In order to learn the tissuse perfusion and oxygenization in the patient with septic shock (SS) in Qinghai plateau,25 cases having suffered from SS in Xining,the capital of Qinghai province, were divided into death group (group D) and survival group(group S), and the data of oxygen dynamics, determined by Swan-Ganz cathter and thermodilution methods,were analyzed retrospectively. The results showed that the oxygen delivery (DO_2) and oxygen consumption (VO_2) increased to varying degrees in all of cases;VO_2 was positively correlated with DO_2, and in group D the correlation remained significant during whole duration of disease,but in group S it became unsignificant as DO_2 was above 700 ml?min~(-1)?m~(-2); the oxygen extraction rate decreased markedly in both groups,but much more in group D. These suggest that the insufficient oxygenization of general tissuse in patient with SS results from the dysfunction of oxygen extraction,and increasing DO_2 is helpful for the shock resuscitation except VO_2 is persistently and positively correlatded with DO_2.

Objective:To investigate the therapeutic effect of different prone position ventilation (PPV) on patients with severe acute respiratory distress syndrome (ARDS) at high altitude.Methods:The severe ARDS patients who met the Berlin standard admitted to the department of intensive care unit (ICU) of Qinghai Provincial People's Hospital from January 2017 to January 2020 were enrolled. The patients with classic PPV treatment (i.e. alternate prone supine position, about 16 hours per day) were included in the discontinuous PPV group; the patients with modified PPV treatment (i.e. alternate left and right prone positions 20°-30°, every 4 hours and continuous treatment for 24 hours per day) were included in the continuous PPV group. The oxygenation index (PaO 2/FiO 2), mechanics of breathing, ventilator parameters before treatment and 72 hours after treatment, and mechanical ventilation time, the length of ICU stay, and related complications between the two groups were analyzed. Results:Eighteen cases were treated with continuous PPV and 20 cases were treated with discontinuous PPV. There were no significant differences in gender, age, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ), PaO 2/FiO 2, lung compliance, driving pressure (ΔP) and positive end expiratory pressure (PEEP) before treatment between the two groups. Compared with before treatment, PaO 2/FiO 2 in discontinuous PPV group and continuous PPV group was increased significantly after 72-hour treatment [mmHg (1 mmHg = 0.133 kPa): 99.7±15.4 vs. 55.5±6.3, 121.8±25.3 vs. 55.1±7.1, both P < 0.05], lung compliance was improved significantly (mL/cmH 2O: 36.8±2.4 vs. 28.0±2.0, 43.4±6.7 vs. 27.7±2.1, both P < 0.05), and ΔP was decreased significantly [cmH 2O (1 cmH 2O = 0.098 kPa): 10.5 (10.0, 12.0) vs. 13.0 (12.3, 14.0), 10.0 (8.0, 12.0) vs. 13.0 (12.0, 14.0), both P < 0.05], PEEP was also decreased [cmH 2O: 12 (12, 14) vs. 14 (13, 14), 10 (8, 10) vs. 14 (12, 15), both P < 0.05], and the indexes in continuous PPV group were improved more significantly than those in discontinuous PPV group [PaO 2/FiO 2 (mmHg): 121.8±25.3 vs. 99.7±15.4, lung compliance (mL/cmH 2O): 43.4±6.7 vs. 36.8±2.4, ΔP (cmH 2O): 10.0 (8.0, 12.0) vs. 10.5 (10.0, 12.0), PEEP (cmH 2O): 10 (8, 10) vs. 12 (12, 14), all P < 0.05]. The duration of mechanical ventilation and the length of ICU stay in the continuous PPV group were significantly shorter than those in the intermittent PPV group [days: 6.0 (5.0, 7.3) vs. 8.0 (7.0, 9.0), 9.7±1.5 vs. 12.1±2.2, both P < 0.01]. During the PPV treatment, there were 3 cases of cheek skin damage and 2 cases of ear skin damage in the continuous PPV group, and 3 cases of facial skin damage in the intermittent PPV group. There was no significant difference in the incidence of complications between the two groups ( χ2 = 0.321, P = 0.571). All patients were repaired normally after PPV, without adverse consequences. Conclusion:Continuous PPV is more effective than discontinuous PPV in the treatment of severe ARDS patients at high altitude, and the related complications are did not increased in prolonged time of PPV.

Objective To observe the changes in microcirculation after induction of anesthesia in patients in plateau region. Methods Ten patients of both sexes, aged 35-58 yr, weighing 52-87 kg, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, were enrolled in this study. Anesthesia was induced with intravenous etomidate 0. 3 mg∕kg, sufentanil 0. 75 μg∕kg and vecuronium 0. 10 mg∕kg. Me-chanical ventilation was performed after tracheal intubation. Fluid was replaced by intravenously infusing lactated Ringer′s solution 500 ml over 30-45 min after completion of anesthesia induction. At 5 min before anesthesia induction, 5 min after induction and after the end of fluid replacement, the hemodynamic pa-rameters such as heart rate (HR), SpO2and mean arterial pressure (MAP) were recorded, and microcir-culatory indices such as total vascular density (TVD), perfused vessel density (PVD), proportion of per-fused small vessels (PPV) and microvascular flow index (MFI) were measured. Results Compared with the baseline value before anesthesia induction, HR was significantly increased, SpO2and MAP were de-creased, TVD, PVD, PPV and MFI were decreased at 5 min after anesthesia induction (P＜0. 05). Com-pared with the baseline value at 5 min after anesthesia induction, HR was significantly decreased, and SpO2and MAP were increased immediately after fluid replacement (P＜0. 05), and no significant change was found in TVD, PVD, PPV or MFI immediately after fluid replacement (P＞0. 05). Conclusion Mi- crocirculatory disturbance is obvious after induction of general anesthesia in patients undergoing operation in plateau region, and no marked improvement is found in microcirculation after rapid fluid replacement, which may be the main cause of metabolic disorders such as acidosis after operation.

Purpose: The influence of fasting blood glucose (FBG) and cholesterolemia primary liver cancer (PLC) in china was analyzed via a large prospective cohort study based on a community population, and the combined effects between them were investigated. Materials and Methods: Overall, 98,936 staff from the Kailuan Group who participated in and finished physical examinations between 2006 and 2007 were included in the cohort study. Their medical information was collected and they were followed up after examination. The correlations of serum FBG or TC with PLC were analyzed. Then, we categorized all staff into four groups: normal FBG/ non-hypocholesterolemia, normal FBG/hypocholesterolemia, elevated FBGon-hypocholesterolemia, elevated FBG/hypocholesterolemia and normal FBG/ non-hypocholesterolemia was used as a control group. The combined effects of elevated FBG and hypocholesterolemia with PLC were analyzed using the Age-scale Cox proportional hazard regression model. Results: During 1,134,843.68 person*years follow up, a total of 388 PLC cases occured. We found the elevated FBG and hypocholesterolemia increases the risk for PLC, respectively. Compared with the non-hypocholesterolemiaormal FBG group, the risk of PLC was significantly increased in the non-hypocholesterolemia/elevated FBG group (HR=1.19,95%CI 0.88–1.62) and hypocholesterolemiaormal FBG group (HR=1.53,95%CI 1.19–1.97), and in the hypocholesterolemia/elevated FBG group (HR=3.16 95%CI2.13-4.69). And, a significant interaction effect was found of FBG and TC on PLC. All results were independent from the influence of liver disease. Conclusion Elevated serum FBG and hypocholesterolemia are risk factors for PLC, especially when combined. Thus, for the prevention and treatment of PLC, serum FBG and TC levels should be investigated.

Acute respiratory distress syndrome (ARDS) is a common cause of critical illness and high mortality from respiratory failure. Increased dead space fraction (VD/VT) was independently associated with lung injury and mortality of ARDS. VD/VT is readily obtained by bedside measurements of arterial blood gas and end-tidal carbon dioxide. Early attention and application of VD/VT as an indicator will help to better understand the pathophysiological of ARDS, guide clinical treatment, and better assess the severity and clinical prognosis of the disease.

Objective To observe the clinical manifestations of elderly patients with acute infectious purpura fulminant(AIPF)and septic shock caused by Streptococcus pyogenes(GAS),analyze the changes in indicators and treatment processes,and provide clinical references for the diagnosis and treatment of such diseases.Methods A retrospective analysis was conducted on the case data,clinical manifestations,signs,examination indexes and treatment process of an elderly patient who presented with GAS-induced AIPF combined with septic shock and was treated by the department of critical care medicine of Qinghai Provincial People's Hospital on June 17th,2021.This study also involved a discussion on the pathophysiological characteristics and treatment measures for these diseases as well as observation of patient prognosis.Results The 80-year-old male patient,who was previously in good health,underwent knee surgery one year ago and was admitted to the hospital on June 17,2021 due to"pain and swelling of the left face with difficulty opening the mouth for the past 2 days".Upon admission,a complete set of laboratory tests including blood routine,blood biochemistry and coagulation function were conducted.A head CT revealed swelling of the masseter muscle on the left side,subcutaneous exudation of the cheek,non-cyanotic space on the left parapharyngeal space,poor display of eustachian tube opening,and narrow throat.Color ultrasound showed soft tissue swelling and interstitial edema in the left maxillofacial region and eyelid.Six hours after admission,the patient gradually developed purple spots,blood scars and necrosis on the right side neck shoulder and upper chest accompanied by tenderness and high fever mainly on his face.The heart rate fluctuated around 150 times per minute while blood pressure was at 108/71 mmHg(1 mmHg≈0.133 kPa,Metaraminol 6.67 μg·kg-1·min-1).The patient was diagnosed with septic shock and transferred to intensive care unit(ICU)for emergency treatment.With timely comprehensive monitoring in place,the patient received active treatment focused on maintaining respiratory circulation stability.After plasma infusion,early wound treatment,reasonable anti-infection measures as well as inflammation clearance,organ function protection,and supportive therapy,the patient eventually recovered from hospitalization without recurrence after 6 months follow-up.Conclusion The onset of acute GAS infection is characterized by its rapid and severe progression,high mortality,and challenging treatment.However,timely and effective refined comprehensive monitoring,evaluation,and treatment can still yield favorable outcomes.

Purpose: From the perspective of positive psychology, our study aimed to explore depressive symptomsand psychological well-being among Chinese nurses, as well as analyze the impacts of characterstrengths, self-efficacy and social support on the mental health of nurses. Methods: A cross-sectional and descriptive design using five self-reported questionnaires was used toinvestigate a cohort of 4238 nurses during 2018. A structural equation modeling analysis was used toverify a hypothetical model linking character strengths, self-efficacy, social support, depressive symptoms,and psychological well-being. Results: The prevalence of depression among this cohort of Chinese nurses was 58.1%. The mean scoresfor caring, inquisitiveness, and self-control were 19.93 (SD = 2.82), 15.94 (SD = 3.00), and 16.34(SD = 2.95), respectively. The hypothesized model was a good fit of the data (x2/df = 1.77, p = .183, rootmean square error of approximation = 0.04, goodness of fit index = 1.00, comparative fit index = 1.00,TuckereLewis index = 1.00). Except for the path from self-control to depression, the other hypotheticalpaths investigated were statistically significant. Conclusion Character strengths were directly and positively associated with psychological well-being.Inquisitiveness was the strongest direct protective factor for depression. In addition, characterstrengths indirectly alleviated depression and increased psychological well-being through mediatingvariables of social support and self-efficacy. This study should alert nurse managers that more attentionshould be paid to the character strengths and mental health of nurses. This study provides evidence forinterventions based on character strengths as a management strategy to support the mental health ofnurses.

Purpose: From the perspective of positive psychology, our study aimed to explore depressive symptomsand psychological well-being among Chinese nurses, as well as analyze the impacts of characterstrengths, self-efficacy and social support on the mental health of nurses. Methods: A cross-sectional and descriptive design using five self-reported questionnaires was used toinvestigate a cohort of 4238 nurses during 2018. A structural equation modeling analysis was used toverify a hypothetical model linking character strengths, self-efficacy, social support, depressive symptoms,and psychological well-being. Results: The prevalence of depression among this cohort of Chinese nurses was 58.1%. The mean scoresfor caring, inquisitiveness, and self-control were 19.93 (SD = 2.82), 15.94 (SD = 3.00), and 16.34(SD = 2.95), respectively. The hypothesized model was a good fit of the data (x2/df = 1.77, p = .183, rootmean square error of approximation = 0.04, goodness of fit index = 1.00, comparative fit index = 1.00,TuckereLewis index = 1.00). Except for the path from self-control to depression, the other hypotheticalpaths investigated were statistically significant. Conclusion Character strengths were directly and positively associated with psychological well-being.Inquisitiveness was the strongest direct protective factor for depression. In addition, characterstrengths indirectly alleviated depression and increased psychological well-being through mediatingvariables of social support and self-efficacy. This study should alert nurse managers that more attentionshould be paid to the character strengths and mental health of nurses. This study provides evidence forinterventions based on character strengths as a management strategy to support the mental health ofnurses.

Objective:To investigate the effect of Notch on periprosthetic fracture (PPF) of the femoral prosthesis after primary total knee arthroplasty.Methods:A total of 34 patients diagnosed with femoral PPF at Xi'an Honghui Hospital were retrospectively collected from January 2013 to December 2020. There were 4 males and 30 females with a mean age of 69.2±7.2 years (range, 55-84 years). A total of 102 patients without PPF were matched by gender and age as the control group in a ratio of 1∶3. There were 12 males and 90 females with a mean age of 69.2±7.2 years (range, 55-84 years). The main observation indexes included patients' general information and factors such as coronal alignment, prosthesis design and Notch conditions. Then, subgroup analysis was performed with the depth and Tayside classification of Notch to analyze their effects on PPF.Results:The PPF and control groups were comparable in terms of baseline information such as gender, age, body mass index (BMI), and surgical side. There was no significant difference between the two groups in coronal alignment (χ 2=1.019, P=0.601) and prosthesis design (χ 2=1.545, P=0.214). There was no statistical difference in Notch between the PPF and control groups (χ 2=3.548, P=0.060). The mean length of Notch in the PPF group was 4.5±2.7 mm, compared with 4.9±2.8 mm in the control group, with no significant difference between the two groups ( t=0.732, P=0.465). Further subgroup analysis using a Notch depth of 3 mm as a cut-off and Tayside classification revealed a statistical difference between the two groups (χ 2=11.262, P=0.004; χ 2=14.601, P=0.003). Compared with patients without Notch, the risk of PPF was higher when the depth of Notch exceeded 3 mm, with an odds ratio ( OR) of 4.88 (95% CI: 1.76, 13.51). The incidence of PPF was higher when Notch depth reached Tayside grade 3 or 4. Compared with patients without Notch, the risk of PPF would be 6.99-fold (95% CI: 1.85, 26.32) higher when Notch depth reached grade 3. In female patients, there was a significant difference in Notch status between the PPF and control groups (χ 2=3.956, P=0.047), with a higher risk of PPF in female patients with Notch, OR 2.33 (95% CI: 1.01, 5.43). In patients who underwent right-sided TKA, the risk of PPF was higher in patients with Notch compared to those without Notch (χ 2=5.502, P=0.019), with an OR of 3.58 (95% CI: 1.19, 10.75). Conclusion:The Notch has no significant effect on the femoral PPF after primary total knee arthroplasty. However, the risk of PPF will increase significantly when the Notch depth exceeds 3 mm or is above Tayside grade 3.

Objective Combined with domestic and foreign guidelines,to explore the individualized treatment strategy of urosepsis,and to provide reference for standardized diagnosis and treatment of urosepsis patient.Methods To analyze the diagnosis and treatment process of a patient with urogenic sepsis who was admitted to the department of critical care medicine of the First Affiliated Hospital of Xi'an Jiaotong University in April 15,2021.During the diagnosis and treatment process,we performed puncture drainage fluid and urine culture as soon as possible to confirm the diagnosis from the perspective of etiology.Considering the possible pathogenic bacteria at the infection site,the drug resistance of pathogenic bacteria in medical units,and drug safety,imipenem and cilastatin was chosen for anti-infective therapy.A two-step approach was used for drug administration based on drug pharmacokinetics/pharmacodynamic(PK/PD)characteristics,and drug concentration monitoring.The patients were followed up after discharge.Results The patient was critically ill on admission and was diagnosed with urosepsis.We optimize the empirical use of antimicrobials based on their PK/PD characteristics.Ultrasound-guided percutaneous nephrostomy of the left renal pelvis was performed to adequately drain the infection.Urine culture returned as extended-spectrum β-lactamase(ESBL)-producing Escherichia coli,confirming the etiological diagnosis.After 7 days of treatment,the patient's condition improved,the antibacterial drugs were downgraded to piperacillin-tazobactam,and the total course of anti-infection was 14 days.The patient was in good condition 2 months after discharge,and underwent left ureteral calculus and lithotripsy in the local hospital,and the left nephrostomy tube was removed.After discharge,the patient's condition was stable,no recurrence was found after 7 months of follow-up,and daily life was not affected.Conclusions Management of infection foci in urosepsis patient is critical.Diagnosis and treatment should refer to domestic and foreign guidelines,and formulate treatment strategies based on the distribution of local pathogens,drug resistance,and the actual clinical conditions of patients.Optimize the use of antibiotics based on drug PK/PD characteristics,monitor the concentration of therapeutic drugs,and realize individualized treatment.