Current Issue Archive 15 December 2020, Volume 11 Issue 4 Previous Issue Improving antibiotic prescribing in the emergency department for uncomplicated community-acquired pneumonia Rebekah Shaw, Erica Popovsky, Alyssa Abo, Marni Jacobs, Nicole Herrera, James Chamberlain, Andrea Hahn World Journal of Emergency Medicine. 2020, 11(4): 199-205. doi:10.5847/wjem.j.1920-8642.2020.04.001 Asbtract HTML PDF (151KB) Outcome prediction value of National Early Warning Score in septic patients with community-acquired pneumonia in emergency department: A single-center retrospective cohort study Hai-jiang Zhou, Tian-fei Lan, Shu-bin Guo World Journal of Emergency Medicine. 2020, 11(4): 206-215. doi:10.5847/wjem.j.1920-8642.2020.04.002 Asbtract HTML PDF (255KB) Effects of fluid balance on prognosis of acute respiratory distress syndrome patients secondary to sepsis Yu-ming Wang, Yan-jun Zheng, Ying Chen, Yun-chuan Huang, Wei-wei Chen, Ran Ji, Li-li Xu, Zhi-tao Yang, Hui-qiu Sheng, Hong-ping Qu, En-qiang Mao, Er-zhen Chen World Journal of Emergency Medicine. 2020, 11(4): 216-222. doi:10.5847/wjem.j.1920-8642.2020.04.003 Asbtract HTML PDF (107KB) Effects of sepsis on hippocampal volume and memory function Miao Yuan, Ding-yi Yan, Fang-shi Xu, Yi-di Zhao, Yang Zhou, Long-fei Pan World Journal of Emergency Medicine. 2020, 11(4): 223-230. doi:10.5847/wjem.j.1920-8642.2020.04.004 Asbtract HTML PDF (138KB) Death and do-not-resuscitate order in the emergency department: A single-center three-year retrospective study in the Chinese mainland Chuan-qi Ding, Yu-ping Zhang, Yu-wei Wang, Min-fei Yang, Sa Wang, Nian-qi Cui, Jing-fen Jin World Journal of Emergency Medicine. 2020, 11(4): 231-237. doi:10.5847/wjem.j.1920-8642.2020.04.005 Asbtract HTML PDF (144KB) BACKGROUND: Consenting to do-not-resuscitate (DNR) orders is an important and complex medical decision-making process in the treatment of patients at the end-of-life in emergency departments (EDs). The DNR decision in EDs has not been extensively studied, especially in the Chinese mainland. METHODS: This retrospective chart study of all deceased patients in the ED of a university hospital was conducted from January 2017 to December 2019. The patients with out-of-hospital cardiac arrest were excluded. RESULTS: There were 214 patients’ deaths in the ED in the three years. Among them, 132 patients were included in this study, whereas 82 with out-of-hospital cardiac arrest were excluded. There were 99 (75.0%) patients’ deaths after a DNR order medical decision, 64 (64.6%) patients signed the orders within 24 hours of the ED admission, 68 (68.7%) patients died within 24 hours after signing it, and 97 (98.0%) patients had DNR signed by the family surrogates. Multivariate analysis showed that four independent factors influenced the family surrogates’ decisions to sign the DNR orders: lack of referral (odds ratio [OR] 0.157, 95% confidence interval [CI] 0.047-0.529, P=0.003), ED length of stay (ED LOS) ≥72 hours (OR 5.889, 95% CI 1.290-26.885, P=0.022), acute myocardial infarction (AMI) (OR 0.017, 95% CI 0.001-0.279, P=0.004), and tracheal intubation (OR 0.028, 95% CI 0.007-0.120, P<0.001). CONCLUSIONS: In the Chinese mainland, the proportion of patients consenting for DNR order is lower than that of developed countries. The decision to sign DNR orders is mainly affected by referral, ED LOS, AMI, and trachea intubation.

Objective To investigate the influences of carbon dioxide (CO2) pneumoperitoneum and operation position on intraocular pressure (IOP) during laparoscopic surgery under general anesthesia. Methods Thirty-six patients were divided into two groups of udergoing laparoscopic pelvic surgeries (group A) and udergoing laparoscopic cholecytectomies(group B) with 18 cases each. The patients in group A were operated under 25 degrees head-down position and those in group B under 25 degrees head-up position. IOP was recorded before surgery(T0), at 5 min after tracheal intubation (T1), 5 min after CO2 pneumoperitoneum(T2), 5 min(T3) and 30 min(T4) after body position changed and the time of normal PETCO2 regained(T5). Results IOP was remarkably decreased after induction of general anesthesia in both groups. IOP of group A raised to (21.0±1.6) mm Hg at T4, which was dropped to (14. 6±1.6) mm Hg at T5. IOP of group B raised to (12.1±2.9) mm Hg at T4,which was dropped to (11.1±1.2) mm Hg at T5. Changes of IOP of both groups were positively correlated with the changes of PETCO2. Conclusion IOP can be decreased remarkably after induction of general anesthesia with propofol. The head-up position and normal range of PETCO2 are the two important factors to avoid an increase of IOP in surgical patients under general anesthesia.

OBJECTIVE:To discuss the training method for clinical pharmacists working in Neurology Intensive Care Unit. METHODS: The characteristics of the specialty of neurology were analyzed and out experiences in training clinical pharmacists were summarized. RESULTS: With a good and systematic learning method, clinical pharmacists can adapt to clinical work and become one of the members in the treatment corps as soon as possible. CONCLUSION: With a specialty characteristic, clinicians' participating in the training of clinical pharmacists is of great important for the quick transformation of pharmacists' working model.

Objective To evaluate the value of dynamic grey-scale enhanced ultrasonography in the differential diagnosis of hepatic tumors.Methods Twenty-four patients with 25 hepatic solid lesions were examined by dynamic enhanced ultrasonography with a bolus injection of Levovist (400 mg/ml). Results All lesions were confirmed by operation and pathology, including 16 hepatocellular carcinomas (HCC), 3 hepatic hemangiomas (HCH), 1 inflammatory pseudotumor of liver (IPL), 2 focal nodular hyperplasias (FNH) and 3 angiomyolipomas (AML). Twenty-five lesions were variously enhanced on grey-scale ultrasonogram after injection of Levovist except for IPL. The lesions with HCCs were enhanced early in the arterial phase and disappeared quickly in portal phase. The lesions with HCHs were enhanced slowly in the peripheral region of the lesion. The FNH and AML were also enhanced early in arterial phase, but disappeared slowly in delay phase. If the hepatic lesions showed the earlier enhancement in arterial phase and fast disappearance in portal phase on contrast enhanced ultrasonogram were regarded as a criterion of malignant tumor, the sensitivity, specificity and accuracy with contrast enhanced ultrasonography in the diagnosis of hepatic malignant tumor were 94%(15/16),89%(8/9)and 92%(23/25), respectively. Conclusions The dynamic grey-scale enhanced ultrasonography is a useful technique in the differential diagnosis of hepatic tumors.

Tiredness is a physiological phenomenon,inevitably appears in certain period of exercise.If the tiredness has not been eliminated promptly,it would roll up to fatigue.It is important to analyze the generation,evaluation and recovery of fatigue,to make people come back to training,working or studying as soon as possible.

Humans ; Torsades de Pointes

Objective To evaluate the analgesic effect of dexmedetomidine on the ultrasonic guidance brachial plexus block.Methods Sixty patients who underwent elective for one-side upper limb or forearm surgery were selected,they were received ultrasonic guidance brachial plexus block.The patients were divided into observation group and control group by random digits table method with 30 cases each.The observation group received 0.5％ ropivacaine 100 mg and dexmedetomidine 0.75 μg/kg,and the control group received 0.5％ ropivacaine 100 mg alone.The heart rate,mean arterial pressure (MAP),pulse oxygen saturation (SpO2) at the time of entering operating room,brachial plexus block completed,incision and the end of surgery were recorded.After brachial plexus block completed,the visual analogue score (VAS) at the time of incision,1 h during surgery and 1,2,6,12,24,48 h after surgery was recorded.Morphine was given the patients when VAS ＞ 4 scores,and the time to first prescription of morphine and total morphine consumption dose within 48 h after surgery were also detected.The adverse reaction was recorded.Results There were no statistical differences in heart rate and MAP at the time of entering operating room and brachial plexus block completed between the 2 groups (P ＞ 0.05).The heart rate and MAP at the time of incision and the end of surgery in observation group were significantly lower than those at the time of entering operating and the same time of control group,there were statistical differences (P ＜ 0.05).There was no statistical difference in SpO2 between the 2 groups (P ＞0.05).The VAS at the time of 6,12,24 and 48 h after surgery in observation group were significantly lower than those in control group [(3.0 ± 0.9) scores vs.(4.9 ± 0.5) scores,(3.0 ± 0.7) scores vs.(5.6 ± 1.2) scores,(2.2 ± 0.9) scores vs.(4.8 ± 1.8) scores,(1.7 ± 0.5) scores vs.(3.2 ± 1.0) scores],there were statistical differences (P ＜ 0.05).The time to first prescription of morphine in observation group was significantly longer than that in control group [(450 ± 37) min vs.(368 ± 42) min],the total morphine consumption dose was significantly lower than that in control group [(8.3 ± 2.8) mg vs.(15.5 ± 4.5) mg],there were statistical differences (P ＜ 0.05).There was no adverse reaction found.Conclusion Ropivacaine plus 0.75 μ g/kg dexmedetomidine for ultrasonic guidance brachial plexus block may prolong the duration of analgesia,thus reduce morphine consumption within 48 h after surgery without severe adverse reaction.

Background:The morbidity and mortality of gastric cancer remain high worldwide,and it is urgent to explore new targets for the diagnosis and treatment of gastric cancer. Nuclear protein 1 (Nupr1)has a variety of biological functions, especially in the tumorigenesis and development of the malignancies. Aims:To investigate the expression and clinical significance of Nupr1 in gastric cancer. Methods:Quantitative RT-PCR was used to determine the mRNA expression of Nupr1 in 72 cases of gastric cancerous tissue and the paired paracancerous tissue. Western blotting and immunohisto-chemistry were employed to detect the protein expression and cellular localization of Nupr1. The correlation of Nupr1 with the clinicopathological characteristics of gastric cancer was analyzed. Results:Expressions of Nupr1 mRNA and protein in gastric cancer were both significantly higher than those in paracancerous tissue (P < 0. 05),and their expressions were coincident. Nupr1 protein was expressed mainly in cytoplasm,and the nuclear expression was reduced. Expression of Nupr1 mRNA in gastric cancer was significantly correlated with tumor size,differentiation,pathological type,Bormann's classification,depth of invasion,lymph node and distant metastases and TNM staging (P < 0. 05),and was not correlated with gender,age and site of tumor (P > 0. 05). Conclusions:Nupr1 is overexpressed and correlated with invasion, metastasis and progression of gastric cancer. It can be used as a novel biomarker for early diagnosis and prognosis evaluation,and as a potential target for treatment of gastric cancer.

Objective To observe the effect of paraoxonase 1 (PON1) application of the new method of arylesterase activity in patients with coronary heart disease,analysis of paraoxonase 1 (PON1) of the clinical value of arylesterase activity in the new testing method.Methods From January 2014 to January 2016 in our hospital 86 patients with coronary heart disease as the research object,and then select the healthy people at the same time to the hospital physical examination of 50 as the control group to take the research object,spectrophotometric method for the determination of coronary heart disease patients and control subjects serum PON1 arylesterase activity,PON1 arylesterase activity at the same time with statistics the different degree of coronary heart disease,PON1 arylesterase activity between patients with coronary heart disease and control group comparison study and different severity of coronary heart disease patients,the patients with coronary heart disease PON1 aromatic ester enzyme activity,age,gender,BMI,TC,total cholesterol,low density lipoprotein cholesterol LDL-C and glycerin three greases TG included in the analysis of factors of coronary heart disease multiple linear regression equation,to determine the changes of patients with coronary artery disease by PON1 arylesterase activity,to provide a reference for clinical treatment.Results The activity of PON1 in patients with coronary heart disease was significantly lower than that of the control group,and the difference was statistically significant (P<0.05).Single branch lesions in patients with PON1 arylesterase activity was significantly higher than that of double vessel lesions and three lesions were double branch lesions in patients with PON1 arylesterase activity was significantly higher than that in three patients,the differences were statistically significant (P<0.05).According to the multiple linear regression analysis showed that coronary heart disease and the patient′s age,gender,BMI,TC,LDL-C,TG and PON1 arylesterase activity (P<0.05),which was related with age,gender,BMI,TC,LDL-C and TG were positively correlated,negatively correlated with PON1 arylesterase activity.Conclusion The PON1 activity of in patients with coronary heart disease is significantly decreased,and the extent of the disease is more severe,the more obvious the decline of PON1,the activity of PON1 shows a negative correlation with coronary heart disease.

Objective To explore the change of serum vascular endothelial growth factor(VEGF)、nitric oxide(NO)levers in patients with Kawasaki disease(KD) and their Clinical significance.Methods Serum VEGF and NO were detected by the double antibody sandwich ELISA and the method of nitratase respectively in 38 patients with KD at their acute and remission stages,and compared with anther 30 normal children.Results The lever of serum VEGF、 NO at the acute stage in KD group were significantly higher than those at the remission stage and the normal control group(P