Objective

To explore the effects of early continuous renal replacement therapy （CRRT）combined with veno-arterial extracorporeal membrane oxygenation （VA-ECMO） on patients with refractory cardiogenic shock and its impact on their prognosis.

Methods

A prospective randomized controlled trial was conducted to analyze 74 patients with refractory cardiogenic shock who received VA-ECMO treatment in the ICU of Xinyang Central Hospital from January 2021 to October 2023. The cohort consisted of 49 males and 25 females， aged between 19 and 78 years， with an average age of 56.3±14.0 years. Patients were randomly assigned to either the early CRRT group （Group A， 35 patients） or the conventional CRRT group（Group B， 39 patients）. The study compared various clinical parameters， including blood tests， liver and kidney function， blood gas analysis， cardiac function indicators， and treatment outcomes at four time points：T0 （pre-VA-ECMO）， T3 （3 days post-VA-ECMO）， T5 （5 days post-VA-ECMO）， and T7 （7 days post-VAECMO）.

Results

A total of 74 patients were enrolled （35 in Group A and 39 in Group B）. No significant differences were observed between the two groups in baseline characteristics. However， significant differences were found in the treatment duration between the groups， including CRRT treatment time ［176.1（152.2-222.9） hours vs. 82.3 （0-103.9） hours， P＜0.001］， mechanical ventilation time ［（309.3±38.5） hours vs（331.7±43.6） hours， P=0.023］， and VA-ECMO support time ［237.0 （220.0-255.5） hours vs. 253.0 （236.5-265.0） hours， P=0.029］. ICU stay and complication incidence rates were not statistically different between the groups ［（16.3±3.0） days vs. （17.8±3.8） days， P=0.052］， ［60% vs 71.79%， P=0.284］， respectively. However，the mortality rate was significantly lower in Group A ［15 （42.86%） vs. 26 （66.67%）， P=0.040］.Hemoglobin（Hb） values at T3 showed a statistical difference ［（106.1±18.7） g/L vs （114.7±19.6） g/L， P=0.018］. C-reactive protein （CRP） values at T3 and T5 were different ［73.0 （39.5-115.5） mg/L vs. 97.0 （62.5-158.5） mg/L， P=0.021］， ［82.0 （59.5-126.5） mg/L vs. 120.0 （47.5-175.0） mg/L， P=0.028］. Interleukin-6 （IL-6） values were also significantly lower in Group A at T3 and T5 ［344.0 （153.0-740.5） pg/mL vs. 667.0 （342.0-1484.0） pg/mL， P=0.038］ and ［270.0 （108.0-556.0） pg/mL vs. 721.0 （401.0-1195.5） pg/mL， P=0.001］. Blood urea nitrogen（BUN） values were significantly lower in Group A at T3， T5， and T7 ［6.7 （6.0-10.3） mmol/L vs. 21.9 （13.5-29.2） mmol/L， P＜0.001； 6.8 （5.4-10.0） mmol/L vs. 27.8 （17.6-37.8） mmol/L， P＜0.001； 6.0 （4.5-10.7） mmol/L vs. 31.0 （24.4-34.7） mmol/L， P＜0.001］. Serum creatinine （Cr） values were also significantly lower in Group A at all three time points ［94.3 （80.0-124.5） μmol/L vs. 257.0 （167.5-362.5） μmol/L， P＜0.001］， ［100.0 （80.5-141.5） μmol/L vs. 318.0 （210.5-490.0） μmol/L， P＜0.001］， and ［108.0 （71.0-146.8） μmol/L vs 350.0 （256.0-440.0） μmol/L， P＜0.001］. Serum pH values at T3 were significantly higher in Group A ［7.3 （7.2-7.4） vs. 7.2（7.1-7.3）， P=0.008］， but with no differences at T5 and T7. Oxygenation index （OI） values were significantly better in Group A at T3 and T5 ［（193.5±48.4） mmHg vs. （153.5±64.4） mmHg， P=0.015］ ， ［ （214.6±49.1）mmHg vs. （176.6±69.6） mmHg， P=0.015］， but with no difference at T7. Left ventricular outflow tract velocitytime integral （LOVTI） at T3 showed a statistical difference ［13.3 （12.2-15.5） cm vs. 12.2 （9.8-13.4） cm， P=0.025］， with no differences at T5 and T7. Left ventricular ejection fraction （LVEF） at T3 and T5 showed statistical differences ［35.1 （32.8-40.0）% vs. 32.3 （26.3-36.9）%， P=0.048］ ， ［40.2 （32.8-51.1）% vs. 35.1 （28.3-41.4）%， P=0.046］， with no difference at T7. Fluid balance showed differences at T3 and T5 time points， with values of ［-16.0 （-23.5 to -8.0） mL/kg vs. -7.0 （-14.5 to 1.0） mL/kg， P=0.007］ ， ［-13.0 （-19.5 to -7.5） mL/kg vs.-5.0 （-10.5 to -1.0） mL/kg， P=0.013］. No significant differences were observed between the two groups in PCT values， liver enzymes （ALT）， albumin， or total bilirubin at any of the time points.

Conclusion

Early initiation of CRRT combined with VA-ECMO may improve inflammatory markers， renal function， blood gas parameters， and cardiac function in patients with refractory cardiogenic shock. This approach also appears to reduce in-hospital mortality and improve overall prognosis.

Objective

To identifies the primary factors contributing to the low compliance of cleaning personnel with standard precautions， and devises corresponding intervention measures to enhance compliance by applying failure mode and effects analysis （FMEA） theory.

Methods

An FMEA project team was assembled to systematically analyze the compliance status of cleaning staff with standard precautions. The team established scoring criteria and calculated the risk priority number （RPN） to identify high-risk factors. Based on the principle of prioritizing high-risk interventions， the standard precaution processes were redesigned and optimized， with targeted interventions proposed.

Results

The FMEA intervention significantly improved the compliance of cleaning personnel with standard preventive measures.Compliance scores for handwashing and disinfection timing， proper glove wearing， appropriate use of personal protective equipment， environmental management， and handling of occupational exposure all showed significant increases （P＜0.001）. The implemented improvement measures effectively reduced the RPN， leading to a decline in the infection rate in the hospital ICU from 12.53% to 1.88% （P＜0.001）.

Conclusion

The introduction of the FMEA model to improve compliance with standard precautions among cleaning staff is innovative and provides valuable insights for intervention effectiveness， with important practical significance and potential for broader application.

Objective

To analyze the genotype resistance characteristics of HIV/AIDS patients who had failed virology in Guangzhou， and to explore the factors affecting the occurrence of drug resistance.

Methods

The clinical data of HIV/AIDS patients who failed virology and had a complete drug resistance report after antiretroviral therapy （ART） were retrospectively analyzed in an infection clinic in Guangzhou from March 2021 to March 2023 and the binary logistics regression method was used to analyze the incidence of drug resistance.

Results

A total of 394 patients with virological failure were included， of which 152 developed resistance， resulting in a resistance rate of 38.6%. Among these， 106 cases （26.9%），115 cases （29.2%）， 10 cases （2.5%）， and 3 cases （0.8%） exhibited resistance to nucleoside reverse transcriptase inhibitors （NRTIs）， non - nucleoside reverse transcriptase inhibitors （NNRTIs）， protease inhibitors （PIs）， and integrase inhibitors （INSTIs）， respectively. Additionally， 100 cases （65.8%） showed moderate to high resistance to lamivudine （3TC） and emtricitabine （FTC）. Furthermore， 108 cases （71.1%）and 94 cases （61.8%） showed moderate to high resistance to nevirapine （NVP） and efavirenz （EFV），respectively. Multi-factor logistic analysis showed that the baseline CD4+ T lymphocyte count was ≤200/μL，recent CD4+ T lymphocyte count was ≤200/μL， 201～399/μL，and HIV load was ≥1000 copies/ml during drug resistance detection， which were resistant risk factors for the occurrence of drug resistance.

Conclusion

HIV/AIDS patients with virological failure after ART in Guangzhou are complex in drug resistance， and the drug resistance sites are diverse. Low CD4+T lymphocyte count and high HIV load are risk factors for drug resistance.

急性中毒是临床常见的急危重症，某些中毒性疾病起病急、病情重，具有较高的病死率和致残率，可谓是“急诊中的急诊”、“重症中的重症”。随着临床医学的发展，急性中毒救治从学科发展到救治思维等方面均取得较大的进展，但是仍然有不少中毒性疾病特别是新发的急性中毒，尚无成熟的救治方法。从基础到临床、从治疗到预防、从科研到创新，关于急性中毒救治，还有很多工作可以做。

Objective

To analyze the influencing factors of successful pre hospital recovery and to explore strategies for improving the success rate of OHCA recovery in the local area.

Methods

The clinical data from all out-of-hospital cardiac arrest （OHCA） patients who underwent cardiopulmonary resuscitation（CPR） were retrospectively collected during pre hospital visits at Yantian District People's Hospital in Shenzhen from January 1， 2015 to December 31， 2019. Analyses of demographic indicators， etiology，emergency response time， initial heart rate， presence or absence of witnesses， bystander CPR， use of automatic external defibrillators （AED） by bystanders， and pre hospital advanced life support status were carried out. The impact of various factors in key links of the out of hospital storage chain on resuscitation effectiveness was investigated and the corresponding response strategies were explored.

Results

This study included 63 patients with respiratory and cardiac arrest， with an emergency response time of （14.68 sses， bystander CPR， use of automatic external defibd expiratory volume （FEV1））， asthma control loud platform video anics and airway clearaaneous circulation （ROSC）］. Compared with the ineffective resuscitation group， the pre hospital ROSC successful group showed statistically significant differences in average age， location of OHCA， etiology， initial heart rhythm， emergency response time， eyewitness CPR，adrenaline use， and other aspects （P＜0.05）.

Conclusions

The emergency medical service system for OHCA in Yantian District is not perfect yet.It is necessary to further strengthen public awareness of first aid，enhance public training in first aid skills， and implement early CPR and defibrillation for patients with cardiac arrest.At the same time，AEDs should be scientifically configured to further improve the success rate of rescue for OHCA patients in the local area.

Objective

To investigate the changes in serum zinc and associated inflammatory factors in human immunodeficiency virus/tuberculosis （HIV/TB） co-infected individuals following the development of immune reconstitution inflammatory syndrome （IRIS） during antiretroviral therapy （ART）， as well as to assess their clinical implications.

Methods

A total of 83 patients with co-infection of HIV/TB were involved in this study with follow-up. According to the occurrence of TB/IRIS during ART， the patients were divided into IRIS group （34 cases） and no-IRIS group （49 cases）. In addition， healthy individuals without HIV/TB （40 cases） were also enrolled as control. Serum levels of zinc and related inflammatory factors were analyzed and compared between different groups.

Results

The serum zinc concentration in the IRIS group of HIV/TB co-infected patients was lower than that in the control group of HIV-infected patients and also lower than that in the no-IRIS group of HIV/TB co-infected patients.

Conclusion

Zinc deficiency may be a potential factor in the occurrence of tuberculosis-related immune reconstitution inflammatory syndrome.

Objective

To explore the efficacy of“three-acupoint and five-needle”combined with abdominal pressure lifting on lung rehabilitation in patients with mechanical ventilation.

Methods

Thirtysix hospitalized patients with pulmonary invasive mechanical ventilation from July 2021 to February 2023 were randomly divided into two groups： control group and experimental group. The experimental group was treated with“three-acupoint and five-needle”combined with abdominal pressure lifting on the basis of routine treatment in the control group.The clinical efficacy，mechanical ventilation time and 28-day survival rate were compared between the two groups.The indexes of respiratory mechanics and airway clearance were compared between the two groups before getting off the ventilator. The indexes of inflammatory reaction at 1 day，2 days，3 days and 7 days after treatment were compared between the two groups.

Results

The time of mechanical ventilation in the experimental group was significantly lower than that in the control group （P＜0.05）.The 28-day mortality in the experimental group was lower than that in the control group，but there was no significant difference between the two groups （P＞0.05）. The tidal volume and peak expiratory flow before getting off the ventilator in the experimental group were significantly higher than those in the control group（P＜0.05）， and the cough strength score in the experimental group was higher than that in the control group，but there was no significant difference between the two groups （P＞0.05）. The levels of interleukin-6 （IL-6），interleukin-10（IL-10），C-reactive protein （CRP）and lactate decreased gradually in the control group and the experimental group at 1 day， 2 days， 3 days and 7 days after treatment （P＜0.05）. IL-6， IL-10， CRP and lactate in the experimental group were lower than those in the control group at each time point after treatment（P＜0.05）.

Conclusions

The method of“three-acupoint and five-needle”combined with abdominal pressure lifting can better promote the recovery of pulmonary ventilation function， shorten the time of mechanical ventilation and reduce the inflammatory reaction， but cannot reduce the 28-day survival rate of patients with mechanical ventilation.

Objective

To observe the application effect of cloud platform video nursing in children with severe asthma， and to analyze its influence on coping style.

Methods

A total of 146 children with severe asthma admitted to our hospital from October 2021 to October 2023 were prospectively selected as research objects，and were divided into 73 observation group （receiving cloud platform video nursing）and 73 control group （receiving routine nursing） by simple digital random table method. Pulmonary function （FVC），maximum expiratory flow （PEF）， 1s forced expiratory volume （FEV1））， asthma control test （C-ACT）， coping style （CODI）， disease perception and medical fear （BIPQ）， medical fear questionnaire （CMFS） and quality of life were compared between the two groups.

Results

Pulmonary function indexes FVC，PEF，FEV1，CODI acceptance， fantasy， self-comfort scores， quality of life scores， asthma symptoms， treatment-related problems and worries-related problems were higher than those before intervention （P＜0.05） in both groups after intervention.After intervention，the pulmonary function indexes FVC，PEF，FEV1，CODI acceptance，fantasy，self-comfort score and quality of life score of the observation group were higher than those of the control group（P＜0.05）. The C-ACT scores of the children in both groups were higher at 6 months， 3 months and before intervention sequentially（P＜0.05），and the C-ACT scores of the children in the observation group were higher at 3 months and 6 months than those in the control group（P＜0.05）.After intervention，CODI distance，escape，negative emotional response and BIPQ and CMFS scores in both groups were lower than before intervention（P＜0.05）. After intervention， CODI， avoidance， negative emotional reaction， BIPQ and CMFS scores in observation group were lower than those in control group （P＜0.05）.

Conclusions

The application of cloud platform video nursing in severe asthma can improve the lung function and asthma control effect of children，improve coping style，disease perception and medical fear，and improve the quality of life of children.

Objective

To analyze the impact of early mechanical ventilation on the mortality of adult in-hospital cardiac arrest （IHCA） retrospectively and to provide a theoretical basis for whether early mechanical ventilation should be implemented in IHCA patients.

Methods

This study included 1540 adult IHCA patients who received at least two minutes of external chest compressions at National Taiwan University Hospital from 2006 to 2014. Mortality of IHCA patients was the outcome indicator used， and the relationship between early mechanical ventilation and mortality was analyzed using univariate analysis and multivariate logistic regression models.

Results

Among the 1540 adult IHCA patients， 329 （21.36%）received early mechanical ventilation， while 1211 （78.64%） did not. The respective mortality rates were 89.67% （95% CI： 86.38～92.96） and 84.39% （95% CI： 82.35～86.44）. The multivariate logistic regression model showed that the risk of death for IHCA patients receiving early mechanical ventilation was increased by 58% （OR： 1.580， 95% CI： 1.03～2.43， P=0.04） compared to those who did not receive mechanical ventilation.

Conclusion

Early mechanical ventilation is an independent risk factor of mortality in IHCA patients，and it may increase the death rate in these patients.

Objective

To explore the application value of PDCA-style ［plan （P）， execution （Do， D），check （C） and action （A）］ circular teaching method in the training of severe ultrasound-guided hemodynamic evaluation for internal medicine residents.

Methods

In this study， a prospective randomized controlled study method was used.From July 2017 to August 2024，90 third-year residents in Xinyang Central Hospital were selected and randomly divided into group A （experimental group） and group B （control group）， with 45 residents in each group. Both groups received routine education after entering the department， among which the group A was trained in severe ultrasound-guided hemodynamic evaluation by PDCA circulation method；the group B was trained according to the training objectives and requirements of the Department of Critical Care Medicine in the Standardized Training Contents and Standards for Internal Medicine Residents. After the training period， questionnaire survey， written test and clinical ability assessment were conducted for the two groups of internal medicine residents， and the research results were statistically analyzed.

Results

Group A was superior to group B in theoretical achievement， and the difference was statistically significant（P＜0.05）. Group A was superior to group B in the diagnosis and differential diagnosis of diseases and the evaluation of clinical decision-making ability， with statistically significant difference （P＜0.05）. There was no significant difference between the two groups in skill operation， receiving patients and writing medical records（P＞0.05）.

Conclusion

Training residents majoring in internal medicine to apply PDCA cycle method in the rotation of critical medicine department can master the basic theory and skills of critical illness faster and better， which is more conducive to improving the clinical decision-making ability of residents majoring in internal medicine.

Objective

To investigate the current situation of pre-hospital doctors in emergency medical institutions， to analyze the factors impacting their career longevity， to propose countermeasures and recommendations， and to provide insights for stabilizing the emergency team and promoting the sustainable development of pre-hospital emergency services.

Methods

The study selected all doctors from the Zhenjiang Emergency Center between February 2016 and August 2024 as research subjects. Data on current and departed doctors （including age structure， years of service， educational background， professional titles，and training channels） were analyzed using a combination of statistical data and surveys （retrospective questionnaires and interviews）.

Results

The career longevity of emergency doctors was influenced by various factors， such as industry conditions， environment， societal influences， team dynamics， family circumstances， experience， skill updating speed， and physical health. These factors contributed to varying career trajectories and directly impacted the development of the pre-hospital emergency system and the capability to provide public health services.

Conclusion

It is suggested to improve the legal framework，extend the career longevity of emergency doctors， and explore professional development channels. These measures could stabilize the emergency team and enhance the career longevity of those engaged in prehospital emergency services.

直升机医学：研究直升机飞行器、航空环境对飞行人员健康的影响和促进飞行能力的理论体系，并运用多种医学方法和手段，最大限度地扩展飞行人员的能力。直升机医学的研究内容：人机工效研究、基础应用研究、医学选拔鉴定研究、航空医学训练研究、安全控制体系研究。直升机医学研究特点：围绕“人-机-环-任务”研究直升机飞行人员作业能力提升和健康水平维护。影响直升机飞行人员作业效能的主要影响因素：噪声、振动、低气压、缺氧、温度、加速度、辐射、有害气体等。直升机飞行人员常见伤病：颈腰相关疾病、噪声性耳聋、鼻炎、泌尿系统结石、飞行错觉、冠心病高血压消化道疾病（慢性胃炎、消化道溃疡）、眼部疾病（青光眼、屈光不正）等。直升机医疗后送是提高创伤救治成功率的主要途径，但必须遵循一系列应急医学救援要求、注意事项和法律法规，而且以安全知识与技能、医疗知识与技能和非技术技能为内容的航空医学救援医务人员培训至关重要。未来直升机医学研究要注重直升机飞行人员创伤救治技术、特殊环境直升机飞行人员创伤谱和直升机女飞行员精准航卫保障等方面研究，直升机应急医学救援则要关注直升机智能化、无人化以及机器人技术的应用和与时俱进的应急医学救援训练。

Objective

To explore the risk factors for invasive syndrome in patients with Klebsiella pneumoniae liver abscess by analyzing the clinical characteristics of these patients.

Methods

A retrospective collection of data from 161 patients diagnosed with Klebsiella pneumoniae liver abscess at the First Affiliated Hospital of Nanjing Medical University between January 2017 and September 2023 was conducted. The 161 patients were divided into an invasive group of 64 cases （39.8%） and a non-invasive group of 97 cases （60.2%） based on whether invasive syndrome occurred during hospitalization. Basic data，initial symptoms， vital signs， laboratory examination results， and imaging manifestations were compared between the two groups. Univariate analysis and multivariate logistic regression analysis were used to assess the correlation of various indicators with the occurrence of invasive syndrome.

Results

The prevalence of diabetes in the invasive group was higher than that in the non-invasive group （P＜0.05）； The heart rate of patients in the invasive group was higher than that in the non - invasive group （P＜0.05）； Imaging manifestations showed that the maximum diameter of intra-hepatic abscesses in the invasive group was lower than that in the non-invasive group， while the probability of multiple intra -hepatic abscesses was higher in the invasive group than in the non-invasive group （P＜0.05）； There was no significant difference in the laboratory test indicators between the invasive group and the non-invasive group（P＞0.05）；Logistic regression analysis showed that independent risk factors included a history of diabetes， a higher heart rate， and a smaller maximum diameter of intra-hepatic abscesses （P＜0.05）.

Conclusion

Independent risk factors for invasive syndrome in patients with Klebsiella pneumoniae liver abscess include a history of diabetes， a higher heart rate， and a smaller maximum diameter of intra-hepatic abscesses. Clinically， it is necessary to strengthen the monitoring and early intervention for these high-risk patients to reduce the harm of invasive syndrome.

Objective

To observe the effect of different doses of dexmedetomidine nasal drops in the elderly percutaneous vertebroplasty （PVP）.

Methods

A total of 100 elderly patients who underwent elective Percutaneous Vertebroplasty （PVP） at the Traditional Chinese Medicine Hospital of Pi District，Chengdu City from June to December 2023， including 38 males and 62 females. Their ages ranged from 60 to 79 years old， with an average age of （69.08±4.86） years. Patients were divided into 4 groups（n=25） by random number table method： dexmedetomidine 0.8 μg/kg group （D1 group）， 1.0 μg/kg group （D2 group）， 1.2 μg/kg group （D3 group） and normal saline control group （N group）. Ramsay calm score， visual analog scale （VAS）， mean arterial pressure （MAP）， heart rate （HR） and pulse oxygen saturation （SpO₂） were compared immediately after entering the operating room （T1）， 30 min after nasal drops （T2）， immediately after cannula reached vertebra （T3）， bone cement injection （T4）， and 5 min after resuming position （T5）between the groups. Intraoperative adverse reactions were recorded.

Results

The sedation score at each time point of D3 group after nasal drip was higher than that of other groups （P＜0.05）.At T3 and T4，the pain score of D3 group was lower than that of other groups （P＜0.05）. There was no significant difference in MAP and HR of D3 group at T3 and T4 compared with T2 （P＞0.05）.Postoperative blood glucose in all groups was higher than that before surgery （P＜0.05）， and the increase of blood glucose in D3 group was lower than that in other groups （P＜0.05）. The amount of lidocaine and operation time in D3 group were lower than those in other groups （P＜0.05）， and the satisfaction score in D3 group was higher than that in other groups （P＜0.05）.The incidence of agitation and intraoperative hypertension in group N was higher than that in other groups（P＜0.05）.However，there was no statistical difference in the occurrence of adverse reactions among all groups（P＞0.05）.

Conclusion

For elderly patients undergoing PVP treatment， 1.2 μg/kg of dexmedetomidine can be effectively sedated and analgesic before operation，and patients are safer，more comfortable and satisfied.

Objective

To investigate the incidence of acute renal dysfunction and related factors in critically ill patients in Xinjiang Uygur Autonomous Region of China， in order to provide evidence for targeted special training and quality control in critical care medicine.

Methods

This was a prospective multicenter cross-sectional survey conducted in Xinjiang Uygur Autonomous Region， China on January 31，2024 and included patients who meet the inclusion criteria.

Results

A total of 591 patients in 77 ICUs were included in the analysis， including 132 patients （22.3%） with acute renal dysfunction. Multivariate logistic regression analysis showed that age， multiple organ dysfunction syndrome （MODS）， diastolic blood pressure， APACHE II score， lymphocyte ratio， alanine aminotransferase， procalcitonin， and base excess were associated with acute renal dysfunction in these patients. Meanwhile， peripheral oxygen saturation （OR=0.966， 95% CI ［0.953， 0.979］， P＜0.001）， mechanical ventilation （OR=3.406， 95% CI ［1.396， 8.309］， P=0.007）， white blood cell count （OR=1.072， 95% CI ［1.009， 1.139］， P=0.025） and lactate （OR=1.241， 95% CI［1.044， 1.475］， P=0.014） were independent risk factors for the 28-day mortality rate in critically ill patients with acute renal dysfunction.

Conclusion

Acute renal dysfunction is a common clinical syndrome in ICU patients. Clinicians need to strengthen the etiological screening of anemia in these patients and optimize the clinical protocol to improve the quality of intensive care for anemia patients in ICU. It is necessary for the intensivist to strengthen the identification of such patients， and optimize the diagnosis and treatment protocol according to the risk factors related to their morbidity and mortality. It is also necessary to carry out training program to improve the medical quality of critical care medicine in the region.