Objective To study risk factors associated with predisposition to Lm -ABM in adult patients and to evaluate the clinical features,management and out in this cohort of patients because Listeria monocytogenes (Lm) is the third most common cause of acute community acquired bacterial meningitis (Ac-ABM),after Streptococcus pneumoniae and Neisseria meningitides aetiologies.Methods A descriptive,prospective study carried out in a tertiary grade medical center emergency department in Beijing over a 10 -year period.During the study period,15 patients of Lm- ABM were included.Comparison of episodes of Lm - ABM versus other aetiologies was made.Results Fifteen episodes of Lm - ABM were identified in327 adult Ac - ABM patients.Three cohorts of individuals were vulnerable to Lm - ABM:the elderly ( RR=3.14; 95％ CI 1.84-5.35),the immunocompromised (RR =3.34; 95％ CI2.08-5.38),and pregnant women ( RR 12.48 ; 95％ CI 3.29 ～ 47.39 ).The classic triad of fever,neck stiffness,and altered mental status was present in 40％ (6 of 15) Lm - ABM patients.Similarly,40％ patients had at least one of cerebrospinal fluid (CSF) samples with features met the criteria of typical bacterial meningitis.The coverage of empirical antimicrobial therapy was microbiologically inadequate for 13 ( 86.7％ ) patients.The mortality rate was 33.3％ (5 of 15),and 7 (46.7％ ) of 15 patients led to an unfavorable outcome ( GOS ＜ 4),both of which were significantly higher than those in other aetiologies of Ac - ABM ( P =0.015P =0.009 respectively). Conclusions Our study showed the elderly,the immunocompromised patients,and pregnant women predisposed to Ac - ABM most likely to be Listeria monocytogenes aetiology.In contrast with similar previous reports, the current study showed that patients with meningitis due to Listeria monocytogenes did not present with atypical clinical features.A high proportion of patients received empirical antimicrobial therapy that did not cover Listeria monocytogenes.Lm - ABM is still a serious disease that leads to high morbidity and mortality rates.With these important caveats in mind,our findings have implications for clinical practice and food safety policy makers.

Objective:To analyze the changes of mean arterial pressure (MAP) and end expiratory carbon dioxide (ETCO 2) in patients after emergency endotracheal intubation (ETI). To explore the values of MAP and ETCO 2 monitoring in early prediction of severe cardiovascular collapse (CVC) after emergency ETI. Methods:The clinical data of adult patients who underwent ETI from March 2015 to May 2020 were collected consecutively in the emergency departments of Peking Union Medical College Hospital. The values of MAP and ETCO 2 were observed and recorded at 5, 10, 30, 60 and 120 min after intubation. According to whether severe CVC occurred after ETI, the patients were divided into the severe CVC group and non-severe CVC group. The values of MAP and ETCO 2 were compared at the same time points between the two groups and the adjacent time points within the groups. The correlation between MAP and ETCO 2 after ETI was also analyzed. ROC curve was used to analyze the ability of MAP and ETCO 2 at 5 min and 10 min after ETI to predict severe CVC. Results:Totally 116 patients were enrolled in this study, among them 75 (64.7%) cases had severe CVC after ETI. The majority were male and elderly patients in the severe CVC group. The values of MAP and ETCO 2 in 5, 10, 30, 60 and 120 min after ETI in severe CVC group were significantly lower than those in the non-severe CVC group. The values of MAP and ETCO 2 in the two groups showed simultaneous decrease from 5 min to 30 min after ETI, reached the lowest value at 30 min after ETI, and appeared the synchronous recover from then to 120 min after ETI. After ETI, the changes of MAP was correlated with that of ETCO 2 ( rs = 0.653, P<0.01). At 5 min after ETI, MAP could predict severe CVC (AUC=0.86, P<0.01), MAP≤72 mmHg was the best cutoff value (sensitivity 78.7%, specificity 87.8%); ETCO 2 could also predict severe CVC (AUC=0.85, P<0.01), and ETCO 2≤35 mmHg was the best cutoff value (sensitivity 77.3%, specificity 85.4%). At 10 min after ETI, MAP could predict severe CVC (AUC = 0.90, P<0.01), MAP≤67 mmHg was the best cutoff value (sensitivity 89.3%, specificity 85.4%), ETCO 2 could also predict severe CVC (AUC=0.87, P<0.01), and ETCO 2≤33 mmHg was the best cutoff value (sensitivity 81.3%, specificity 78.0%). There was no significant difference in the ability of prediction between any two indexes of the MAP and ETCO 2 at 5 min and 10 min after ETI ( P>0.05). Conclusions:Patients with severe CVC after ETI have early signs of decreased MAP and ETCO 2, but the delayed recognition and insufficient intervention may be related to the occurrence and development of severe CVC. MAP and ETCO 2 at the early stage after ETI have high accuracy in predicting severe CVC. MAP≤72 mmHg, ETCO 2≤35 mmHg at 5 min after intubation, MAP≤67 mmHg and ETCO 2≤33 mmHg at 10 minutes after intubation all suggest the possibility of severe CVC.

Objective: To investigate the acquired drug-resistant genes and strains relationship in 40 strains of Pseudomonas aeruginosa isolated from burn patients. Methods: Forty strains of Pseudomonas aeruginosa isolated from burn patients hospitalized in our burn department from January 2014 to December 2015 were selected, with 20 strains from each year. Kirby-Bauer paper disk diffusion method was used to detect sensitivity of the isolated Pseudomonas aeruginosa to 9 kinds of antibiotics of cefotaxime, ceftazidime, cefepime, imipenem, meropenem, gentamicin, amikacin, ciprofloxacin, and levofloxacin. Polymerase chain reaction was applied to detect 9 kinds of acquired β-lactamase antibiotics-resistant genes, outer membrane porin protein oprD2 genes, 12 kinds of acquired aminoglycosides antibiotics-resistant genes, and 6 kinds of acquired disinfectant-resistant genes and genetic marker genes of mobile genetic elements. Among the above genes, positive expression genes were verified by DNA sequencing and comparison. Sequences of twenty-eight acquired drug-resistant genes of the above 40 Pseudomonas aeruginosa strains were analyzed by unweighted pair-group method with arithmetic means cluster analysis. Results: Forty strains of Pseudomonas aeruginosa were resistant to the above 9 kinds of antibiotics. Two kinds of acquired β-lactamase antibiotics-resistant genes of bla_TEM, bla_CARB, 5 kinds of acquired aminoglycosides antibiotics-resistant genes of aac(6′)-Ⅰb, aac(6′)-Ⅱ, ant(2″)-Ⅰ, ant(3″)-Ⅰ, and rmtB, and 3 kinds of acquired disinfectant-resistant genes and genetic marker genes of mobile genetic elements of qacE△1-sul1, merA, and intⅠ1were detected in 40 strains of Pseudomonas aeruginosa with oprD2 gene deficiency. Forty strains aggregated obviously, with a total of 7 gene modes and 3 clones. Drug-resistant gene sequences of strains of number 2 to 4, 6 to 9, 11, 14, and 17 to 39 were similar and with close relationship. Drug-resistant gene sequences of number 12 and 13 strains were similar and with close relationship. Drug-resistant sequences of number 10 and 16 strains were similar and with close relationship. Conclusions Genes of bla_TEM, bla_CARB, aac(6′)-Ⅰb, aac(6′)-Ⅱ, ant(2″)-Ⅰ, rmtB, qacE△1-sul1, merA, and intⅠ1 were prevalent in these strains of Pseudomonas aeruginosa with oprD2 gene deficiency isolated from burn patients, which may play key roles in resistance of Pseudomonas aeruginosa to β-lactamase, aminoglycoside, and quinolone antibiotics, and the drug-resistant phenotypes were in good coincidence with genotypes. Pseudomonas aeruginosa strains isolated from burn patients were with similar acquired drug-resistant genes and close relationship.

Objective To investigate the epidemiology and features of severe poisoning.Methods A retrospective analysis of patients with severe poisoning admitted into the emergency intensive care unit of Peking Union Medical College Hospital from February 2008 to March 2010 was made.Results A total of 138 patients consisting of 45 males and 93 females were enrolled.The average age was 39.2 years.Committed suicide with toxic agents was the major cause of poisoning (76.8％ ),followed by alcoholism (8.7％ ) and misuse of medicine (5.8％).Of them,96.4％ patients were poisoned by swallowing poison agents,and 45.7％ patients were treated with gastric lavage and 15.2％ of patients with hemofiltration.Mortality was 3.62％.Conclusions Our study presents the current status of acute severe poisoning in the large general hospital.

Objective To assess the value of indocyanine green excretion test in predicting hepatic failure after hepatectomy. Methods The retention rate of indocyanine green at 15 minutes (ICG R15), effective hepatic blood flow (EHBF) and clinical and biochemical parameters of 128 patients who received hepatectomy at the Affiliated Provincial Hospital of Anhui Medical University from June 2007 to June 2008 were detected by pulse dye densitometry. All patients were divided into non-hepatic failure group (n = 110) and hepatic failure group (n =18). ICG R15, EHBF, Child's score, histology activity index (HAI) score, clinical and biochemical parameters and other indexes were analyzed to predict hepatic failure by the t test, chi-square test, linear regression analysis or regression model. The relationship between positive predictive indexes and HAI score was studied. Results Eighteen patients suffered from hepatic failure after operation. ICG R15, Child's score, HAI score of patients without hepatic failure were 9% ±4%, 5.6 ±0.7, 3.8 ±0.5, which were significantly lower than 15% ±6%,6.1 ± 0. 8, 5.0 ± 0. 8 of patients with hepatic failure (t = 11. 121,2. 356, 3. 915, P ＜ 0.05). EHBF of patients without hepatic failure was (1.2 ±0.2) L/min, which was significantly higher than (1.0 ±0.2) L/min of patients with hepatic failure (t = 2. 802, P ＜ 0. 05). In a logistic regression model, age ≥ 65 years, ICG R15 ≥ 14% and EHBF ＜ 1.0 L/min were risk factors of postoperative hepatic failure (x2 = 4. 758, 9.709, 5. 362, P ＜ 0.05).ICG R15 was negatively correlated with EHBF (r =-0. 527, P ＜0.05). HAI score was positively correlated with ICG R15 (r =0. 638, P ＜0.05), while it was negatively correlated with EHBF (r =-0. 445, P ＜0. 05).Conclusions ICG R15 and EHBF are good predictive indicators for hepatic failure after hepatectomy. Patients with ICG R15≥14% and EHBF ＜ 1.0 L/min are prone to have postoperative hepatic failure.

Objective To evaluate the differences of α-fetoprotein (AFP), ffeeβ-human chorionic gnnadotropin (HCG) indexes in 3 foreign median databases for antepartum risk screening, and establish the median databases of normal pregnant women in Wenzhou for antepartum screening of AFP, free-β-HCG indexes through the suitable median computational models. Methods The levels of AFP and free β-HCG of 20054 normal pregnant women in Wenzhou were detected by time-resolved fluorometry. The data in this paper were compared with the data of 2T-risk ( 2T), Lifecycle-2. 2 (LC2.2 ) and Lifecycle -3.0 (LC3.0) by double-factor ANOVA. The differences between the data in the paper and the data from Shenyang and Ningbo were analyzed. The median database of Wenzhou pregnant women was established by the suitable regression model, with the stability of nonlinear regression models of the 3 software assessed by model correcting fitting, distribution mean of model fitting logarithmic and standard deviation. Results The levels of AFP and freeβ- hCG reported here were 10% and 16% higher than the data of 2T-risk, 15% and 20% higher than that of LC 2. 2, 6% and 17% higher than that of LC 3.0 respectively. The differences were statistically significant. ( FAFP = 161. 757 ,P < 0. 01 ; Ffree-β-HCG = 58. 261, P < 0.01 ). The levels of AFP and free β- hCG in Wenzhou were 2% higher and 3% lower than that of Shenyang, 1% and 2% higher than that of Ningbo. There was no statistical difference of AFP levels among Wenzhou , Shenyang and Ningbo( FAFP = 0. 174 ,P =0. 840) while the differences of free-β-hCG were statistically significant( F<,free-β-HCG> = 13.303 ,P < 0. 01 ). The differences of quadratic equation regression model, exponent quadratic function regression model and exponent quadru-function regression model of 2T, LC-2. 2 and LC-3.0 were not remarkable. The exponent quadru-function regression model was the best. Conclusions There are significant differences between the data from Wenzhou, Shenyang and Ningbo and the data of T-2 risk, LC-2. 2, LC -3.0. The discrepancy is due to the ethnic and different parameters of regression models. So the model parameters and the median databases are urgently required in China. The differences of large sample size of AFP from Wenzhow, Shengyang and Ningbo are not significant, while the differences of free-β- hCG from Wenzhow, Shengyang and Ningbo is remained because of its instability. The levels from Wenzhow and Ningbo are near. It is suggested that the laboratories with small sample size can establish their own laboratory parameters using the reference obtained from large sample size under the same experimental conditions. There are no significant differences of stability among regression computational models in the 3 software. The exponent quadru-function regression model can be used to establish the median databases for the screening with the similar data distribution in the paper.

Objective To compare the effects of standard decompressive craniectomy (DC) vs.combined cisternostomy on severe traumatic brain injury (STBI).Methods Seventy-two patients with severe brain injury were divided into standard decompressive craniectomy group (control group,n=34) and DC combined cisternostomy group (treatment group,n=38).The clinical parameters from pre-and post-surgery were compared between the two groups.Results There was no statistical difference in clinical data including gander,age,injury causes,GSC score,Helsinki CT score and operative opportunity between two groups before surgery (P＞0.05).The treatment group was inferior in the duration of decompression (2.8±0.4 h vs.2.5±0.3 h,P＜0.05) relative to control treatment group.However,treatment group were superior to control group in the mean time of admission in neuro-intensive care unit (5.54±3.09 d vs.7.24±2.74 d,P＜0.01),the cumulative time of intracranial pressure (ICP) more than 20 nmHg within seven days after surgery(23.2±4.4 h vs.56.8±8.3 h,P＜0.01),Helsinki CT scores at postoperative day (3(2,5) vs.5(2,9),P＜ 0.01)and Glasgow Outcome Scores (GOS) at 3 month after surgery (P＜0.01).Conclusion DC combined with cisternostomy for STBI is significantly better than standard decompressive craniectomy,which is worth further study by multicenter clinical trials.

The effects of liraglutide on glucose and lipid metabolism, fibroblast growth factor-21 ( FGF-21 )and its receptors (FGFR) in APoE-/-mice with hypoadiponectinemia were investigated.Hypoadiponectinemia facilitated disturbance in glucose and lipid metabolism and insulin resistance. Compared with the control mice, FGF21 mRNA and protein expressions of liver and adipose tissues as well as plasma FGF-21 level were significantly increased in ApoE-/-mice with hypoadiponectinemia, along with lowered expressions of FGFR1 and β-klotho mRNA in adipose tissues, and expressions of FGFR1-3 and β-klotho mRNA in liver. Liraglutide administration improved glucose and lipid metabolism and insulin resistance, and partially reversed the changes of FGF-21 and its receptors induced by hypoadiponectinemia.

Objective:To evaluate the accuracy of CHANNEL process in predicting difficult airway of patients in emergency department.Methods:From July 2016 to December 2019, we selected patients who underwent airway management in the emergency department of Peking Union Medical College Hospital. They were evaluated by CHANNEL and improved Mallampati (modified Mallampati test, MMT) classification at the same time. After completion, the glottis was exposed under direct laryngoscope, and then Cormack Lehane classification was performed. Difficult airway was defined as Cormack-Lehane grade Ⅲ or Ⅳ. The receiver-operating characteristics curve was used to evaluate the accuracy of MMT and CHANNEL in predicting difficult airway.Results:122 of 312 patients who underwent emergency airway management were included in the study. The sensitivity of CHANNEL in predicting difficult airway was 100%, the specificity was 90.1%, the area under the curve(95% confidence interval) was 0.948(0.907~0.988).Compared with MMT, the area under the curve of CHANNEL in predicting difficult airway was significantly increased( P<0.05). Conclusion:CHANNEL can accurately predict difficult airway of patients in the emergency department.

Objective: To analyze the epidemiological characteristics of adult inpatients with gas burns in the Department of Burns of Hwa Mei Hospital of University of Chinese Academy of Sciences (hereinafter referred to as the author′s unit) , so as to provide evidence for the prevention of gas burn. Methods: Medical records of all inpatients with flame burns admitted to the author′s unit from January 2011 to December 2017 were collected. The percentage of adult inpatients with gas burns in total inpatients with flame burns in the same period, and their gender, age, injury season, accident place, burn severity, common compound injury, complication, population caliber, education, industry, as well as the pre-injury disease and prognosis of elderly inpatients with gas burns were retrospectively analyzed. In addition, the age, accident place, education, and industry of the floating population in the adult inpatients with gas burns were analyzed separately and compared with the total population of adult inpatients with gas burns in 7 years. Data were processed with chi-square test or Fisher′s exact probability test (Monte Carlo algorithm). Results: During the 7 years, 1 490 inpatients with flame burns were admitted to the author′s unit, among which 511 were adult inpatients with gas burns, accounting for 34.30%. The number of adult inpatients with gas burns increased gradually during the 7 years, but its percentage in the total inpatients with flame burns during the same period showed no significant difference (χ²=7.087, P>0.05). Among the 511 adult inpatients with gas burns (hereinafter referred to as the patients in this group), there were 315 males and 196 females, with a male/female ratio of 1.61 to 1.00, and the middle-aged patients were the most, up to 270 cases, accounting for 52.84%. The distribution of adult inpatients with gas burns during the 7 years was significantly different in gender and age (χ²=54.810, 27.832, P<0.01). Among the patients in this group, most were injured in summer, totally 251 cases, accounting for 49.12%, and the accident place was mainly at home, totally 388 cases, accounting for 75.93%. The distribution of adult inpatients with gas burns during the 7 years was significantly different in injury season (χ²=42.254, P<0.01), but not in accident place (χ²=6.782, P>0.05). The patients in this group were mainly with moderate burns (237 cases, accounting for 46.38%), and the distribution trend of burn severity of adult inpatients with gas burns was basically the same during the 7 years (χ²=19.680, P>0.05); 176 patients (34.44%) were accompanied by inhalation injury, and 30 patients (5.87%) were accompanied by blast injury of lung; post injury complications occurred in 20 patients (3.91%). In the elderly inpatients with gas burns, 44.44% (32/72) were accompanied by pre-injury basic diseases, and the proportion of death or unhealed reached 18.06% (13/72). Most of the patients in this group were permanent residents (358 cases, accounting for 70.06%) and received secondary education (304 cases, accounting for 59.49%), and the majority of them were engaged in manufacturing/construction (138 cases, accounting for 27.01%), self-employed business (90 cases, accounting for 17.61%), and catering (90 cases, accounting for 17.61%) industries. The distribution of adult inpatients with gas burns during the 7 years was significantly different in population caliber, education, and occupation (χ²=17.496, 29.898, 88.896, P<0.05 or P<0.01). Among the patients of this group, the floating population were mainly young (90 cases, accounting for 58.82%) and middle-aged (62 cases, accounting for 40.52%), with main accident place at home (97 cases, accounting for 63.40%), generally received secondary education (101 cases, accounting for 66.01%), and were mainly engaged in manufacturing/construction (71 cases, accounting for 46.41%), self-employed business (26 cases, accounting for 16.99%), and catering (20 cases, accounting for 13.07%) industries. Compared with the total adult inpatients with gas burns in 7 years, the floating population were younger, more injured in the workplace, and more concentrated in industry (χ²=42.924, 9.390, 27.819, P<0.01). Conclusions Gas burn was the leading injury cause of inpatients with flame burns in the author′s unit, which mainly occurred in summer and at home; the patients were mainly male, young and middle-aged, and permanent residents, most of which were with moderate burn, often accompanied by inhalation injury. Most of the patients were of secondary education, engaged in manufacturing/construction, self-employed business, and catering industries, among which the floating population were younger, more injured in the workplace, and more concentrated in industry. In order to prevent gas burn, we should pay more attention to the propaganda and education of gas safety among young and middle-aged men, floating population, retired old people and housewives, especially in summer, we should do a good job in gas safety inspection at home. In addition, we should urge enterprises to further strengthen the supervision of production safety.