Objective To analyze and discuss the negative effects of atomization inhalation in mechanical ventilation patients in intensive care unit. Methods A retrospective study of all the mechanical ventilation patients in the general ICU of our hospital was carried out from Aprilto December 2015. The risk of multidrug-resistant organisms(MDROs)colonizationin the lower respiratory tract and ventilation associated pneumonia(VAP)in mechanical ventilation patients were analyzed. Results A total of 922 patients were monitored, 160 of whom had atomization inhalation, 92 for MDROs colonizationin the lower respiratory tract and 18 for VAP. The rates ofatomization inhalation in patients with and without MDROs colonizationin the lower respiratory tract were 30.4%(28/92)and 15.9%(132/830)with statistical difference (χ2=12.193, P=0.000). And those in patients with and without VAP were 50.0%(9/18) and 16.7%(151/904), with statistical difference (χ2=11.420, P=0.000). Atomization inhalation was the independent risk factor both of MDROs colonizationin the lower respiratory tract(OR=1.917, 95%CI1.163-3.159, P=0.011) and VAP(OR=4.613, 95%CI 1.773-12.002, P=0.000) in mechanical ventilation patients. Conclusions Atomization inhalation may increase the risk of MDROs colonizationin the lower respiratory tract and VAP in mechanical ventilation patients. Thus unnecessary and too frequent operations of atomization inhalation should be decreased.

Objective To use the fluorescence PCR‐melting curve method to detect CYP2C9 and VKORC1 gene polymorphism in Xinjiang Hui population ,to analyze their gene distribution and gene mutation frequency ,and to evaluate the clinical applicability of the fluorescence PCR‐melting curve method .Methods The fluorescence PCR‐melting curve method and sequencing method were adopted to contrastively detect CYP2C9*2 ,CYP2C9*3 and VKORC1(‐1639G/A)gene polymorphism .Results Among detected 228 Xinjiang Hui individuals ,199 cases of CYP2C9*1/*1 ,2 cases of CYP2C9*1/*2 ,26 cases of CYP2C9*1/*3 and only 1 case of CYP2C9*3/*3 were detected ,no case of CYP2C9*2/*2 and CYP2C9*2/*3 was detected .Two kinds of allele G and A were detected for VKORC1(‐1639G/A) ,in which VKORC1‐1639G/G type was detected in 2 cases ,VKORC1‐1639G/A type was detected in 39 cases and VKORC1‐1639A/A type was detected in187 cases ,compared with the sequencing method ,the results of the fluorescence PCR‐melting curve method were completely consistent .Conclusion Xinjiang Hui population also has CYP2C9 gene *2 ,*3 loci and VKORC1 gene(‐1639G/A) locus polymorphism ,their occurrence frequency has a certain difference with Xingjiang Uygur and other regional populations ,the adopted fluorescence PCR‐melting curve method used in the gene polymorphism detection can meet clinical detection requirements .

Mutations in the CACNA1C gene which encodes the α1C subunit of voltage dependent l-type Ca²⁺ channel can cause mental and cardiovascular diseases.It is the pathogenic gene of Timothy syndrome.Its cardiovascular-system phenotype mainly includes long QT syndrome, Brugada syndrome, short QT syndrome, etc.In recent years, it has been found that CACNA1C gene mutations can also lead to non-syndromic phenotypes, including congenital heart disease, cardiomyopathy, etc, further enriching the clinical phenotype of CACNA1C gene mutation.Now, the recent advances in heart disease phenotypes and mechanisms involved in CACNA1C gene mutations are reviewed.

Objective To compare the advantages and disadvantages of different immunohistochemical methods in detecting isocitrate dehydrogenase-1 (IDH 1) mutations in gliomas,and to optimize the processes these detection.Methods One hundred and thirty-eighty glioma specimens,collected and conformed by pathology in our hospital from January 2013 to December 2013,were used in our study,including 18 of WHO grade Ⅰ,49 of WHO grade Ⅱ,24 of WHO grade Ⅲ and 47 of WHO grade Ⅳ.Manual immunohistochemical method and automatic immunohistochemical instrument were used to detect the IDH1 mutation.PCR-high resolution melting curve analysis (PCR-HRM) was used to verify the above results.Results There were 65.9％ positive specimens those had IDH1 positive tumor cells higher than 75％,and 70.7％ positive specimens those were strong staining.Manual immunohistochemical method enjoyed advantages as clean background,clearness and easy reading,and no interpretation difficulty or false-positive result were noted with this method;while automatic immunohistochemical instrument enjoyed dark background,which led to interpretation difficulty or false-positive result;the results of IDH1 staining had significant differences between and automatic immunohistochemical instrument (x2=22.042,P=0.000).The positive detection rate of automatic immunohistochemical instrument was significantly higher than that of manual immunohistochemical method,and the results of IDH1 detection had no significant difference between manual immunohistochemical method and PCR-HRM (x2=0.800,P=0.371).Conclusions The results of IDH1 detection by manual immunohistochemical method are more accurate than that of immunohistochemical instrument.IDH1 gene mutation only has a relationship with the number of positive tumor cells,and not the staining intensity.The specimen can be considered to IDH1 gene mutation when the positive cells are more than 5％.

Objective:To study the effects of different fluid balance strategies on severe pneumonia patients and explore the possible influence path in order to optimize fluid treatment for severe pneumonia patients.Methods:A total of 89 adult patients with severe pneumonia admitted to EICU and RICU of Jiangsu Provincial Hospital from January 2017 to August 2019 were retrospectively analyzed . The differences of clinical data between the death group ( n=35) and the survival group ( n=54) were analyzed. Multivariate logistic regression analysis was used to identify predictors of 30-day mortality after entering ICU of severe pneumonia patients. Patients were divided into a positive fluid balance (PFB) group ( n=48) and a negative fluid balance (NFB) group ( n=41). Kaplan-Meier survival curve was used to analyze the difference of 30-day survival rate between the PFB and NFB groups. Results:Age ( OR=1.060, 95% CI: 1.018-1.104, P=0.005), ventilator dependency ( OR=6.679, 95% CI: 1.218-36.620, P=0.029), vasoactive agents ( OR=21.068, 95% CI: 4.654-95.376, P<0.001), and new hyperchloremia occurred within 24 h after admission to the ICU ( OR=21.714, 95% CI: 1.059-445.008, P=0.046) were the risk factors for severe pneumonia patients' 30-day mortality after entering ICU. The concentrations of creatinine, urea nitrogen, sodium and chlorine of the NFB patients were lower than those of the PFB patients within 5 days after admission to ICU (day 1-day 5) ( P<0.05). The serum calcium concentrations of the NFB patients were higher than those of the PFB patients on day 3-5 ( P<0.05). The 30-day survival rate was significantly higher in the NFB patients than in the PFB patients ( P<0.001). Conclusions:The strategy of negative fluid balance can reduce serum chlorine concentration, improve renal function and reduce mortality in patients with severe pneumonia.

Objective:To investigate the predictive value of platelet dynamics on the prognosis of 28-day in patients with extracorporeal membrane oxygenation (ECMO).Methods:From January 2017 to December 2020, 60 patients from the Emergency Medicine Center of the First Affiliated Hospital of Nanjing Medical University received ECMO for life support. The baseline data of the patients were collected, the minimum value of platelets on day 1-7 of the machine was calculated, and the platelet change value and change rate were calculated. The patients were divided into the survival group and death group according to the 28-day survival status after ECMO was installed, and the receiver operating curve (ROC) was drawn based on the platelet change value and change rate to evaluate its predictive value for prognosis.Results:Among patients receiving VV-ECMO, the platelet change value and change rate on day 7 had the best prediction effect on the patient's 28-day outcome ( AUCΔPLT7=0.772, P=0.016; AUCΔPLT7%=0.764, P=0.020), when the platelet change value was 4×10 9/L as the critical value, the sensitivity was 0.857, the specificity was 0.615, and when the platelet change rate was -28.99% as the critical value, the sensitivity was 0.857, the specificity was 0.615, and when the platelet change rate was -28.99%. The sensitivity was 0.643 with a specificity of 0.846. In patients receiving VA-ECMO, the platelet change rate on day 6 predicted the best effect on the patient's 28-day outcome ( AUCΔPLT6%= 0.707, P = 0.045). When the platelet change rate was -26.19% as the critical value, the sensitivity was 0.842 and the specificity was 0.643. Conclusions:Platelet dynamic changes of platelets are correlated with the 28-day prognosis of patients receiving ECMO, and the combination of platelet change value and the critical value of change rate can better predict the poor prognosis of patients in both ECMO modes.

Objective:To summarize the experience and effect of extracorporeal cardiopulmonary resuscitation (ECPR) on the treatment of sudden cardiac death (SCD).Methods:The data of 120 adults with SCD-ECPR in emergency department of the first affiliated hospital of Nanjing Medical University from April 2015 to April 2023 were retrospectively analyzed. The patients were grouped by Survival/death at 90 days, OHCA/IHCA (out-of-hospital/in-hospital cardiac arrest), with/without acute myocardial infarction (AMI) and divided according to 60 min of the time from cardiac arrest to extracorporeal membrane oxygenation (ECMO) initiation (CA-Pump On time). Age, sex, Charlson comorbidity index, IHCA/OHCA, initial rhythm, no-flow time, CA-Pump On time, ECMO evacuation success rate, 90-day survival rate, ECMO treatment time were analyzed.Results:①Total of 114 adult patients with SCD-ECPR were enrolled, and 45 (39.5%) patients survived at 90 days, of whom 40 (88.9%) patients had good neurological outcomes.②Age and no-flow time were significantly lower in the 90-day survival group than that in death group, and the proportion of IHCA and shockable initial rhythm was higher. ③The no flow time in IHCA group was significantly lower than that in OHCA group, and the 90-day survival rate was higher. ④OHCA and regional interhospital transport prolonged CA-Pump On time and reduced the 90-day survival rate. ⑤The AMI group was older with a higher Charlson comorbidity index, and the 90-day survival rate was significantly lower than that in non-AMI group.Conclusions:ECPR improves the prognosis of patients with SCD, there are high benefits in patients with long healthy life expectancy, IHCA, shockable initial rhythm, and short no flow time. The smooth life-saving chain of SCD-ECPR improves survival rate, by screening high benefit candidates in patients with OHCA, delayed initiation of ECPR or requiring interhospital transport, despite CA-Pump On time > 60 min, there is still survival potential.

Objective:To investigate the major adverse kidney events (MAKE) in acute myocardial infarction (AMI) with extracorporeal cardiopulmonary resuscitation (ECPR).Methods:The data of 75 patients with AMI-ECPR in Emergency Medicine Department of the First Affiliated Hospital of Nanjing Medical University from April 2015 to April 2023 were retrospectively analyzed. The patients were grouped by survival/death at 90 days, with/without renal replacement therapy (RRT), and whether to initiate RRT because of acute kidney injury (AKI). age, sex, Charlson comorbidity index, OHCA/IHCA (out-of-hospital/in-hospital cardiac arrest), initial rhythm, Gensini score, ECPR initial blood gas pH and lactate value, no-flow time, time from cardiac arrest to extracorporeal membrane oxygenation (ECMO) initiation (CA-Pump On time), ECMO and RRT treatment time, 90-day survival rate were analyzed. Moreover, the renal function of the survivors was followed up.Results:① Total of 68 AMI-ECPR patients were enrolled, 22 (32.4%) patients survived at 90 days, 54 (79.4%) combined with RRT, and 48 (70.6%) MAKE within 90 days. ②Compared with the death group, the 90-day survival group had a higher proportion of initial shockable heart rhythm, a lower Gensini score, a higher ECPR initial blood gas pH and a lower lactic acid value. ③The severity of coronary artery disease, ECPR initial acidosis and hyperlactacemia in the RRT group was significantly higher than that in the non-RRT group, and all the non-RRT group patients survived. ④ There was no difference between the AKI-RRT group and the non-AKI-RRT group. Of 21 patients with stage 1 AKI initiating RRT, 5 survived, one of them still needs RRT for 90 days, and 7 patients with stage 2 to 3 AKI initiating RRT died.Conclusions:The 90-day MAKE rate in AMI-ECPR patients was as high as 70.6%, and the 90-day renal insufficiency rate in AMI-ECPR survivors with AKI was as high as 20.0%. Active initiation of RRT to avoid AKI or early initiation of RRT may improve the prognosis of AMI-ECPR patients.

Objective:To analyze the potential role and prognostic value of platelet-to-lymphocyte ratio (PLR) at an early stage in arterial-venous extracorporeal membrane oxygenation (VA -ECMO).Methods:Totally 83 adult patients with VA-ECMO from June 2018 to June 2020 treated at Emergency Department of Jiangsu Provincial Hospital were retrospectively analyzed. Baseline characteristics between survivors ( n=46) and non-survivors ( n=37) were compared. Logistic regression analysis was used to predict the risk factors associated with 28-day mortality in VA-ECMO patients. The cut-off value was calculated by the receiver operating characteristic (ROC) curve. Results:PLR48-h ( OR=1.018,95% CI: 1.001-1.036, P=0.039) and continuous renal replacement therapy (CRRT) ( OR=7.095,95% CI: 1.099-45.799, P=0.039) were relevant risk factors of 28-day mortality in VA-ECMO patients. The cut-off value of PLR48-h was 156.3 [sensitivity: 57.8%, specificity: 86.1%, and area under the curve (AUC): 0.756]. Compared with the high PLR group (>156.3), the incidences of acute kidney injury (AKI) ( P<0.001) and bleeding events ( P=0.013) were significantly higher in the low PLR group (<156.3). Conclusions:The early PLR reduction and CRRT application during VA-ECMO support are related to poor prognosis.

Objective:To investigate the clinical significance of the acute physiology and chronic health evaluationⅡ (APACHEⅡ) combined with different systematic inflammation markers (SIMs) including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR)-in adult patients with venous-arterial extracorporeal membrane oxygenation (VA-ECMO).Methods:A total of 89 adult patients with VA-ECMO ( ≥ 3 d) in the Emergency Department of Jiangsu Provincial People's Hospital from January 2017 to June 2020 were retrospectively analyzed. Patients were divided into two groups: survivors ( n=39) and non-survivors ( n=50). The baseline APACHE Ⅱscore and PLR, NLR, LMR before ECMO implantation and at 1, 2, 3 day after ECMO were recorded. Binary logistic regression was used to analyze the risk factors of 28-day mortality in patients with VA-ECMO. The utility of APACHEⅡ score and SIMs alone or combination for predicting clinical prognosis was evaluated using receiver operating characteristic (ROC) curve analysis. The patients were divided into the high risk group and the low risk group according to the best cut-off value, and the difference of ECMO-related complications between the two groups was compared. Results:When combined APACHEⅡ score with SIMs, APACHEⅡ + PLR 48 h + LMR 24 h + LMR 72 h demonstrated the greatest predictive ability with an AUC of 0.833. Compared with the high-risk group, the low-risk group has a lower incidence of acute renal injury, infection, bleeding complications, the use of continuous renal replacement therapy, mechanical ventilation, and a higher hospital survival rate.Conclusions:The combination of APACHEⅡ score and SIMs-PLR, LMR- is better than a single one for death prediction, and it is expected to be a new predictive model for early identification of the risk of death or poor prognosis in patients with VA-ECMO.