Objective To study the role of plasma B type natriuretic peptide(BNP)concentration in the diagnosis and predicting prognosis of patients with heart failure(HF).Methods Plasma BNP concentration was measured with immunofluorescenee assay in 90 patients with dyspnea.Left ventricular ejection fraction(LVEF)and pulmonary capillary wedge pressure(PCWP)were determined by eehoeardiography and Swan-Ganz catheter respectively in these patients at the same time.The gradation of HF was based on the criteria of cardiac function classification setted by New York Heart Association(NYHA).The HF patients were classified into 2 groups according to BNP concentration measured just before the discharge:patients with BNP＜400 ng/L and BNP≥400 ng/L.The re-admisslon rate within 30 days because of the HF between the two groups was compared.Results Plasma BNP levels were higher in the patients with left heart failure than those in the non-heart failure patients[(569?222)ng/L vs.(52?10)ng/L,P＜0.01],and BNP levels were increased in accordance with the severity of HF.The sensitivity,specificity,and negative predictive values of plasma BNP levels≥100 ng/L for predicting HF were 94.7%,91.7% and 96.7%,respectively.Plasma BNP levels were positively related to PCWP(r=0.55,P＜0.01),and negatively related to LVEF(r=-0.62,P＜0.01).There was no significant difference of plasma BNP levels between patients with different causes of HF.The re-admission rate within 30 days after discharge was notably high if the plasma BNP concentrations were over 400 ng/L.Conclusion Plasma BNP concentration can be regarded as a valuable marker for diagnosis and predicting prognosis of patients with HF.

Objective To observe the therapeutic effects of rude rhubarb on intestinal barrier in septic patients. Methods A total of 40 septic patients were enrolled in this study and randomly divided into two groups:rude rhubarb treatment group(a=18)and control group(n=22).The ratio of laetulose to mannitol(L/M)and D-lactate were determined on the first day and the 6th day after patients were enrolled.Results No signifieant differences were found on L/M and D-lactate in plasma on the first day between the rude rhubarb treatment group and the control group(P＞0.05). The L/M on the 6th day in the eontrol group was(0.1674?0.0361),and that in the rude rhubarb treatment group was (0.0621?0.0128)(P＜0.05).D-laetate in plasma in the 6 th day in the the rude rhubarb treatment group was(0.09?0.03)mmol/L,and was obviously lower than that in the control group(0.24?0.06)mmol/L(P＜0.05). Conclusion Rude rhubarb can improve the intestinal barrier.

Objective To explore the clinical manifestations,antimicrobial therapy,and risk factors of mortality in patients with Acinetobacter baumannii bloodstream infection.Methods Clinical data of 153 patients with Acinetobacter baumannii bloodstream infection hospitalized in First Affiliated Hospital of Zhejiang University from January 2013 to September 2014 were analyzed retrospectively.According to the 28-day survival after diagnosis,the patients were divided into death group (n =76) and survival group (n =77).Data related to demographic and clinical characteristics,underlying diseases,treatment,invasive procedures,bacterial resistance to antibiotics,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ)scores at onset,and antimicrobial therapy were collected.The index as an independent risk factor of mortality was demonstrated by multivariate logistic regression analysis.Results This study included 153 patients with Acinetobacter baumannii bloodstream infection.The 28-day mortality was 49.7％.The independent risk factors of mortality were APACHE Ⅱ score ≥22 at onset (OR =15.7,95％ CI 5.1-48.1,P ＜ 0.001),septic shock (OR =6.3,95 ％ CI 1.9-21.3,P =0.003),and administration of steroids (OR =3.6,95％ CI 1.0-12.3,P =0.043).Compared with subjects treated with non-cefoperazone-sulbactam-based regimen,those treated with cefoperazone-sulbactam for multidrug-resistant Acinetobacter baumannii (MDR-AB) had significantly lower mortality on day7,day14 and day28 (8.9％ vs 59.2％,31.1％ vs 65.8％,44.4％ vs 72.4％ respectively).Conclusions The patients with Acinetobacter baumannii bloodstream infection have high mortality within one month.Administration of steroids and septic shock are associated with poor prognosis.APACHE Ⅱ score ≥ 22 at onset predicts adverse outcome.Cefoperazone-sulbactam-based antimicrobial therapy improves patients' survival.

Carbapenem-resistant Enterobacteriaceae (CRE) mainly cause hospital-acquired infections, which have become an major threat in clinical practice and there are few antibacterial drugs available for CRE infection. At present, the main drugs for CRE treatment are polymyxin, tigecycline, ceftazidime-avibactam, fosfomycin and aminoglycoside antibiotics. Polymyxin and tigecycline are highly sensitive to CRE in vitro and are not affected by the type of carbapenemase produced by bacteria. Due to heterogeneous resistance and dose-related nephrotoxicity, polymyxin is often used in combination with other antibiotics. Tigecycline is difficult to reach sufficient concentrations in blood and alveolar lining fluid when using conventional dose. Therefore, it is necessary to increase the dose or to be used in combination with other drugs. Ceftazidime-avibactam lacks effective antibacterial activity against metalloenzyme-producing CRE, which can be used for the treatment of non metalloenzyme-producing CRE infection. The most common site of CRE colonization is the gastrointestinal tract. If the patient have intestinal mucosal destruction and decreased immune function, CRE can cause persistent bacteremia from intestinal blood.

Cloud technology and the Internet of things ( IOT) technology can be used in building the patient-centered critical care medical information platform.The platform could inenable medical staff to efficiently obtain critical care medical information, and raise critical patients′ cure rates. The authors introduced the critical process of rapidly building and improving the urgent care medical information integration platform in a campus of the First Affiliated Hospital of Zhejiang University Medical School.The IOT platform could effectively interconnect a variety of critical care medical equipments, and features such functions as vital signs monitoring and life support, bedside treatment data retrieval, remote diagnosis and treatment, and cloud sharing. The platform featured the advantages of complete information integration, fast construction, and satisfactory system extensibility. It could improve the medical work efficiency, improve the effect of critical care, and reduce the frequency of contact with patients, hence providing references for rapidly establishing a vital care treatment platform for public health events.

Objective To explore the occurrence and related factors of diarrhea in the early stage of enternal nutrition in critically ill patients, therefore providing guidance for the optimization of enteral nutrition. Methods A prospective cross-sectional study was conducted in 29 ICUs of 28 general hospitals of Zhejiang Province between June 1 and October 1, 2016. Patients who were admitted to ICU required for enteral nutrition were included and continuously observed for over 7 days or till discharged from ICU. The patient's general characteristics, severity of disease, enteral nutrition, diarrhea-related and prognostic indicators were recorded. Multivariable logistic regression was performed to analysis risk factors associated with diarrhea and in-hospital mortality. Results A total of 533 critically ill patientswere enrolled in this study. The overall incidence of diarrhea was 30.8％ (n = 164). Diarrhea occurred most frequently on the three days after EN, with a median duration of 2 (1, 3) days. The daily incidence of diarrhea were significantly different between groups (all P< 0.05), which were gradually reduced on day 7. Multivariable logistic regression analysis showed that prokinetic drugs (OR=1.82; 95％ CI: 1.24-2.65), APACHE II score (OR=1.04; 95％ CI: 1.02-1.07), post-pylorus enteral feeding (OR=1.90; 95％ CI:1.11-3.36) were independent risk factors for diarrhea, while interruption of EN (OR=3.74; 95％ CI: 1.85-7.54), APACHE II score (OR=1.07; 95％ CI: 1.04-1.11), vasoactive agent (OR=2.31; 95％ CI: 1.42-3.77), and timing (>48 h) (OR=2.00; 95％ CI: 1.08-3.70) were independent risk factors for in-hospital mortality. Conclusions Our study showed that APACHE II score, the use of prokinetic drugs, and post-pylorus enteral feeding were risk factors for diarrhea. Patients suffering diarrhea experienced increased ICU length of stay, increased the time of mechanical ventilation and in-hospital mortality compared with patients without diarrhea. Interruption of EN induced by diarrhea significantly increased the risk of in-hospital mortality.

OBJECTIVE: To analyze the clinical characteristics and pregnancy outcomes of pregnant women complicated with coronavirus disease 2019 (COVID-19). METHODS: The clinical data of 3 pregnant women with COVID-19 admitted to the First Affiliated Hospital of Zhejiang University School of Medicine from January 19 to February 10, 2020 were retrospectively analyzed. RESULTS: There was one case in the first-trimester pregnancy (case 1), one in the second-trimester pregnancy (case 2) and one in third-trimester pregnancy (case 3). Cough, fever, fatigue, lung imaging changes were the main manifestations. The white cell count, lymphocyte percentage had no significantly changes in case 1 and case 3, while the levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), IL-6 and IL-10 elevated. The lymphocyte count and lymphocyte percentage decreased and the inflammatory indicators significantly increased in case 2. All patients were treated with antiviral, antitussive, oxygen inhalation; case 3 received glucocorticoids, case 2 with severe illness received glucocorticoids and additionally gamma globulin. All three cases were cured and discharged. Case 1 with early pregnancy chose to terminate pregnancy after discharge; case 2 chose to continue pregnancy without obstetric complications; and case 3 had cesarean section delivery due to abnormal fetal heart monitoring. CONCLUSIONS The report shows that COVID-19 in pregnancy women could be cured with active treatment, and the maternal and fetal outcomes can be satisfactory.
Antiviral Agents ; therapeutic use ; Betacoronavirus ; isolation & purification ; Cesarean Section ; Coronavirus Infections ; complications ; drug therapy ; Female ; Glucocorticoids ; therapeutic use ; Humans ; Oxygen ; therapeutic use ; Pandemics ; Pneumonia, Viral ; complications ; drug therapy ; Pregnancy ; Pregnancy Complications, Infectious ; drug therapy ; pathology ; Pregnancy Outcome ; Retrospective Studies ; Treatment Outcome ; gamma-Globulins ; therapeutic use

Acute respiratory failure due to acute hypoxemia is the major manifestation in severe coronavirus disease 2019 (COVID-19). Rational and effective respiratory support is crucial in the management of COVID-19 patients. High-flow nasal cannula (HFNC) has been utilized widely due to its superiority over other non-invasive respiratory support techniques. To avoid HFNC failure and intubation delay, the key issues are proper patients, timely application and improving compliance. It should be noted that elder patients are vulnerable for failed HFNC. We applied HFNC for oxygen therapy in severe and critical ill COVID-19 patients and summarized the following experiences. Firstly, to select the proper size of nasal catheter, to locate it at suitable place, and to confirm the nose and the upper respiratory airway unobstructed. Secondly, an initial ow of 60 L/min and 37℃ should be given immediately for patients with obvious respiratory distress or weak cough ability; otherwise, low-level support should be given first and the level gradually increased. Thirdly, to avoid hypoxia or hypoxemia, the treatment goal of HFNC should be maintained the oxygen saturation (SpO) above 95% for patients without chronic pulmonary disease. Finally, patients should wear a surgical mask during HFNC treatment to reduce the risk of virus transmission through droplets or aerosols.
Aged ; Betacoronavirus ; isolation & purification ; Cannula ; Coronavirus Infections ; therapy ; Humans ; Oxygen ; administration & dosage ; Pandemics ; Pneumonia, Viral ; therapy

Severe and critically ill patients with coronavirus disease 2019 (COVID-19) were usually with underlying diseases, which led to the problems of complicated drug use, potential drug-drug interactions and medication errors in special patients. Based on ( 6), and -19: , we summarized the experience in the use of antiviral drugs, corticosteroids, vascular active drugs, antibacterial, probiotics, nutrition support schemes in severe and critically ill COVID-19 patients. It is also suggested to focus on medication management for evaluation of drug efficacy and duration of treatment, prevention and treatment of adverse drug reactions, identification of potential drug-drug interactions, individualized medication monitoring based on biosafety protection, and medication administration for special patients.
Adrenal Cortex Hormones ; adverse effects ; therapeutic use ; Anti-Bacterial Agents ; therapeutic use ; Antiviral Agents ; adverse effects ; therapeutic use ; Betacoronavirus ; isolation & purification ; Coronavirus Infections ; drug therapy ; Critical Illness ; Drug Therapy ; Humans ; Nutritional Support ; Pandemics ; Pneumonia, Viral ; drug therapy ; Probiotics ; administration & dosage