OBJECTIVE: To evaluate the prognostic value of ultrasonographic measurement of optic nerve sheath diameter (ONSD) and ONSD/eyeball transverse diameter (ETD) ratio in stroke patients during hospitalization. METHODS: Adult patients with stroke (ischemic stroke or hemorrhagic stroke) admitted to department of critical care medicine of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine from November 2017 to November 2018 were enrolled. On the day of admission, ONSD and ETD (retina-retina at 3 mm behind the globe along) were detected by ultrasound, the ONSD/ETD ratio was calculated, and the baseline data and outcomes were recorded. Patients were divided into survival group and death group according to their survival status. Locally weighted scatterplot smoothing (LOWESS) and the receiver operating characteristic (ROC) curve were used to calculate the thresholds of ONSD and ONSD/ETD. The correlation between ONSD, ONSD/ETD and prognosis were assessed. RESULTS: Thirty-eight of 83 patients (45.8%) survived and were discharged from the hospital, while 45 patients died (54.2%). There were significant differences in Glasgow coma score (GCS), shifting of the middle structure, ONSD and ONSD/ETD between the death group and the survival group [GCS: 4.7±2.8 vs. 11.0±3.2, shifting of the middle structure (mm): 5.8±5.9 vs. 1.3±2.6, ONSD (mm): 5.5±0.4 vs. 4.4±0.5, ONSD/ETD: 0.25±0.02 vs. 0.20±0.02, all P < 0.05]. LOWESS and ROC curve analysis suggested thresholds of ONSD and ONSD/ETD for predicting adverse prognosis of stroke patients were 5.0 mm and 0.25, respectively. By adjusting the influence of confounding factors on prognosis, a prediction model based on ONSD was established, and the ROC curve was drawn. The area under the curve (AUC) was 0.978, the optimal predictive point of the model was 0.870, the sensitivity was 89%, and the specificity was 100%. The ONSD/ETD prediction model was also obtained, and the AUC was 0.988, the optimal prediction threshold of the model was 0.768, and the sensitivity for predicting adverse clinical prognosis was 94%, and the specificity was 97%. The stability of ONSD/ETD was better than that of ONSD. ONSD coefficient of variation was 0.14, and ONSD/ETD coefficient of variation was 0.13. CONCLUSIONS ONSD and ONSD/ETD were significantly correlated with the prognosis of critical patients with stroke. The mortality increased significantly in patients with an ONSD greater than 5.0 mm and ONSD/ETD greater than 0.25. ONSD and ONSD/ETD may be promising tools for early assessment of clinical outcomes in these patients.
Adult ; China ; Hospitalization ; Humans ; Intracranial Pressure ; Optic Nerve ; Prognosis ; ROC Curve ; Stroke ; Ultrasonography

OBJECTIVEStudy on the diagnostic accuracy and value of cell block and tissue fragment preparations collected from lung fine needle aspiration (FNA).

METHODSA total of 187 FNA (22G) samples from the lungs with matched histological diagnosis were studied. Among them, the diagnosis made by depending on 124 cell block and fragment preparations were analyzed in comparing retrospectively with the diagnosis of 187 cases by smear preparations.

RESULTS(1) Of the 124 cell blocks cases, 89 cases were true positives, 22 cases were true negatives, 13 cases were false negatives and no false positives. Of the 187 smears cases, the figure were 136, 30, 19 and 2 cases respectively. The diagnostic accuracy of cell blocks was 87.3% in sensitivity, 100% in specificity, 89.5% in overall accuracy. The figures for smears were 87.7%, 93.8% and 88.8% respectively. (2) For malignant tumours, the histological typing accuracy of cell blocks was 93.3% (83/89), and to be 67.9% (91/134) by diagnosis depending on the smears (P < 0.01). For the benign lesions, the figures were 86.4% (19/22) and 60% (18/30) respectively (P < 0.05). (3) It was possible to obtain many minisections for further studies from cell blocks. Immunoperoxidase staining on minisections was reliable and agreed with those on the surgical specimens.

CONCLUSIONSThe diagnostic accuracy of cell block is high, particularly in histological typing which approaches to that of the diagnosis made depending on the postoperative specimens. A combined use of smears and cell block is recommended which may raise further the diagnostic accuracy.

Adolescent ; Adult ; Aged ; Biopsy, Needle ; Female ; Histocytological Preparation Techniques ; Humans ; Lung Neoplasms ; classification ; pathology ; Male ; Middle Aged

AIM　To investigate the effect of frozen recombinant staphylokinase on the hemostatic and fibrinolytic systems in healthy volunteers, in order to obtain reliable evidence for the possibility of further clinical application. METHOD　r-Sak had been taken intravenously by 20 cases of healthy volunteers in different dosages (1 mg, 2.5 mg, 5 mg, 10 mg, 15 mg). The clinical hemorrhagic manifestations were observed and a set of hemostatic tests(BT, BPC, ATPP, PT, TT, Fg) and fibrinolytic tests (PL∶A,α2-PI∶A, FDP, D-D) monitored before and after injection.　RESULT　Four of 20 volunteers showed slight hemorrhagic tendency on mucocutaneous area (3/4 from gingivea and 2/4 at the sites of injection). It stopped spontaneously. None of them showed visceral bleeding. There were no significant changes in hemorrhagic and coagulative phases. Only 4 of them showed slight abnormal changes in D-D. It was supported that r-Sak was a highly selective fibrirolytic agent without significant influence in human hemostatic and coagulatic system. CONCLUSION　The specific ranges of doseges, r-Sak is a relatively safe and well tolerated agent for healthy people. Further clinical study is still needed for the suitable dosage for clinical application.

Objective To compare the effects of cardiopulmonary resuscitation by bending and pressing the lower extremities (BPLE-CPR) with standard cardiopulmonary resuscitation (S-CPR). Methods A multicenter prospective nonrandomized controlled study was performed. Patients with cardiac arrest (CA) treated in the emergency departments and intensive care units (ICU) of seven hospitals in Eastern China from January 2013 to February 2017 were enrolled. BPLE-CPR or S-CPR was used for resuscitation according to the patient's condition. Data registration was completed in Utstein style. The primary outcome was recovery of spontaneous circulation (ROSC) rate, and the secondary outcome included survival rate at discharge, the resuscitation time of ROSE patients, blood pressures during resuscitation, the survival rates within 24 hours and beyond 24 hours, and the cerebral performance categories (CPC) of discharged patients. Results A total of 279 patients completed data registration, including 142 in the BPLE-CPR group and 137 in the S-CPR group. ROSC rate, survival rates over 24 hours and at discharge in BPLE-CPR group were significantly higher than those in S-CPR group [ROSC rate: 63.4% (90/142) vs. 29.2% (40/137), survival rate over 24 hours: 56.7% (51/90) vs. 45.0% (18/40), survival rate at discharge: 43.0% (61/142) vs. 20.4% (28/137), all P < 0.01]. The CPR duration of ROSC patients in BPLE-CPR group was significantly shorter than that in S-CPR group [minute:10 (5, 15) vs. 20 (11, 30), P < 0.01], while systolic blood pressure during CPR was significantly higher than that in S-CPR group [mmHg (1 mmHg = 0.133 kPa): 92.0 (80.0, 110.0) vs. 73.5 (65.5, 80.0), P < 0.01]. In survival discharged patients, the proportion of CPC 1 patients in BPLE-CPR group was significantly higher than that in S-CPR group [24.6% (15/61) vs. 10.7% (3/28), P < 0.01]. Conclusion BPLE-CPR is superior to S-CPR in terms of ROSC rate and discharge survival rate. In addition, the BPLE-CPR procedure is simple and easy to expand in public. Clinical Test Registration Chinese Clinical Trial Registry, ChiCTR-TRC-13003150.

Objective: To understand the public health emergency response capacity in primary and secondary schools, and to explore the problems and challenges in the prevention and control of public health emergency in primary and secondary schools for specific strategies. Methods: By using the stratified group sampling method, a questionnaire survey on general situation, knowledge, attitude and training, as well as public health emergencies response capacity among 2 988 teachers or leaders responsible for school emergency response in primary and secondary schools from Beijing, Chongqing and Yunnan. Results: Participants varied on their positions, titles, educational background and knowledge accuracy. Higher knowledge accuracy was associated with higher educational background ( χ 2=50.73-203.36, P < 0.05 ). The implementation of regular public health emergency related programs was poorly conducted in high schools (50.0%). Urban schools (42.0%) had higher proportion of qualified health care professionals than rural schools (18.2%), and private schools (48.5%) was higher than public schools (24.7%). The primary challenges included the shortage of guidance from professionals and the lack of related testing equipment (84.91%, 74.03%). Conclusion Although the ability of emergency handling of public health emergencies in schools in the three regions is advancing with the times, there are still many deficiencies, some omissions in the mastery of knowledge. It is suggested to inerease pre service and special training of school health work CDC should strengthen technical guidance and work supervision of infectious disease management in schools.

Obj ective To explore yhe causes and yhe nursing measures of unexpecyed exyu-bayion of indwelling cayheyer in hepayobiliary surgery.Methods The clinical daye of 10 payienys wiyh unexpecyedly exyubayion among 402 payienys wiyh hepayobiliary surgery and indwelling cayheyers was analyzed.Results In 10 unexpecyedly exyubayion payienys,yhere were 3 payienys pulling ouy yhe syomach yube by yhemselves,2 payienys pulled ouy abdominal drainage yube in yhe nighy when yurning over.2 payienys′abdominal drainage were auyomayically pulled ouy.1 payieny′s cayheyer and 1 payieny’s deep venous inyubayion were pulled ouy by overly power in yheir yranspory. Jejunum nuyriyion yube wiyhouy suyure fixayion of 1 payieny was pulled ouy.Conclusion According yo yhe causes of unexpecyed exyubayion,improvemeny of nursing measures,syandardized and insyiyu-yionalized nursing can reduce yhe incidence raye of unexpecyed exyubayion.

Obj ective To explore yhe causes and yhe nursing measures of unexpecyed exyu-bayion of indwelling cayheyer in hepayobiliary surgery.Methods The clinical daye of 10 payienys wiyh unexpecyedly exyubayion among 402 payienys wiyh hepayobiliary surgery and indwelling cayheyers was analyzed.Results In 10 unexpecyedly exyubayion payienys,yhere were 3 payienys pulling ouy yhe syomach yube by yhemselves,2 payienys pulled ouy abdominal drainage yube in yhe nighy when yurning over.2 payienys′abdominal drainage were auyomayically pulled ouy.1 payieny′s cayheyer and 1 payieny’s deep venous inyubayion were pulled ouy by overly power in yheir yranspory. Jejunum nuyriyion yube wiyhouy suyure fixayion of 1 payieny was pulled ouy.Conclusion According yo yhe causes of unexpecyed exyubayion,improvemeny of nursing measures,syandardized and insyiyu-yionalized nursing can reduce yhe incidence raye of unexpecyed exyubayion.

Objective:To construct a risk prediction model for infection with Klebsiella pneumonia (KP) for patients with severe acute pancreatitis (SAP).Methods:Retrospective analysis was done on the clinical data of 109 SAP patients who were admitted to Shanghai General Hospital, between March 2016 and December 2021. Patients were classified into infection group ( n=25) and non-infection group ( n=84) based on the presence or absence of KP infection, and the clinical characteristics of the two groups were compared. The least absolute shrinkage and selection operator (LASSO) algorithm was used to reduce the dimension of the variables with statistical significance in univariate analysis. A nomogram prediction model was created by incorporating the optimized features from the LASSO regression model into the multivariate logistic regression analysis. Receiver operating characteristic curve (ROC) was drawn and the area under curve (AUC) was calculated; and consistency index (C-index) were used to assess the prediction model's diagnostic ability. Results:A total of 25 strains of KP were isolated from 109 patients with SAP, of which 21(84.0%) had multi-drug resistance. 20 risk factors (SOFA score, APACHEⅡ score, Ranson score, MCTSI score, mechanical ventilation time, fasting time, duration of indwelling of the peritoneal drainage tube, duration of deep vein indwelling, number of invasive procedures, without or with surgical intervention, without or with endoscopic retrograde cholangiopancreatography (ERCP), types of high-level antibiotics used, digestion disorders, abnormalities in blood coagulation, metabolic acidosis, pancreatic necrosis, intra-abdominal hemorrhage, intra-abdominal hypertension, length of ICU stay and total length of hospital stay) were found to be associated with KP infection in SAP patients by univariate analysis. The four variables (APACHEⅡ score, duration of indwelling of the peritoneal drainage tube, types of high-level antibiotics used, and total length of hospital stay) were extracted after reduced by LASSO regression. These four variables were found to be risk factors for KP infection in SAP patients by multiple logistic regression analysis (all P value <0.05). Nomogram prediction model for KP infection in SAP was established based on the four variables above. The verification results of the model showed that the C-index of the model was 0.939, and the AUC was 0.939 (95% CI 0.888-0.991), indicating that the nomogram model had relatively accurate prediction ability. Conclusions:This prediction model establishes integrated the basic clinical data of patients, which could facilitate the risk prediction for KP infection in patients with SAP and thus help to formulate better therapeutic plans for patients.

Objective:To analyse the clinical efficacy and outcome of early abdominal paracentesis drainage (APD) in the treatment of severe acute pancreatitis (SAP).Methods:The clinical data of 107 SAP patients with massive abdominal fluid in Shanghai General People Hospital from May 2017 to December 2021 were collected and analyzed. Patients were divided into APD group ( n=56) and NO-APD group ( n=51) according to whether they underwent APD or not within 3 days after admission. The APD group was then divided into abdominal compartment syndrome (ACS) subgroup ( n=29) and NO-ACS subgroup ( n=27) according to whether ACS had occurred or not at the time of puncture. Patients' general data, the duration of systemic inflammatory response (SIRS), length of ICU stay, the trends of intra-abdominal pressure and inflammatory indicators (white blood cell count and the content of C-reactive protein) within 1-3 days after admission, incidence of infection complication, step-up therapy, discharge or death were recorded. Results:The intra-abdominal pressure were 18.6±5.6mmHg , 13.7±4.2mmHg (1 mmHg=0.133 kpa) in APD group and NO-APD group, respectively. The intra-abdominal pressure of APD group was significantly higher than that of NO-APD group, and the difference was statistically significant ( P=0.000). Compared with NO-APD group, the duration of SIRS was significantly shortened in APD group [3(2, 4) days vs 4(3, 6) days, P=0.029]. On day 1, 2 and 3 after admission, the intra-abdominal pressure was 18.6±5.6 mmHg, 16.4±4.7 mmHg and 13.5±3.9 mmHg in APD group, and was 13.7±4.2 mmHg, 12.3±3.6 mmHg and 11.0±2.6 mmHg in NO-APD group, respectively. The intra-abdominal pressure of the APD group dropped faster than the NO-APD group ( P=0.004). The white blood cell count was (14.8±4.8), (10.5±4.5) and (9.0±3.8)×10 9/L in APD group, and was (14.2±5.4), (12.3±7.3), (11.7±5.3)×10 9/L in NO-APD group, respectively. Compared with the NO-APD group, the decrease rate of white blood cell count was faster in APD group ( P=0.006). The C-reactive protein content was (153.6±47.1), (150.4±10.5) and (108.8±49.4)mg/L in APD group, and were (174.8±31.1), (191.6±29.4) and (186.8±45.5)mg/L in NO-APD group . The content of C-reactive protein in APD group decreased significantly, while that in NO-APD group did not decrease. There was a significant difference between the two groups ( P=0.009). In the subgroup comparisons, the duration of SIRS in the ACS subgroup was significant longer than that in the NO-ACS subgroup [4(3, 5) days vs 2(1, 3)days, P=0.000]. Compared between the two groups and two subgroups respectively, there were no statistically significant differences on length of ICU stay, infection complication rate, advanced treatment rate and mortality. Conclusions:For SAP patients with abdominal fluid, APD in the early stage could shorten the duration of SIRS, decrease intra-abdominal pressure rapidly, improve inflammatory indicators, but could not improve the clinical outcome.

Objective:To evaluate the hemostatic efficacy of N-carboxyethylchitosan fiber gauze (numbered NWL-K) in a leporine bleeding wounds of intraperitoneal parenchymal visceral.Methods:Sixty New Zealand rabbits were divided into two groups according to the randomized digital number method, with 30 rabbits per group. The leporine bleeding models of hepatic or splenic wound were made respectively. The two groups were subdivided into three groups: common gauze group, SURGICEL group and NWL-K group, with 10 rabbits per group. By analyzing the weight of excised liver tissue and amount of bleeding, the model stability was measured. The time to hemostasis and bleeding score in each group were analyzed every (20±5)seconds after compression for 30 seconds in the hepatic bleeding models or every (30±5)seconds after compression for 3 minutes in the splenic bleeding models. The adhesion between wound and gauze was evaluated at the same time.Results:There was no significant difference in the weight of excised liver tissue and amount of bleeding when the hepatic or splenic bleeding models were made ( P>0.05). It showed that the model was made stably and the hemostasis experiment would not be affected. In the splenic wound model experiment, the time to hemostasis was 255(233, 300)seconds in SURGICEL group and 210(180, 248)seconds in NWL-K group, both of which were significantly shorter than 465(383, 660)seconds in common guaze group ( P<0.05). NWL-K achieved shorter time to hemostasis than SURGICEL ( P<0.05). In the hepatic wound model experiment, the time to hemostasis was 90(85, 110)seconds in SURGICEL group and 70(70, 95)seconds in NWL-K group, both of which were significantly shorter than 250(225 290)seconds in common gauze group ( P<0.05). In the splenic wound model experiment, the bleeding score in NWL-K group and SURGICEL group decreased faster than that in common gauze group ( P<0.05). The difference of bleeding score was significant between NWL-K group and SURGICEL group at 180 seconds ( P<0.05). In the hepatic wound model experiment, the bleeding score in NWL-K group and SURGICEL group decreased faster than that in common gauze group at 50 seconds, 70 seconds and 90 seconds ( P<0.05). The bleeding score in common gauze group and NWL-K group showed significant difference at 30 seconds, 110 seconds and 130 seconds ( P<0.05). For the adhesion evaluation, both the water-absorbency and adhesion to tissue of NWL-K were better than common gauze and SURGICEL. Conclusions:For hepatic and splenic bleeding wounds, compared with other types of gauze, the application of NWL-K can effectively shorten the time to hemostasis and reduce the blood loss. The NWL-K shows high water-absorbency and firm adhesion to bleeding wound.