Background: With the publication of Sepsis-3 definition, epidemiological data based on Sepsis-3 definition from middle-income countries including China are scarce, which prohibits understanding of the disease burden o...Background: With the publication of Sepsis-3 definition, epidemiological data based on Sepsis-3 definition from middle-income countries including China are scarce, which prohibits understanding of the disease burden of this newly defined syndrome in these settings. The purpose of this study was to describe incidence and outcome of Sepsis-3 in Yuetan sub-district of Beijing and to estimate the incidence rate of Sepsis-3 in China. Methods: The medical records of all adult residents hospitalized from July 1, 2012 to June 30, 2014 in Yuetan sub-district of Beijing were reviewed. Patients with sepsis-3 and severe sepsis/septic shock were identified. The incidence rates and mortality rate of sepsis-3 and sepsis/septic shock were calculated, incidence rates and in-hospital mortality rates were normalized to the population distribution in the 2010 National Census. Population incidence rate and case fatality rate between sexes were compared with the Z test, as the data conformed to Poisson distribution. Results: Of the 21,191 hospitalized patients, 935 patients were diagnosed with Sepsis-3, and 498 cases met severe sepsis/septic shock criteria. The crude annual incidence rate of Sepsis-3 in Yuetan sub-district was 363 cases per 100,000 population, corresponding to standardized incidence rates of 236 cases per 100,000 population per year, respectively. The overall case fatality rate of Sepsis-3 was 32.0%, the crude population mortality rates of Sepsis-3 was 116 cases per 100,000 population per year, the standardized mortality rate was 67 cases per 100,000 population per year, corresponding to a speculative extrapolation of 700,437 deaths in China. The incidence rate and mortality rate of Sepsis-3 were significantly higher in males, elderly people, and patients with more comorbidities. The 62.1% of patients with Sepsis-3 had community-acquired infections, compared with 75.3% of infected patients without Sepsis-3 (P < 0.001). The most common infection in patients with Sepsis-3 was lower respiratory tract infection. When compared with patients with Sepsis-3, patients diagnosed as severe sepsis/septic shock were more likely to have higher case fatality rate (53.4% vs. 32.0%, P < 0.001) Conclusions: This study found the standardized incidence rate of 236 cases per 100,000 person-year for Sepsis-3, which was more common in males and elderly population. This corresponded to about 2.5 million new cases of Sepsis-3 per year, resulting in more than 700,000 deaths in China.展开更多
Background：The Space Glucose Control （SGC） system is a computer-assisted device combining infusion pumps with the enhanced Model Predictive Control algorithm to achieve the target blood glucose （BG） level safely....Background：The Space Glucose Control （SGC） system is a computer-assisted device combining infusion pumps with the enhanced Model Predictive Control algorithm to achieve the target blood glucose （BG） level safely.The objective of this study was to evaluate the efficacy and safety of glycemic control by SGC with customized BG target range of 5.8-8.9 mmol/L in the critically ill patients.Methods：It is a randomized controlled trial of seventy critically ill patients with mechanical ventilation and hyperglycemia （BG 〉 9.0 mmol/L）.Thirty-six patients in the SGC group and 34 in the routine glucose management group were observed for three consecutive days.Target BG for both groups was 5.8-8.9 mmol/L.The primary outcome was the percentage time in the target range.Results：The percentage time within BG target range in the SGC group （69 ＆#177; 15%） was significantly higher than in the routine management group （52 ＆#177; 24%;P 〈 0.01）.No measurement was 〈2.2 mmol/L,and there was only one episode of hypoglycemia （2.3-3.3 mmol/L） in each group.The average BG was significantly lower in the SGC group （7.8 ＆#177; 0.7 mmol/L） than in the routine management group （9.1 ＆#177; 1.6 mmol/L,P 〈 0.001）.Target BG level was reached earlier in the SGC group than routine management group （2.5 ＆#177; 2.9 vs.12.1 ＆#177; 15.3 h,P =0.001）.However,the SGC group performed worse for daily insulin requirement （59.8 ＆#177; 39.3 vs.28.4 ＆#177; 36.7 U,P =0.001）and sampling interval （2.0 ＆#177; 0.5 vs.3.7 ＆#177; 0.5 h,P 〈 0.001） than the routine management group did.Multiple linear regression showed that the intervention group remained a significant individual predictor （P 〈 0.001） of the percentage time in target range.Conclusions：The SGC system,with a BG target of 5.8-8.9 mmol/L,resulted in effective and reliable glycemic control with few hypoglycemic episodes in critically ill patients with mechanical ventilation and hyperglycemia.However,the workload was increased.Trial Registration：http：//www.clinicaltrials.gov,NCT 02491346;https：//www.clinicaltrials.gov/ct2/show/NCT02491346？term=NCT0 2491346＆amp;cond=Hyperglycemia＆amp;cntry1=ES%3ACN＆amp;rank=1.展开更多
To the Editor:Anti-melanoma differentiation-associated gene 5(MDA-S)positive interstitial lung disease(ILD)is featured by rapidly progressing respiratory failure and limited hospital survival.No standard therapy has b...To the Editor:Anti-melanoma differentiation-associated gene 5(MDA-S)positive interstitial lung disease(ILD)is featured by rapidly progressing respiratory failure and limited hospital survival.No standard therapy has been established or proven to be beneficial.Herein,we report a case of a rapidly progressing patient diagnosed of ILD with positive anti-MDA-5 antibody receiving tocilizumab treatment.展开更多
To the Editor:A previously healthy 33-year-old Chinese man initially presented to local hospital with fever,upper abdominal pain,vomiting,and diarrhea over a period of 5 days.Laboratory findings of local medical cente...To the Editor:A previously healthy 33-year-old Chinese man initially presented to local hospital with fever,upper abdominal pain,vomiting,and diarrhea over a period of 5 days.Laboratory findings of local medical center revealed liver and kidney function impairments.The patient was treated for suspected bacterial infection and anuria.On illness day 8,the patient became confused and disoriented.He was transferred to our emergency room.Initial investigations showed severe elevations of transaminases and moderate coagulopathy[Table 1].Viral serologies for hepatitis A,B,C,and E were negative.Chest X-ray was normal.Computed tomography of brain and abdomen showed hepatomegaly and a small amount of ascites.On illness day 10,he developed status epilepticus and was intubated for airway protection.The relatives denied history of alcohol abuse,illicit drug use,and orolabial lesions.The patient was admitted to intensive care unit for further management on illness day 10.展开更多
文摘Background: With the publication of Sepsis-3 definition, epidemiological data based on Sepsis-3 definition from middle-income countries including China are scarce, which prohibits understanding of the disease burden of this newly defined syndrome in these settings. The purpose of this study was to describe incidence and outcome of Sepsis-3 in Yuetan sub-district of Beijing and to estimate the incidence rate of Sepsis-3 in China. Methods: The medical records of all adult residents hospitalized from July 1, 2012 to June 30, 2014 in Yuetan sub-district of Beijing were reviewed. Patients with sepsis-3 and severe sepsis/septic shock were identified. The incidence rates and mortality rate of sepsis-3 and sepsis/septic shock were calculated, incidence rates and in-hospital mortality rates were normalized to the population distribution in the 2010 National Census. Population incidence rate and case fatality rate between sexes were compared with the Z test, as the data conformed to Poisson distribution. Results: Of the 21,191 hospitalized patients, 935 patients were diagnosed with Sepsis-3, and 498 cases met severe sepsis/septic shock criteria. The crude annual incidence rate of Sepsis-3 in Yuetan sub-district was 363 cases per 100,000 population, corresponding to standardized incidence rates of 236 cases per 100,000 population per year, respectively. The overall case fatality rate of Sepsis-3 was 32.0%, the crude population mortality rates of Sepsis-3 was 116 cases per 100,000 population per year, the standardized mortality rate was 67 cases per 100,000 population per year, corresponding to a speculative extrapolation of 700,437 deaths in China. The incidence rate and mortality rate of Sepsis-3 were significantly higher in males, elderly people, and patients with more comorbidities. The 62.1% of patients with Sepsis-3 had community-acquired infections, compared with 75.3% of infected patients without Sepsis-3 (P < 0.001). The most common infection in patients with Sepsis-3 was lower respiratory tract infection. When compared with patients with Sepsis-3, patients diagnosed as severe sepsis/septic shock were more likely to have higher case fatality rate (53.4% vs. 32.0%, P < 0.001) Conclusions: This study found the standardized incidence rate of 236 cases per 100,000 person-year for Sepsis-3, which was more common in males and elderly population. This corresponded to about 2.5 million new cases of Sepsis-3 per year, resulting in more than 700,000 deaths in China.
文摘Background：The Space Glucose Control （SGC） system is a computer-assisted device combining infusion pumps with the enhanced Model Predictive Control algorithm to achieve the target blood glucose （BG） level safely.The objective of this study was to evaluate the efficacy and safety of glycemic control by SGC with customized BG target range of 5.8-8.9 mmol/L in the critically ill patients.Methods：It is a randomized controlled trial of seventy critically ill patients with mechanical ventilation and hyperglycemia （BG 〉 9.0 mmol/L）.Thirty-six patients in the SGC group and 34 in the routine glucose management group were observed for three consecutive days.Target BG for both groups was 5.8-8.9 mmol/L.The primary outcome was the percentage time in the target range.Results：The percentage time within BG target range in the SGC group （69 ＆#177; 15%） was significantly higher than in the routine management group （52 ＆#177; 24%;P 〈 0.01）.No measurement was 〈2.2 mmol/L,and there was only one episode of hypoglycemia （2.3-3.3 mmol/L） in each group.The average BG was significantly lower in the SGC group （7.8 ＆#177; 0.7 mmol/L） than in the routine management group （9.1 ＆#177; 1.6 mmol/L,P 〈 0.001）.Target BG level was reached earlier in the SGC group than routine management group （2.5 ＆#177; 2.9 vs.12.1 ＆#177; 15.3 h,P =0.001）.However,the SGC group performed worse for daily insulin requirement （59.8 ＆#177; 39.3 vs.28.4 ＆#177; 36.7 U,P =0.001）and sampling interval （2.0 ＆#177; 0.5 vs.3.7 ＆#177; 0.5 h,P 〈 0.001） than the routine management group did.Multiple linear regression showed that the intervention group remained a significant individual predictor （P 〈 0.001） of the percentage time in target range.Conclusions：The SGC system,with a BG target of 5.8-8.9 mmol/L,resulted in effective and reliable glycemic control with few hypoglycemic episodes in critically ill patients with mechanical ventilation and hyperglycemia.However,the workload was increased.Trial Registration：http：//www.clinicaltrials.gov,NCT 02491346;https：//www.clinicaltrials.gov/ct2/show/NCT02491346？term=NCT0 2491346＆amp;cond=Hyperglycemia＆amp;cntry1=ES%3ACN＆amp;rank=1.
文摘To the Editor:Anti-melanoma differentiation-associated gene 5(MDA-S)positive interstitial lung disease(ILD)is featured by rapidly progressing respiratory failure and limited hospital survival.No standard therapy has been established or proven to be beneficial.Herein,we report a case of a rapidly progressing patient diagnosed of ILD with positive anti-MDA-5 antibody receiving tocilizumab treatment.
文摘To the Editor:A previously healthy 33-year-old Chinese man initially presented to local hospital with fever,upper abdominal pain,vomiting,and diarrhea over a period of 5 days.Laboratory findings of local medical center revealed liver and kidney function impairments.The patient was treated for suspected bacterial infection and anuria.On illness day 8,the patient became confused and disoriented.He was transferred to our emergency room.Initial investigations showed severe elevations of transaminases and moderate coagulopathy[Table 1].Viral serologies for hepatitis A,B,C,and E were negative.Chest X-ray was normal.Computed tomography of brain and abdomen showed hepatomegaly and a small amount of ascites.On illness day 10,he developed status epilepticus and was intubated for airway protection.The relatives denied history of alcohol abuse,illicit drug use,and orolabial lesions.The patient was admitted to intensive care unit for further management on illness day 10.
