Analysis of Influencing Factors and Predictive Models of Multidrug-resistant Bacterial Infection in Severe Patients

Objective:To investigate the influencing factors of multi-drug resistant bacterial infections in patients with severe disease and establish a predictive model.Methods:207 infected patients in our hospital from 2018 to May 2020 were selected for the study,of which 73 carried drug-resistant bacteria.Results:The risk factor network of people infected with multidrug resistant bacteria is higher than that of people infected with non-multidrug resistant bacteria,and the interaction between risk factors of the former is stronger.Conclusion:Antibiotics must be used appropriately after surgery.When the elderly was abnormal in indicators such as fever and procalcitonin in the ward,they should be considered as high-risk groups of MDRO infection.They need special care and preventive measures.

Analysis of the Effect of Implementing Humanized Care Service in Severe ICU Patients

Objective:To analyze the effect of implementing humanized nursing service intervention for severe patients in the intensive care unit(ICU).Methods:A hundred severely ill ICU patients who were treated from January 2021 to December 2022 were selected and grouped into a control group and an observation group.The control group adopted routine nursing services and the observation group adopted humanized nursing services.The nursing outcome of the two groups was analyzed.Results:The nursing risk incidence of the observation group was lower than that of the control group(P<0.05).The scale of comfort and nursing satisfaction in the observation group was higher than those in the control group(P<0.05).Conclusion:The implementation of a humanized care service for ICU patients lowered nursing risk incidences and increased the physical comfort and nursing satisfaction of these patients.

Long-term medical treatment of patients with severe burns at exposed sites

BACKGROUND Body parts such as the face and hands are highly exposed during daily life and burns may accumulate in these areas.In addition,residual wounds,scar hyperplasia and contracture often exist in the late stage of a deep burn in these areas,which may affect patients’appearance,movements,and mental health.However,inadequate attention has been paid to this issue which can result in problems,such as difficulty in healing,possibility of carcinoma,chronic pain and a heavy mental burden.AIM To investigate the long-term medical treatment of patients with severe burns at exposed sites following a mass burn casualty event.METHODS A retrospective analysis of 13 patients with severe burns at exposed sites was performed to determine their respective long-term medical treatment.A combined wound dressing scheme consisting of traditional Chinese and Western medicine was introduced to repair residual wounds.Active and passive functional exercises with massage,Chinese herbal baths and compression fixation were proposed to ameliorate the condition of the hands.A combination of physical,chemical and photoelectrical measures was adopted for anti-scar treatment.A psychological intervention and recovery guide was provided which corresponded to the patients’psychological status.RESULTS Compared to patients who did not simultaneously receive the same treatment,patients who underwent systematic treatment recovered with a lower woundinfection rate(P<0.05),a shorter healing time(13.6±3.2 d)compared with(19.1±3.5 d)and more bearable pain during wound dressing at three days,one week and two weeks after a Chinese herbal bath(P<0.05).Satisfactory results were achieved with regard to restored function of patients’joints and blood supply to nerve endings,closure of the eyelids and the size of mouth opening tended to be normal,and only 7.1%of patients were diagnosed with severe scar hyperplasia and contracture deformity compared with 30.7%in the control group.In addition,the color,thickness,vascular distribution and softness score of the scars improved(P<0.01),and the effects of the psychological intervention was remarkable as shown by the Self-Rating Anxiety Scale and Self-Rating Depression Scale.CONCLUSION A better prognosis can be achieved in patients in the late stage of a burn with active residual wound repair,limb functional exercise,anti-scar and psychological rehabilitation.

Severe bilateral anterior cingulum injury in patients with mild traumatic brain injury

The cingulum,the neural tract connecting the orbitofrontal cortex with the medial temporal lobe,plays an important role in cognition（Bush et al.,2000）.It is also important in memory because it provides cholinergic innervations to the cerebral cortex after obtaining innervation from the medial septal nucleus,the vertical nucleus of the diagonal band, and the nucleus basalis of Meynert via the medial cholinergic pathway （Nieuwenhuys et al., 2008; Naidich and Duvernoy, 2009; Hong and Jang, 2010a）.

Risk factors of posttraumatic cerebral infarction in patients with severe and extremely severe head injury

Objective To explore pathogenesis and risk factors for posttraumatic cerebral infarction (PTCI) in patients with severe and extremely severe head injuries for the purpose of providing clues for reducing occurrence of PTCI and case-fatality. Methods Gender,age,Glasgow coma scale (GCS) ,the presence or absence of basicranial fracture,cerebral hernia or infection,surgical modality,hypotension,and the use of diuretics

Study on difference between intravascular cooling system and traditional moderate hypothermia in patients with severe traumatic brain injury

Objective To study difference between intravascular cooling system and traditional moderate hypothermia in patients with severe traumatic brain injury. Methods Eighty sTBI patients were randomly divided into intravascular hypothermic groups (IVT) and traditional moderate hypothermia groups(HT) . Inclusion criteria included a Glasgow Coma Scale(GCS) score ≤8 and time from injury to admission must be within 12 hours.

The effects of decompressive craniectomy on cerebral blood flow volume and brain metabolism in different aged patients with severe traumatic brain injury

Objective To explore effects of decompressive craniectomy on cerebral blood flow volume and brain metabolism in different aged patients with severe traumatic brain injury. Methods 71 cases were divided into three groups according age: group A( 【 30 years) ,group B ( 30 ～ 50 years) 。

Quantitative electroencephalography in predicting on outcome of awakening in long-term unconscious patients after severe traumatic brain injury

Objective To explore quantitative electroencephalography in unconscious patients after severe traumatic brain injury (TBI) to predict awakening. Methods All cases were divided into two groups(the awake group 19 cases and the unfavourable prognosis group 22 cases).Two weeks after admission the original EEGs were preformed in 41 patients suffering from severe TBI with duration of disturbance of

Utilization of edge-to-edge valve plastic technique to correct severe tricuspid regurgitation in patients with congenital heart disease

Objective Tricuspid regurgitation is often associated in patients with congenital heart disease. Significant morbidity and mortality are related to tricuspid valve replacement. Tricuspid valve plasty is still a preferred choice. This report deals with our surgical experience in using edge-to-edge valve plasty technique to correct severe

Effect of mild hypothermia on glucose metabolism and glycerol of brain tissue in patients with severe traumatic brain injury

To study the effect of mild hypothermia on glucose metabolism and glycerol of brain tissue in patients with severe traumatic brain injury (sTBI).Methods All 33 patients with sTBI(GCS≤8) were randomly divided into hypothermic group and control group.Microdialysis catheters were inserted into the cerebral cortex of perilesion,relative normal brain tissue and subcutaneous tissue of abdomen in order to analyze the concentrations of lactate/pyruvate (L/P),lactate/glucose (L/G) and the glycerol(Gly) in extracellular fluid (ECF).Results In comparison with the control group,the concentration of L/G,L/P and Gly in periphery and that of L/P in ECF of the “normal brain tissue” were significantly decreased in the hypothermic group.In control group,concentration of L/G,L/P and Gly in periphery were higher than those in relative normal brain.In the hypothermic group,L/P concentration in periphery was higher than that in relative normal brain.Conclusion Mild hypothermia protects brain by decreasing concentrations of L/G,L/P and Gly in periphery and L/P concentration in “normal brain tissue”.The energy crisis and membrane phospholipid breakage in periphery are easier to happen after TBI,where mild hypothermia exerts significant protgective role.12 refs,3 tabs.

Relationship between the incidence of non-hepatic hyperammonemia and the prognosis of patients in the intensive care unit

BACKGROUND Ammonia is a normal constituent of body fluids and is found mainly through the formation of urea in the liver.Blood levels of ammonia must remain low as even slightly elevated concentrations(hyperammonemia)are toxic to the central nervous system.AIM To examine the relationship between the incidence of non-hepatic hyperammonemia(NHH)and the prognosis of patients who were admitted to the intensive care unit(ICU).METHODS This is a prospective,observational and single-center study.A total of 364 patients who were admitted to the ICU from November 2019 to February 2020 were initially enrolled.Changes in the levels of blood ammonia at the time of ICU admission and after ICU admission were continuously monitored.In addition,factors influencing the prognosis of NHH patients were analyzed.RESULTS A total of 204 patients who met the inclusion criteria were enrolled in this study,including 155 NHH patients and 44 severe-NHH patients.The incidence of NHH and severe-NHH was 75.98% and 21.57%,respectively.Patients with severe-NHH exhibited longer length of ICU stay and higher Acute Physiologic Assessment and Chronic Health Evaluation and Sequential Organ Failure Assessment scores compared to those with mild-NHH and non-NHH.Glasgow Coma Scale scores of patients with severe-NHH were than those of non-NHH patients.In addition,the mean and initial levels of ammonia in the blood might be helpful in predicting the prognosis of NHH.CONCLUSION High blood ammonia level is frequent among NHH patients admitted to the ICU,which is related to the clinical characteristics of patients.Furthermore,the level of blood ammonia may be helpful for prognosis prediction.

Association of severity and sex with vasoactive substance and sexual hormone level in patients with vascular dementia in the type of kidney asthenia and blood stasis syndrome

BACKGROUND: Kidney asthenia is the basic cause of the development of vascular dementia (VD). Kidney asthenia lasting for a long time will result in blood stasis. Also, the cause of VD may have relationships with endothelin (ET), nitric oxide (NO), homocysteine (HCY), estrogen (E2), and testosterone (T). OBJECTIVE: To observed clinical curative effect of the kidney tonic, pancreas tonic, and blood tonic with promoting blood circulation components in treating kidney asthenia with blood stasis syndrome of VD. DESIGN: Case controlled study. SETTING: Geriatric Institute of Integrated Medicine, Fujian College of Traditional Chinese Medicine. PARTICIPANTS: A total of 70 patients, including 39 males and 31 females aged 60-80 years, were selected from Department of Neurology, Pingshan Hospital from May 2000 to September 2002. Diagnostic criteria were used for probable VD of the American Psychiatric Association. Diagnostic and Statistical of Manual of Mental Disorder, 4th ed (DSM-Ⅳ), 1994 revised, mini-mental state examination (MMSE), and criteria of kidney asthenia with blood stasis with mixed weak and sthenia syndrome of Guidelines of Clinical Research of New Chinese Medicine in Treating Dementia. According to score of kidney asthenia with blood stasis syndrome, they were classified to three groups: mild (n =22), moderate (n =33) and severe (n =15). All of them with complete chest X-Ray, ECG, blood chemistry and other related examinations, exclusive of cardiovascular, liver, kidney diseases, homeopathy and psychiatry diseases. And hereby we also select 30 normal people as the comparing group, having no substantial diseases in heart, brain, kidney, liver, lung and other main organic systems after medical examination. Of this group, 11 were males and 19 were females, ranging from 62 years old to 78 years old. There were no obvious differences between the above two groups in sex, age, and education level after statistical analysis. All patients observed in Pingxi Hospital, Fuzhou, from May 2000 to September 2002. METHODS: ① According to the diagnoses standard of blood stasis syndrome: 0-89: The increase in score indicated that blood stasis syndrome was getting serious. ② According to MMSE: All the test samples were evaluated, those with scores of 0-30, in which the non-educated ≤ 17, primary school ≤ 20, above middle school ≤ 24 were categorized. ③ Testing all sample's ET, E2 and T by using radioimmunoassay, the RIA kits were provided by Scientific and Technological Development Center of General Hospital of PLA. ④ Testing the level of NO by using colorimetic method. ⑤ Testing the level of HCY by using Enzyme-linked Immunoassay. ⑥ Meanwhile, analyzing the blood stasis score by comparing with every standard. The differences of data were compared by using t test and F test. MAIN OUTCOME MEASURES: ① Blood plasma ET, blood serum NO, HCY, E2 and T. ② The analyzing results obtained from comparing score of blood stasis with every indicators. RESULTS: The result analysis was including of both the 70 patients of VD with kidney asthenia and blood stasis and compared group consist of 30 healthy people. ① ET, NO, HCY and ET/NO: The levels of ET, HCY and ET/NO were increasing with pathography, while the levels of ET, NO, HCY and ET/NO were decreasing with the pathography, and the difference in statistics was significant (P < 0.01). ② The level of E2 and T: The levels of both E2, T and E2/T for male VD patients were (67.72±12.18) pg/L and (351.58±155.02) ng/L, 0.24±0.12 respectively, which were higher than the compared group [(53.96±16.13) pg/L, (471.83±143.99) ng/L, 0.12±0.00, P < 0.05]. The level of E2 in the female VD patients was lower than the compared group [(34.23±10.99), (44.81±14.65) pg/L, P < 0.05]. ③ The relationship between the score of blood stasis and each indicators: The levels of ET, ET/NO and HCY had significant positive relationship with blood stasis mark (r = 0.352, 0.754, 0.347, P < 0.05-0.01), obvious negative relationship with NO (r =-0.528, P < 0.01) and no clear relationship with female E2/T and male E2/T (r = -0.210, 0.04, P > 0.05). CONCLUSION: ① The levels of ET, HCY and ET/NO are increasing with pathography, while the level of NO is decreasing, which may be the evidence that the possibility of VD pathography may have relationship with the indicators above. ② The level of E2 increase in male's VD patients, and decrease in male's. And the decrease of the female may have relationship with the VD.

Clinical and antibody characteristics reveal diverse signatures of severe and non-severe SARS-CoV-2 patients

Background COVID-19 pandemic continues,clarifying signatures in clinical characters and antibody responses between severe and non-severe COVID-19 cases would benefit the prognosis and treatment.Methods In this study,119 serum samples from 37 severe or non-severe COVID-19 patients from the First People's Hospital of Yueyang were collected between January 25 and February 182020.The clinical features,antibody responses targeting SARS-CoV-2 spike protein(S)and its different domains,SARS-CoV-2-specific Ig isotypes,IgG subclasses,ACE2 competitive antibodies,binding titers with FcγIIa and FcγIIb receptors,and 14 cytokines were comprehensively investigated.The differences between severe and non-severe groups were analyzed using Mann–Whitney U test or Fisher’s exact test.Results Severe group including 9 patients represented lower lymphocyte count,higher neutrophil count,higher level of LDH,total bile acid(TBA)(P<1×10–4),r-glutaminase(P=0.011),adenosine deaminase(P<1×10–4),procalcitonin(P=0.004),C-reactive protein(P<1×10–4)and D-dimer(P=0.049)compared to non-severe group(28 patients).Significantly,higher-level Igs targeting S,different S domains(RBD,RBM,NTD,and CTD),FcγRIIa and FcγRIIb binding capability were observed in a severe group than that of a non-severe group,of which IgG1 and IgG3 were the main IgG subclasses.RBD-IgG were strongly correlated with S-IgG both in severe and non-severe group.Additionally,CTD-IgG was strongly correlated with S-IgG in a non-severe group.Positive RBD-ACE2 binding inhibition was strongly associated with high titers of antibody(S-IgG1,S-IgG3,NTD-IgG,RBD-IgA,NTD-IgA,and CTD-IgA)especially RBD-IgG and CTD-IgG in the severe group,while in the non-severe group,S-IgG3,RBD-IgG,NTD-IgG,and NTD-IgM were correlated with ACE2 blocking rate.S-IgG1,NTD-IgM and S-IgM were negatively associated with illness day in a severe group,while S-IgG3,RBD-IgA,CTD-IgA in the severe group(r=0.363,P=0.011)and S-IgG1,NTD-IgA,CTD-IgA in the non-severe group were positively associated with illness day.Moreover,GRO-α,IL-6,IL-8,IP-10,MCP-1,MCP-3,MIG,and BAFF were also significantly elevated in the severe group.Conclusion Antibody detection provides important clinical information in the COVID-19 process.The different signatures in Ig isotypes,IgG subclasses,antibody specificity between the COVID-19 severe and non-severe group will contribute to future therapeutic and preventive measures development.

QT DISPERSION: A RISK INDICATOR FOR SEVERE VENTRICULAR ARRHYTHMIA IN PATIENTS WITH ISCHEMIC AND IDIOPATHIC CARDIOMYOPATHY

Increased QT dispersion in the surface ECG (QTd = QTmax minus QTmin) is considered as an indicator of electrical inhomogeneitv and a useful predictor for severe ventricular arrhythmia and sudden cardiac death in patients with different heart diseases. Patients with ischemic and idiopathic cardiomyopathy have a very high incidence of severe ventricular arrhythmia and sudden cardiac death. We compared QT, QTc. JT and JTc dispersion in ischemic (ICMP) and idopathic (CCMP) cardiomyopathy patients with and without severe ventricular arrhythmia and normal controls.

Impact of cytomegalovirus intestinal disease on the prognosis in patients with severe intestinal graft-versus-host disease

Objective To explore risk factors,clinical characteristics and prognosis of CMV enteritis combined with severe intestinal graft-versus-host disease(GVHD).Methods The data of 80 intestinal gradeⅢ/ⅣGVHD patients from January 2005 to September 2015 in hematology of PKUPH were retrospectively analyzed.All patients received colonoscopy and all GVHD diagnoses

Why do some trauma patients die while others survive?A matched-pair analysis based on data from Trauma Register DGU(R)

Purpose:The mortality rate for severely injured patients with the injury severity score(ISS)>16 has decreased in Germany.There is robust evidence that mortality is influenced not only by the acute trauma itself but also by physical health,age and sex.The aim of this study was to identify other possible influences on the mortality of severely injured patients.Methods:In a matched-pair analysis of data from Trauma Register DGU(R),non-surviving patients from Germany between 2009 and 2014 with an ISS_>16 were compared with surviving matching partners.Matching was performed on the basis of age,sex,physical health,injury pattern,trauma mechanism,conscious state at the scene of the accident based on the Glasgow coma scale,and the presence of shock on arrival at the emergency room.Results:We matched two homogeneous groups,each of which consisted of 657 patients(535 male,average age 37 years).There was no significant difference in the vital parameters at the scene of the accident,the length of the pre-hospital phase,the type of transport(ground or air),pre-hospital fluid management and amounts,ISS,initial care level,the length of the emergency room stay,the care received at night or from on-call personnel during the weekend,the use of abdominal sonographic imaging,the type of X-ray imaging used,and the percentage of patients who developed sepsis.We found a significant difference in the new injury severity score,the frequency of multi-organ failure,hemoglobine at admission,base excess and international normalized ratio in the emergency room,the type of accident(fall or road traffic accident),the pre-hospital intubation rate,reanimation,in-hospital fluid management,the frequency of transfusion,tomography(whole-body computed tomography),and the necessity of emergency intervention.Conclusion:Previously postulated factors such as the level of care and the length of the emergency room stay did not appear to have a significant influence in this study.Further studies should be conducted to analyse the identified factors with a view to optimising the treatment of severely injured patients.Our study shows that there are significant factors that can predict or influence the mortality of severely injured patients.

Chertsey Outcome Score for Trauma： Development and validation of a new unifying patient reported outcome measure for orthopaedic trauma

Purpose： Lately there is an increasing tendency of using Patient Reported Outcome Measures （PROMs） as a final indicator of the outcome of many surgical treatments in orthopaedics and in other medical specialties. Currently there are many outcome scores in orthopaedics and most of them are site specific. In the contrary there is a lack of trauma specific outcome scores. Methods： We have designed a new PROM especially for orthopaedic trauma patients, in order to measure in what extent the patients manage to return to their pre-injury state. This score uses as baseline the preinjury status of the patient and has the aim to determine the percentage of rehabilitation after treatment for any injury. Results： A total of 60 Chertsey Outcome Score for Trauma （COST） questionnaires were gathered in our outpatients department. The participants were 57% male （aged 46.81 years ± 18.5 years） and the questionnaires collected at mean 10 months post-injury. A Cronbach＇s Alpha value of 0.89 was identified for the whole construct. The three dimensions of the scale had good internal consistency as well （Cronbach＇s Alpha test values 0.74, 0.84 and 0.81 for symptoms, function and mental status respectively）. Strong/moderate correlation （Spearman＇s Rho test 0.43-0.65） was observed between the respective physical/mental dimensions of the COST and SF-12v2 questionnaires. Conclusion： There is a need among the orthopaedic trauma society for a specific PROM of trauma. COST is a useful and easy to use tool for every trauma surgeon.