Prediction of cardiac arrest in critically ill patients based on bedside vital signs monitoring.

PURPOSE: Cardiac arrest (CA) is the most serious death-related event in critically ill patients and the early detection of CA is beneficial to reduce mortality according to clinical research. This study aims to develop and verify a real-time, interpretable machine learning model, namely cardiac arrest prediction index (CAPI), to predict CA of critically ill patients based on bedside vital signs monitoring. METHODS: A total of 1,860 patients were analyzed retrospectively from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Based on vital signs, we extracted a total of 43 features for building machine learning model. Extreme Gradient Boosting (XGBoost) was used to develop a real-time prediction model. Three-fold cross validation determined the consistency of model accuracy. SHAP value was used to capture the overall and real-time interpretability of the model. RESULTS: On the test set, CAPI predicted 95% of CA events, 80% of which were identified more than 25 min in advance, resulting in an area under the receiver operating characteristic curve (AUROC) of 0.94. The sensitivity, specificity, area under the precision-recall curve (AUPRC) and F1-score were 0.86, 0.85, 0.12 and 0.05, respectively. CONCLUSION: CAPI can help predict patients with CA in the vital signs monitoring at bedside. Compared with previous studies, CAPI can give more timely notifications to doctors for CA events. However, current performance was at the cost of alarm fatigue. Future research is still needed to achieve better clinical application.

Immunogenicity and safety of the homogenous booster shot of a recombinant fusion protein vaccine (V-01) against COVID-19 in healthy adult participants primed with a two-dose regimen

BackgroundRising concerns over waning immunity and reduction in neutralizing activity against variants of concern (VOCs) have contributed to deploying booster doses by different strategies to tackle the COVID-19 pandemic. Preliminary findings from Phase I and II have shown that V-01, a recombinant fusion protein vaccine against COVID-19, exhibited favorable safety and immunogenicity profiles in 1060 adult participants of both younger and senior age. Herein, we aimed to assess the immunogenicity and safety for a booster dose in participants previously primed with a two-dose 10g V-01 regimen (day 0, 21) from phase I trial, providing reassuring data for necessity and feasibility of a homogenous booster dose. MethodsWe conducted a single-arm, open-label trial at the Guangdong Provincial Center for Disease Control and Prevention (Gaozhou, China). Forty-three eligible participants who were previously primed 4-5 months earlier with two-dose 10g V-01 regimen from phase I trial received booster vaccination. We primarily assessed the immunogenicity post-booster vaccination, measured by RBD-binding antibodies using ELISA and neutralizing activity against wild-type SARS-CoV-2 and emerging variants of concern (VOCs) using neutralization assays. We secondarily assessed the safety and reactogenicity of the booster vaccination. ResultsThe third dose of V-01 exhibited significant boosting effects of humoral immune response in participants primed with two-dose 10g V-01 regimen regarding both wild-type SARS-CoV-2 and VOCs. We observed a 60.4-folds increase in neutralizing titres against SARS-CoV-2 of younger adults, with GMTs of 17 (95%CI: 12-23) prior to booster vaccination in comparison to 1017 (95%CI: 732-1413) at day 14 post booster vaccination; and a 53.6-folds increase in that of older adults, with GMTs of 14 (95%CI: 9-20) before booster vaccination in comparison to 729(95%CI: 397-1339) at day 14 post-booster vaccination. The neutralizing titres against SARS-CoV-2 Delta strain also demonstrated a sharp increase from the day of pre booster vaccination to day 14 post booster vaccination, with GMTs of 11 (95%CI:8-15) versus 383 (95%CI:277-531) in younger adults (35.4-folds increase), and 6.5(95%CI: 5-8) versus 300(95%CI:142-631) in older adults (46.0-folds increase), respectively. We also observed a considerable and consistent increase of pseudovirus neutralizing titres against emerging VOCs from day 28 post second vaccination to day 14 post booster vaccination, with GMTs of 206 (95%CI:163-259) versus 607 (95%CI: 478-771) for Alpha strain, 54 (95%CI:38-77) versus 329 (95%CI: 255-425) for Beta strain, 219 (95%CI:157-306) versus 647 (95%CI: 484-865) for Delta strain. Our preliminary findings indicate a homogenous booster dose of V-01 was safe and well-tolerated, with overall adverse reactions being absent or mild-to-moderate in severity, and no grade 3 or worse AEs were related to booster vaccination. ConclusionsA homogenous booster immunization in participants receiving a primary series of two-dose V-01 elicited a substantial humoral immune response against wild-type SARS-CoV-2 and emerging VOCs, along with a favorable safety and reactogenicity profile. Our study provided promising data for a homogenous prime-boost strategy using recombinant protein vaccine to tackle the ongoing pandemic, potentially providing broad protection against emerging VOCs and overcoming waning immunity.

Review of Physiological Parameters Monitoring Technology in the ICU / 中国医疗器械杂志

Physiological parameters monitoring is essential to direct medical staff to evaluate, diagnose and treat critical patients quantitatively. ECG, blood pressure, SpO2, respiratory rate and body temperature are the basic vital signs of patients in the ICU. The measuring methods are relatively mature at present, and the trend is to be wireless and more accurate and comfortable. Hemodynamics, oxygen metabolism and microcirculation should be taken seriously during the treatment of acute critical patients. The related monitoring technology has made significant progress in recent years, the trend is to reduce the trauma and improve the accuracy and usability. With the development of machine vision and data fusion technology, the identification of patient behavior and deterioration has become hot topics. This review is focused on current parameters monitoring technologies, aims to provide reference for future related research.

Research on Patient Monitoring Alarms in ICU and NICU / 中国医疗器械杂志

OBJECTIVE@#The patient monitors were used to explore the alarm actuality in a ICU and NICU to investigate the awareness and reaction of medical staff to alarms.@*METHODS@#A series of surveys and interviews were taken to acquire clinicians' feelings and attitudes to monitoring alarms. The researchers were scheduled to track the alarms with annotations, and collect the alarm data of patient monitors using central monitoring system.@*RESULTS@#A total of 235 387 and 67 783 alarms occurred in ICU and NICU respectively. The average alarm rate was about 142 alarms/patient-day in ICU and 96 alarms/patient-day in NICU.@*CONCLUSIONS@#There remains alarm fatigue in ICU and NICU, the main reason is the large number of false alarms and clinically irrelevant alarms. In addition, patient monitor is still in the level of threshold alarms or combined alarms, the data integrity and intelligence level need to be improved in future.

Research of Methods to Reduce Alarm Fatigue of Monitoring System / 中国医疗器械杂志

OBJECTIVE@#In order to solve alarm fatigue, the algorithm optimization strategies were researched to reduce false and worthless alarms.@*METHODS@#A four-lead arrhythmia analysis algorithm, a multiparameter fusion analysis algorithm, an intelligent threshold reminder, a refractory period delay technique were proposed and tested with collected 28 679 alarms in multi-center study.@*RESULTS@#The sampling survey indicate that the 80.8% of arrhythmia false alarms were reduced by the four-lead analysis, the 55.9% of arrhythmia and pulse false alarms were reduced by the multi-parameter fusion analysis, the 28.0% and 29.8% of clinical worthless alarms were reduced by the intelligent threshold and refractory period delay techniques respectively. Finally, the total quantity of alarms decreased to 12 724.@*CONCLUSIONS@#To increase the dimensionality of parametric analysis and control the alarm limits and delay time are conducive to reduce alarm fatigue in intensive care units.

Investigation and analysis of one year survival rate and life quality of patients with non-small cell lung cancer treated by different arms / 中国综合临床

Objective To investigate one year survival rate and life quality of patients with non-small cell lung cancer(NSCLC)treated by different arms.Methods One hundred and seventy-nine cases NSCLC patients from January 2013 to December 2014 were selected from the Third Hospital of Tanshan and followed-up,including 57 cases with surgical treatment,70 cases with the use of Navelbine plus cisplatin,52 cases with dendritic cells(DC)and cytokine induced killer cells(CIK)immune based therapy(DC/CIK)treatment.After one year period of radiotherapy and chemotherapy,the SF-36 questionnaire was used to investigate the quality of life of the surviving patients,and the quality of life was assessed from three aspects of the physiological,psychological and social functions.To quantify the quality of life score,the 100 percentage grading system was adopted,logistic regression analysis was used to adjust the influence of age and gender on survival rate,and the data were analyzed by SAS 9.2 statistical software package.Results One hundred and seventy-nine subjects were included in this study,by the end of follow-up on December 2015,there were 119 cases survived,the survival rate was 66.5％(119/179).Survival rate of surgical operation group,DC/CIK group and chemotherapy group orderly decreased(82.5％(47/57),76.9％(40/52)and 45.7％(32/70),P＜0.01).After adjusting age and gender impact,multiple logistic regression model showed that DC/CIK group survival rate was 3.96 times higher than the pure chemotherapy group(95％CI=1.78-8.80),surgical operation group was 5.58 times higher than simple chemotherapy group(95％CI=2.44-12.79).There were no significant differences between DC/CIK group and surgical operation group on physical disease,health status,emotional intelligence,mental health and social function,no significant difference(P＞0.05),but the chemotherapy group was lower(P＜0.05);physiological function in the chemotherapy group,operation group and DC/CIK group showed an increasing trend(P＜0.05).Conclusion The one year survival rate of NSCLC patients treated by different arms is 66.5％,and the life quality of patients with biological immune therapy method is better.

Value of combined CA125, CT and MRI in diagnosing the ovarian thecoma / 中国综合临床

Objective To discusses the value of combined CA125 and CT/MR/ in diagnosing the ovarian thecoma.Methods Forty cases of patients with ovarian thecoma were retrospectively analyzed.The results of CA125 and the appearance of CT and MRI were recorded,the value of CA125 changes and CT/MRI features was analysed in the diagnosis of ovarian thecoma.Results The value of CA125 elevated in 17 cases of ovarian thecoma,and showed statistical significance in the ratio((12/35 vs.5/5;x2=2.274,P=0.046) and the levels of the value of CA125 ((90.24 ± 18.56) U/ml vs.(243.35 ± 20.45) U/ml;t =7.780,P =0.002).Compared with 40 cases of control group,elevated CA125 level showed no obviously statistical significance (t =5.348,P=0.22).Forty patients in CT and MRI were all single lesion,30 cases were solid neoplasm,the rest were cystic-solidary lesions or priority of cystic component,75％ lesions were more than 5 cm,9 cases of lesions contains calcification.In pre-enhanced CT and MR/scan the lesions showed iso-density or signal-intensity,mildly enhanced;Twenty-two patients with ascites and 11 cases with symptoms in the elevating of estrogen.Combined the results of CA125 and the apperaance of CT and MR/,the accuracy of the diagnosis in ovarian thecoma was 85％.Conclusion CT and MR/imaging combining with CA125 can improve the diagnosis accuracy of ovarian thecoma.which should be given priorities.

Clinical effects analyses of nedaplati or docetaxel combined with radiotherapy on patients with locally advanced uterine cervical cancer / 中国综合临床

Objective To investigate the efficacy of nedaplati docetaxel combined with radiotherapy on patients with locally advanced cervical cancer.Methods The clinical data of 99 cases with pathologically diagnosed advanced cervical cancer from Jun.2013 to jul.2014 in the Matemal and Child Health Care Hospital of Tangshan were recorded.The patients were randomly divided into the control group (45 cases only with radiotherapy) and the observation group(54 cases with nedaplati and docetaxel beside radiotherapy).Results The effective rate in observation group was 90.74％,higher than control group (71.11％,x2 =6.358,P =0.017).There were significant incidence of bone marrow suppression renal dysfunction and gastrointestinal both in two groups,but can endure.There was no significant difference in term of side effect in two groups (P ＞0.05).Conclusion The therapy of nedaplati and docetaxel combined with radiotherapy has better effect for patients with advanced cervical cancer and without significantly increasing side effect.

Change of leptin and adiponectin levels in patients with diabetic retinopathy / 中国综合临床

Objective To analyze the changes of leptin and adiponectin levels in serum of patients with diabetic retinopathy and investigate their chnical significance in diabetic retinopathy (DR).Methods One hundred and twenty-one patients with type 2 diabetes mellitus as the case group who hospitalized from Nov.2012 to Nov.2013.Among the patients,41 cases of non-DR,40 cases of nonproliferative-DR,40 cases of proliferativeDR.Forty healthy were served as the control group.The levels of leptin and adiponectin in serum were detected by Enzyme-Linked Immuno Sorbent Assay (ELISA).Results The overall levels of leptin in case group was (15.25 ± 4.70) μg/L,significantly higher than the control group ((6.15 ± 1.70) μg/L; t =-11.696,P ＜0.01)).The level of adiponectin in case group was (7.39 ± 1.92) mg/L,lower than the control group ((11.10 ± 1.46) mg/L; t =11.216,P ＜ 0.01).Moreover,the levels of leptin increased successively from (10.91 ±1.21) μg/L in NDR,(15.22 ±3.75) μg/ L in NPDR and (20.50 ±3.70) μg/L in PDR.While,the adiponectin levels decreased from (9.61 ± 1.35) mg/L in NDR,(7.11 ± 1.18) mg/L in NPDR and (5.34 ± 1.36) mg/L in PDR respectively.And the differences between the groups were significant(F =149,542,291,550;P ＜0.05).The levels of leptin and adiponectin in serum showed a negative correlation (r =-0.662,P ＜0.01).Condusion Levels of leptin and adiponectin in serum associate with DR,and both of them might be the important indexes for the prediction and curative effect evaluation of DR.