Controlled low central venous pressure reduces blood loss and transfusion requirements in hepatectomy

AIM: To evaluate the effect of low central venous pressure (LCVP) on blood loss and blood transfusion in patients undergoing hepatectomy.

Expert consensus on the perioperative management of patients with sepsis

INTRODUCTION Sepsis is defined as an infection associated with systemic manifestations of inflammation, which has become the most common complication in the perioperative period caused by severe burn/trauma and major surgical operation.[1,2] The incidence of sepsis in adults is estimated to be 149–240/100 000 per year, and that of severe sepsis and septic shock is 56–91/100 000 per year. In the last decade, the short-term mortality of sepsis has declined to around 20% in developed countries partly due to the international Surviving Sepsis Campaign （SSC）, while the mortality remains very high （50%–80%） in 1–5 years after discharge from hospitals.[3–7] Thus, sepsis and its subsequent severe sepsis and septic shock are currently major issues in the field of medical and health care.

Posttraumatic stress disorder: From diagnosis to prevention

Posttraumatic stress disorder(PTSD) is a chronic impairment disorder that occurs after exposure to traumatic events.This disorder can result in a disturbance to individual and family functioning, causing significant medical, financial,and social problems. This study is a selective review of literature aiming to provide a general outlook of the current understanding of PTSD. There are several diagnostic guidelines for PTSD, with the most recent editions of the DSM-5 and ICD-11 being best accepted. Generally, PTSD is diagnosed according to several clusters of symptoms occurring after exposure to extreme stressors. Its pathogenesis is multifactorial, including the activation of the hypothalamic–pituitary–adrenal(HPA) axis, immune response, or even genetic discrepancy. The morphological alternation of subcortical brain structures may also correlate with PTSD symptoms. Prevention and treatment methods for PTSD vary from psychological interventions to pharmacological medications. Overall, the findings of pertinent studies are difficult to generalize because of heterogeneous patient groups, different traumatic events, diagnostic criteria, and study designs. Future investigations are needed to determine which guideline or inspection method is the best for early diagnosis and which strategies might prevent the development of PTSD.

Nomogram for prediction of fatal outcome in patients with severe COVID-19:a multicenter study

Background:To develop an effective model of predicting fatal outcomes in the severe coronavirus disease 2019(COVID-19)patients.Methods:Between February 20,2020 and April 4,2020,consecutive confirmed 2541 COVID-19 patients from three designated hospitals were enrolled in this study.All patients received chest computed tomography(CT)and serological examinations at admission.Laboratory tests included routine blood tests,liver function,renal function,coagulation profile,C-reactive protein(CRP),procalcitonin(PCT),interleukin-6(IL-6),and arterial blood gas.The SaO2 was measured using pulse oxygen saturation in room air at resting status.Independent high-risk factors associated with death were analyzed using Cox proportional hazard model.A prognostic nomogram was constructed to predict the survival of severe COVID-19 patients.Results:There were 124 severe patients in the training cohort,and there were 71 and 76 severe patients in the two independent validation cohorts,respectively.Multivariate Cox analysis indicated that age≥70 years(HR=1.184,95%CI 1.061–1.321),panting(breathing rate≥30/min)(HR=3.300,95%CI 2.509–6.286),lymphocyte count<1.0×109/L(HR=2.283,95%CI 1.779–3.267),and interleukin-6(IL-6)>10pg/ml(HR=3.029,95%CI 1.567–7.116)were independent high-risk factors associated with fatal outcome.We developed the nomogram for identifying survival of severe COVID-19 patients in the training cohort(AUC=0.900,95%CI 0.841–0.960,sensitivity 95.5%,specificity 77.5%);in validation cohort 1(AUC=0.811,95%CI 0.763–0.961,sensitivity 77.3%,specificity 73.5%);in validation cohort 2(AUC=0.862,95%CI 0.698–0.924,sensitivity 92.9%,specificity 64.5%).The calibration curve for probability of death indicated a good consistence between prediction by the nomogram and the actual observation.The prognosis of severe COVID-19 patients with high levels of IL-6 receiving tocilizumab were better than that of those patients without tocilizumab both in the training and validation cohorts,but without difference(P=0.105 for training cohort,P=0.133 for validation cohort 1,and P=0.210 for validation cohort 2).Conclusions:This nomogram could help clinicians to identify severe patients who have high risk of death,and to develop more appropriate treatment strategies to reduce the mortality of severe patients.Tocilizumab may improve the prognosis of severe COVID-19 patients with high levels of IL-6.