The morbidity and clinical features of unilateral pulmonary edema in the intensive care unit: A retrospective study / 中华急诊医学杂志

Objective:To explore the morbidity, clinical features and mortality of unilateral pulmonary edema (PE) in the intensive care unit (ICU).Methods:Clinical data of PE patients in ICU between January 2018 and January 2021 were retrospectively collected. All patients were divided into the bilateral PE and unilateral PE groups according to imaging manifestations. Etilogy, clinical performance, cardiac ultrasound parameters, complications, treatment and prognosis were compared between the two groups. Binary logistic regression analysis was used to screen out the risk factors of death.Results:Of the 314 PE patients, 14 (4.5%) were unilateral PE patients , and 11 (78.5%) were right-sided unilateral PE. There were no differences in age, gender, heart rate, respiratory rate and left ventricular eject fraction between the unilateral and bilateral PE groups. Compared with the bilateral PE group, systolic and diastolic blood pressure were significantly lower in the unilateral PE group [128 (102.7-138) mmHg vs. 135 (116-166) mmHg, 72 (54-88.2) mmHg vs. 82 (69-97.7)mmHg, respectively]. The incidence of cardiac arrest and hospital mortality were higher in the unilateral PE group [28.6% vs. 8.0%, 42.9% vs. 10%, all P<0.05]. Binary logistic regression analysis showed that age, unilateral PE, and use of vasoactive agent were associated with poor prognosis. Odds ratio of unilateral PE and use of vasoactive agent were 17.78 and 11.67, respectively. Conclusions:Unilateral PE is not rare, which is an independent risk factors for mortality and should be promptly recognized to avoid delays in treatment.

Characterization and Clinical Course of 1000 Patients with COVID-19 in New York: retrospective case series

ObjectiveTo characterize patients with coronavirus disease 2019 (COVID-19) in a large New York City (NYC) medical center and describe their clinical course across the emergency department (ED), inpatient wards, and intensive care units (ICUs). DesignRetrospective manual medical record review. SettingNewYork-Presbyterian/Columbia University Irving Medical Center (NYP/CUIMC), a quaternary care academic medical center in NYC. ParticipantsThe first 1000 consecutive patients with laboratory-confirmed COVID-19. MethodsWe identified the first 1000 consecutive patients with a positive RT-SARS-CoV-2 PCR test who first presented to the ED or were hospitalized at NYP/CUIMC between March 1 and April 5, 2020. Patient data was manually abstracted from the electronic medical record. Main outcome measuresWe describe patient characteristics including demographics, presenting symptoms, comorbidities on presentation, hospital course, time to intubation, complications, mortality, and disposition. ResultsAmong the first 1000 patients, 150 were ED patients, 614 were admitted without requiring ICU-level care, and 236 were admitted or transferred to the ICU. The most common presenting symptoms were cough (73.2%), fever (72.8%), and dyspnea (63.1%). Hospitalized patients, and ICU patients in particular, most commonly had baseline comorbidities including of hypertension, diabetes, and obesity. ICU patients were older, predominantly male (66.9%), and long lengths of stay (median 23 days; IQR 12 to 32 days); 78.0% developed AKI and 35.2% required dialysis. Notably, for patients who required mechanical ventilation, only 4.4% were first intubated more than 14 days after symptom onset. Time to intubation from symptom onset had a bimodal distribution, with modes at 3-4 and 9 days. As of April 30, 90 patients remained hospitalized and 211 had died in the hospital. ConclusionsHospitalized patients with COVID-19 illness at this medical center faced significant morbidity and mortality, with high rates of AKI, dialysis, and a bimodal distribution in time to intubation from symptom onset.

Phenotype Concept Set Construction from Concept Pair Likelihoods.

Phenotyping algorithms are essential tools for conducting clinical research on observational data. Manually devel- oped phenotyping algorithms, such as those curated within the eMERGE (electronic Medical Records and Genomics) Network, represent the gold standard but are time consuming to create. In this work, we propose a framework for learning from the structure of eMERGE phenotype concept sets to assist construction of novel phenotype definitions. We use eMERGE phenotypes as a source of reference concept sets and engineer rich features characterizing the con- cept pairs within each set. We treat these pairwise relationships as edges in a concept graph, train models to perform edge prediction, and identify candidate phenotype concept sets as highly connected subgraphs. Candidate concept sets may then be interrogated and composed to construct novel phenotype definitions.

Time-specific gene knockout technology：model establishment, present and future / 中国组织工程研究

BACKGROUND: The target gene cannot be deleted at specific time by using conditional gene knockout system. Most gene knockout animals cannot survive during embryonic development and after birth, which limits the study of gene function. OBJECTIVE: To review the recent advances about time-specific gene knockout technology. METHODS: An online search in PubMed was performed from the initial stage of database establishment to August 2014. The key words were gene knockout, inducer and Cre/loxP system. The repeated experiment and unrelated articles were excluded during primary search. A summary was made by analyzing time-specific gene knockout technology. RESULTS AND CONCLUTION: Most important gene knockout animals could not survive after birth, or die at early embryonic stage due to serious physical defects induced by an important gene deletion. Therefore, the progress in the functionality of a gene at a particular time, the genetic characteristics of an individual organism in a particular developmental period, and the treatment of certain acquired disease at a given time have been limited because of the limitations of research methods. However, the occurrence of conditional gene knockout animals, especial y time-specific knockout animals, provides a research model for the study of these areas. This study reviewed the recent advances, development and application about time-specific gene knockout animals, and discussed the significance and broad prospects of time-specific gene knockout technology of specific genes in the field of scientific research.

The clinical study about fluid resuscitation and management through Vigileo with passive leg raising test in shock patients / 中华急诊医学杂志

Objective To compare the procotol of EGDT +Pt (cv-a ) CO2 with EGDT in fluid resuscitation and management after evaluate fluid responsiveness in shock patients by Vigileo and passive leg raising test.Metheds Prospectively collect patients who meet the criteria between 2013.5.1-2013.1 1.30 in our ICU.Randomly (random number)divided into Vigileo group (first evaluate the fluid responsiveness then give EGDT +Pt (cv-a) CO2 ) and CVP group (give EGDT).Compare the hospital mortality and morbility of MODS,the volume given in the first 6 hours and the first 7 days,consume of blood products , the ICU and hospital stay.Results Collected 46 patients,Vigileo group (21 )and CVP group (25 ). There’s no significant difference between groups at baseline.In the first 6 hours the CVP group had received more fluids (3656.281678.57 vs. 2639.141326.59 ) mL, P =0.03;and more blood products (573.00172.57 vs. 190.4770.82)mL,P=0.04,respictivily.Vigileo group significantly short the ICU stay ,(6.384.34 vs. 12.165.77)d,P=0.04.But there’s no significant difference in hospital motality and the morbility of MODS.The ROC of Age ,the accumulative volume of balance in 7 days,APACHEⅡscore in the first day to predict death is 0.84 (0.68-0.99)、0.82 (0.69-0.95)、0.80 (0.66-0.94),all P>0.05,respectively.By 7 days the accumulative volume of balance 3454.51mL as cutoff to predict death with the sensitivity of 0.67,specificity of 0.84.Conclusions 1.Given EGDT +Pt (cv-a) CO2 after evaluate the fluid responsiveness can reduce fluid and blood products given in the first 6 hours,significantly short the ICU stay,without worsen the tissue flow or increase the morbility of MODS;2.Consecutive positive fluid balance is a risk factor about poor prognosis,and also a sensitive indicator to predict death.

Therapeutic effects of sensorimotor training on patients with knee osteoarthritis / 中华物理医学与康复杂志

Objective To investigate the effects of sensorimotor therapy on patients with knee osteoarthritis.Methods Ninety-two patients with knee osteoarthritis were divided into a treatment group and a control group by using random digits table. Both groups received conventional rehabilitation therapy, including knee isometric and isotonic contraction training, ultrashort wave diathermy as well as aerobic exercise. The treatment group was also administered with sensorimotor training, in addition to the conventional training,including the muscle strengthening and control training of quadriceps and hamstring muscle using sling exercise therapy system and on the Thera-band mattress. The visual analogue scale (VAS) for pain, manual muscle testing and knee range of motion as well as the Japanese Orthopedic Association knee function evaluation form were used to evaluate the patients. Results There was no statistic difference between the 2 groups before treatment, with regard to the evaluation parameters used in this study. After 2 months of treatment, both groups improved significantly (P ＜0.05),with the treatment group improved to a significantly greater extent (P ＜0.05). Conclusions Sensorimotor training in addition to the conventional rehabilitation treatment can further relieve the pain of patients with knee osteoarthritis joints arthritis and improve the function of patients with knee osteoarthritis.