Zhonghua wei zhong bing ji jiu yi xue最新文献

Artificial intelligence (AI) technology is advancing rapidly, constantly presenting its application value and broad prospects in the medical field. Especially in the early intervention of burn diseases, the new developments, applications, and challenges of AI technology have a significant impact on the clinical outcomes of burn patients. Based on this, this article reviews the concept, classification, learning style, and application of AI in the early diagnosis and treatment of burn diseases, with a focus on discussing the challenges and suggestions of the application of AI technology in the medical field, in order to provide reference and suggestions for the better application of AI in the early diagnosis and treatment of burn diseases.

Objective: To explore the feasibility and safety of integrating the geriatric intensive care unit (GICU) into the friendly management model of the elderly critically ill patients.

Methods: A prospective controlled study was conducted. Patients with elderly critically ill admitted to the GICU and the general intensive care unit (ICU) of Jintan First People's Hospital of Changzhou from December 2021 to May 2023 were enrolled. Patients in the ICU group received the traditional intensive care and nursing mode. In addition to the ICU group basic medical care measures, the patients in the GICU group were treated with friendly management models such as flexible visitation, diagnosis and treatment environment optimization, caring diagnosis and treatment, and family participation in hospice care according to their condition assessment. The gender, age, main diagnosis, and acute physiology and chronic health evaluation II (APACHE II) at admission were recorded and compared between the two groups. During the treatment period, the incidence of nosocomial infection, unplanned extubation, falling out of bed/fall, unexpected readmission to ICU/GICU, and ICU/GICU mortality, the incidence of post-intensive care syndrome (PICS), the satisfaction rate of patients/families with medical care, and the satisfaction rate of patients/families with diagnosis and treatment environment were recorded and compared between the two groups.

Results: According to the admission criteria for ICU and GICU, as well as the willingness of the patients and/or their families, a total of 59 patients were finally included in the ICU group, and 48 patients were enrolled in the GICU group. There were no significantly differences in gender, age, main diagnosis and APACHE II score between the two groups, and there were comparability. There were no significantly differences in the incidence of adverse events such as nosocomial infection [13.6% (8/59) vs. 12.5% (6/48)], unplanned extubation [5.1% (3/59) vs. 6.2% (3/48)], falling out of bed/fall [3.4% (2/59) vs. 0% (0/48)], unexpected readmission to ICU/GICU [8.5% (5/59) vs. 10.4% (5/48)], and ICU/GICU mortality [6.8% (4/59) vs. 6.2 (3/48)] between the ICU group and GICU group (all P > 0.05). Compared with the ICU group, the incidence of PICS in GICU group was significantly lower [8.3% (4/48) vs. 25.4% (15/59), P < 0.05], the satisfaction rate of patients/families with medical care [89.6% (43/48) vs. 74.6% (44/59)] and satisfaction rate of patients/families with diagnosis and treatment environment [87.5% (42/48) vs. 67.8% (40/59)] were significantly increased (both P < 0.05).

Conclusions: The use GICU as a friendly management model for elderly critically ill patients is feasible and safe, and it is worthy of further exploration and research.

Objective: To investigate the causal association between immune cell and different types of sepsis by using Mendelian randomization (MR) method, and to find the immune cell phenotypes causally associated with sepsis.

Methods: Summary data for various circulating immune cell phenotypes were obtained from the GWAS catalog (GCST90001391-GCST90002121). Sepsis data were sourced from the UK Biobank database. Single nucleotide polymorphisms (SNP) were used as instrumental variables. The correlation threshold of P < 5×10^-6 was used to identify the strongly correlated instrumental variables, and the code was used to remove the linkage disequilibrium and the instrumental variables with F-value < 10. Inverse variance weighting (IVW) was used as the main research method to evaluate the stability and reliability of the results, including Cochran's Q test, MR-Egger regression and Leave one out. Reverse MR analysis was performed based on the immunophenotypic results of the removal of horizontal pleiotropy, and the immune cell phenotype with one-way causal association was obtained. Odds ratio (OR) and 95% confidence interval (95%CI) were used to represent the effect value of the results.

Results: CD16 on CD14^-CD16⁺; monocyte had horizontal pleiotropy in sepsis (OR = 0.965 4, 95%CI was 0.933 5-0.998 3, P = 0.039 6). There were five immunophenotypes that had reverse causal associations with the types associated with sepsis. After excluding immune cell phenotypes with horizontal pleiotropy and reverse causation, a total of 42 immune cell phenotypes with sepsis, 36 immune cell phenotypes with sepsis (28-day death in critical care), 32 immune cell phenotypes with sepsis (critical care), 44 immune cell phenotypes with sepsis (28-day death), and 30 immune cell phenotypes had potential causal associations with sepsis (under 75 years old). After false discovery rate (FDR) correction, the correlations between BAFF-R on IgD^- CD38br and sepsis (28-day death) were negative and strong (OR = 0.737 8, 95%CI was 0.635 9-0.856 0, P = 6.05×10^-5, P_FDR = 0.044 2).

Conclusions: A variety of immune cell phenotypes may have a protective effect on sepsis, especially BAFF-R on IgD^- CD38br expression is negatively correlated with sepsis (28-day death), which provides a new idea for immune modulation therapy in sepsis.

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection, with increasing mortality as septic shock and organ failure progress. Mechanisms such as vascular endothelial dysfunction, microcirculatory disorders, coagulation abnormalities, immune suppression, mitochondrial damage, cell pyroptosis, ferroptosis, endoplasmic reticulum stress, and autophagy play crucial roles in organ dysfunction and death caused by sepsis. Concurrently, the imbalance of the gut microbiota also plays an undeniable role in the development of sepsis, with recent studies demonstrating a close connection between the gut microbiome and sepsis. Thus, how to improve the prognosis of patients with sepsis by reconstructing gut microbiota has become a focus of interest for critical care physicians. This article reviews the research progress on the correlation between gut microbiota and sepsis, providing clinical physicians with more therapeutic strategies to improve patient prognosis.

Mechanical ventilated patients are a high-risk group with impaired cough ability and require corresponding medical techniques for cough assistance to clear airway secretions. Mechanical insufflation-exsufflation (MI-E) technology is widely used in patients with cough weakness caused by neuromuscular diseases. However, there is currently a lack of standardized application procedures for mechanically ventilated patients who retain artificial airways, which can affect treatment outcomes. Chinese Society of Critical Care Medicine organized experts including critical care physicians, nurses, respiratory therapists that focused on the clinical application of mechanical insufflation-exsufflation in mechanically ventilated patients. Through systematic collection, extraction, and summary of evidence-based clinical practice evidence and clinical experience, suggestions are proposed. Expert recommendations on the clinical application of mechanical insufflation-exsufflation in mechanically ventilated patients (2024) was formed by using improved Delphi method, hoping to provide references for standardized application of this technology. At the same time, those recommendations will also provide a reference for future clinical research on the application of mechanical insufflation-exsufflation technology in mechanically ventilated patients.

Respiratory failure caused by acute respiratory distress syndrome and severe pneumonia is common diseases in intensive care medicine. In recent years, with the continuous updating of treatment methods, prone position ventilation has been found to have a good therapeutic effect on such diseases, and has been widely used in clinical practice. However, prone position ventilation significantly increases the workload of medical staff and the risk of accidental extubation and pressure injuries to patients, seriously affecting the safety of diagnosis and treatment. At present, various devices such as mattresses have been used for prone position ventilation, but there are few devices specifically designed to protect and fix the head and face. Therefore, the medical staff of Affiliated Hospital of Zunyi Medical University designed and developed a head support frame for prone position ventilation, and obtained a National Utility Model Patent of China (patent number: ZL 2018 2 0056891.6). The head support frame for prone position ventilation includes a movable chassis and rollers for easy movement and fixation. The retractable column 1 is vertically fixed on the movable chassis, and its height can be freely adjusted according to the position of the patient. A transverse bridge is fixed at the top of the retractable column 1, the two ends of the bridge are designed a bulge, and the rotating ring is fixed above the transverse bridge, so that the rotating ring can rotate along the bridge at a certain angle. The rotating ring is designed with an inner ring and an inlet and outlet which can pass through the tube is designed on the rotating ring. The inflatable air bag is designed above the rotating ring to improve the comfort of patients and reduce the pressure injury of facial skin. A sliding rod is vertically designed on the upper part of the retractable column 1, and there is a retractable column 2 at the distal end of the slide rod, and the retractable column 2 is connected with the rotating ring, so that the rotating ring adjusts the angle along the cross bridge with the contraction of the collapsible column 2. A retractable column 3 is arranged in the middle of the slide rod, and a catheter clamp is arranged at its far end to facilitate the fixation of the artificial airway and the mechanical ventilation tube. The support frame is practical and convenient, which can protect the patient's head safely in the prone position, and greatly reduce the workload of medical staff.

Objective: To evaluate the effects of different intervention measures on duration of mechanical ventilation and the length of intensive care unit (ICU) stay in critically ill patients using network Meta-analysis.

Methods: Randomized controlled trial (RCT) on the effects of different intervention measures on duration of mechanical ventilation and the length of ICU stay in critically ill patients were systematically searched in PubMed, Embase, China Biomedical Literature Database, CNKI, and other databases. The search time limit was from the establishment of the database to November 2023. Literature screening, quality assessment, and data extraction were independently conducted by two researchers. Network Meta-analysis was employed to assess the effects of each intervention on duration of mechanical ventilation and the length of ICU stay, and funnel plots were generated.

Results: A total of 37 RCTs were included, involving 3 977 severe patients, 2 041 in the intervention group and 1 936 in the control group. Thirteen types of interventions were analyzed, including usual care (UC), early activity (EA), early comprehensive rehabilitation (ECR), early pulmonary rehabilitation (EPR), cluster intervention strategy (CS), sedation, analgesia and cluster nursing (SACN), music therapy (MT), neuromuscular electrical stimulation (NMES), modified education and visitation (MV), virtual reality (VR), auricular point sticking (APS), acupoint acupuncture (AA), and concerted intervention (COR). Network Meta-analysis showed that MV significantly better than COR [standardized mean difference (SMD) = -2.35, 95% confidence interval (95%CI) was -4.30 to -0.39], EPR (SMD = -2.59, 95%CI was -4.81 to -0.37), and UC (SMD = -4.10, 95%CI was -5.71 to -2.49) in improving duration of mechanical ventilation in critically ill patients. COR was significantly better than UC in shortened length of ICU stay (SMD = -5.72, 95%CI was -10.07 to -1.37). The efficacy ranking results showed that for duration of mechanical ventilation, the surface under the cumulative ranking curve (SUCRA) was highest for MV (85.4%) and EA (85.4%), followed by AA (74.9%), NMES (63.1%), ECR (51.7%), CS (48.8%), SACN (34.3%), COR (29.4%), EPR (26.1%), and UC (0.7%). For the length of ICU stay, COR had the highest SUCRA (82.3%), followed by APS (79.7%), MV (77.7%), EPR (68.0%), NMES (57.6%), CS (54.4%), ECR (51.1%), SACN (41.9%), MT (39.8%), EA (39.3%), AA (33.0%), VR (15.4%), and UC (9.8%). The funnel plot results of ICU stay showed that the publication bias between studies were relatively small.

Conclusions: MV and COR appear to be effective interventions for reducing mechanical ventilation time and ICU stay in critically ill patients. However, due to the number and quality of included studies, these findings require confirmation through additional high-quality research.

Objective: To investigate the molecular characteristics of obacunone, and to screen and identify potential targets of obacunone against sepsis.

Methods: The pharmacological parameters and molecular characteristics of obacunone were analyzed with the aid of the Traditional Chinese Medicine Systems Pharmacology Database Analysis Platform (TCMSP). The potential targets of obacunone against sepsis were screened using SwissTargetPrediction and Drug Repositioning and Adverse Drug Reaction Chemical-Protein Interactome (DRAR-CPI) software, with a Z'-score < -0.5. The anti-sepsis targets of obacunone were selected by Online Mendelian Inheritance in Man (OMIM), Comparative Toxicogenomics Database (CTD) and Therapeutic Target Database (TTD). The anti-sepsis potential target was identified by molecular docking software.

Results: The oral bioavailability of obacunone was 81.58% and the drug-likeness was 0.57 indicating that obacunone showed good drug formation. A total of 242 potential targets were screened through SwissTargetPrediction and DRAR-CPI software, 13 targets were directly related to sepsis. Cathepsin G (CTSG), caspase-1 (CASP1), S100 calcium binding protein A9 (S100A9), protein C (inactivator of coagulation factors V a and VIII a, PROC), mitogen-activated protein kinase 1 (MAPK1), glucose-6-phosphate dehydrogenase (G6PD), interleukin-10 (IL-10), migration inhibitory factor (MIF), complement C5a receptor 1 (C5AR1), caspase-3 (CASP3), CXC chemokine receptor 2 (CXCR2), thrombin receptor (F2R), nicotinamide phosphoribosyltransferase (NAMPT) were identified as the potential targets for anti-sepsis of obacunone by molecular docking software, the free binding energies were -32.55, 1.26, -30.00, 300.08, -31.88, -30.29, -21.38, -30.79, 16 777.84, -21.80, 6 443.36, -20.38, -23.47 kJ/mol, respectively.

Conclusions: Obacunone can inhibit blood coagulation and improve inflammatory response by regulating PROC and F2R. It regulates MIF, S100A9, G6PD and IL-10 to play a role in immune response. It regulates CTSG, CASP1, MAPK1, C5AR1 and CASP3 to protect sepsis-damaged organs. By regulating CXCR2, it can reduce the excessive migration of neutrophils to the site of inflammation, alleviate tissue damage. By regulating NAMPT, it improves cellular energy status, reduces oxidative stress, and protects cells from damage.