Macbeth is one of the four great tragedies penned by English playwright, William Shakespeare. Lady Macbeth, the primary tragic female character in the play, seems to be different from other typical female roles portra...Macbeth is one of the four great tragedies penned by English playwright, William Shakespeare. Lady Macbeth, the primary tragic female character in the play, seems to be different from other typical female roles portrayed by Shakespeare, and is often characterized by the world as vicious and ambitious. Being in a patriarchal society, Lady Macbeth awakens to female self-awareness and lust for power. She silently rebels against the oppression and constraints imposed by the society, ultimately paying the price of her life. By analyzing the process of Lady Macbeth’s subversion of the identity of the Other from the perspective of feminist criticism, this article offers a new interpretation of Lady Macbeth’s image and delves into the underlying causes of her tragedy. It suggests that it is often difficult for women to break free from the oppressive shackles of a patriarchal society in their pursuit for equality, freedom and power. The path to women’s liberation is long and arduous, which still requires unwavering efforts and perseverance from all.展开更多
This paper critically analyzes Roberto Guzman’s approach to teaching English, as outlined in his TED talk “Teaching English without Teaching English”. While Guzman focuses on inspirational teaching and open-ended d...This paper critically analyzes Roberto Guzman’s approach to teaching English, as outlined in his TED talk “Teaching English without Teaching English”. While Guzman focuses on inspirational teaching and open-ended discussion, the analysis highlights some shortcomings of his methods from three perspectives: 1) whether the approach aligns with socio-cultural theories, 2) whether it overlooks the importance of input assumptions, and 3) whether it can effectively improve students’ communicative competence. Through this analysis, the paper sheds light on the potential limitations of Guzman’s approach to teaching English and provides insights into how educators can design more effective language teaching methods.展开更多
This study explores the application of Abrams’Fourfold Model in the classification of Western literary criticism.Abrams’framework categorizes literary criticism into four fundamental elements:text,author,world,and a...This study explores the application of Abrams’Fourfold Model in the classification of Western literary criticism.Abrams’framework categorizes literary criticism into four fundamental elements:text,author,world,and audience.The text is viewed as an independent entity with intrinsic artistic value,necessitating a detailed analysis of its structure,style,themes,and symbols.Author study delves into the creator’s life and socio-cultural context,often to uncover the work’s deeper meanings.Contextual study situates the work within its historical and social milieu,examining its reflection of or response to societal norms and events.Audience response analysis considers the diverse interpretations shaped by readers’backgrounds,emphasizing the reader’s role in constructing the work’s meaning.The study concludes that Abrams’Fourfold Model offers a comprehensive and flexible analytical tool,enabling critics to engage with literary works from multiple perspectives,thereby enriching the understanding of literary complexity and diversity.展开更多
As a core compulsory course for English majors majoring in teacher education,Literary Theory and Criticism plays an important role in enhancing text understanding,cultivating critical thinking,and shaping correct valu...As a core compulsory course for English majors majoring in teacher education,Literary Theory and Criticism plays an important role in enhancing text understanding,cultivating critical thinking,and shaping correct values in the future development of students.Influenced by traditional teaching ideas,students have many difficulties when learning this course,such as insufficient theoretical understanding,inadequate ability improvement,and not enough investment in course learning.In response to the above issues,this course focuses closely on the fundamental task of“cultivating virtue and nurturing people”,relying on modern information technology and introducing research methods of digital humanities.This course uses“7C”teaching mode under the“three-level integration”,in which“teaching”and“education”are carried out synchronously,and“teacher”and“student”are developed together,in order to greatly enhance students’learning participation and course satisfaction.展开更多
In 2014,Huang Kaihong,a professor at School of Foreign Languages and Cultures,Southwest University of Science and Technology,interviewed the Doctoral advisor Professor Nie Zhenzhao during the period of his academic vi...In 2014,Huang Kaihong,a professor at School of Foreign Languages and Cultures,Southwest University of Science and Technology,interviewed the Doctoral advisor Professor Nie Zhenzhao during the period of his academic visiting to Central China Normal University.As early as in 2005,Huang Kaihong conducted an interview with Professor Nie Zhenzhao on the topic of the general introduction of ethical literary criticism.So around 11 years later,the second interview mainly covers not only the ethical literary criticism theory,but the game theory and the relationship between them as well.Professor Nie thinks whether the game theory can be applied to literature research is still under discussion.The theory of ethical literary criticism is a kind of methodology based on science and it can get the attention of literary critics at home and abroad,which is because it fits the practical needs of literary criticism,draws the literary criticism away from only emphasizing criticism genres and the research of criticism terms,and pays attention to the true nature of the literary text in literature research.After consulting Professor Nie Zhenzhao about some related questions from the perspective of game theory.Huang Kaihong gets some significant information concerning literature research and understands the latest core terms and the concrete application method of ethical literary criticism,especially the relationship between the instructing and aesthetic functions of literature.展开更多
Roles of oligodendrocyte precursor cells in the central nervous system:Oligodendrocyte precursor cells(OPCs)have long been recognized for their critical role as precursors to oligodendrocytes,the primary myelin-produc...Roles of oligodendrocyte precursor cells in the central nervous system:Oligodendrocyte precursor cells(OPCs)have long been recognized for their critical role as precursors to oligodendrocytes,the primary myelin-producing cells.As precursors,OPCs mature and differentiate into oligodendrocytes,which contribute significantly to the formation of myelin sheaths around axons.This myelination,which is critical for the conduction of salutatory nerve impulses in the cerebral white matter,underscores the classical role of oligodendrocytes in central nervous system(CNS)functionality.Importantly,because oligodendrocytes are differentiated cells that cannot proliferate.展开更多
Adult microglia,by continuously sensing changes in their environment and communicating with nearly all brain cell types,are considered to be the immune sentinels of the brain.In the healthy central nervous system(CNS)...Adult microglia,by continuously sensing changes in their environment and communicating with nearly all brain cell types,are considered to be the immune sentinels of the brain.In the healthy central nervous system(CNS),microglia display a unique molecular homeostatic signature(i.e.,Tmem119,P2ry12,Sall1,Siglech,Gpr34,and Hexb)(Figure 1A).展开更多
Hypoglycemia-a critical complication linked to worsened brain function in diabetic subjects:Hypoglycemia is characterized by a decline in circulatory glucose levels below sta nda rd physiological thresholds.Mild hypog...Hypoglycemia-a critical complication linked to worsened brain function in diabetic subjects:Hypoglycemia is characterized by a decline in circulatory glucose levels below sta nda rd physiological thresholds.Mild hypoglycemia,classified as level 1 hypoglycemia,is defined by blood glucose levels below 70 mg/dL and can be effectively addressed through carbohydrate intake.Severe hypoglycemia,denoted by blood glucose levels less than 54 mg/dL,poses a life-threatening risk if left untreated.Individuals with type 1 and type 2 diabetes undergoing insulin treatment are particularly susceptible to hypoglycemia due to impaired counterregulatory mechanisms.展开更多
Solvent extraction,a separation and purification technology,is crucial in critical metal metallurgy.Organic solvents commonly used in solvent extraction exhibit disadvantages,such as high volatility,high toxicity,and ...Solvent extraction,a separation and purification technology,is crucial in critical metal metallurgy.Organic solvents commonly used in solvent extraction exhibit disadvantages,such as high volatility,high toxicity,and flammability,causing a spectrum of hazards to human health and environmental safety.Neoteric solvents have been recognized as potential alternatives to these harmful organic solvents.In the past two decades,several neoteric solvents have been proposed,including ionic liquids(ILs)and deep eutectic solvents(DESs).DESs have gradually become the focus of green solvents owing to several advantages,namely,low toxicity,degradability,and low cost.In this critical review,their classification,formation mechanisms,preparation methods,characterization technologies,and special physicochemical properties based on the most recent advancements in research have been systematically described.Subsequently,the major separation and purification applications of DESs in critical metal metallurgy were comprehensively summarized.Finally,future opportunities and challenges of DESs were explored in the current research area.In conclusion,this review provides valuable insights for improving our overall understanding of DESs,and it holds important potential for expanding separation and purification applications in critical metal metallurgy.展开更多
BACKGROUND Acute hyperglycemia due to insulin resistance is common in critically ill patients,typically managed with insulin infusion.However,the occurrence of transient extreme insulin resistance(EIR)requiring except...BACKGROUND Acute hyperglycemia due to insulin resistance is common in critically ill patients,typically managed with insulin infusion.However,the occurrence of transient extreme insulin resistance(EIR)requiring exceptional high-dose insulin is rare.CASE SUMMARY We present the case of a 68-year-old woman with pneumonia who suffered an out-of-hospital cardiac arrest,subsequently developing transient EIR following a new episode of sepsis.Remarkably,insulin resistance rapidly reversed when the insulin infusion rate peaked at 960 units/hour(a total of 18224 units on that day),and it was promptly titrated down to zero upon achieving the target glucose level.CONCLUSION Exceptional high-dose insulin infusion may be required in critically ill patients with stress-related EIR,which is typically transient.Clinicians should be aware of the phenomenon and cautious to avoid hypoglycemia and fluid overload during the steep titration of high-dose insulin infusion.展开更多
Sepsis is a life-threatening condition caused by a dysregulated response of the body in response to an infection that harms its tissues and organs.Interleukin-6(IL-6)is a significant component of the inflammatory resp...Sepsis is a life-threatening condition caused by a dysregulated response of the body in response to an infection that harms its tissues and organs.Interleukin-6(IL-6)is a significant component of the inflammatory response as part of the pa-thogenesis of sepsis.It aids in the development of Acute lung injury and,subse-quently,multiple organ dysfunction syndrome.This letter probes into the corre-lation between plasma IL-6 levels and the risk of developing acute lung injury and multiple organ dysfunction syndrome in critically ill patients with sepsis.While it shows promising results,limitations like its observational study design,a limited sample size,a single center involvement,single-time-point measurement,and a lack of a control group restrain its cogency.The study is a big step in identifying IL-6 as a biomarker to improve patient care.展开更多
William Carlos Williams,a poet who has an immense influence on the course of 20th century poetry.whose poems characterized his close attention to nature,friendship and the Chinese Classical Poetry. The Widow’s Lament...William Carlos Williams,a poet who has an immense influence on the course of 20th century poetry.whose poems characterized his close attention to nature,friendship and the Chinese Classical Poetry. The Widow’s Lament in Springtime is not only the representative of imitation of Chinese poetry about boudoir repining school but bringing poetry into natural relation with everyday life.展开更多
The provision of anaesthesia for individuals receiving chronic dialysis can be challenging.Sedation and anaesthesia are frequently managed by critical care clinicians in the intensive care unit or operating room.This ...The provision of anaesthesia for individuals receiving chronic dialysis can be challenging.Sedation and anaesthesia are frequently managed by critical care clinicians in the intensive care unit or operating room.This narrative review summarizes the important principles of sedation and anaesthesia for individuals on long-term dialysis,with reference to the best available evidence.Topics covered include the pharmacology of anaesthetic agents,the impacts of patient characteristics upon the pre-anaesthetic assessment and critical illness,and the fundamentals of dialysis access procedures.展开更多
Adolescence and the journey to adulthood involves exciting opportunities as well as psychosocial stress for young people growing up.These normal experiences are potentially magnified for teenagers living with chronic ...Adolescence and the journey to adulthood involves exciting opportunities as well as psychosocial stress for young people growing up.These normal experiences are potentially magnified for teenagers living with chronic illness or disability and their families.Advances in care have improved survival for children with a variety of serious chronic medical conditions such that many who may once have died in childhood now survive well into adulthood with ongoing morbidity.For those with highly complex needs,care is often provided at major paediatric hospitals with expertise,specially trained personnel,and resources to support young people and their families for the first decades of life.At the end of adolescence,however,it is generally appropriate and necessary for young adults and their caregivers to transition to the care of clinicians trained in the care of adults at general hospitals.While there are some well-managed models to support this journey of transition,these are often specific to certain conditions and usually do not involve intensive care.Many patients may encounter considerable challenges during this period.Difficulties may include the loss of established therapeutic relationships,a perception of austerity and reduced amenity in facilities oriented to caring for adult patients,and care by clinicians with less experience with more common paediatric conditions.In addition,there is a risk of potential conflict between clinicians and families regarding goals of care in the event of a critical illness when it occurs in a young adult with major disability and long-term health issues.These challenges present genuine opportunities to better understand the transition from paediatric to adult-based care and to improve processes that assist clinicians who support patients and families as they shift between healthcare settings.展开更多
BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevanc...BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevance in patients with septic shock remains uncertain.AIM To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.METHODS In the present retrospective single-center study,a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University,between August 1,2018,and May 31,2023,were analyzed.Patients were categorized based on the timing of hypernatremia occurrence into the IAH group(n=62),the non-IAH group(n=41),and the normonatremia group(n=54).RESULTS In the present study,there was a significant association between the high serum sodium concentrations,excessive persistent inflammation,immunosuppression and catabolism syndrome and chronic critical illness,while rapid recovery had an apparent association with normonatremia.Moreover,multivariable analyses revealed the following independent risk factors for IAH:Total urinary output over the preceding three days[odds ratio(OR)=1.09;95%CI:1.02–1.17;P=0.014],enteral nutrition(EN)sodium content of 500 mg(OR=2.93;95%CI:1.13–7.60;P=0.027),and EN sodium content of 670 mg(OR=6.19;95%CI:1.75–21.98;P=0.005)were positively correlated with the development of IAH.Notably,the area under the curve for total urinary output over the preceding three days was 0.800(95%CI:0.678–0.922,P=0.001).Furthermore,maximum serum sodium levels,the duration of hypernatremia,and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients(P<0.05).CONCLUSION The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU.It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.展开更多
文摘Macbeth is one of the four great tragedies penned by English playwright, William Shakespeare. Lady Macbeth, the primary tragic female character in the play, seems to be different from other typical female roles portrayed by Shakespeare, and is often characterized by the world as vicious and ambitious. Being in a patriarchal society, Lady Macbeth awakens to female self-awareness and lust for power. She silently rebels against the oppression and constraints imposed by the society, ultimately paying the price of her life. By analyzing the process of Lady Macbeth’s subversion of the identity of the Other from the perspective of feminist criticism, this article offers a new interpretation of Lady Macbeth’s image and delves into the underlying causes of her tragedy. It suggests that it is often difficult for women to break free from the oppressive shackles of a patriarchal society in their pursuit for equality, freedom and power. The path to women’s liberation is long and arduous, which still requires unwavering efforts and perseverance from all.
文摘This paper critically analyzes Roberto Guzman’s approach to teaching English, as outlined in his TED talk “Teaching English without Teaching English”. While Guzman focuses on inspirational teaching and open-ended discussion, the analysis highlights some shortcomings of his methods from three perspectives: 1) whether the approach aligns with socio-cultural theories, 2) whether it overlooks the importance of input assumptions, and 3) whether it can effectively improve students’ communicative competence. Through this analysis, the paper sheds light on the potential limitations of Guzman’s approach to teaching English and provides insights into how educators can design more effective language teaching methods.
基金The paper was supported by Henan Province Teaching Reform and Practice Project(Project Fund No.135)-Research on the Reform of Literary Theory Courses for English Majors in Universities.
文摘This study explores the application of Abrams’Fourfold Model in the classification of Western literary criticism.Abrams’framework categorizes literary criticism into four fundamental elements:text,author,world,and audience.The text is viewed as an independent entity with intrinsic artistic value,necessitating a detailed analysis of its structure,style,themes,and symbols.Author study delves into the creator’s life and socio-cultural context,often to uncover the work’s deeper meanings.Contextual study situates the work within its historical and social milieu,examining its reflection of or response to societal norms and events.Audience response analysis considers the diverse interpretations shaped by readers’backgrounds,emphasizing the reader’s role in constructing the work’s meaning.The study concludes that Abrams’Fourfold Model offers a comprehensive and flexible analytical tool,enabling critics to engage with literary works from multiple perspectives,thereby enriching the understanding of literary complexity and diversity.
基金supported by Henan Province Teaching Reform and Practice Project(Project Fund No.135)—Research on the Reform of Literary Theory Courses for English Majors in Universities.
文摘As a core compulsory course for English majors majoring in teacher education,Literary Theory and Criticism plays an important role in enhancing text understanding,cultivating critical thinking,and shaping correct values in the future development of students.Influenced by traditional teaching ideas,students have many difficulties when learning this course,such as insufficient theoretical understanding,inadequate ability improvement,and not enough investment in course learning.In response to the above issues,this course focuses closely on the fundamental task of“cultivating virtue and nurturing people”,relying on modern information technology and introducing research methods of digital humanities.This course uses“7C”teaching mode under the“three-level integration”,in which“teaching”and“education”are carried out synchronously,and“teacher”and“student”are developed together,in order to greatly enhance students’learning participation and course satisfaction.
文摘In 2014,Huang Kaihong,a professor at School of Foreign Languages and Cultures,Southwest University of Science and Technology,interviewed the Doctoral advisor Professor Nie Zhenzhao during the period of his academic visiting to Central China Normal University.As early as in 2005,Huang Kaihong conducted an interview with Professor Nie Zhenzhao on the topic of the general introduction of ethical literary criticism.So around 11 years later,the second interview mainly covers not only the ethical literary criticism theory,but the game theory and the relationship between them as well.Professor Nie thinks whether the game theory can be applied to literature research is still under discussion.The theory of ethical literary criticism is a kind of methodology based on science and it can get the attention of literary critics at home and abroad,which is because it fits the practical needs of literary criticism,draws the literary criticism away from only emphasizing criticism genres and the research of criticism terms,and pays attention to the true nature of the literary text in literature research.After consulting Professor Nie Zhenzhao about some related questions from the perspective of game theory.Huang Kaihong gets some significant information concerning literature research and understands the latest core terms and the concrete application method of ethical literary criticism,especially the relationship between the instructing and aesthetic functions of literature.
基金supported in part by National Institutes of Health,Nos.5R01NS113556-05,1R21NS128310-01(to KA).
文摘Roles of oligodendrocyte precursor cells in the central nervous system:Oligodendrocyte precursor cells(OPCs)have long been recognized for their critical role as precursors to oligodendrocytes,the primary myelin-producing cells.As precursors,OPCs mature and differentiate into oligodendrocytes,which contribute significantly to the formation of myelin sheaths around axons.This myelination,which is critical for the conduction of salutatory nerve impulses in the cerebral white matter,underscores the classical role of oligodendrocytes in central nervous system(CNS)functionality.Importantly,because oligodendrocytes are differentiated cells that cannot proliferate.
基金supported by NIH grants(R01NS125074,R01AG083164,and R21NS127177)(to YL).
文摘Adult microglia,by continuously sensing changes in their environment and communicating with nearly all brain cell types,are considered to be the immune sentinels of the brain.In the healthy central nervous system(CNS),microglia display a unique molecular homeostatic signature(i.e.,Tmem119,P2ry12,Sall1,Siglech,Gpr34,and Hexb)(Figure 1A).
基金generously supported by the faculty startup funds from Auburn University at Montgomery (to SSVPS)。
文摘Hypoglycemia-a critical complication linked to worsened brain function in diabetic subjects:Hypoglycemia is characterized by a decline in circulatory glucose levels below sta nda rd physiological thresholds.Mild hypoglycemia,classified as level 1 hypoglycemia,is defined by blood glucose levels below 70 mg/dL and can be effectively addressed through carbohydrate intake.Severe hypoglycemia,denoted by blood glucose levels less than 54 mg/dL,poses a life-threatening risk if left untreated.Individuals with type 1 and type 2 diabetes undergoing insulin treatment are particularly susceptible to hypoglycemia due to impaired counterregulatory mechanisms.
基金financially supported by the Original Exploration Project of the National Natural Science Foundation of China(No.52150079)the National Natural Science Foundation of China(Nos.U22A20130,U2004215,and 51974280)+1 种基金the Natural Science Foundation of Henan Province of China(No.232300421196)the Project of Zhongyuan Critical Metals Laboratory of China(Nos.GJJSGFYQ202304,GJJSGFJQ202306,GJJSGFYQ202323,GJJSGFYQ202308,and GJJSGFYQ202307)。
文摘Solvent extraction,a separation and purification technology,is crucial in critical metal metallurgy.Organic solvents commonly used in solvent extraction exhibit disadvantages,such as high volatility,high toxicity,and flammability,causing a spectrum of hazards to human health and environmental safety.Neoteric solvents have been recognized as potential alternatives to these harmful organic solvents.In the past two decades,several neoteric solvents have been proposed,including ionic liquids(ILs)and deep eutectic solvents(DESs).DESs have gradually become the focus of green solvents owing to several advantages,namely,low toxicity,degradability,and low cost.In this critical review,their classification,formation mechanisms,preparation methods,characterization technologies,and special physicochemical properties based on the most recent advancements in research have been systematically described.Subsequently,the major separation and purification applications of DESs in critical metal metallurgy were comprehensively summarized.Finally,future opportunities and challenges of DESs were explored in the current research area.In conclusion,this review provides valuable insights for improving our overall understanding of DESs,and it holds important potential for expanding separation and purification applications in critical metal metallurgy.
文摘BACKGROUND Acute hyperglycemia due to insulin resistance is common in critically ill patients,typically managed with insulin infusion.However,the occurrence of transient extreme insulin resistance(EIR)requiring exceptional high-dose insulin is rare.CASE SUMMARY We present the case of a 68-year-old woman with pneumonia who suffered an out-of-hospital cardiac arrest,subsequently developing transient EIR following a new episode of sepsis.Remarkably,insulin resistance rapidly reversed when the insulin infusion rate peaked at 960 units/hour(a total of 18224 units on that day),and it was promptly titrated down to zero upon achieving the target glucose level.CONCLUSION Exceptional high-dose insulin infusion may be required in critically ill patients with stress-related EIR,which is typically transient.Clinicians should be aware of the phenomenon and cautious to avoid hypoglycemia and fluid overload during the steep titration of high-dose insulin infusion.
文摘Sepsis is a life-threatening condition caused by a dysregulated response of the body in response to an infection that harms its tissues and organs.Interleukin-6(IL-6)is a significant component of the inflammatory response as part of the pa-thogenesis of sepsis.It aids in the development of Acute lung injury and,subse-quently,multiple organ dysfunction syndrome.This letter probes into the corre-lation between plasma IL-6 levels and the risk of developing acute lung injury and multiple organ dysfunction syndrome in critically ill patients with sepsis.While it shows promising results,limitations like its observational study design,a limited sample size,a single center involvement,single-time-point measurement,and a lack of a control group restrain its cogency.The study is a big step in identifying IL-6 as a biomarker to improve patient care.
文摘William Carlos Williams,a poet who has an immense influence on the course of 20th century poetry.whose poems characterized his close attention to nature,friendship and the Chinese Classical Poetry. The Widow’s Lament in Springtime is not only the representative of imitation of Chinese poetry about boudoir repining school but bringing poetry into natural relation with everyday life.
文摘The provision of anaesthesia for individuals receiving chronic dialysis can be challenging.Sedation and anaesthesia are frequently managed by critical care clinicians in the intensive care unit or operating room.This narrative review summarizes the important principles of sedation and anaesthesia for individuals on long-term dialysis,with reference to the best available evidence.Topics covered include the pharmacology of anaesthetic agents,the impacts of patient characteristics upon the pre-anaesthetic assessment and critical illness,and the fundamentals of dialysis access procedures.
文摘Adolescence and the journey to adulthood involves exciting opportunities as well as psychosocial stress for young people growing up.These normal experiences are potentially magnified for teenagers living with chronic illness or disability and their families.Advances in care have improved survival for children with a variety of serious chronic medical conditions such that many who may once have died in childhood now survive well into adulthood with ongoing morbidity.For those with highly complex needs,care is often provided at major paediatric hospitals with expertise,specially trained personnel,and resources to support young people and their families for the first decades of life.At the end of adolescence,however,it is generally appropriate and necessary for young adults and their caregivers to transition to the care of clinicians trained in the care of adults at general hospitals.While there are some well-managed models to support this journey of transition,these are often specific to certain conditions and usually do not involve intensive care.Many patients may encounter considerable challenges during this period.Difficulties may include the loss of established therapeutic relationships,a perception of austerity and reduced amenity in facilities oriented to caring for adult patients,and care by clinicians with less experience with more common paediatric conditions.In addition,there is a risk of potential conflict between clinicians and families regarding goals of care in the event of a critical illness when it occurs in a young adult with major disability and long-term health issues.These challenges present genuine opportunities to better understand the transition from paediatric to adult-based care and to improve processes that assist clinicians who support patients and families as they shift between healthcare settings.
基金Supported by The National Natural Science Foundation of China,No.82072130Key Medical Research Projects in Jiangsu Province,No.ZD2022021Suzhou Clinical Medical Center for Anesthesiology,No.Szlcyxzxj202102。
文摘BACKGROUND Hypernatremia represents a significant electrolyte imbalance associated with numerous adverse outcomes,particularly in cases of intensive care unit(ICU)-acquired hypernatremia(IAH).Nevertheless,its relevance in patients with septic shock remains uncertain.AIM To identify independent risk factors and their predictive efficacy for IAH to improve outcomes in patients with septic shock.METHODS In the present retrospective single-center study,a cohort of 157 septic shock patients with concurrent hypernatremia in the ICU at The First Affiliated Hospital of Soochow University,between August 1,2018,and May 31,2023,were analyzed.Patients were categorized based on the timing of hypernatremia occurrence into the IAH group(n=62),the non-IAH group(n=41),and the normonatremia group(n=54).RESULTS In the present study,there was a significant association between the high serum sodium concentrations,excessive persistent inflammation,immunosuppression and catabolism syndrome and chronic critical illness,while rapid recovery had an apparent association with normonatremia.Moreover,multivariable analyses revealed the following independent risk factors for IAH:Total urinary output over the preceding three days[odds ratio(OR)=1.09;95%CI:1.02–1.17;P=0.014],enteral nutrition(EN)sodium content of 500 mg(OR=2.93;95%CI:1.13–7.60;P=0.027),and EN sodium content of 670 mg(OR=6.19;95%CI:1.75–21.98;P=0.005)were positively correlated with the development of IAH.Notably,the area under the curve for total urinary output over the preceding three days was 0.800(95%CI:0.678–0.922,P=0.001).Furthermore,maximum serum sodium levels,the duration of hypernatremia,and varying sodium correction rates were significantly associated with 28-day in-hospital mortality in septic shock patients(P<0.05).CONCLUSION The present findings illustrate that elevated serum sodium level was significantly associated with a poor prognosis in septic shock patients in the ICU.It is highly recommended that hypernatremia be considered a potentially important prognostic indicator for the outcome of septic shock.
