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1.
Lancet Reg Health West Pac ; 18: 100301, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35024647

RESUMO

Background: China is embracing an ageing population without sustainable end-of-life care services. However, changes in place of death and trends of going home to die (GHTD) from the hospital remains unknown. Methods: A total of 42,956 participants from the China Kadoorie Biobank, a large Chinese cohort, who died between 2009 and 2017 was included into analysis. GHTD was defined as death at home within 7 days after discharge from the hospital. A modified Poisson regression was used to investigate temporal trends of the place of death and GHTD, and estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the association of GHTD with health insurance (HI) schemes. Findings: From 2009 to 2017, home remained the most common place of death (71·5%), followed by the hospital (21·6%). The proportion of GHTD for Urban and Rural Residents' Basic Medical Insurance (URRBMI) beneficiaries was around six times higher than that for Urban Employee Basic Medical Insurance (UEBMI) beneficiaries (66·0% vs 11·6%). Besides, a substantial increase in the proportion of GHTD throughout the study period was observed regardless of HI schemes (4·4% annually for URRBMI, and 5·4% for UEBMI). Compared with UEBMI beneficiaries, URRBMI beneficiaries were more likely to experience GHTD, with an adjusted PR (95% CI) of 1·19 (95% CI: 1·12, 1·27) (P<0·001). Interpretation: In China, most of deaths occurred at home, with a large proportion of decedents GHTD from the hospital, especially for URRBMI beneficiaries. Substantial variation in the phenomenon of GHTD across HI schemes indicates inequalities in end-of-life care utilization. Funding: The National Natural Science Foundation of China, the Kadoorie Charitable Foundation, the National Key R&D Program of China, the Chinese Ministry of Science and Technology.

3.
J Colloid Interface Sci ; 606(Pt 2): 1261-1273, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-34492464

RESUMO

Constructing a p-n heterojunction is a feasible strategy to manipulate the dynamic behaviors of photogenerated carriers through an internal electric field. Herein, a novel highly efficient indium oxide/bismuth oxyiodide (In2O3/BiOI) p-n junction photocatalyst was fabricated using a facile ionic liquid-assisted precipitation method for the first time. The morphologies were modified by adding different amounts of acetic acid solution. Their hierarchical architecture was beneficial for adsorbing contaminants in wastewater, while the in-situ formed p-n heterojunction between BiOI and In2O3 facilitated interfacial charge transfer and improved the quantum efficiency. Their visible light-responsive photocatalytic activities were systematically investigated by photocatalytic o-phenylphenol (OPP) and 4-tert-butylphenol (PTBP) oxidation. The degradation rate of OPP over In2O3/BiOI-2 was up to 5.67 times higher than that for BiOI. The excellent activity of In2O3/BiOI should be attributed to the rapid interfacial charge transfer, depressed carrier recombination, and proper band potentials. Trapping experiments and electron paramagnetic resonance characterizations confirmed the generation of hydroxyl radicals (•OH) and superoxide radicals (•O2-), which have played a key role in decomposing pollutants. The intermediate products generated during the photocatalytic degradation of OPP were detected and identified by liquid chromatography-mass spectrometry. Meanwhile, their possible molecular structures and degradation pathways have also been inferred.


Assuntos
Poluentes Ambientais , Líquidos Iônicos , Estruturas Metalorgânicas , Bismuto , Catálise , Índio
4.
Chemosphere ; 287(Pt 3): 132249, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34555584

RESUMO

Nano-zero-valent iron (nZVI), as a typical nano-material, has been recently used in wastewater treatment and combination with bioreactors. Using nZVI coupled denitrification system research the effect and influence of nZVI enhanced denitrification sludge on the degradation of toxic compounds and system performance. The nZVI coupled denitrification system showed better resistance to 2,6-DCP impact, and the concentrations of effluent NO2- and NO3- were below 2.0 mg/L. At the same time, the addition of nZVI enabled the denitrification system to quickly adapt to the toxic environment of 2,6-DCP within 15 days, and the degradation efficiency of 2,6-DCP reached 99.9%. The released SMP reduced after nZVI coupled with denitrification sludge in 2,6-DCP environment, which could improve the effluent water quality. Nuclear magnetic resonance spectroscopy showed that the addition of nZVI would change the structure of EPS in denitrification sludge. After 90 days of operation, the dominant bacteria in the denitrifying sludge have undergone great changes. Moreover, Thauera was responsible as the dominant bacteria for degrading 2,6-DCP in the denitrification system. The increased in the proportion of functional bacteria with nitrate_reduction, nitrogen_respiration, nitrate_respiration and nitrite_respiration in the presence of NZVI further reveals the mechanism of enhanced denitrification.


Assuntos
Desnitrificação , Nitratos , Clorofenóis , Ferro , Esgotos
5.
Chemosphere ; 289: 133260, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34906524

RESUMO

A novel chelating flocculant with branched architectures, polyacrylamide grafted maleoyl chitosan-mercaptoacetic acid (PAM-g-M(CS-MA)), was successfully fabricated using maleic anhydride as the "bridge" between chitosan and polyacrylamide. The functional groups and structural characteristic information of copolymers were obtained via characterization analysis. Flocculation performance was systematically investigated via purifying a series of simulated wastewater containing Cu or Cd. The properties of the flocs were studied to give in-depth evidences for the role of chelation groups and branched architectures in flocculation. Results indicated that PAM-g-M(CS-MA) showed excellent flocculation capacity for heavy metals in high concentrations and was superior to other chelating flocculants. The maximum flocculation efficiency of Cu (93.90%) and Cd (92.47%) was achieved by PAM-g-M(CS-MA) at pH 7, dosage of 100 mg L-1 and stirring speed of 90 rpm. The flocculation mechanisms of PAM-g-M(CS-MA) were deeply explored through the analyses of floc properties. The strong synergistic chelation of mercapto, carboxyl, amide and hydroxyl groups predominated for the capturing of heavy metals; and the branched architectures facilitated the formation of large and stable flocs via adsorption and bridging-furl effect. This study provided a solid foundation for the fabrication of flocculants for heavy metal wastewater treatment.


Assuntos
Metais Pesados , Purificação da Água , Quelantes , Floculação , Águas Residuárias
7.
Anal Bioanal Chem ; 2021 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-34854959

RESUMO

Abrin is a highly toxic ribosome-inactivating protein, which could be used as a biological warfare agent and terrorist weapon, and thus needs to be detected efficiently and accurately. Affibodies are a new class of engineered affinity proteins with small size, high affinity, high stability, favorable folding and good robustness, but they have rarely played a role in biological detection. In this work, we establish a novel electrochemiluminescence (ECL) method for abrin detection with a phage display affibody as the specific probe for the first time, to our knowledge, and a portable biosensor based on a screen-printed electrode (SPE) as the testing platform. On the basis of the double antibody sandwich structure in our previous work, we used a phage display affibody instead of monoclonal antibody as a new specific labeled probe. Due to numerous signal molecules labeled on M13 phages, significant signal amplification was achieved in this experiment. Under optimized conditions, a linear dependence was observed from 0.005 to 100 ng/mL with a limit of detection (LOD) of 5 pg/mL. This assay also showed good reproducibility and specificity, and performed well in the detection of simulated samples. Considering its high sensitivity, interference resistance and convenience, this new biosensing system based on phage display affibodies and a portable ECL biosensor holds promise for in situ detection of toxins and pollutants in different environments.

8.
Ren Fail ; 43(1): 1569-1576, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34860139

RESUMO

BACKGROUND: Acute kidney injury (AKI) is widespread in the intensive care unit (ICU) and affects patient prognosis. According to Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, the absolute and relative increases of serum creatinine (Scr) are classified into the same stage. Whether the prognosis of the two types of patients is similar in the ICU remains unclear. METHODS: According to the absolute and relative increase of Scr, AKI stage 1 and stage 3 patients were divided into stage 1a and 1b, stage 3a and 3b groups, respectively. Their demographics, laboratory results, clinical characteristics, and outcomes were analyzed retrospectively. RESULTS: Of the 345 eligible cases, we analyzed stage 1 because stage 3a group had only one patient. Using 53 or 61.88 µmol/L as the reference Scr (Scrref), no significant differences were observed in ICU mortality (P53=0.076, P61.88=0.070) or renal replacement therapy (RRT) ratio, (P53=0.356, P61.88=0.471) between stage 1a and 1b, but stage 1b had longer ICU length of stay (LOS) than stage 1a (P53<0.001, P61.88=0.032). In the Kaplan-Meier survival analysis, no differences were observed in ICU mortality between stage 1a and 1b (P53=0.378, P61.88=0.255). In a multivariate analysis, respiratory failure [HR = 4.462 (95% CI 1.144-17.401), p = 0.031] and vasoactive drug therapy [HR = 4.023 (95% CI 1.584-10.216), p = 0.003] were found to be independently associated with increased risk of death. CONCLUSION: ICU LOS benefit was more prominent in KDIGOSCr AKI stage 1a patients than in stage 1 b. Further prospective studies with a larger sample size are necessary to confirm the effectiveness of reclassification.

9.
Chin Med J (Engl) ; 2021 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-34935687

RESUMO

BACKGROUND: It is still unclear what the minimal infusion volume is to effectively predict fluid responsiveness. This study was designed to explore the minimal infusion volume to effectively predict fluid responsiveness in septic shock patients. Hemodynamic effects of fluid administration on arterial load were observed and added values of effective arterial elastance (Ea) in fluid resuscitation were assessed. METHODS: Intensive care unit septic shock patients with indwelling pulmonary artery catheter (PAC) received five sequential intravenous boluses of 100 mL 4% gelatin. Cardiac output (CO) was measured with PAC before and after each bolus. Fluid responsiveness was defined as an increase in CO >10% after 500 mL fluid infusion. RESULTS: Forty-seven patients were included and 35 (74.5%) patients were fluid responders. CO increasing >5.2% after a 200 mL fluid challenge (FC) provided an improved detection of fluid responsiveness, with a specificity of 80.0% and a sensitivity of 91.7%. The area under the ROC curve (AUC) was 0.93 (95% CI: 0.84-1.00, P < 0.001). Fluid administration induced a decrease in Ea from 2.23 (1.46-2.78) mmHg/mL to 1.83 (1.34-2.44) mmHg/mL (P = 0.002), especially for fluid responders in whom arterial pressure did not increase. Notably, the baseline Ea was able to detect the fluid responsiveness with an AUC of 0.74 (95% CI: 0.59-0.86, P < 0.001), whereas Ea failed to predict the pressure response to FC with an AUC of 0.50 (95% CI: 0.33-0.67, P = 0.086). CONCLUSION: In septic shock patients, a minimal volume of 200 mL 4% gelatin could reliably detect fluid responders. Fluid administration reduced Ea even when CO increased. The loss of arterial load might be the reason for patients who increased their CO without pressure responsiveness Moreover, a high level of Ea before FC was able to predict fluid responsiveness rather than to detect the pressure responsiveness. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04515511.

10.
ACS Omega ; 6(50): 34242-34249, 2021 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-34963910

RESUMO

Noise pollution is acknowledged as the main environmental problem and is as harmful to human physical and mental health as water and air pollution. However, the acoustic properties of traditional sound absorption materials in low frequency ranges still need to be improved. Herein, the low-frequency sound absorption coefficient of porous ceramics was further improved by coating a graphene oxide (GO) and styrene-butadiene rubber (SBR) composite film inside the porous ceramics. The improved sound absorption coefficient of the porous composite reached 30.4% in the range of 200-800 Hz, which is attributed to the enhancement of the thermal viscous effect and the extension of the dissipation mechanism. Predictably, designing the morphology of three-dimensional interconnected porous structures on the microscale is comparatively useful for developing a porous sound absorbing material effective in middle- and low-frequency noise.

11.
Food Chem ; 373(Pt B): 131473, 2021 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-34741968

RESUMO

Reducing sugar (RS) quantification is essential in the potato industry because RS content plays a vital role in potato quality, acrylamide formation, post-harvest management, and new variety development. A miniaturized Somogyi-Nelson (SN) analysis can effectively and accurately quantify RS. However, soluble proteins in potatoes interfere with SN analysis. Our research goal was to develop an applicable deprotinization procedure without influencing the precision of the SN analysis. Results showed ethanol effectively removed potato proteins and, unlike other chemicals (salts, acids), ethanol did not affect SN accuracy. Protein removal also can be achieved by heating and pH adjustment, but the ethanol-based procedure provides a simpler alternative. RS content measured by the miniaturized SN assay after deproteinization by ethanol was precise and validated by HPAEC-PAD. Data from 118 potao juicies showed that a commonly used biochemical analyzer obtained a lower reducing sugar content than the deprotinization-SN assay because fructose was not identified by the biochemical analyzer. Results demonstrate the reliability of quantifying potato RS with the SN assay following the ethanol-based deproteinization.

12.
Nanomaterials (Basel) ; 11(11)2021 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-34835594

RESUMO

Chronic wound repair is a common complication in patients with diabetes mellitus, which causes a heavy burden on social medical resources and the economy. Hypaphorine (HYP) has good anti-inflammatory effect, and chitosan (CS) is used in the treatment of wounds because of its good antibacterial effect. The purpose of this research was to investigate the role and mechanism of HYP-nano-microspheres in the treatment of wounds for diabetic rats. The morphology of HYP-NPS was observed by transmission electron microscopy (TEM). RAW 264.7 macrophages were used to assess the bio-compatibility of HYP-NPS. A full-thickness dermal wound in a diabetic rat model was performed to evaluate the wound healing function of HYP-NPS. The results revealed that HYP-NPS nanoparticles were spherical with an average diameter of approximately 50 nm. The cell experiments hinted that HYP-NPS had the potential as a trauma material. The wound test in diabetic rats indicated that HYP-NPS fostered the healing of chronic wounds. The mechanism was through down-regulating the expression of pro-inflammatory cytokines IL-1ß and TNF-α in the skin of the wound, and accelerating the transition of chronic wound from inflammation to tissue regeneration. These results indicate that HYP-NPS has a good application prospect in the treatment of chronic wounds.

13.
Opt Lett ; 46(22): 5663-5666, 2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34780431

RESUMO

The reflection spectra of conventional fiber Bragg gratings (FBGs) with uniform index modulation profiles typically have strong sidelobes, which hamper the performance of FBG-based optical filters, fiber lasers, and sensors. Here, we propose and demonstrate a femtosecond laser line-by-line (LbL) scanning technique for fabricating apodized FBGs with suppressed sidelobes. This approach can flexibly achieve various apodized modulation profiles via precise control over the length and/or transverse position of each laser-inscribed index modification track. We theoretically and experimentally studied the influences of the apodization function on the side-mode suppression ratio (SMSR) in the fabricated apodized FBG, and the results show that a maximum SMSR of 20.6 dB was achieved in a Gaussian-apodized FBG. Subsequently, we used this method to fabricate various apodized FBGs, and the SMSRs in these FBGs were reduced effectively. Specifically, a dense-wavelength-division-multiplexed Gaussian-apodized FBG array with a wavelength interval of 1.50 nm was successfully fabricated, and the SMSR in such an array is 14 dB. Moreover, a Gaussian-apodized phase-shifted FBG and chirped FBG were also demonstrated with a high SMSR of 14 and 16 dB, respectively. Therefore, such an apodization method based on a modified femtosecond laser LbL scanning technique is an effective and flexible way to fabricate various FBGs with high SMSRs, which is promising to improve the performance of optical filters, fiber lasers, and sensors.

14.
Int J Biol Macromol ; 2021 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-34767881

RESUMO

Hydrophobic cellulose laurate (CL) with high degree of substitution has been successfully synthesized. The mechanical property, water-resistance, antimicrobial activity, barrier properties and food decontamination of cellulose-laurate-curcumin films (CL-Cux, x = 0.1, 0.5, and 1) were investigated. The results showed that the mechanical properties of CL-Cux hardly change after soaking in water for 24 h, probably due to the strong hydrophobicity of cellulose laurate. CL-Cu1 represented a good photoinduced antibacterial effect against S. aureus. After irradiation of white light at 60 mW·cm-2 for 20 min, the inhibition efficiency reached to 95 ± 2.02%, probably owing to the generated active 1O2. In comparison with CL-Cu1 stored in natural light, the bacteriostatic effect of CL-Cu1 in dark storage was better, and the inhibition rate of CL-Cu1 remained 80 ± 1.22 at 60th day. The stabler excited state of curcumin in hydrophobic cellulose laurate was probably assigned to inhibition of tautomerism or conformational transition, which was beneficial to the generation of singlet oxygen. CL-Cu1 can significantly inhibit the growth of TVBN and TVC values of chilled meat upon white light irradiation, indicating the potential application of cellulose-laurate-curcumin films in food decontamination.

15.
Lancet Infect Dis ; 2021 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-34774188

RESUMO

During the current COVID-19 pandemic, health-care workers and uninfected patients in intensive care units (ICUs) are at risk of being infected with SARS-CoV-2 as a result of transmission from infected patients and health-care workers. In the absence of high-quality evidence on the transmission of SARS-CoV-2, clinical practice of infection control and prevention in ICUs varies widely. Using a Delphi process, international experts in intensive care, infectious diseases, and infection control developed consensus statements on infection control for SARS-CoV-2 in an ICU. Consensus was achieved for 31 (94%) of 33 statements, from which 25 clinical practice statements were issued. These statements include guidance on ICU design and engineering, health-care worker safety, visiting policy, personal protective equipment, patients and procedures, disinfection, and sterilisation. Consensus was not reached on optimal return to work criteria for health-care workers who were infected with SARS-CoV-2 or the acceptable disinfection strategy for heat-sensitive instruments used for airway management of patients with SARS-CoV-2 infection. Well designed studies are needed to assess the effects of these practice statements and address the remaining uncertainties.

16.
Biol Trace Elem Res ; 2021 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-34674107

RESUMO

Cadmium (Cd) contamination in the environment is a major public health concern since it has been linked to osteoporosis and other bone deformities. Linarin is a flavonoid glycoside, and it can promote osteoblastogenesis. This research aimed to investigate the potential role of linarin against Cd-exposed bone deformations in mice model. In our research, male mice were randomly allocated into four groups: control, Cd-exposed, and Cd + linarin (20 and 40mg/kg/bw, respectively). Linarin prevented body weight loss, increased serum calcium (Ca) and phosphorus (P), and bone alkaline phosphatase (BAP) levels in Cd-exposed groups. Furthermore, linarin treatment at 20 and 40mg/kg/bw significantly decreased RANK and OPG, resulting in an increase in RANKL mRNA levels and protein distribution in the bone of Cd-exposed mice. In addition, the bone of Cd-exposed mice administered with linarin showed higher TRAP, NFATc1, MMP9, and RUNX2 mRNA levels and protein distribution. Linarin significantly decreased oxidative stress in Cd-exposed mice bone by decreasing MDA, a lipid peroxidation product. Moreover, linarin protects Cd-exposed mice antioxidant enzymes by increasing bone SOD, CAT, and GPx levels. Besides, linarin suppresses alterations in the inflammatory system, i.e., NF-κB p65/IKKß, by reducing NF-κB p65, IKKß, IL-6, and TNF-α in the bone of Cd-exposed animals. This study concluded that linarin has potential to cure osteoporosis in Cd-exposed mice by reducing oxidative stress and inflammation and modulating the RANK/RANKL/OPG pathway.

17.
Front Med (Lausanne) ; 8: 659793, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34712673

RESUMO

Background: Extracorporeal membrane oxygenation (ECMO) might benefit critically ill COVID-19 patients. But the considerations besides indications guiding ECMO initiation under extreme pressure during the COVID-19 epidemic was not clear. We aimed to analyze the clinical characteristics and in-hospital mortality of severe critically ill COVID-19 patients supported with ECMO and without ECMO, exploring potential parameters for guiding the initiation during the COVID-19 epidemic. Methods: Observational cohort study of all the critically ill patients indicated for ECMO support from January 1 to May 1, 2020, in all 62 authorized hospitals in Wuhan, China. Results: Among the 168 patients enrolled, 74 patients actually received ECMO support and 94 not were analyzed. The in-hospital mortality of the ECMO supported patients was significantly lower than non-ECMO ones (71.6 vs. 85.1%, P = 0.033), but the role of ECMO was affected by patients' age (Logistic regression OR 0.62, P = 0.24). As for the ECMO patients, the median age was 58 (47-66) years old and 62.2% (46/74) were male. The 28-day, 60-day, and 90-day mortality of these ECMO supported patients were 32.4, 68.9, and 74.3% respectively. Patients survived to discharge were younger (49 vs. 62 years, P = 0.042), demonstrated higher lymphocyte count (886 vs. 638 cells/uL, P = 0.022), and better CO2 removal (PaCO2 immediately after ECMO initiation 39.7 vs. 46.9 mmHg, P = 0.041). Age was an independent risk factor for in-hospital mortality of the ECMO supported patients, and a cutoff age of 51 years enabled prediction of in-hospital mortality with a sensitivity of 84.3% and specificity of 55%. The surviving ECMO supported patients had longer ICU and hospital stays (26 vs. 18 days, P = 0.018; 49 vs. 29 days, P = 0.001 respectively), and ECMO procedure was widely carried out after the supplement of medical resources after February 15 (67.6%, 50/74). Conclusions: ECMO might be a benefit for severe critically ill COVID-19 patients at the early stage of epidemic, although the in-hospital mortality was still high. To initiate ECMO therapy under tremendous pressure, patients' age, lymphocyte count, and adequacy of medical resources should be fully considered.

18.
J Clin Lab Anal ; 35(11): e24043, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34617627

RESUMO

BACKGROUND: The urine protein/creatinine ratio (UPCR) is commonly used in current clinical practice. However, there are only few published clinical data on UPCR from large cohorts of Chinese adults. This study aimed to determine the overall and age- and sex-specific UPCR reference values for healthy Dalian adults. METHODS: According to the Clinical & Laboratory Standards Institute EP28-A3c guidelines, 1321 healthy Dalian adults (646 men and 675 women) aged 20-69 years were enrolled. Urine protein and creatinine levels were analyzed in the random morning spot urine samples, and UPCR was calculated. The 95th percentile of the UPCR was used as the normal upper limit. The Mann-Whitney U test was used to test differences among groups. RESULTS: The UPCR reference value was 141.7 mg/g for the entire cohort, 128.7 mg/g for men, and 150.8 mg/g for women. In addition, women had relatively higher UPCR values than men in the same age group. We also compared the UPCR reference values between different estimated glomerular filtration rate (eGFR) groups and found that women had significantly higher UPCR values than men in the normal eGFR groups. CONCLUSIONS: This study provides the overall and age- and sex-specific UPCR reference values for healthy Dalian adults.

19.
Resuscitation ; 2021 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-34624410

RESUMO

OBJECTIVE: This study aimed to investigate the predictive value of pulse oximetry plethysmography (POP) for the return of spontaneous circulation (ROSC) in cardiac arrest (CA) patients. METHODS: This was a multicenter, observational, prospective cohort study of patients hospitalized with cardiac arrest at 14 teaching hospitals cross China from December 2013 through November 2014. The study endpoint was ROSC, defined as the restoration of a palpable pulse and an autonomous cardiac rhythm lasting for at least 20 minutes after the completion or cessation of CPR. RESULTS: 150 out-of-hospital cardiac arrest (OHCA) patients and 291 in-hospital cardiac arrest (IHCA) patients were enrolled prospectively. ROSC was achieved in 20 (13.3%) and 64 (22.0%) patients in these cohorts, respectively. In patients with complete end-tidal carbon dioxide (ETCO2) and POP data, patients with ROSC had significantly higher levels of POP area under the curve (AUCp), wave amplitude (Amp) and ETCO2 level during CPR than those without ROSC (all p < 0.05). Pairwise comparison of receiver operating characteristic (ROC) curve analysis indicated no significant difference was observed between ETCO2 and Amp (p = 0.204) or AUCp (p = 0.588) during the first two minutes of resuscitation. CONCLUSION: POP may be a novel and effective method for predicting ROSC during resuscitation, with a prognostic value similar to ETCO2 at early stage.

20.
Front Med (Lausanne) ; 8: 716086, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34604257

RESUMO

Background: Extracorporeal membrane oxygenation (ECMO) is a rapidly evolving therapy for acute lung and/or heart failure. However, the information on the application of ECMO in severe coronavirus disease 2019 (COVID-19) is limited, such as the initiation time. Especially in the period and regions of ECMO instrument shortage, not all the listed patients could be treated with ECMO in time. This study aimed to investigate and clarify the timing of ECMO initiation related to the outcomes of severe patients with COVID-19. The results show that ECMO should be initiated within 24 h after the criteria are met. Methods: In this retrospective, multicenter cohort study, we enrolled all ECMO patients with confirmed COVID-19 at the three hospitals between December 29, 2019 and April 5, 2020. Data on the demographics, clinical presentation, laboratory profile, clinical course, treatments, complications, and outcomes were collected. The primary outcomes were successful ECMO weaning rate and 60-day mortality after ECMO. Successful weaning from ECMO means that the condition of patients improved with adequate oxygenation and gas exchange, as shown by the vital signs, blood gases, and chest X-ray, and the patient was weaned from ECMO for at least 48 h. Results: A total of 31 patients were included in the analysis. The 60-day mortality rate after ECMO was 71%, and the ECMO weaning rate was 26%. Patients were divided into a delayed ECMO group [3 (interquartile range (IQR), 2-5) days] and an early ECMO group [0.5 (IQR, 0-1) days] based on the time between meeting the ECMO criteria and ECMO initiation. In this study, 14 and 17 patients were included in the early and delayed treatment groups, respectively. Early initiation of ECMO was associated with decreased 60-day mortality after ECMO (50 vs. 88%, P = 0.044) and an increased ECMO weaning rate (50 vs. 6%, P = 0.011). Conclusions: In ECMO-supported patients with COVID-19, delayed initiation of ECMO is a risk factor associated with a poorer outcome. Trial Registration: Clinical trial submission: March 19, 2020. Registry name: A medical records-based study for the clinical application of extracorporeal membrane oxygenation in the treatment of severe respiratory failure patients with novel coronavirus pneumonia (COVID-19). Chinese Clinical Trial Registry: https://www.chictr.org.cn/showproj.aspx?proj=51267,identifier:~ChiCTR2000030947.

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