Early peripheral perfusion index predicts 28-day outcome in patients with septic shock

BACKGROUND:To investigate the prognostic value of the peripheral perfusion index(PPI)in patients with septic shock.METHODS:This prospective cohort study,conducted at the emergency intensive care unit of Peking University People's Hospital,recruited 200 patients with septic shock between January 2023 and August 2023.These patients were divided into survival(n=84)and death(n=116)groups based on 28-day outcomes.Clinical evaluations included laboratory tests and clinical scores,with lactate and PPI values assessed upon admission to the emergency room and at 6 h and 12 h after admission.Risk factors associated with mortality were analyzed using univariate and multivariate Cox regression analyses.Receiver operator characteristic(ROC)curve was used to assess predictive performance.Mortality rates were compared,and Kaplan-Meier survival plots were created.RESULTS:Compared to the survival group,patients in the death group were older and had more severe liver damage and coagulation dysfunction,necessitating higher norepinephrine doses and increased fl uid replacement.Higher lactate levels and lower PPI levels at 0 h,6 h,and 12 h were observed in the death group.Multivariate Cox regression identifi ed prolonged prothrombin time(PT),decreased 6-h PPI and 12-h PPI as independent risk factors for death.The area under the curves for 6-h PPI and 12-h PPI were 0.802(95%CI 0.742-0.863,P<0.001)and 0.945(95%CI 0.915-0.974,P<0.001),respectively,which were superior to Glasgow Coma Scale(GCS),Sequential Organ Failure Assessment(SOFA)scores(0.864 and 0.928).Cumulative mortality in the low PPI groups at 6 h and 12 h was signifi cantly higher than in the high PPI groups(6-h PPI:77.52%vs.22.54%;12-h PPI:92.04%vs.13.79%,P<0.001).CONCLUSION:PPI may have value in predicting 28-day mortality in patients with septic shock.

Comparing 11 early warning scores and three shock indices in early sepsis prediction in the emergency department

BACKGROUND:This study aimed to evaluate the discriminatory performance of 11 vital sign-based early warning scores(EWSs)and three shock indices in early sepsis prediction in the emergency department(ED).METHODS:We performed a retrospective study on consecutive adult patients with an infection over 3 months in a public ED in Hong Kong.The primary outcome was sepsis(Sepsis-3 definition)within 48 h of ED presentation.Using c-statistics and the DeLong test,we compared 11 EWSs,including the National Early Warning Score 2(NEWS2),Modified Early Warning Score,and Worthing Physiological Scoring System(WPS),etc.,and three shock indices(the shock index[SI],modified shock index[MSI],and diastolic shock index[DSI]),with Systemic Inflammatory Response Syndrome(SIRS)and quick Sequential Organ Failure Assessment(qSOFA)in predicting the primary outcome,intensive care unit admission,and mortality at different time points.RESULTS:We analyzed 601 patients,of whom 166(27.6%)developed sepsis.NEWS2 had the highest point estimate(area under the receiver operating characteristic curve[AUROC]0.75,95%CI 0.70-0.79)and was significantly better than SIRS,qSOFA,other EWSs and shock indices,except WPS,at predicting the primary outcome.However,the pooled sensitivity and specificity of NEWS2≥5 for the prediction of sepsis were 0.45(95%CI 0.37-0.52)and 0.88(95%CI 0.85-0.91),respectively.The discriminatory performance of all EWSs and shock indices declined when used to predict mortality at a more remote time point.CONCLUSION:NEWS2 compared favorably with other EWSs and shock indices in early sepsis prediction but its low sensitivity at the usual cut-off point requires further modification for sepsis screening.

Delta shock index predicts injury severity,interventions,and outcomes in trauma patients:A 10-year retrospective observational study

BACKGROUND Most trauma occurs among young male subjects in Qatar.We examined the predictive values of the delta shock index(DSI),defined as the change in the shock index(SI)value from the scene to the initial reading in the emergency unit(i.e.,subtracting the calculated SI at admission from SI at the scene),at a Level 1 trauma center.AIM To explore whether high DSI is associated with severe injuries,more interventions,and worse outcomes[i.e.,blood transfusion,exploratory laparotomy,ventilator-associated pneumonia,hospital length of stay(HLOS),and in-hospital mortality]in trauma patients.METHODS A retrospective analysis was conducted after data were extracted from the National Trauma Registry between 2011 and 2021.Patients were grouped based on DSI as low(≤0.1)or high(>0.1).Data were analyzed and compared usingχ2 and Student’s t-tests.Correlations between DSI and injury severity score(ISS),revised trauma score(RTS),abbreviated injury scale(AIS),Glasgow coma scale(GCS),trauma score-ISS(TRISS),HLOS,and number of transfused blood units(NTBU),were assessed using correlation coefficient analysis.The diagnostic testing accuracy for predicting mortality was determined using the validity measures of the DSI.Logistic regression analysis was performed to identify predictors of mortality.RESULTS This analysis included 13212 patients with a mean age of 33±14 years,and 24%had a high DSI.Males accounted for 91%of the study population.The trauma activation level was higher in patients with a high DSI(38%vs 15%,P=0.001).DSI correlated with RTS(r=-0.30),TRISS(r=-0.30),NTBU(r=0.20),GCS(r=-0.24),ISS(r=0.22),and HLOS(r=0.14)(P=0.001 for all).High DSI was associated with significantly higher rates of intubation,laparotomy,ventilator-associated pneumonia,massive transfusion activation,and mortality than low DSI.For mortality prediction,a high DSI had better specificity,negative predictive value,and negative likelihood ratio(77%,99%,and 0.49%,respectively).After adjusting for age,emergency medical services time,GCS score,and ISS,multivariable regression analysis showed that DSI was an independent predictor of mortality(odds ratio=1.9;95%confidence interval:1.35-2.76).CONCLUSION In addition to sex-biased observations,almost one-quarter of the study cohort had a higher DSI and were mostly young.High DSI correlated significantly with the other injury severity scores,which require more time and imaging to be ready to use.Therefore,DSI is a practical,simple bedside tool for triaging and prognosis in young patients with trauma.

Traumatic brain injury and variants of shock index

Traumatic Brain Injury is a major cause of death and long-term disability.The early identification of patients at high risk of mortality is important for both management and prognosis.Although many modified scoring systems have been developed for improving the prediction accuracy in patients with trauma,few studies have focused on prediction accuracy and application in patients with traumatic brain injury.The shock index(SI)which was first introduced in the 1960s has shown to strongly correlate degree of circulatory shock with increasing SI.In this editorial we comment on a publication by Carteri et al wherein they perform a retrospective analysis studying the predictive potential of SI and its variants in populations with severe traumatic brain injury.

Effectiveness of Combined Application of Shock Index and Early Warning Scoring System in Patients with Acute Gastrointestinal Hemorrhage

Objective:To explore the effect of the combined application of the Shock Index(SI)and the Early Warning Score(EWS)in patients with acute gastrointestinal bleeding.Methods:Seventy patients with acute gastrointestinal bleeding admitted to a hospital from June 2022 to May 2024 were selected and randomly divided into two groups:the control group and the observation group,with 35 patients in each group.The control group received conventional emergency care measures,while the observation group received SI combined with NEWS emergency care measures.The treatment effects in both groups were compared.Results:The observation group had shorter waiting times for consultation(4.45±1.59 minutes),intravenous access establishment(6.79±2.52 minutes),hemostasis time(4.41±1.52 hours),and hospital stays(8.39±2.13 days)compared to the control group,which had times of 5.46±1.34 minutes,8.41±2.16 minutes,5.16±1.47 hours,and 10.26±2.98 days,respectively.The differences were statistically significant(P<0.05).Before management,there were no significant differences in the levels of hemoglobin,prealbumin,and serum protein between the two groups(P>0.05).However,after systematic emergency management,the serum indexes in both groups significantly improved,with the observation group showing greater improvement than the control group,and these differences were statistically significant(P<0.05).In the observation group,only one case of cardiovascular complications occurred during the rescue period,with an incidence rate of 2.86%.In contrast,the control group experienced eight cases of complications,including hemorrhagic shock,anemia,multi-organ failure,cardiovascular complications,and gastrointestinal rebleeding,with an incidence rate of 22.85%.The difference between the groups was statistically significant(P<0.05).Conclusion:The application of SI combined with EWS emergency care measures in patients with acute gastrointestinal hemorrhage can effectively improve serum indexes,shorten resuscitation time and hospital stay,and reduce the risk of complications such as hemorrhagic shock,anemia,infection,multi-organ failure,cardiovascular complications,acute renal failure,and gastrointestinal rebleeding.This approach has positive clinical application value.

NLR与MSI对急性NSTEMI短期预后判断价值

目的本研究旨在探讨校正休克指数(MSI)和中性粒细胞/淋巴细胞比值(NLR)在判断急性非ST段抬高型心肌梗死(NSTEMI)患者短期内可能出现不良预后的预测能力。方法研究组选择2020年3月到2021年9月期间,首次就诊急诊科明确诊断为急性非ST段抬高型心肌梗死的276例患者。通过快速急诊绿道监测血压与心率,并于急诊科10 min内抽取血常规、床旁心脏彩超等相关化验检查,依据监测及化验结果,研究小组计算了校正休克指数(MSI)和中性粒细胞/淋巴细胞比值(NLR),然后根据统计结果将患者分为2组:NLR≥5.0组(n=75)与NLR﹤5.0组(n=201);(2)MSI≥1.2组(n=57)与MSI<1.2组(n=219)。比较2组一般资料情况,发生不良心血管事件的比例,采用受试者ROC曲线下面积来评估NLR值和MSI值对NSTEMI院内不良心血管事件的预测能力。结果连续入选的276例NSTEMI患者中,发生不良心血管事件52例,占18.8%,心源性休克患者15例,占5.4%,恶性心律失常患者24例,占8.7%,死亡13例,占4.7%。NLR≥5.0与MSI≥1.2值组的心功能、收缩压(SBP)、舒张压(DBP)及心率(HR)分别与NLR<5.0与MSI<1.2组比较,差异有统计学意义(P<0.05);NLR≥5.0与MSI≥1.2组MACE发生率分别高于NLR<5.0组与MSI<1.2组(P<0.05)。此外,NLR和MSI的ROC曲线下面积分别为0.734和0.703,提示NLR和MSI均具有评价急性非ST段抬高型心肌梗死患者短期不良心血管事件发生能力。结论MSI与NLR是评估NSTEMI短期不良预后的两个简单的重要的易获得指标。

Shock index of patients with sepsis after continuous blood purification treatment and its relationship with systemic inflammatory response syndrome and immune response

Objective:To study the shock index of patients with sepsis after continuous blood purification (CBP) treatment and its relationship with systemic inflammatory response syndrome and immune response.Methods:A total of 88 patients with sepsis who underwent continuous blood purification treatment in our hospital between June 2012 and May 2016 were chosen as research subjects, shock index (SI) was compared before and after the treatment, and according to the level of SI after treatment, all patients were divided into shock group (n=27) with SI>0.5 points and no shock group (n=61) with SI≤0.5 points. Serum contents of inflammatory mediators, Th1/Th2 cellular immunity indexes, immunoglobulin and complement were compared between two groups of patients after treatment.Results: The level of SI in patients with sepsis was significantly lower than that before treatment. Serum contents of inflammatory mediators PCT, CRP and HMGB1 in no shock group were lower than those in shock group, contents of Th1 cytokines IL-2 and IFN-γ were higher than those in shock group, contents of Th2 cytokines IL-10 and IL-13 were lower than those in shock group, and contents of IgG, IgM, IgA, C3 and C4 were higher than those in shock group.Conclusion: The level of SI decreases in the patients with sepsis after CBP treatment, and SI level is directly correlated with the systemic inflammatory response syndrome and immune response levels.

急诊多发伤患者rSIG休克指数、初始血乳酸及D-二聚体变化分析

目的探讨并分析急诊多发伤患者rSIG休克指数、初始血乳酸及D二聚体(D-D)变化。方法选取本院2021年6月至2023年7月接诊的68例急诊多发伤患者的病历资料,根据治疗结局分为死亡组7例、存活组61例。根据损伤严重程度评分(ISS)对68例急诊多发伤患者进行划分,其中轻中度伤组55例(ISS评分≤25分)、重伤组13例(ISS评分>25分)。比较死亡组和存活组、轻中度伤组和重伤组急诊多发伤患者rSIG休克指数、初始血乳酸及D-D水平变化,采用Pearson相关分析法分析急诊多发伤rSIG休克指数、初始血乳酸及D-D水平与预后及损伤严重程度的相关性。结果死亡组患者的rSIG休克指数、初始血乳酸及D-D水平均明显高于存活组(P<0.05);重伤组患者的rSIG休克指数、初始血乳酸及D-D水平均明显高于轻中度伤组(P<0.05);经Pearson相关分析结果显示,急诊多发伤的rSIG休克指数、初始血乳酸及D二聚体水平与预后及损伤严重程度均呈正相关(P<0.05)。结论r SIG休克指数、初始血乳酸及D-D变化均与急性多发伤患者的死亡风险和不良预后密切相关。在急诊救治中,监测这些指标可以为医生提供重要的参考依据,有助于评估患者的病情和预后,从而制定更加合理的治疗方案。

Application and Nursing of Pulse Index Continuous Cardiac Output (PiCCO) Volume Monitoring in Early Fluid Resuscitation in Patients with Septic Shock

Background: Septic shock is a rapidly changing and fatal syndrome that can cause comprehensive deterioration of cardiopulmonary and renal function and multiple organ failure. At the same time, septic shock has the complex clinical manifestations and hemodynamics. PiCCO can accurately monitor blood flow, physical and volume indicators, and active and effective fluid resuscitation are important measures to reduce the fatality rate of septic shock and improve the prognosis of patients. Objectives: To explore the application and nursing of PiCCO in early fluid resuscitation in patients with septic shock. Methods: This was a retrospective observational study. The observation group and the control group each had 30 cases. The observation group used PiCCO to guide fluid resuscitation;the control group used conventional methods to guide fluid resuscitation. The changes in CVP, HR, MAP, and urine volume per hour were observed in the two groups. The changes of various indicators before and after fluid resuscitation, the length of stay in ICU and the mortality rate were compared between the two groups. All the outcomes were collected from the electronic medical case system after patients’ discharge from the hospital. Results: APACHE II, CVP, HR, MAP were compared between the observation group and the control group, and the differences were statistically significant (P < 0.05). The blood volume of patients in the observation group was significantly improved after fluid supplementation (P < 0.05). Compared with the control group, the length of stay in ICU in the observation group was significantly shorter, and the mortality rate was also significantly reduced (P < 0.05). Conclusion: PiCCO can be better used in early fluid resuscitation of patients with septic shock.

Diagnostic Performance of Serial bedside Capillary Lactate, Hemoglobin, and Shock Index for Severe Postpartum

Objective: To assess the diagnostic capacity of bedside capillary lactate (CLact), capillary Haemoglobin (CHb), and shock index (SI) for severe postpartum haemorrhage (SPPH > 2000 ml) at diagnosis, 15 minutes and 30 minutes later. Method: A cohort study was carried out in a reference hospital in San Luis Potosi, Mexico from February 2020 to March 2021, and included sixty women in vaginal labor or c-section who presented PPH (≥500 ml in labor or ≥1000 ml in c-section) measured by the gravimetric method. CLact, SI, and CHb concentrations were analyzed at diagnosis of PPH, 15 minutes, and 30 minutes. Patients who presented total blood loss of >2000 ml were considered SPPH. A T-test or Wilcox test was performed to compare the groups of non-severe and severe. Sensitivity, specificity, and performance were calculated by A Receiver Operating Curve. Results: A CLact measurement at 30 minutes was significantly different between the non-severe and severe groups (4.0 + 1.9 vs 4.8 + 1.15 P-value 0.001, with an optimal cut point of 4.3 mmol/dl at AUC 0.75, sensitivity 0.85, and specificity of 0.62. With a cut-point of 1.17, an AUC of 0.76, sensitivity of 0.43, and specificity of 0.98, SI at diagnosis was significantly different between the non-severe and severe groups (0.70 + 0.20 vs. 0.90 + 0.38 P-value 0.0228). Conclusion: SI is an early sign of SPPH;CLact can significantly identify SPPH after 30 minutes.

SiC_(f)/SiC复合材料表面Si/Yb_(2)Si_(2)O_(7)涂层1350℃抗热冲击和抗热冲刷性能研究

为了研究Si/Yb_(2)Si_(2)O_(7)涂层在1350℃条件下的抗热冲击和抗热冲刷性能,首先在SiC_(f)/SiC复合材料上采用真空等离子喷涂技术制备了Si/Yb_(2)Si_(2)O_(7)涂层,并采用金相、物相、SEM、EDS、燃气热冲击设备和燃气热冲刷设备对试样进行了结构及性能表征。结果表明:涂层与SiC_(f)/SiC复合材料的结合强度为25.01 MPa。经过1350℃燃气热冲击1000次,1350℃、550 m/s燃气热冲刷1 h后,Yb_(2)Si_(2)O_(7)涂层的表面物相均主要为Yb_(2)Si_(2)O_(7)、Yb_(2)SiO_(5)、Yb_(2)O_(3)和SiO_(2),抗热冲击和抗热冲刷2项性能测试结果均达设计要求。涂层结合强度很高,复合材料、Si层和Yb_(2)Si_(2)O_(7)层耐高温且热匹配性能较好,且面层的抗燃气腐蚀能力很强,是涂层热冲击、热冲刷性能良好的主要原因。燃气热冲刷的燃气燃烧时间比燃气热冲击的总时间短,且热冲刷为恒温连续冲刷,无冷热的剧烈交替变化,故燃气冲刷后涂层边缘处靠近工装装卡的地方未见明显开裂,且连续冲刷后的黑色烧蚀区域较燃气热冲击的面积小。

Correlation between shock index and inflammation, oxidative stress as well as target organ damage in patients with sepsis

Objective:To study the correlation between shock index and inflammation, oxidative stress as well as target organ damage in patients with sepsis.Methods: A total of 70 patients with sepsis treated in our hospital between March 2013 and May 2016 were collected and divided into no shock group (SI<0.5) (n=11), general shock group (0.5 SI 2) (n=42) and severe shock group (SI>2.0) (n=17) according to the shock index (SI). Immediately after admission, serum levels of inflammatory factors, oxidative stress indexes and liver function indexes were detected.Results:Serum interleukin-1β (IL-1β), interleukin-8 (IL-8), tumor necrosis factor (TNF-α), advanced oxidation protein products (AOPPs), total bilirubin (TB),γ-glutamyl transpeptidase (GGT) and alanine aminotransferase (ALT) levels of severe shock group and general shock group were higher than those of no shock group while anti-inflammatory factors interleukin-10 (IL-10), interleukin-13 (IL-13), soluble tumor necrosis factor receptorⅠ(sTNF-RI), glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) and catalase (CAT) levels were lower than those of no shock group;serum IL-1β, IL-8, TNF-α, AOPPs, TB, GGT and ALT levels of severe shock group were higher than those of general shock group while IL-10, IL-13, sTNF-RI, CAT, GSH-Px and SOD levels were lower than those of general shock group.Conclusion:The higher the shock index in patients with sepsis, the more severe the inflammation, oxidative stress and target organ damage, and the two are positively correlated.

Testing the Proposed Municipality Resilience Index to Climate Change Shocks and Stresses in Mbale Municipality in Eastern Uganda

Since climate change shocks and stresses cannot be fully prevented, building resilient urban areas is gaining more attention in the global community. By building resilience, the negative impacts of climate change shocks and stresses can be alleviated. Several indices have been developed to measure urban resilience. Yet, most of these indices focus more on objective methods which require robust bio-physical and socio-economic data sets which are generally lacking in many developing countries. To reduce this challenge, the use of subjective methods has recently been suggested. This study proposed and tested a Municipality Resilience Index (MRI) which employed a subjective method to assess the resilience of Mbale municipality in Eastern Uganda against climate change shocks and stresses. The proposed MRI includes 46 variables describing the physical, social, economic and institutional dimensions. The MRI can be applied in any municipality in developing countries facing climate related shocks and stresses and with limited survey data. The application of this index to Mbale municipality shows that the municipality has a low resilience index of 0.2. Similarly, most variables in the four dimensions of resilience reflected very low resilience scores with other divisions being more resilient than the others. Furthermore, the social dimension has the lowest score as compared to the physical, economic and institutional dimensions. The findings indicate a spatial variability in the contribution of the resilience dimensions within this small geographic confine. Moreover, the findings show the strengths and weaknesses in the different dimensions of the proposed MRI. This can act as a guide for policy and practitioners on which sectors to target in order to enhance the resilience of Mbale municipality.

Application of pulse index continuous cardiac output system in elderly patients with acute myocardial infarction complicated by cardiogenic shock: A prospective randomized study

BACKGROUND Cardiogenic shock (CS) secondary to acute myocardial infarction (AMI) complicates management of the condition, and often leads to poor prognosis. Prompt and accurate monitoring of cardiovascular and accompanying hemodynamic changes is crucial in achieving adequate management of the condition. Advances in technology has availed procedures such as pulse index continuous cardiac output (PiCCO), which can offer precise monitoring of cardiovascular functions and hemodynamic parameters. In this study, PiCCO is evaluated for its potential utility in improving management and clinical outcomes among elderly patients with AMI complicated by CS. AIM To assess whether use of the PiCCO system can improve clinical outcomes in elderly patients with AMI complicated by CS.METHODS Patients from emergency intensive care units (EICU) or coronary care units (CCU) were randomized to receive PiCCO monitoring or not. The APACHE II score, SOFA score, hs-TnI, NT-proBNP, PaO2/FiO2 ratio and lactate levels on day 1, 3 and 7 after treatment were compared. The infusion and urine volume at 0-24 h, 24-48 h and 48-72 h were recorded, as were the cardiac index (CI), extravascular lung water index (EVLWI), intrathoracic blood volume index (ITBVI) and global end diastolic volume index (GEDVI) at similar time intervals. RESULTS Sixty patients with AMI complicated by CS were included in the study. The PiCCO group had a significantly lower APACHE II score, SOFA score, hs-TnI and NT-proBNP levels on day 1, 3 and 7 after treatment. The infusion and urine volume during 0-24 h in the PiCCO group were significantly greater, and this group also showed significantly higher ADL scores. Furthermore, the PiCCO group spent lesser days on vasoactive agents, mechanical ventilation, and had a reduced length of stay in EICU/CCU. Additionally, the CI was significantly higher at 48 h and 72 h in the PiCCO group compared with that at 24 h, and the EVLWI, ITBVI and GEDVI were significantly decreased at 48 h and 72 h. CONCLUSION Applying the PiCCO system could improve the clinical outcomes of elderly patients with AMI complicated by CS.

Modified shock index and mortality rate of emergency patients

BACKGROUND:This study aimed to determine whether modified shock index(MSI)is associated with mortality that is superior to heart rate,blood pressure,or the shock index(SI).in emergency patients.METHODS:A retrospective database review was performed on 22 161 patients who presented to Peking Union Medical College Hospital Emergency Department and received intravenous fluids from January 1 to December 31,2009.We gathered data of the patients on age,gender,vital signs,levels of consciousness,presenting complaints,and SI and MSI were calculated for all patients.RESULTS:Multivariate regression analysis was performed to determine the correlation between risk factors and outcome.There is a significant correlation between emergency patient mortality rate and patient's vital signs obtained at the triage desk(HR>120 beats/min,systolic BP<90 mmHg,diastolic BP<60 mmHg).MSI is a stronger predictor of emergency patient mortality compared to heart rate and blood pressure alone,whereas SI does not have a significant correlation with emergency patient mortality rate.CONCLUSION:MSI is a clinically significant predictor of mortality in emergency patients.It may be better than using heart rate and blood pressure alone.SI is not significantly correlated with the mortality rate of the emergency patient.

电子封装用Al-Si功能梯度材料的显微组织和性能

通过喷雾沉积法制备用于电子封装的双层和三层Al-Si功能梯度材料。结果表明,梯度材料具有致密的显微组织和良好的层间结合。三层梯度材料的抗弯强度高于双层梯度材料,以高Si含量层为承载面的H-L方向的抗弯强度高于以低Si含量层为承载面的L-H方向。所有梯度材料的导热系数均超过140W/(m·K),且其热膨胀系数没有明显的差异。经热冲击处理后,双层梯度材料出现的裂纹比三层梯度材料更多更大,这是由于界面上的高热应力和大尺寸Si颗粒因应力集中而趋于破裂。

Correlation of Inferior Vena Cava Respiratory Variability Index with Central Venous Pressure and Hemodynamic Parameters in Ventilated Pigs with Septic Shock

Septic shock is a common critical condition, for which effective early fluid resuscitation is the therapeutic focus. According to the 2008 international guidelines for management of severe sepsis and septic shock, resuscitation should achieve a central venous pressure （CVP） of 8-12 mmHg within the first 6 h. However, it is still uncertain about the sensitivity and specificity of CVP in reflecting the cardiac preload. Ultrasonography is a simple, rapid, non-invasive, and repeatable method for the measurement of sensitivity and specificity of CVP and has thus gradually attracted the increasing attention of physicians. It was reported that ultrasonography can show the inferior vena cava diameter, respiratory variability index, and blood volume in patients with sepsis or heart failure.

Validation of the age-adjusted shock index for pediatric casualties in Iraq and Afghanistan

Background: Pediatric casualties account for a notable proportion of encounters in the deployed setting based on the humanitarian medical care mission. Previously published data demonstrates that an age-adjust shock index may be a useful tool in predicting massive transfusion and death in children. We seek to determine if those previous findings are applicable to the deployed, combat trauma setting.Methods: We queried the Department of Defense Trauma Registry(DODTR) for all pediatric subjects admitted to US and Coalition fixed-facility hospitals in Iraq and Afghanistan from January 2007 to January 2016. This was a secondary analysis of casualties seeking to validate previously published data using the shock index, pediatric age adjusted. We then used previously published thresholds to determine patients outcome for validation by age grouping, 1–3 years(1.2), 4–6 years(1.2), 7–12 years(1.0), 13–17 years(0.9).Results: From January 2007 through January 2016 there were 3439 pediatric casualties of which 3145 had a documented heart rate and systolic pressure. Of those 502(16.0%) underwent massive transfusion and 226(7.2%) died prior to hospital discharge. Receiver operating characteristic(ROC) thresholds were inconsistent across age groups ranging from 1.0 to 1.9 with generally limited area under the curve(AUC) values for both massive transfusion and death prediction characteristics. Using the previously defined thresholds for validation, we reported sensitivity and specificity for the massive transfusion by age-group: 1–3(0.73, 0.35), 4–6(0.63, 0.60), 7–12(0.80, 0.57), 13–17(0.77, 0.62). For death, 1–3(0.75, 0.34), 4–6(0.66–0.59), 7–12(0.64, 0.52), 13–17(0.70, 0.57). However, negative predictive values(NPV) were generally high with all greater than 0.87.Conclusions: Within the combat setting, the age-adjusted pediatric shock index had moderate sensitivity and relatively poor specificity for predicting massive transfusion and death. Better scoring systems are needed to predict resource needs prior to arrival, that perhaps include other physiologic metrics. We were unable to validate the previously published findings within the combat trauma population.

Sub-bandgap refractive indexes and optical properties of Sidopedβ-Ga_(2)O_(3) semiconductor thin films

In this article,we present a theoretical study on the sub-bandgap refractive indexes and optical properties of Sidopedβ-Ga_(2)O_(3) thin films based on newly developed models.The measured sub-bandgap refractive indexes ofβ-Ga_(2)O_(3) thin film are explained well with the new model,leading to the determination of an explicit analytical dispersion of refractive indexes for photon energy below an effective optical bandgap energy of 4.952 eV for theβ-Ga_(2)O_(3) thin film.Then,the oscillatory structures in long wavelength regions in experimental transmission spectra of Si-dopedβ-Ga_(2)O_(3) thin films with different Si doping concentrations are quantitively interpreted utilizing the determined sub-bandgap refractive index dispersion.Meanwhile,effective optical bandgap values of Si-dopedβ-Ga_(2)O_(3) thin films are further determined and are found to decrease with increasing the Si doping concentration as expectedly.In addition,the sub-bandgap absorption coefficients of Si-dopedβ-Ga_(2)O_(3) thin film are calculated under the frame of the Franz–Keldysh mechanism due to the electric field effect of ionized Si impurities.The theoretical absorption coefficients agree with the available experimental data.These key parameters obtained in the present study may enrich the present understanding of the sub-bandgap refractive indexes and optical properties of impurity-dopedβ-Ga_(2)O_(3) thin films.

rSIG/A在急诊创伤中的应用

目的 探讨rSIG/A(reverse shock index multiplied by Glasgow coma score divided by age)在急诊创伤患者中对预后的评估价值。方法 收集2012年1月至2014年3月浙江大学医学院附属第一医院急诊收治的1060例创伤患者的临床资料,以28d预后为结局,将患者分为存活组和死亡组;根据rSIG/A最佳截断值,将患者分为rSIG/A≤0.34组和rSIG/A>0.34组;根据急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluation Ⅱ,APACHE Ⅱ)评分最佳截断值,将患者分为APACHE Ⅱ评分≤12分组、APACHE Ⅱ评分>12分组。回顾性分析其生命体征、格拉斯哥昏迷评分(Glasgow coma score,GCS)、APACHE Ⅱ评分、rSIG/A、病死率等指标,并比较rSIG/A与APACHE Ⅱ评分间的关系,分析其与预后的关系。结果 存活组患者的rSIG/A、GCS评分均高于死亡组,APACHE Ⅱ评分低于死亡组(P<0.01)。rSIG/A与APACHE Ⅱ评分对创伤患者病死率均有一定的预测价值(曲线下面积分别为0.866、0.856),但两者间差异无统计学意义。rSIG/A≤0.34组患者的APACHE Ⅱ评分、病死率均大于rSIG/A>0.34组(P<0.01),APACHE Ⅱ评分≤12分组患者的rSIG/A值大于APACHE Ⅱ评分>12分组,病死率小于APACHE Ⅱ评分>12分组(P<0.01)。创伤患者rSIG/A值与APACHE Ⅱ评分呈负相关(r=–0.574,P<0.01)。rSIG/A值(OR=0.008,95%CI:0~0.620,P=0.030)与死亡呈负相关;APACHE Ⅱ评分(OR=1.106,95%CI:1.009~1.213,P=0.031)与死亡呈正相关(P<0.05)。结论 rSIG/A、APACHE Ⅱ评分在创伤患者伤情严重程度及预后评估方面有一定的价值,但由于rSIG/A具有无创、简便、快速及持续评估的优势,因此,更加值得在急诊推广。