AIM:To identify risk factors predictive of intensive care unit(ICU) mortality in patients with ventilator-related pancreatitis.The clinical outcomes of patients with ventilator-related pancreatitis were compared with ...AIM:To identify risk factors predictive of intensive care unit(ICU) mortality in patients with ventilator-related pancreatitis.The clinical outcomes of patients with ventilator-related pancreatitis were compared with those of patients with pancreatitis-related respiratory failure as well as controls.METHODS:One hundred and forty-eight patients with respiratory failure requiring mechanical ventilation and concomitant acute pancreatitis were identified from a prospectively collected dataset of 9108 consecutive patients admitted with respiratory failure over a period of five years.Sixty patients met the criteria for ventilator-related pancreatitis,and 88(control patients),for pancreatitis-related respiratory failure.RESULTS:Mortality rate in ventilator-related pancreatitis was comparable to that in ICU patients without pancreatitis by case-control methodology(P=0.544).Multivariate logistic regression analysis identified low PaO2/FiO2(OR:1.032,95% CI:1.006-1.059,P=0.016) as an independent risk factor for mortality in patients with ventilator-related pancreatitis.The mortality rate in patients with ventilator-related pancreatitis was lower than that in patients with acute pancreatitis-related respiratory failure(P<0.001).CONCLUSION:We found that low PaO2/FiO2 was an independent clinical parameter predictive of ICU mortality in patients with ventilator-related pancreatitis.展开更多
Aiming to get the strata behavior and stability rules of surrounding rock of the main return airway of Yushujing Coal Mine, convergence deformation of two sides and force of U-shaped steel yieldable support and bolt w...Aiming to get the strata behavior and stability rules of surrounding rock of the main return airway of Yushujing Coal Mine, convergence deformation of two sides and force of U-shaped steel yieldable support and bolt were monitored, and deformation of surrounding rock and mechanical characteristics of support structure were timely obtained to guide the informa- tion construction and optimize supporting parameters in water-rich soft rock roadway. The field monitoring results indicate the following. （1） Convergence displacement of rock surface increases with time continuity and shows surrounding rock＇s intense theological behavior. The original support scheme cannot control the large deformation and strongly theological behavior; （2） Without backfilling, the U-shaped steel support begins to bear load after erecting for 4-7 days and increases rapidly in the first 30 days. The U-shaped steel support at the right shoulder and top of roadway bears a larger force and the left side and shoulder bears a smaller force; （3） The stress of bolt increasing over time and at the right shoulder of roadway has larger growth and value. The mechanism of rock deformation and the failure and strata behavior in water-rich soft rock roadway are revealed based on the results of the measured relaxation zone of surrounding rock, measured stresses, and the rock mechanics tests.展开更多
Objective： To explore and analyze the concept of intensive care unit （ICU） delirium. Method： Walker and Avant’sstrategy of analysis was adopted to this research. Results： ICU delirium is defined as the presence ...Objective： To explore and analyze the concept of intensive care unit （ICU） delirium. Method： Walker and Avant’sstrategy of analysis was adopted to this research. Results： ICU delirium is defined as the presence of an acute cognitiveimpairment, accompanied by a disturbance of consciousness with fluctuating inattention, and the array of dysfunctionsonly developed for a short period of time in ICU. The antecedents of ICU delirium include （1） the high severity of illness,（2） pain, （3） sedative use, （4） immobilization, （5） sleep deprivation and （6） unpleasant awareness. The consequencesinvolve （1） promoting the risks of self-extubation and unplanned removal of catheters, （2） prolonging the length of ICUstay, （3） increasing the mortality of critical patients and （4） Some different ICU delirium assessment instruments aregathered. Confusion Assessment Method for Intensive Care Unit assessment tool （CAM-ICU） was the most populardiagnostic tool used by nurses. Conclusion： Concept analysis as an extension and development of nursing theory cancreate a linkage between practice and theory. It will create a knowledge foundation of ICU delirium and provide atheoretical basis to construct nursing theory. This study can help ICU nurses to understand and recognize ICU delirium.ICU nurses will be enlightened to develop effective interventions of ICU delirium to improve critical patients’ clinicaloutcomes.展开更多
This paper proposes a proper methodology in data modification by using AHP （analytical hierarchy process） technique and FCM （fuzzy c-mean） model in the ICU （intensive care unit）. The binary data were created fro...This paper proposes a proper methodology in data modification by using AHP （analytical hierarchy process） technique and FCM （fuzzy c-mean） model in the ICU （intensive care unit）. The binary data were created from continuous data using FCM model, while the continuous data were constructed from binary data using AHP technique. The models used in this study are FCRM （fuzzy c-regression model）. A case study in scale of health at the ICU ward using the AI-IP, FCM model and FCRM models was conducted. There are six independent variables in this study. There are four cases which are considered as the result of using AHP technique and FCM model against independent data. After comparing the four cases, it was found that case 4 appeared to be the best model, because it has the lowest MSE （mean square error） value. The original data have the MSE value of 97.33, while the data in case 4 have the MSE value of 82.75. This means that the use of AHP technique can reduce the MSE value, while the use of FCM model can not reduce the MSE value. In other words, it can be proved that the AHP technique can increase the accuracy of prediction in modeling scale of health which is associated with the mortality rate in the ICU.展开更多
The Jianpudong No. 4 tunnel is a shallow tunnel, which belongs to Shaoshan County scenic highway in Hunan province, China and whose surrounding rock is weak. According to its characteristics, the field monitoring test...The Jianpudong No. 4 tunnel is a shallow tunnel, which belongs to Shaoshan County scenic highway in Hunan province, China and whose surrounding rock is weak. According to its characteristics, the field monitoring tests and numerical analysis were done. The mechanical characteristics of shallow tunnels under weak surrounding rock and the stress-strain rule of surrounding rock and support were analyzed. The numerical analysis results show that the settlement caused by upper bench excavating accounts for 44% of the total settlement, and the settlement caused by tunnel upper bench supporting accounts for 56% of the total settlement. The maximum axial force of shotcrete lining is 177.2 k N, which locates in hance under the secondary lining. The maximum moment of shotcrete lining is 5.08 k N·m, which locates in the arch foot. The stress curve of steel arch has three obvious stages during the tunnel construction. The maximum axial force of steel arch is 297.4 k N, which locates in tunnel vault. The axial forces of steel arch are respectively 23.5 k N and-21.8 k N, which is influenced by eccentric compression of shallow tunnel and locates in hance. The results show that there is larger earth pressure in tunnel vault which is most unfavorable position of steel arch. Therefore, the advance support should be strengthened in tunnel vault during construction process.展开更多
In the present study,we aimed to explore the timing of dosing with dapagliflozin(DAPA)in patients with hypovolemia and the role of the clinical pharmacist in pharmacological monitoring.The clinical pharmacist was invo...In the present study,we aimed to explore the timing of dosing with dapagliflozin(DAPA)in patients with hypovolemia and the role of the clinical pharmacist in pharmacological monitoring.The clinical pharmacist was involved in the dosing regimen of two patients with hypovolemia using DAPA and advising patients with insufficient blood volume to withhold the use of the drug.They reviewed the relevant literature to provide a theoretical basis for clinicians and the role of clinical pharmacists in pharmacy services.When considering patients with hypovolemia,the clinical pharmacist can promptly identify that DAPA can reduce blood volume and provide rational advice and rationale for the patient‟s medication that is adopted by the clinician,resulting in an individualized dosing regimen for the patient.Clinical pharmacists are advised to pay attention to the dosing adjustments of DAPA when patients are in hypovolemia and to be more alert to the adverse effects that can result from its use.展开更多
文摘AIM:To identify risk factors predictive of intensive care unit(ICU) mortality in patients with ventilator-related pancreatitis.The clinical outcomes of patients with ventilator-related pancreatitis were compared with those of patients with pancreatitis-related respiratory failure as well as controls.METHODS:One hundred and forty-eight patients with respiratory failure requiring mechanical ventilation and concomitant acute pancreatitis were identified from a prospectively collected dataset of 9108 consecutive patients admitted with respiratory failure over a period of five years.Sixty patients met the criteria for ventilator-related pancreatitis,and 88(control patients),for pancreatitis-related respiratory failure.RESULTS:Mortality rate in ventilator-related pancreatitis was comparable to that in ICU patients without pancreatitis by case-control methodology(P=0.544).Multivariate logistic regression analysis identified low PaO2/FiO2(OR:1.032,95% CI:1.006-1.059,P=0.016) as an independent risk factor for mortality in patients with ventilator-related pancreatitis.The mortality rate in patients with ventilator-related pancreatitis was lower than that in patients with acute pancreatitis-related respiratory failure(P<0.001).CONCLUSION:We found that low PaO2/FiO2 was an independent clinical parameter predictive of ICU mortality in patients with ventilator-related pancreatitis.
基金Supported by the Projects of National Natural Science Foundation （51174196） the Program for New Century Excellent Talents in University （NCET-07-0519）
文摘Aiming to get the strata behavior and stability rules of surrounding rock of the main return airway of Yushujing Coal Mine, convergence deformation of two sides and force of U-shaped steel yieldable support and bolt were monitored, and deformation of surrounding rock and mechanical characteristics of support structure were timely obtained to guide the informa- tion construction and optimize supporting parameters in water-rich soft rock roadway. The field monitoring results indicate the following. （1） Convergence displacement of rock surface increases with time continuity and shows surrounding rock＇s intense theological behavior. The original support scheme cannot control the large deformation and strongly theological behavior; （2） Without backfilling, the U-shaped steel support begins to bear load after erecting for 4-7 days and increases rapidly in the first 30 days. The U-shaped steel support at the right shoulder and top of roadway bears a larger force and the left side and shoulder bears a smaller force; （3） The stress of bolt increasing over time and at the right shoulder of roadway has larger growth and value. The mechanism of rock deformation and the failure and strata behavior in water-rich soft rock roadway are revealed based on the results of the measured relaxation zone of surrounding rock, measured stresses, and the rock mechanics tests.
文摘Objective： To explore and analyze the concept of intensive care unit （ICU） delirium. Method： Walker and Avant’sstrategy of analysis was adopted to this research. Results： ICU delirium is defined as the presence of an acute cognitiveimpairment, accompanied by a disturbance of consciousness with fluctuating inattention, and the array of dysfunctionsonly developed for a short period of time in ICU. The antecedents of ICU delirium include （1） the high severity of illness,（2） pain, （3） sedative use, （4） immobilization, （5） sleep deprivation and （6） unpleasant awareness. The consequencesinvolve （1） promoting the risks of self-extubation and unplanned removal of catheters, （2） prolonging the length of ICUstay, （3） increasing the mortality of critical patients and （4） Some different ICU delirium assessment instruments aregathered. Confusion Assessment Method for Intensive Care Unit assessment tool （CAM-ICU） was the most populardiagnostic tool used by nurses. Conclusion： Concept analysis as an extension and development of nursing theory cancreate a linkage between practice and theory. It will create a knowledge foundation of ICU delirium and provide atheoretical basis to construct nursing theory. This study can help ICU nurses to understand and recognize ICU delirium.ICU nurses will be enlightened to develop effective interventions of ICU delirium to improve critical patients’ clinicaloutcomes.
文摘This paper proposes a proper methodology in data modification by using AHP （analytical hierarchy process） technique and FCM （fuzzy c-mean） model in the ICU （intensive care unit）. The binary data were created from continuous data using FCM model, while the continuous data were constructed from binary data using AHP technique. The models used in this study are FCRM （fuzzy c-regression model）. A case study in scale of health at the ICU ward using the AI-IP, FCM model and FCRM models was conducted. There are six independent variables in this study. There are four cases which are considered as the result of using AHP technique and FCM model against independent data. After comparing the four cases, it was found that case 4 appeared to be the best model, because it has the lowest MSE （mean square error） value. The original data have the MSE value of 97.33, while the data in case 4 have the MSE value of 82.75. This means that the use of AHP technique can reduce the MSE value, while the use of FCM model can not reduce the MSE value. In other words, it can be proved that the AHP technique can increase the accuracy of prediction in modeling scale of health which is associated with the mortality rate in the ICU.
基金Projects(51408060,51208063)supported by the National Natural Science Foundation of China
文摘The Jianpudong No. 4 tunnel is a shallow tunnel, which belongs to Shaoshan County scenic highway in Hunan province, China and whose surrounding rock is weak. According to its characteristics, the field monitoring tests and numerical analysis were done. The mechanical characteristics of shallow tunnels under weak surrounding rock and the stress-strain rule of surrounding rock and support were analyzed. The numerical analysis results show that the settlement caused by upper bench excavating accounts for 44% of the total settlement, and the settlement caused by tunnel upper bench supporting accounts for 56% of the total settlement. The maximum axial force of shotcrete lining is 177.2 k N, which locates in hance under the secondary lining. The maximum moment of shotcrete lining is 5.08 k N·m, which locates in the arch foot. The stress curve of steel arch has three obvious stages during the tunnel construction. The maximum axial force of steel arch is 297.4 k N, which locates in tunnel vault. The axial forces of steel arch are respectively 23.5 k N and-21.8 k N, which is influenced by eccentric compression of shallow tunnel and locates in hance. The results show that there is larger earth pressure in tunnel vault which is most unfavorable position of steel arch. Therefore, the advance support should be strengthened in tunnel vault during construction process.
文摘In the present study,we aimed to explore the timing of dosing with dapagliflozin(DAPA)in patients with hypovolemia and the role of the clinical pharmacist in pharmacological monitoring.The clinical pharmacist was involved in the dosing regimen of two patients with hypovolemia using DAPA and advising patients with insufficient blood volume to withhold the use of the drug.They reviewed the relevant literature to provide a theoretical basis for clinicians and the role of clinical pharmacists in pharmacy services.When considering patients with hypovolemia,the clinical pharmacist can promptly identify that DAPA can reduce blood volume and provide rational advice and rationale for the patient‟s medication that is adopted by the clinician,resulting in an individualized dosing regimen for the patient.Clinical pharmacists are advised to pay attention to the dosing adjustments of DAPA when patients are in hypovolemia and to be more alert to the adverse effects that can result from its use.
