The predictive value of warning scores for intensive care unit admission in coronavirus disease 2019 patients / 中华内科杂志

To evaluate the predictive value of early warning scores for intensive care unit (ICU) admission in patients with coronavirus disease 2019 (COVID-19). For COVID-19 patients who were admitted to Shijiazhuang People's Hospital from January 2021 to February 2021, national early warning score (NEWS), national early warning score 2 (NEWS2), rapid emergency medicine score (REMS), quick sepsis-related organ failure (qSOFA), altered consciousness, blood urea nitrogen, respiratory rate, blood pressure, and age-65 (CURB-65) were used to evaluate the inpatient condition and the predictive value for ICU admission. A total of 368 patients were included, and 32 patients (8.7%) were transferred to the ICU. The median age was 49.0 (34.0,61.0) years. The scores of NEWS, NEWS2, REMS, and CURB-65 were 1 (0, 2), 1 (0, 2), 4 (2, 6) and 0 (0, 1), respectively. The receiver operating characteristic (ROC) cure (AUC) was used to evaluate the predictive value in detecting patients who are at risk of being transferred to the ICU. Area under the ROC AUC of NEWS was 0.756, sensitivity 65.6%, and specificity 71.3%. ROC AUC of NEWS2 was 0.732, sensitivity 62.5%, and specificity 61.3%. ROC AUC of REMS was 0.787, sensitivity 84.4%, and specificity 64.6%. ROC AUC of CURB-65 was 0.814, sensitivity 81.3%, and specificity 76.8%. The predictive value of NEWS and NEWS2 combined with age were significantly improved. The ROC AUC of NEWS combined with age was 0.885, sensitivity 85.1%, and specificity 75.0%. The ROC AUC of NEWS2 combined with age was 0.883, sensitivity 84.2%, and specificity 75.0%. NEWS and NEWS2 combined with age can be used as a predictive tool for whether COVID-19 patients will be admitted to the ICU.

Dose-response association between fluid overload and hospital mortality in patients with sepsis / 中华内科杂志

Objective: To investigate dose-response associations between fluid overload (FO) and hospital mortality in patients with sepsis. Methods: The current cohort study was prospective and multicenter. Data were derived from the China Critical Care Sepsis Trial, which was conducted from January 2013 to August 2014. Patients aged≥18 years who were admitted to intensive care units (ICUs) for at least 3 days were included. Fluid input/output, fluid balance, fluid overload (FO), and maximum FO (MFO) were calculated during the first 3 days of ICU admission. The patients were divided into three groups based on MFO values: MFO<5%L/kg, MFO 5%-10%L/kg, and MFO≥10% L/kg. Kaplan-Meier analysis was used to predict time to death in hospital in the three groups. Associations between MFO and in-hospital mortality were evaluated via multivariable Cox regression models with restricted cubic splines. Results: A total of 2 070 patients were included in the study, of which 1 339 were male and 731 were female, and the mean age was (62.6±17.9) years. Of 696 (33.6%) who died in hospital, 968 (46.8%) were in the MFO<5%L/kg group, 530 (25.6%) were in the MFO 5%-10%L/kg group, and 572 (27.6%) were in the MFO≥10%L/kg group. Deceased patients had significantly higher fluid input than surviving patients during the first 3 days [7 642.0 (2 874.3, 13 639.5) ml vs. 5 738.0 (1 489.0, 7 153.5)ml], and lower fluid output [4 086.0 (1 367.0, 6 354.5) ml vs. 6 130.0 (2 046.0, 11 762.0) ml]. The cumulative survival rates in the three groups gradually decreased with length of ICU stay, and they were 74.9% (725/968) in the MFO<5% L/kg group, 67.7% (359/530) in the MFO 5%-10%L/kg group, and 51.6% (295/572) in the MFO≥10%L/kg group. Compared with the MFO<5%L/kg group, the MFO≥10%L/kg group had a 49% increased risk of inhospital mortality (HR=1.49, 95%CI 1.28-1.73). For each 1% L/kg increase in MFO, the risk of in-hospital mortality increased by 7% (HR=1.07, 95% CI 1.05-1.09). There was a"J-shaped"non-linear association between MFO and in-hospital mortality with a nadir of 4.1% L/kg. Conclusion: Higher and lower optimum fluid balance levels were associated with an increased risk of in-hospital mortality, as reflected by the observed J-shaped non-linear association between fluid overload and inhospital mortality.

Cholinesterase inhibitor at different doses in treating patients with Alzheimer's disease and their correlative research / 中华神经医学杂志

Objective To compare the effects of different doses ofdonepezil,the cholinesterase inhibitor,on patients with mild to moderate Alzheimer's disease (AD) and analyze the correlations of different rating scales of AD so as to choose a better evaluation tool for AD treatment efficacy.Methods Sixty-nine AD patients,admitted to our hospital from January 2010 to November 2010,were randomly divided into 5 mg donepezil treatment group (n=33) and 10 mg donepezil treatment group (n=36); the treatments were given daily for a consecutive 12 months.They were performed Mini Mental State Examination (MMSE),Alzheimer's Disease Assessment Scale-cognitive sub scale (ADAS-cog),activities of daily living (ADL) and instrumental activities of daily living (LADL) every 3 months (3,6,9 and 12 months after the first evaluation time). Results Improvements were noted in both groups on MMSE scores,ADAS-cog scores,ADL scores,IADL scores,and latency of P300 and N200:the MMSE scores,ADAS-cog scores and latency of P300 in the 10 mg treatment group were obviously higher/longer than those in the 5 mg treatment group.Relation between MMSE scores and ADAS-cog scores was noted (r=-0.378,P=0.001).No relation was noted on neuro-psychology and electrophysiology of these patients (P＞0.05). Conclusion Donepezil is safe and effective in improving cognition of patients with mild to moderate AD,and has obvious dose-effect:the efficacy of 10 mg donepezil is superior to that of 5 mg donepezil; the parameters of cognitive assessment in neuro-psychology were found having relation with each other,which can be used with combination to improve the evaluation efficacy.

Effects of atorvastatin on levels of C-reactive protein and other inflammatory factors in patients with hypertension / 中华神经医学杂志

Objective To identify the effects of atorvastatin on high-sensitivity C-reactive protein (hs-CRP), yon willebrand factor (vWF), P-selectin, low-density lipoprotein-cholesterol (LDL-C)and carotid intima-media thickness (IMT) of patients with essential hypertension. Methods One hundred and fifty-one patients with mild hypertension were randomly divided into 3 groups: 10 mg atorvastatin, amlodipine and benazepril were daily delivered to group A (n=50); 20 mg atorvastatin,amlodipine and benazepril were daily delivered to group B (n=61); and amlodipine and benazepril were daily delivered to control group (n=40). All patients were assessed for the levels of hs-CRP, vWF,P-selectin, LDL-C and IMT at the baseline and every 3 months. The observation period lasted for 1 y and statistical analysis was performed on these collected data. Results As compared with that in the control group, significant reduction was identified on the levels of hs-CRP, vWF, P-selectin, LDL-C and IMT in group A and group B (P＜0.05). Correlation analysis discovered that the changes of levels of hs-CRP, VWF, P-selectin and IMT did not correlate with the reduction of LDL-C. Conclusion The progression of atherosclerosis can be delayed by atorvastatin in patients with hypertension, which is probably independent from its lipid-lowering function.

Keratorefractive surgery and glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

Keratorefractive surgery changes the central corneal thickness (CCT) and corneal curvature, which could influence the Goldmann applanation tonometer (GAT) and non-contact tonometer (NCT) measurements of intraocular pressure (IOP), but not dynamic contour tonometer(DCT). During the procedure of LASIK, there is a transient rise of IOP, which increases the risks of optic nerve damage. Meanwhile, the presence of functioning filtering blebs may affect the choice and outcome of refractive surgery, or even becomes a contraindication of surgery. Steroids are typically used after keratorefractive surgery, which could lead to IOP elevation. Hence it is important to monitor IOP after LASIK and to be aware of inaccurate IOP readings due to corneal flap interface fluid. Treating patients with postoperative elevated IOP after keratorefractive surgery is similar to that for patients with glaucoma. This review will address the issues surrounding the safety, relevant complications and implications of keratorefractive surgeries on glaucoma and relevant diagnostic tests.

Expression and subcellular localization of the ORF4 gene of barley yellow dwarf virus GAV strain in baculovirus-insect cell expression system / 生物工程学报

According to published nucleotide sequences, ORF4 gene of barley yellow dwarf virus GAV (BYDV-GAV) was synthesized by reverse transcription-polymerase chain reaction (RT-PCR). The BYDV-GAV ORF4 gene was expressed in baculovirus -insect cell expression system efficiently, and western bolt analysis confirmed its expression product. Confocal laser scanning microscopy showed that GFP: ORF4 fusion protein was associated with the nuclear envelope of insect cells. By expressing the N- and C-terminal regions of ORF4-encoding product (P4) in insect cells combined with structure prediction, it was found that the N-terminal region of P4 containing four a-helices is required for targeting P4 to the nuclear envelope. These results provide a base for biological function of ORF4 gene during systemic infection of BYDV-GAV in host plants further.