Management of regional citrate anticoagulation for continuous renal replacement therapy:guideline recommendations from Chinese emergency medical doctor consensus

Continuous renal replacement therapy(CRRT)is widely used for treating critically-ill patients in the emergency department in China.Anticoagulant therapy is needed to prevent clotting in the extracorporeal circulation during CRRT.Regional citrate anticoagulation(RCA)has been shown to potentially be safer and more effective,and is now recommended as the preferred anticoagulant method for CRRT.However,there is still a lack of unified standards for RCA management in the world,and there are many problems in using this method in clinical practice.The Emergency Medical Doctor Branch of the Chinese Medical Doctor Association(CMDA)organized a panel of domestic emergency medicine experts and international experts of CRRT to discuss RCA-related issues,including the advantages and disadvantages of RCA in CRRT anticoagulation,the principle of RCA,parameter settings for RCA,monitoring of RCA(mainly metabolic acid-base disorders),and special issues during RCA.Based on the latest available research evidence as well as the paneled experts'clinical experience,considering the generalizability,suitability,and potential resource utilization,while also balancing clinical advantages and disadvantages,a total of 16 guideline recommendations were formed from the experts'consensus.

Venous thromboembolism in the emergency department:A survey of current best practice awareness in physicians and nurses in China

BACKGROUND: For emergency department(ED) patients, risk assessment, prophylaxis, early diagnosis and appropriate treatment of venous thromboembolism(VTE) are essential for preventing morbidity and mortality. This study aimes to investigate knowledge amongst emergency medical staff in the management of VTE. METHODS: We designed a questionnaire based on multiple scales. The questionnaire was distributed to the medical and nursing clinical staff in the large urban ED of a medical center in Northern China. Data was described with percentages and the Kruskal-Wallis test was used to compare ranked data between different groups. The statistical analysis was done using the SPSS 22.0 software.RESULTS: In this survey, 180 questionnaires were distributed and 174 valid responses(response rate of 96.67%) were collected and analyzed. In scores of VTE knowledge, no signifi cant differences were found with respect to job(doctor vs. nurse), the number of years working in clinical medicine, education level, and current position, previous hospital experience and nurses' current work location within the ED. However, in pair wise comparison, we found participants who worked in ED for more than 5 years(n=83) scored signifi cantly higher on the questionnaire than those under 5 years(n=91)(95.75 vs. 79.97, P=0.039). There was a signifi cant difference in some questions based on gender, age, job, and nurse work location, number of working years, education level, and different ED working lifetime.CONCLUSION: Our survey has shown defi ciencies among ED medical staff in knowledge and awareness of the management of VTE. We recommend several changes be considered, such as the introduction of an interdisciplinary workshop for medical staff; the introduction of a standardized VTE protocol; a mandatory study module on VTE for new physicians and nurses; the introduction of a mandatory reporting system for adverse events(including VTE).

Morbidity and mortality risk factors in emergency department patients with Acinetobacter baumannii bacteremia

BACKGROUND:Acinetobacter baumannii(AB)bacteremia is an increasingly common and often fatal nosocomial infection.Identification of morbidity and mortality risk factors for AB bacteremia in emergency department(ED)patients may provide ways to improve the clinical outcomes of these patients.METHODS:The records for 51 patients with AB bacteremia and 51 patients without AB infection were collected and matched in a retrospective case-control study between 2013 and 2015 in a singlecenter ED.Risk factors were analyzed by Chi-square and multivariate logistic regression statistical models.RESULTS:A significant risk factor for morbidity was the presence of a central venous catheter(CVC)(P<0.001).The mortality rate for the 51 patients with AB bacteremia was 68.6%.Risk factors for mortality were the presence of a CVC(P=0.021)and an ED stay longer than two weeks(P=0.015).CONCLUSION:AB infections lead to high morbidity and mortality.The presence of a CVC was associated with higher morbidity and mortality in patients with AB bacteremia.Avoiding CVC insertions may improve outcomes in ED patients with AB bacteremia.

Tension hydropneumothorax in a Boerhaave syndrome patient:A case report

Dear editor,Boerhaave syndrome,firstly described by Hermann Boerhaave in 1724,is a rare and life-threatening condition characterized by spontaneous transmural tear of the oesophagus.[1]The early diagnosis of Boerhaave syndrome is extremely important since a delay in the diagnosis can increase the mortality rate.[2]Here,we reported a Boerhaave syndrome patient combined with tension hydropneumothorax.

A 12-month follow-up study of discharged patients with acute pancreatitis:An acute condition with prolonged sequela

To the Editor:Acute pancreatitis(AP)is the most common gastrointestinal condition that leads to acute hospitalization.[1]The incidence of AP has increased in recent decades,with a current global incidence of 34/100,000,probably due to a rising trend of obesity and gallstone disease.AP is associated with remarkable pain,reduced quality of life(QoL),and even death,thus posing a heavy socioeconomic burden.In addition,approximately 22%of AP patients experience recurrent AP(RAP)and 10%of AP patients progress to chronic pancreatitis.[2]Petrov and Yadav[3]have,therefore,argued that AP should not be considered as an acute and self-limiting disease.Treatment and long-term care after AP have drawn widespread attention,which has improved patients’physical and mental health.

Laparoscopic surgery for trans-anal barotrauma: a case report

Trans-anal barotrauma resulting from the use of air guns is rare in the emergency department.Early diagnosis and timely treatment can yield a good prognosis.The first published case of trans-anal barotrauma caused by a manually operated force pump was reported in 1904.[1]Colorectal injuries have the potential to progress to high-mortality complications,such as abdominal infection,peritonitis,and septic shock.[2,3]Herein,we report a case of trans-anal barotrauma in a man who presented with pneumoperitoneum,pneumomediastinum,and pneumoscrotum.We performed laparoscopic exploration and loop ileostomy on this patient.

The Chinese guideline for management of snakebites

In 2009,the World Health Organization included snakebite on the list of neglected tropical diseases,acknowledging it as a common occupational hazard for farmers,plantation workers,and others,causing tens of thousands of deaths and chronic physical disabilities every year.This guideline aims to provide practical information to help clinical professionals evaluate and treat snakebite victims.These recommendations are based on clinical experience and clinical research evidence.This guideline focuses on the following topics:snake venom,clinical manifestations,auxiliary examination,diagnosis,treatments,and prevention.

Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury

The outbreak of the 2019-nCoV infection began in December 2019 in Wuhan,Hubei province,and rapidly spread to many provinces in China as well as other countries.Here we report the epidemiological,clinical,laboratory,and radiological characteristics,as well as potential biomarkers for predicting disease severity in 2019-nCoV-infected patients in Shenzhen,China.All 12 cases of the 2019-nCoV-infected patients developed pneumonia and half of them developed acute respiratory distress syndrome (ARDS).The most common laboratory abnormalities were hypoalbuminemia,lymphopenia,decreased percentage of lymphocytes (LYM) and neutrophils (NEU),elevated C-reactive protein (CRP) and lactate dehydrogenase (LDH),and decreased CD8 count.The viral load of 2019-nCoV detected from patient respiratory tracts was positively linked to lung disease severity.ALB,LYM,LYM (%),LDH,NEU (%),and CRP were highly correlated to the acute lung injury.Age,viral load,lung injury score,and blood biochemistry indexes,albumin (ALB),CRP,LDH,LYM (%),LYM,and NEU (%),may be predictors of disease severity.Moreover,the Angiotensin Ⅱlevel in the plasma sample from 2019-nCoV infected patients was markedly elevated and linearly associated to viral load and lung injury.Our results suggest a number of potential diagnosis biomarkers and angiotensin receptor blocker (ARB) drugs for potential repurposing treatment of 2019-nCoV infection.

Sublingual Immunotherapy Tablets Relieve Symptoms in Adults with Allergic Rhinitis： A Meta-analysis of Randomized Clinical Trials

Background： Sublingual immunotherapy （SLIT） has been proven to be effective against house dust mite-induced allergic rhinitis. However, the efficacy in adults with allergic rhinitis has never been reported on SLIT tablets. The current meta-analysis aimed to illustrate the differentiated efficacy of SLIT tablets on allergic rhinitis. Methods： Our systematic review and meta-analysis were performed on allergic rhinitis patients and aimed to summarize those randomized controlled studies （RCTs）. PubMed, EMBASE, Cochrane library, and MEDLINE were screened for associated articles. We included RCTs on allergic rhinitis patients undergoing SLIT therapy and reporting outcornes on symptom relief and serum-specific lgE levels. The effect of SLIT tablets on the Rhinitis Quality Life Questionnaire Score （RQLQ）, Rhinitis Total Symptom Score （RTSS）, and serum-specific IgE levels was evaluated using RevMan 5.3. Results： Seven studies were included, with 2723 patients identified. All of the studies were RCT. The included seven studies were all conducted on adults. Among the included seven articles, five researches administered patients with SLIT tablets and were eligible for meta-analysis of RTSS, consisting of 1490 patients. Overall, RTSS was significantly reduced in the SLIT tablet group compared with that in the placebo group （standard mean difference = -0.33, 95% confidence interval [-0.54, -0.13], P 〈 0.01 ）. There was no significant difference in specific lgE levels between SLIT and placebo patients. Conclusions： SLIT tablets effectively relieve rhinitis symptoms in adults with allergic rhinitis. Nevertheless, the current evidence may be limited due to sample size and the heterogeneity between studies. Large sample size and multiple center RCTs on the efficacy of different formulations of SLIT drugs are still needed to provide further evidence and a more precise recommendation.