Objective To explore the value of cardiopulmonary and additional ultrasound(CLAUS)protocol and point-of-care ultrasound rapid management(POCURM)protocol in etiological diagnosis of acute respiratory distress in critically ill patients in the emergency room.Methods A total of 242 patients with acute respiratory distress admitted to Jinhua City Central Hospital from January 2022 to January 2024 were selected as the research subjects.According to the final diagnosis after discharge,they were divided into cardiogenic group(n=144)and pulmonary group(n=98).Compare the CLAUS findings of two groups and accuracy of two protocols in diagnosing etiology of acute respiratory distress.Results The history of heart disease in cardiogenic group was higher than that in pulmonary group,and difference was statistically significant(P＜0.05).The lung disease history of patients in cardiogenic group was lower than that in pulmonary group,and difference was statistically significant(P＜0.05).The proportion of pleural smoothness/slight thickening,sliding presence/slight weakening,left heart dysfunction,right heart dysfunction,and B-line pulmonary ultrasound scores in cardiogenic group were higher than those in pulmonary group,and differences were statistically significant(P＜0.05).The sensitivity,specificity of POCURM protocol for diagnosing acute respiratory distress were 90.28％,91.84％.The sensitivity,specificity of CLAUS protocol for diagnosing acute respiratory distress were 96.53％,97.96％.Conclusion CLAUS regimen can effectively diagnose specific causes of acute respiratory distress in patients,with higher accuracy than POCURM regimen.

Objective Exploring the clinical value of pulmonary ultrasound B-line score,left ventricular ejection fraction(LVEF),insulin-like growth factor binding protein-7(IGFBP7),and N-terminal pro-brain natriuretic peptide(NT-proBNP)levels in diagnosing cardiogenic acute dyspnea.Methods A retrospective analysis was conducted on the clinical data of 80 patients with acute dyspnea diagnosed and treated at Jinhua Municipal Central Hospital from February 2021 to February 2024.According to the discharge diagnosis of patients,they were divided into cardiogenic group(cardiogenic acute dyspnea,50 cases)and non-cardiogenic group(non-cardiogenic acute dyspnea,30 cases).The pulmonary ultrasound B-line score,LVEF,IGFBP7 and NT-proBNP levels of two groups of patients were compared,their correlations were analyzed,and the receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic value of each index for cardiogenic acute dyspnea.Results There were no statistically significant differences in the clinical baseline data such as age,gender,body mass index,proportion of atrial fibrillation,urea nitrogen,serum creatinine,systolic blood pressure,arterial partial pressure of oxygen,heart rate and blood oxygen saturation between two groups of patients(P＞0.05).The pulmonary ultrasound B-line score,the levels of IGFBP7 and NT-proBNP in cardiogenic group were significantly higher than those in non-cardiogenic group,and the LVEF was significantly lower than that in non-cardiogenic group(P＜0.05).Pearson correlation analysis showed that the pulmonary ultrasound B-line score was positively correlated with both IGFBP7 and NT-proBNP(P＜0.05),with no significant correlation with LVEF(P＞0.05).The results of ROC curve showed that the pulmonary ultrasound B-line score,LVEF,IGFBP7 and NT-proBNP all had high diagnostic value for cardiogenic acute dyspnea,and the area under the curve were 0.917,0.855,0.946 and 0.925,respectively.Conclusion The pulmonary ultrasound B-line score,LVEF,IGFBP7,and NT-proBNP levels have high diagnostic value for cardiogenic acute dyspnea and are worthy of clinical promotion and application.

Objective:To compare the clinical effects of plasma exchange（PE）combined with continuous veno-venous hemodiafiltration（CVVHDF）at different time points in children with Kawasaki disease shock syndrome（KDSS）.Methods:Thirty-five children with KDSS admitted to the intensive care unit of Hunan Children's Hospital from January 2018 to December 2022 were enrolled.According to whether PE combined with CVVHDF was performed within 24 hours after reaching the blood purification criteria for KDSS，the patients were divided into the early treatment group(8 cases) and the control group (27 cases).The clinical and laboratory indicators and prognosis were compared between the two groups.Results:There were no statistically significant differences in age，gender，mean arterial pressure，and pediatric critical illness score between the two groups before treatment（ P>0.05）.In the early treatment group,the vasoactive inotropic score (VIS) gradually decreased,and was significantly lower than that in the control group after 24 hours of treatment.The duration of vasopressor use，pediatric logistic organ dysfunction score（PELOD），inflammatory markers，total hospitalization time，and PICU stay were all lower in the early treatment group than in the control group（ P<0.05）.The incidence of coronary artery involvement within 6 months post-discharge was lower in the early treatment group than in the control group（ P<0.05）.Among the 12 children who underwent PE combined with CVVHDF，four cases were in the late treatment group.The duration of CVVHDF，PICU stay，and PELOD scores were lower in the early treatment group than in the late treatment group（ P<0.05）.Additionally，the concentrations of interleukin-6，tumor necrosis factor-α，heparin-binding protein，and N-terminal pro-brain natriuretic peptide before PE were lower in the early treatment group than in the late treatment group（ P<0.05）. Conclusion:Early PE combined with CVVHDF treatment for KDSS patients can reduce inflammatory response，shorten the course of the disease，and reduce the duration of vasopressor use.However，most patients' conditions can be controlled with active conventional treatment.

Objective To explore the value of cardiopulmonary and additional ultrasound(CLAUS)protocol and point-of-care ultrasound rapid management(POCURM)protocol in etiological diagnosis of acute respiratory distress in critically ill patients in the emergency room.Methods A total of 242 patients with acute respiratory distress admitted to Jinhua City Central Hospital from January 2022 to January 2024 were selected as the research subjects.According to the final diagnosis after discharge,they were divided into cardiogenic group(n=144)and pulmonary group(n=98).Compare the CLAUS findings of two groups and accuracy of two protocols in diagnosing etiology of acute respiratory distress.Results The history of heart disease in cardiogenic group was higher than that in pulmonary group,and difference was statistically significant(P＜0.05).The lung disease history of patients in cardiogenic group was lower than that in pulmonary group,and difference was statistically significant(P＜0.05).The proportion of pleural smoothness/slight thickening,sliding presence/slight weakening,left heart dysfunction,right heart dysfunction,and B-line pulmonary ultrasound scores in cardiogenic group were higher than those in pulmonary group,and differences were statistically significant(P＜0.05).The sensitivity,specificity of POCURM protocol for diagnosing acute respiratory distress were 90.28％,91.84％.The sensitivity,specificity of CLAUS protocol for diagnosing acute respiratory distress were 96.53％,97.96％.Conclusion CLAUS regimen can effectively diagnose specific causes of acute respiratory distress in patients,with higher accuracy than POCURM regimen.

Objective:To compare the clinical effects of plasma exchange（PE）combined with continuous veno-venous hemodiafiltration（CVVHDF）at different time points in children with Kawasaki disease shock syndrome（KDSS）.Methods:Thirty-five children with KDSS admitted to the intensive care unit of Hunan Children's Hospital from January 2018 to December 2022 were enrolled.According to whether PE combined with CVVHDF was performed within 24 hours after reaching the blood purification criteria for KDSS，the patients were divided into the early treatment group(8 cases) and the control group (27 cases).The clinical and laboratory indicators and prognosis were compared between the two groups.Results:There were no statistically significant differences in age，gender，mean arterial pressure，and pediatric critical illness score between the two groups before treatment（ P>0.05）.In the early treatment group,the vasoactive inotropic score (VIS) gradually decreased,and was significantly lower than that in the control group after 24 hours of treatment.The duration of vasopressor use，pediatric logistic organ dysfunction score（PELOD），inflammatory markers，total hospitalization time，and PICU stay were all lower in the early treatment group than in the control group（ P<0.05）.The incidence of coronary artery involvement within 6 months post-discharge was lower in the early treatment group than in the control group（ P<0.05）.Among the 12 children who underwent PE combined with CVVHDF，four cases were in the late treatment group.The duration of CVVHDF，PICU stay，and PELOD scores were lower in the early treatment group than in the late treatment group（ P<0.05）.Additionally，the concentrations of interleukin-6，tumor necrosis factor-α，heparin-binding protein，and N-terminal pro-brain natriuretic peptide before PE were lower in the early treatment group than in the late treatment group（ P<0.05）. Conclusion:Early PE combined with CVVHDF treatment for KDSS patients can reduce inflammatory response，shorten the course of the disease，and reduce the duration of vasopressor use.However，most patients' conditions can be controlled with active conventional treatment.

Objective Exploring the clinical value of pulmonary ultrasound B-line score,left ventricular ejection fraction(LVEF),insulin-like growth factor binding protein-7(IGFBP7),and N-terminal pro-brain natriuretic peptide(NT-proBNP)levels in diagnosing cardiogenic acute dyspnea.Methods A retrospective analysis was conducted on the clinical data of 80 patients with acute dyspnea diagnosed and treated at Jinhua Municipal Central Hospital from February 2021 to February 2024.According to the discharge diagnosis of patients,they were divided into cardiogenic group(cardiogenic acute dyspnea,50 cases)and non-cardiogenic group(non-cardiogenic acute dyspnea,30 cases).The pulmonary ultrasound B-line score,LVEF,IGFBP7 and NT-proBNP levels of two groups of patients were compared,their correlations were analyzed,and the receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic value of each index for cardiogenic acute dyspnea.Results There were no statistically significant differences in the clinical baseline data such as age,gender,body mass index,proportion of atrial fibrillation,urea nitrogen,serum creatinine,systolic blood pressure,arterial partial pressure of oxygen,heart rate and blood oxygen saturation between two groups of patients(P＞0.05).The pulmonary ultrasound B-line score,the levels of IGFBP7 and NT-proBNP in cardiogenic group were significantly higher than those in non-cardiogenic group,and the LVEF was significantly lower than that in non-cardiogenic group(P＜0.05).Pearson correlation analysis showed that the pulmonary ultrasound B-line score was positively correlated with both IGFBP7 and NT-proBNP(P＜0.05),with no significant correlation with LVEF(P＞0.05).The results of ROC curve showed that the pulmonary ultrasound B-line score,LVEF,IGFBP7 and NT-proBNP all had high diagnostic value for cardiogenic acute dyspnea,and the area under the curve were 0.917,0.855,0.946 and 0.925,respectively.Conclusion The pulmonary ultrasound B-line score,LVEF,IGFBP7,and NT-proBNP levels have high diagnostic value for cardiogenic acute dyspnea and are worthy of clinical promotion and application.

Objective:To investigate the value of the ratio of heparin binding protein (HBP) to albumin (ALB) in diagnosis and predict the severity of Kawasaki disease shock syndrome (KDSS).Methods:This study was a retrospective study. Pediatric patients with Kawasaki disease (KD) admitted to the Children's Intensive Care Unit and department of Pediatric Emergency Center of Hunan Children's Hospital from January 2019 to May 2022 were enrolled. The HBP/ALB ratio was calculated according to HBP and serum ALB. The children were divided into three groups (low, medium, and high ratio groups) according to the median and upper and lower quartiles of the HBP/ALB ratio. The differences of each index among the three groups were compared. The receiver operating characteristic curves were drawn to evaluate the clinical value of the HBP/ALB ratio in diagnosis of KDSS and the severity of the disease.Results:A total of 111 cases were included in this study, including 28 cases in the low ratio group, 56 cases in the medium ratio group, and 27 cases in the high ratio group. There were 24 cases with coronary artery damage, 87 cases without coronary artery damage, 27 cases with abnormal ECG findings, and 17 children with KDSS (including 5 cases in the medium ratio group, and 12 cases in the high ratio group). The incidence of KDSS, coronary involvement, and abnormal electrocardiogram proportions in the high ratio group were significantly higher than those in the other two groups. Compared with low and medium ratio groups, the levels of cardiac troponin I, N-terminal pro-brain natriuretic peptide, lactate, stroke output variation, trends in thoracic fluid content, white blood cell count, C-reactive protein, procalcitonin, and D-dimer levels were higher in the high ratio group, while ALB and blood sodium levels were lower in the high ratio group (all P<0.05). There was no significant difference in above indicators between the low and medium ratio groups (all P>0.05). The HBP/ALB ratio had a higher area under the curve, sensitivity, and specificity (0.942, 0.882, and 0.883, respectively) in predicting KDSS compared to HBP alone (0.776, 0.842, and 0.670, respectively). Conclusion:The HBP/ALB ratio could reflect the severity of children with KD and has certain clinical value for prognostic evaluation.

Objective:To explore the clinical value of serum insulin combined with cardiac-related markers in evaluating the severity of sepsis associated encephalopathy (SAE).Methods:The clinical data of 130 children with sepsis who admitted to the Pediatric Intensive Care Unit of Hunan Children's Hospital from January 2018 to December 2021 were analyzed retrospectively, and the differences of serum insulin and cardiac-related markers in children with sepsis and SAE were compared.Results:The levels of serum insulin, creatine kinase isoenzyme, hypersensitive troponin T, and N-terminal cerebral urine peptide in the SAE group were significantly higher than those in the non-SAE group ( P<0.05), but there was no significant difference in heart rate and lactic acid ( P>0.05). The levels of serum insulin, creatine kinase isoenzyme, hypersensitive troponin T, N-terminal cerebral urine peptide and lactic acid in the death group were significantly higher than those in the survival group ( P<0.05), while the heart rate was not significantly different ( P>0.05). The area under ROC curve of serum insulin, creatine kinase isoenzyme, hypersensitive troponin T, and N-terminal cerebral urine peptide in predicting SAE were 0.841, 0.599, 0.700, and 0.667, respectively; in terms of judging the prognosis of sepsis, the area under ROC curve were 0.647, 0.669, 0.645, and 0.683, respectively; and in terms of judging the prognosis of children with SAE, the areas under the ROC curve were 0.509, 0.682, 0.666 and 0.555, respectively. Binary logistic regression equation was established with serum insulin, creatine kinase isoenzyme, hypersensitive troponin T, and N-terminal cerebral urine peptide: Y=8.153×NT-proBNP+1.704×CTnT-hs+27.121×insulin+0.946×CK-MB+1.573. The area under the ROC curve of the new variable Y in predicting sepsis SAE, evaluating the prognosis of sepsis, and predicting the prognosis of children with sepsis and SAE was 0.890, 0.756, and 0.729, respectively. Conclusions:Serum insulin, creatine kinase isoenzyme, hypersensitive troponin T, and N-terminal cerebral urine peptide can be used alone to determine the severity of sepsis and sepsis in children with SAE. The combined value of the four indicators is obviously better than that of the single indicator. The combined application of the four indicators may better evaluate the severity of sepsis and SAE.

Objective:To investigate the predictive value of sputum heparin binding protein(HBP) in sepsis related acute respiratory distress syndrome(ARDS).Methods:This study was a prospective case-control study.A total of 134 children with sepsis who were admitted in PICU at Hunan Children′s Hospital from January 2020 to November 2021 were included, including 63 children who had completed fiberoptic bronchoscopy.The 63 children were divided into sepsis without ARDS group, sepsis with mild ARDS group, and sepsis with moderate to severe ARDS group according to the presence and severity of ARDS.Sputum was collected and HBP was detected in all children with sepsis when they were admitted to the hospital.The alveolar lavage fluid within 72 hours of admission was reserved for HBP.The levels of interleukin (IL)-6 and tumor necrosis factor (TNF)- α were detected, and the blood biochemistry, pulmonary imaging, pediatric critical case score and other data within 72 hours were collected.Results:(1) Among 63 children with fiberoptic bronchoscopy, 29 were in sepsis without ARDS group, 18 were in the sepsis with mild ARDS group, and 16 were in the sepsis with moderate to severe ARDS group.There was no significant difference in the pediatric critical case score and the location of primary infection focus among the three groups at admission.The primary infection focus was respiratory system in 36 cases, whose sputum HBP level was (42.1±9.8) ng/mL, and 27 children with other systems infection, whose sputum HBP level was (37.8±10.8) ng/mL, there was no significant difference between two groups ( t=1.65, P=0.104). (2) There were significant differences in sputum HBP, alveolar lavage fluid HBP, IL-6 and TNF-α levels among sepsis with mild ARDS group, sepsis with moderate and severe ARDS group and sepsis without ARDS group ( P<0.05). The sputum HBP of 34 children with sepsis combined with ARDS was positively correlated with alveolar lavage fluid HBP, IL-6, TNF-α levels and lung injury score, and negatively correlated with SpO 2/FiO 2 ( P<0.05). (3)Among the 34 children with sepsis combined with ARDS, the sputum HBP concentration of children with invasive ventilation was significantly higher than that of children with non-invasive ventilation ( P<0.05). The sputum HBP concentration in children with three or more organ damage was significantly higher than that of children with two or less organ damage ( P<0.05). The sputum HBP concentration of dead children was higher than that of surviving children ( P<0.05). (4) The area under curve of sputum HBP for predicting ARDS was 0.772 (95% CI: 0.655~0.889). When the cut-off point value of sputum HBP was 27.9 mU/L, whose sensitivity and specificity were 70.6% and 79.3%, respectively.The area under curve of sputum HBP for predicting moderate and severe ARDS was 0.793 (95% CI: 0.661~0.926). When the cut-off point value of sputum HBP was 51.55 mU/L, whose sensitivity and specificity were 81.3% and 76.6%, respectively. Conclusion:Sputum HBP is elevated in children with sepsis and ARDS, which is related with the severity of the disease.Sputum HBP has a good predictive value for the diagnosis and severity of children with sepsis and ARDS, and can be used as a clinically effective and convenient evaluation index for children with sepsis related ARDS.

Objective:To observe the changes in blood flow density of radial retinal peripapillary capillary (RPC) around the optic disc in patients with non-arteritic anterior ischemic optic neuropathy (NAION) at different stages of the continuous course of the disease.Methods:A prospective cohort study. From January to December 2020, 29 cases of 29 eyes of NAION patients diagnosed in the Eye Center of the Second Affiliated Hospital of Zhejiang University School of Medicine were included in the study. Among them, there were 18 males with 18 eyes and 11 females with 11 eyes. The average age was 53.62±6.67 years old. The affected eye underwent routine eye examination and visual field, optic cohenrence tomography angiography (OCTA) examination. Visual field inspection was performed to obtain the average visual mean defect (MD) value. OCTA was used to measure the thickness of the peripapillary retinal nerve flayer (pRNFL) around the optic disc, the whole en face image vessel density (wiVD), intro disc vessel density (diVD), RPC blood flow density around the optic disc, and macular ganglion cell complex (GCC). The course of disease ≤3 weeks was defined as the acute phase; 4-12 weeks was defined as the subacute phase; >12 weeks was defined as the chronic phase. The changes of visual field MD, optic disc RPC blood flow density, pRNFL thickness and macular GCC thickness were observed in the acute, subacute and chronic phases (12-24, >24 weeks). A completely randomized design of variance analysis was used to compare the differences in visual field MD, RPC blood flow density, GCC, and pRNFL thickness in different courses. Pearson correlation analysis was used to analyze the correlation between pRNFL thickness, macular GCC thickness, visual field MD changes and RPC blood flow density around the optic disc sex.Results:The wiVD of the eyes in the acute phase, subacute phase, and chronic phase (12-24 weeks, >24 weeks) were (44.96±2.76)%, (41.50±3.49)%, (39.08±5.43)%, (38.56±6.48)%. There was a statistically significant difference in wiVD of eyes with different disease courses ( F=8.939, P<0.001). The average difference of wiVD between 12-24 weeks and >24 weeks in the chronic phase was -0.984, and the difference was not statistically significant ( P>0.05). There was no statistically significant difference in diVD of patients with different courses of disease ( F=1.079, P=0.365). The blood flow density of RPC around the optic disc of the affected eye, except for the lower part, the blood flow density of the nasal side, the temporal side, and the upper quadrant, decreased significantly with the progression of the disease, and the difference was statistically significant ( F=8.816, 6.069, 8.943; P<0.05). In the chronic phase, the average difference of blood flow density between the nasal, temporal, and upper sides of the eyes between 12-24 weeks and more than 24 weeks in the chronic phase was -0.984, -0.230, -0.198, and the difference was not statistically significant ( P>0.05). There was no statistically significant difference in the visual field MD of patients with different courses of disease ( F=0.277, P=0.842); the overall pRNFL thickness and average macular GCC thickness were compared with statistical significance ( F=47.122, 14.954; P<0.001, <0.001), all became significantly thinner with the progression of the disease. The results of Pearson correlation analysis showed that the blood flow density of the entire optic disc wiVD, the blood flow density of RPC in the temporal quadrant around the optic disc and the visual field MD ( r=-0.225, -0.268; P<0.05), and the average thickness of GCC ( r=0.480, 0.436; P<0.01) were all related. Conclusion:The blood flow density of RPC in the entire optic disc and around the optic disc (except the lower quadrant) of NAION eyes gradually decrease with the progression of the disease, and stabilize after 12 weeks of the disease.