(P=0.005) in the prophylactic antibiotic group, and endoscopic treatment(P=0.010) in the non-prophylactic antibiotic group. Stratified analyses showed that patients with age ≥ 65 years, endotracheal intubation, endoscopic treatment, and AUGIB of variceal etiologies benefited from prophylactic antibiotics.CONCLUSION: AUGIB patients may benefit from prophylactic antibiotics to decrease mortality, especially those aged ≥ 65 years and those with endotracheal intubation, endoscopic treatment, and variceal etiologies.

Chinese Expert Consensus on Early Prevention and Intervention of Sepsis

Sepsis is currently a major problem and challenge facing the medical community.With rapid development and progress of modern medicine,researchers have put more and more attention on sepsis;meanwhile,the morbidity and mortality of sepsis remains high despite great efforts from experts in various fields.According to updated guidelines,sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection.Infection is the initial step of sepsis progression,and development from infection to sepsis is a complex pathophysiological process,including pathogen invasion,cytokine release,capillary leakage,microcirculation dysfunction,etc.which finally leads to organ metabolic disorders and functional failure.According to the latest recommended international guidelines of Sepsis 3.0,the presence of infection and SOFA score≥2 are considered as the diagnostic criteria for sepsis,and the"rescue"measures mainly focus on reversal of organ dysfunction.However,despite nearly two decades of efforts,the"Save Sepsis Campaign"has not achieved satisfactory results.Emergency medicine is the frontier subject of acute and severe illness which treats patients with acute infections at the earliest.If at this stage,physicians can predict the possibility of sepsis progression from demographic characteristics,localize the pathogen and infection,detect the inflammatory storms by tests of cytokines and evaluate the severity of the infection with more effective clinical scoring system,and then take effective measures to prevent infection from developing into sepsis in high-risk patients,the morbidity and mortality of sepsis in patients with acute infection will be greatly reduced.Based on this situation,Chinese emergency medicine experts proposed the concept of"preventing and blocking"sepsis,and launched the nationwide"Preventing Sepsis Campaign in China(PSCC)"nationwide.The main concept is summarized as"three early and two reduces"which includes early detection,early diagnosis and early intervention during the"pre-symptomatic"and"peri-septic"stage in order to reduce the incidence of sepsis and it proposed a new approach for diagnosis and treatment of acute severe infection.This consensus is jointly advocated,discussed and written by four academic associations in the field of emergency medicine and five scholarly publishing organizations.More than 40 experts from fields of emergency medicine,critical care medicine,infectious diseases,pharmacy and laboratory medicine have participated in several rounds of deliberation and finally reached consensus on the criteria of identifying patients with acute infection,taking anti-infective treatments,screening of high-risk patients with sepsis,detection and treatment of inflammatory storm,protection of vascular endothelial cells and the regulation of coagulation function,as well as strategies of liquid support and organ function protection etc.The consensus summarizes the commonly used clinical diagnosis criteria and treatment measures of sepsis both in Western medicine and traditional Chinese medicine for clinicians in order to provide evidence for the diagnosis and treatment of the disease.

Expert consensus guidelines on clinical use of Xiyanping injection for acute infectious diseases

Xiyanping injection,a traditional Chinese medicine injection made of andrographolide sulfonate,consisting of well-defined ingredients with antiviral,antibacterial,anti-inflammatory and antipyretic efficacy,has been widely used for treating infectious diseases of respiratory and digestive systems.However,its wide applications may easily lead to unreasonable clinical medication.In order to guide the precise clinical application and rational use of Xiyanping injection,experts in related fields conducted systematically literature review,evaluated and deliberated the application of Xiyanping injection in treating acute infectious diseases using evidence-based medicine method,and jointly drafted the consensus to summarize types of acute infectious diseases in children and adults that can be treated with Xiyanping injection,and recommend the intervention time,usage and dosage,course of treatment and combined medication of the injection.Besides,the consensus elucidates the safety,precautions and contraindications of the injection,so as to provide guidance for clinical use.

Expansion of the South China Sea basin:Constraints from magnetic anomaly stripes,sea floor topography,satellite gravity and submarine geothermics

The widely distributed E-W-trending magnetic anomaly stripes in the central basin and the N-Etrending magnetic anomaly stripes in the southwest sub-basin provide the most important evidence for Neogene expansion of the South China Sea.The expansion mechanism remains,however,controversial because of the lack of direct drilling data,non-systematic marine magnetic survey data,and irregular magnetic anomaly stripes with two obvious directions.For example,researchers have inferred different ages and episodes of expansion for the central basin and southwest sub-basin.Major controversy centers on the order of basinal expansion and the mechanism of expansion for the entire South China Sea basin.This study attempts to constrain these problems from a comprehensive analysis of the seafloor topography,magnetic anomaly stripes,regional aeromagnetic data,satellite gravity,and submarine geothermics.The mapped seafloor terrain shows that the central basin is a north-south rectangle that is relatively shallow with many seamounts,whereas the southwest sub-basin is wide in northeast,gradually narrows to the southwest,and is relatively deeper with fewer seamounts.Many magnetic anomaly stripes are present in the central basin with variable dimensions and directions that are dominantly EWtrending,followed by the NE-,NW- and NS-trending.Conversely such stripes are few in the southwest sub-basin and mainly NE-trending.Regional magnetic data suggest that the NW-trending Ailaoshan-Red River fault extends into the South China Sea,links with the central fault zone in the South China Sea,which extends further southward to Reed Tablemount.Satellite gravity data show that both the central basin and southwest sub-basin are composed of oceanic crust.The Changlong seamount is particularly visible in the southwest sub-basin and extends eastward to the Zhenbei seamount.Also a low gravity anomaly zone coincides with the central fault zone in the sub-basin.The submarine geothermic distribution demonstrates that the southwest sub-basin has a higher geothermal value than the central basin,and that the central fault zone is defined by a low thermal anomaly.This study suggests that NW-SE expansion of the southwest subbasin is later than the N-S expansion of the central basin with the sub-basin extending into the central basin and with both expansions ending at the same time.The expansion of southwestern sub-basin,similar to the Japanese Sea,is likely caused by left-lateral strike slip on the central fault zone in the South China Sea,which may have significance for finding oil and gas in this region.

Chinese multidisciplinary guideline for management of hypertensiveintracerebral hemorrhage

ypertensive intracerebral hemorrhage(HICH)refers tothe sudden onset of hemorrhage within cerebral paren-chyma or ventricles of patients with a history ofhypertension.Secondary intracerebral hemorrhage(ICH)with an underlying causative pathology,such astrauma,structural blood vessel abnormalities,coagulationor hematological disorder(s),systemic diseases,or neo-plasms,should be excluded to make the diagnosis ofHICH.HICH is characterized by high incidence,disabili-ty,mortality,and recurrence rates.In 2015,experts fromthe Chinese Medical Association branch of Neurosurgery,Chinese Medical Doctor Association branch of theEmergency Physician and Stroke Screening,and Preven-tion and Treatment Committee of the National HealthCommission of the People’s Republic of China gathered toformulate and draft the Chinese Multidisciplinary ExpertsConsensus on the Management of Spontaneous Intrace-rebral Hemorrhage.[1]This consensus has played animportant role in guiding and standardizing the manage-ment of spontaneous ICH in China.

Clinical decision-making by the emergency department resident physicians for critically ill patients

The application of main methodologies for clinical decision-making by residents in emergency medical practice was assessed,and issues in this area were investigated.The treatments provided to 2611 critical patients by the Emergency Department of Peking Union Medical College Hospital were analyzed by independent investigators who evaluated the main clinical decision-making processes applied by the hospital residents.The application of decision-making strategies by PG1 and PG3 groups,which means the residents in first year and the third year,were compared.The patients were treated according to pattern recognition(43.0%),hypotheticodeductive reasoning(23.4%),event-driven models(19.3%),and rule-using algorithms(5.9%).A significant difference was found between PG1 and PG3 groups(χ^(2)=498.01,P<0.001).Pattern recognition and hypotheticdeductive methods were the most common techniques applied by emergency physicians in evaluating critically ill patients.The decision-making processes applied by junior and senior residents were significantly different,although neither group adequately applied rule-using algorithms.Inclusion of clinical decision-making in medical curricula is needed to improve decision-making in critical care.

Bridging the translation gap and building the translation platform:translational medicine at Peking Union Medical College Hospital

Although there have been progressive advancements in the life sciences since the beginning of the 21st Century, basic medical sciences generally fail to be efficiently translated into clinical research and ultimately into clinical practice. Translational medicine has become a fashionable term de- scribing the inclination of basic science and clinical re- searchers to ultimately help patients through facilitating the incorporation of basic research findings into clinical prac- tice （Zerhouni, 2005）.