Access block and prolonged length of stay in the emergency department are associated with a higher patient mortality rate

Access block,known as exit block or boarding,is defined as a situation in which patients who are admitted or planned for admission remain in the emergency department(ED)as they are unable to be transferred to an inpatient unit within a reasonable time frame(no longer than 8 hours).[1,2]Access block often occurs due to insufficient hospital capacity and is a major issue in emergency medicine.[3]

The revised Atlanta criteria 2012 altered the classification,severity assessment and management of acute pancreatitis

BACKGROUND： The Atlanta criteria for acute pancreatitis （AP） has been revised recently. This study was to evaluate its practical value in classification of AP, the severity assessment and management. METHODS： The clinical features, severity classification, out- come and risk factors for mortality of 3212 AP patients who had been admitted in Ruijin Hospital from 2004 to 2011 were analyzed based on the revised Atlanta criteria （RAC） and the original Atlanta criteria （OAC）.

Effects of fluid balance on prognosis of acute respiratory distress syndrome patients secondary to sepsis

BACKGROUND:Fluid management is crucial to acute respiratory distress syndrome(ARDS)secondary to sepsis.However,choices of fluid resuscitation strategies and fluid input volumes remain a thorny problem.Our study aimed to elucidate the relationship between fluid balance and prognosis of ARDS patients secondary to sepsis.METHODS:Our study included 322 sepsis patients from Ruijin Hospital between 2014 and 2018,and 84 patients were diagnosed as ARDS within 72 hours after onset of sepsis according to Berlin ARDS Defi nition.RESULTS:Among the 322 sepsis patients,84(26.1%)were complicated with ARDS within 72 hours.ARDS patients had a lower oxygenation index(PaO2/FiO2166.4±71.0 vs.255.0±91.2,P<0.05),longer duration of mechanical ventilation(11[6-24]days vs.0[0-0]days,P<0.05)than those without ARDS.Sepsis patients with ARDS showed daily positive net fl uid balance during seven days compared with those without ARDS who showed daily negative net fluid balance since the second day with signifi cant statistical differences.Among the 84 sepsis patients with ARDS,58(69.0%)died.Mean daily fl uid input volumes were much lower in survivors than in non-survivors(43.2±16.7 mL/kg vs.51.0±25.2 mL/kg,P<0.05)while output volumes were much higher in survivors(45.2±19.8 mL/kg vs.40.2±22.7 mL/kg,P<0.05).Using binary logistic regression analysis,we found that the mean daily fl uid balance was independently associated with mortality of sepsis patients complicating with ARDS(P<0.05).CONCLUSIONS:Early negative fluid balance is independently associated with a better prognosis of sepsis patients complicated with ARDS.

Successful treatment of aortic dissection with pulmonary embolism:A case report

BACKGROUND Aortic dissection(AD)and pulmonary embolism(PE)are both life-threatening disorders.Because of their conflicting treatments,treatment becomes difficult when they occur together,and there is no standard treatment protocol.CASE SUMMARY A 67-year-old man fell down the stairs due to syncope and was brought to our hospital as a confused and irritable patient who was uncooperative during the physical examination.Further examination of the head,chest and abdomen by computed tomography revealed a subdural hemorrhage,multiple rib fractures,a hemopneumothorax and a renal hematoma.He was admitted to the Emergency Intensive Care Unit and given a combination of oxygen therapy,external rib fixation,analgesia and enteral nutrition.The patient regained consciousness after 2 wk but complained of abdominal pain and dyspnea with an arterial partial pressure of oxygen of 8.66 kPa.Computed tomography angiograms confirmed that he had both AD and PE.We subsequently performed only nonsurgical treatment,including nasal high-flow oxygen therapy,nonsteroidal analgesia,amlodipine for blood pressure control,beta-blockers for heart rate control.Eight weeks after admission,the patient improved and was discharged from the hospital.CONCLUSION Patients with AD should be alerted to the possibility of a combined PE,the development of which may be associated with aortic compression.In patients with type B AD combined with low-risk PE,a nonsurgical,nonanticoagulant treatment regimen may be feasible.

Clinical characteristics of 5375 cases of acute pancreatitis from a single Chinese center, 1996-2015

Acute pancreatitis (AP) remains a common and lifethreatening gastrointestinal emergency, which is usually induced by gallstones, hyperlipidaemia, alcohol abuse, pancreatic carcinoma, and trauma.[1] According to the 2012 Atlanta consensus, AP is divided into three general grades of severity: mild (MAP), moderate (MSAP), and severe (SAP).

Inactivated SARS-CoV-2 vaccine does not influence the profile of prothrombotic antibody nor increase the risk of thrombosis in a prospective Chinese cohort

The presence of antiphospholipid antibodies was shown to be associated with thrombosis in coronavirus disease 2019(COVID-19)patients.Recently,according to reports from several studies,the vaccineinduced immune thrombotic thrombocytopenia is mediated by anti-platelet factor 4(PF4)-polyanion complex in adenovirus-vectored COVID-19 vaccine recipients.It is impendent to explore whether inactivated COVID-19 vaccine widely used in China influences prothrombotic autoantibody production and induces thrombosis.In this prospective study,we recruited 406 healthcare workers who received two doses,21 days apart,of inactivated severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)vaccine(BBIBP-CorV,Sinopharm).Paired blood samples taken before vaccination and four weeks after the second vaccination were used in detecting prothrombotic autoantibodies,including anticardiolipin(aCL),anti-b2 glycoprotein I(ab2GP1),anti-phosphatidylserine/prothrombin(aPS/PT),and anti-PF4-heparin.The seroconversion rate of SARS-CoV-2 specific antibodies was 95.81%(389/406)four weeks after vaccination.None of the subjects had spontaneous thrombosis or thrombocytopenia over a minimum follow-up period of eight weeks.There was no significant difference in the presence of all ten autoantibodies between samples collected before and after vaccination:for aCL,IgG(7 vs.8,P=0.76),IgM(41 vs.44,P=0.73),IgA(4 vs.4,P=1.00);anti-b2GP1,IgG(7 vs.6,P=0.78),IgM(6 vs.5,P=0.76),IgA(3 vs.5,P=0.72);aPS/PT IgG(0 vs.0,P=1.00),IgM(6 vs.5,P=0.76);aPF4-heparin(2 vs.7,P=0.18),and antinuclear antibody(ANA)(18 vs.21,P=0.62).Notably,seven cases presented with anti-PF4-heparin antibodies(range:1.18–1.79 U/mL)after vaccination,and none of them exhibited any sign of thrombotic disorder.In conclusion,inactivated SARS-CoV-2 vaccine does not influence the profile of antiphospholipid antibody and anti-PF4-heparin antibody nor increase the risk of thrombosis.

Potential benefit of high-dose intravenous vitamin C for coronavirus disease 2019 pneumonia

The coronavirus disease 2019(COVID-19)has been declared as a pandemic by the World Health Organization.[1]Most COVID-19 patients exhibit mild to moderate symptoms,while approximately 15%progress rapidly to severe pneumonia,and about 5%eventually develop acute respiratory distress syndrome(ARDS),[2]which requires mechanical ventilation(MV)and even extracorporeal membrane oxygenation.The mortality of COVID-19 patients who received MV was reported to be as high as 66%.[3]Therefore,the treatments aiming to improve mortality should focus on two aspects:first,prevention of the aggravation of the disease in mild and moderate COVID-19 patients;second,the rescue therapy for patients in serious conditions.We have been applying high-dose intravenous vitamin C(HDIVC)in the treatment of critical illnesses for almost 10 years in our center.Our previous in vivo research showed that HDIVC protected hemorrhagic shock-related multiple organ failure(MOF)by inhibiting inflammatory cytokines and oxidative indicators through activating Sirtuin1 pathway.