Sea level anomalies in the northwestern Pacific during 2011 associated with La Nina and negative Indian Ocean Dipole

The sea level anomalies(SLAs)pattern in the northwestern Pacific delineated significant differences between La Ni?a events occurring with and without negative Indian Ocean Dipole(IOD)events.During the pure La Ni?a events,positive the sea surface level anomalies(SLAs)appear in the northwestern Pacific,but SLAs are weakened and negative SLAs appear in the northwestern Pacific under the contribution of the negative IOD events in 2010/2011.The negative IOD events can trigger significant westerly wind anomalies in the western tropical Pacific,which lead to the breakdown of the pronounced positive SLAs in the northwestern Pacific.Meanwhile,negative SLAs excited by the positive wind stress curl near the dateline propagated westward in the form of Rossby waves until it approached the western Pacific boundary in mid-2011,which maintained and enhanced the negative phase of SLAs in the northwestern Pacific and eventually,it could significantly influence the bifurcation and transport of the North Equatorial Current(NEC).

Intra-seasonal variability of the abyssal currents in COMRA's contract area in the Clarion-Clipperton Zone

In this paper,the intra-seasonal variability of the abyssal currents in the China Ocean Mineral Resources Association(COMRA)polymetallic nodule contact area,located in the western part of the Clarion and Clipperton Fraction Zone in the tropical East Pacific,is investigated using direct observations from subsurface mooring instruments as well as sea-surface height data and reanalysis products.Mooring observations were conducted from September 13,2017 to August 15,2018 in the COMRA contact area(10°N,154°W).The results were as follows:(1)At depths below 200 m,the kinetic energy of intra-seasonal variability(20-100 d)accounts for more than 40%of the overall low-frequency variability,while the ratio reaches more than 50%below 2000 m.(2)At depths below 200 m,currents show a synchronous oscillation with a characteristic time scale of 30 d,lasting from October to the following January;the energy of the 30-d oscillation increases with depth until the layer of approximately 4616 m,and the maximum velocity is approximately 10 cm/s.(3)The 30-d oscillation of deep currents is correlated with the tropical instability waves in the upper ocean.

Prevention of urinary tract infection using a silver alloy hydrogel-coated catheter in critically ill patients: A single-center prospective randomized controlled study

Background:A new type of silver alloy hydrogel-coated(SAH)catheter has been shown to prevent bacterial adhesion and colonization by generating a microcurrent,and to block the retrograde infection pathway.However,these have only been confirmed in ordinary patients.This study aims to evaluate the effectiveness of a SAH catheter for preventing urinary tract infections in critically ill patients.Methods:This was a prospective single-center,single-blind,randomized,controlled study.A total of 132 patients requiring indwelling catheterization in the intensive care unit(ICU)of the First Affiliated Hospital of the University of Science and Technology of China between October 2022 and February 2023 and who met the study inclusion/exclusion criteria were randomly divided into two groups.Patients in the SAH catheter group received a SAH catheter,while patients in the conventional catheter group received a conventional siliconized latex Foley catheter.The main outcome measure was the incidence of catheter-associated urinary tract infections(CAUTIs).Secondary outcome indicators included urine positivity for white blood cells and positive urine cultures on 3 days,7 days,10 days,and 14 days after catheterization,number of viable bacteria in the catheter biofilm on day 14,pathogenic characteristics of positive urine cultures,length of ICU stay,overall hospital stay,ICU mortality,and 28-day mortality.All the data were compared between the two groups.Results:A total of 68 patients in the conventional catheter group and 64 patients in the SAH catheter group were included in the study.On day 7 after catheter placement,the positivity rate for urinary white blood cells was significantly higher in the conventional catheter group than in the SAH catheter group(33.8%vs.15.6%,P=0.016).On day 10,the rates of positive urine cultures(27.9%vs.10.9%,P=0.014)and CAUTIs(22.1%vs.7.8%,P=0.023)were significantly higher in the conventional catheter group than in the SAH catheter group.On day 14,the numbers of viable bacteria isolated from the catheter tip([3.21±1.91]×10^(6) colony-forming units[cfu]/mL vs.[7.44±2.22]×10^(4) cfu/mL,P<0.001),balloon segment([7.30±1.99]×10^(7) cfu/mL vs.[3.48±2.38]×10^(5) cfu/mL,P<0.001),and tail section([6.41±2.07]×10^(5) cfu/mL vs.[8.50±1.46]×10^(3) cfu/mL,P<0.001)were significantly higher in the conventional catheter group than in the SAH catheter group.The most common bacteria in the urine of patients in both groups were Escherichia coli(n=13)and Pseudomonas aeruginosa(n=6),with only one case of Candida in each group.There were no significant differences between the two groups in terms of ICU hospitalization time,total hospitalization time,ICU mortality,and 28-day mortality.Conclusion:SAH catheters can effectively inhibit the formation of catheter-related bacterial biofilms in critically ill patients and reduce the incidence of CAUTIs,compared with conventional siliconized latex Foley catheters;however,regular replacement of the catheter is still necessary.

Expert consensus on blood pressure management in critically ill patients

Introduction For critically ill patients with unstable hemodynamics,goal‑directed therapy for arterial blood pressure is needed with continuous daily bedside monitoring.The prevalence of hypertension in Chinese adults is 25.2%,of which 1–2%of patients may experience a hypertensive emergency,with a mortality rate of 6.9%in the acute phase.The mortality and readmission rates within 90 days of onset are as high as 11%.[1]Furthermore,the mortality rate for patients who experience hypertensive emergencies can reach 50%within 12 months of the incident.[2]The incidence of perioperative hypertension in patients undergoing cardiac surgery is approximately 50%,with this figure dropping to 25%for non-cardiac surgery.Surgery may increase the incidence of perioperative cardio-cerebrovascular adverse events by 3–5%.[3]

Expert consensus on the glycemic management of critically ill patients

Introduction The incidence of hyperglycemia is 40-60%in critically ill patients and is up to 60-80%in those who have undergone car-diac surgery.[1]The results of an epidemiological study in the United States showed that 28.6%of diabetic patients and 9.3%of non-diabetic patients had elevated mean daily glucose on the day of ICU admission.[2]In critically ill patients,elevated blood glucose is primarily the result of stress,and stress-induced hy-perglycemia is an independent risk factor associated with prog-nosis,regardless of a previous diagnosis of diabetes.Nutritional therapy has become an integral treatment option for patients in the ICU,[3,4]though nearly 30%of patients with enteral nu-trition and 44-50%with parenteral nutrition(PN)experience elevated glucose.[5,6]Intensive insulin therapy(IIT)is an impor-tant treatment for controlling hyperglycemia in critically ill pa-tients,but it also carries a corresponding risk of hypoglycemia.

Tocilizumab in patients with moderate or severe COVID-19: a randomized, controlled, open-label, multicenter trial

Tocilizumab has been reported to attenuate the“cytokine storm”in COVID-19 patients.We attempted to verify the effectiveness and safety of tocilizumab therapy in COVID-19 and identify patients most likely to benefit from this treatment.We conducted a randomized,controlled,open-label multicenter trial among COVID-19 patients.The patients were randomly assigned in a 1:1 ratio to receive either tocilizumab in addition to standard care or standard care alone.The cure rate,changes of oxygen saturation and interference,and inflammation biomarkers were observed.Thirty-three patients were randomized to the tocilizumab group,and 32 patients to the control group.The cure rate in the tocilizumab group was higher than that in the control group,but the difference was not statistically significant(94.12%vs.87.10%,rate difference 95%CI−7.19%–21.23%,P=0.4133).The improvement in hypoxia for the tocilizumab group was higher from day 4 onward and statistically significant from day 12(P=0.0359).In moderate disease patients with bilateral pulmonary lesions,the hypoxia ameliorated earlier after tocilizumab treatment,and less patients(1/12,8.33%)needed an increase of inhaled oxygen concentration compared with the controls(4/6,66.67%;rate difference 95%CI−99.17%to−17.50%,P=0.0217).No severe adverse events occurred.More mild temporary adverse events were recorded in tocilizumab recipients(20/34,58.82%)than the controls(4/31,12.90%).Tocilizumab can improve hypoxia without unacceptable side effect profile and significant influences on the time virus load becomes negative.For patients with bilateral pulmonary lesions and elevated IL-6 levels,tocilizumab could be recommended to improve outcome.

Expert consensus on the diagnosis and treatment of severe and critical coronavirus disease 2019(COVID-19)

Introduction Coronavirus disease 2019(COVID-19),a disease caused by severe acute respiratory syndrome-coronavirus-2(SARS-CoV-2),is highly contagious[1]and has developed into a global pan-demic.Up to July 1,2022,COVID-19 has affected>200 coun-tries and regions across the globe and caused 545,226,550 con-firmed cases and 6334,728 deaths,[2]seriously compromising human life,public properties.