Objective:To construct a nomogram model for predicting the occurrence of acute kidney injury (AKI) in patients with cardiac arrest (CA) after cardiopulmonary resuscitation (CPR), and to verify its validity for early prediction.Methods:The study retrospectively included patients aged 18 years and older who received CPR for CA and were admitted to the emergency room of Tianjin Medical University General Hospital from February 2016 to September 2023. The general information, underlying diseases, resuscitation related indicators, and first laboratory test results of patients were collected. The patients were randomly divided into training and validation groups at a ratio of 7:3. AKI diagnosis was based on the diagnostic criteria of the Kidney Disease Improving Global Outcomes. Univariate and multivariate logistic regression models were used to identify independent risk factors for AKI in patients with cardiac arrest, and a nomogram was constructed on the basis of the independent risk factors. The predictive performance was evaluated by the area under the curve (AUC) of the receiver operating characteristic. The calibration curve, decision curve and clinical impact curve were used to evaluate the model. Bootstrap and cross validation methods were used for internal validation.Results:A total of 527 patients with cardiac arrest were included in the study, 230 patients developed AKI, with an AKI incidence of 43.6%. There was no statistically significant difference in clinical baseline data between the training and validation groups (all P>0.05), indicating comparability between the two groups of data. Multivariate logistic analysis revealed that age ( OR=1.346, 95% CI: 1.197-1.543, P<0.001), CA to CPR time ( OR=2.214, 95% CI: 1.512-3.409, P=0.016), adrenaline dosage ( OR=1.921, 95% CI: 1.383-2.783, P=0.004), APACHE-Ⅱ score ( OR=1.531, 95% CI: 1.316-1.820, P<0.001), baseline creatinine ( OR=1.137, 95% CI: 1.090-1.196, P<0.001), and lactate ( OR=2.558, 95% CI: 1.680-4.167, P<0.001) were the independent risk factors for AKI in patients with cardiac arrest. Initial defibrillable rhythm ( OR=0.214, 95% CI: 0.051-0.759, P=0.023) was a protective factor for AKI in patients with cardiac arrest. A nomogram prediction model was constructed based on the above variables. The AUC of the training group was 0.943 (95% CI: 0.921-0.965) and that of the validation group was 0.917 (95% CI: 0.874-0.960). This prediction model demonstrated good discrimination, calibration and clinical applicability. Conclusions:A nomogram predictive model was constructed on the basis of age, CA to CPR time, initial defibrillable rhythm, adrenaline dosage, the APACHE-Ⅱ score, and baseline creatinine and lactate levels. This nomogram has good predictive value for the early occurrence of AKI in patients with cardiac arrest after cardiopulmonary resuscitation, which can provide new strategies for the early identification of AKI and precise intervention.

Objective:To develop and validate an interactive network dynamic nomogram for early prediction of poor neurological prognosis in patients with post-cardiac arrest brain injury (PCABI).Methods:A retrospective study was conducted on hospitalized patients who achieved return of spontaneous circulation after cardiac arrest at Tianjin Medical University General Hospital between January 2020 and April 2024. Patients were classified into favorable and poor prognosis groups based on the Glasgow-Pittsburgh Cerebral Performance Category at discharge. Eligible patients were randomly assigned to a training cohort and an internal validation cohort in a 7:3 ratio. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of poor neurological outcomes in PCABI, which were subsequently used to develop a nomogram prediction model. The predictive performance of the nomogram was evaluated by comparing its area under the curve (AUC) of receiver operating characteristic with those of individual predictors using the DeLong test. Model calibration and clinical utility were assessed using calibration curves and decision curve analysis, respectively. Internal validation was conducted, and an interactive dynamic nomogram was developed using web-based visualization techniques.Results:A total of 276 PCABI patients were enrolled (training set: 196; validation set: 80), with 82 cases (29.7%) classified as poor prognosis. Multivariate logistic regression analysis identified age ( OR=1.071, 95% CI: 1.021-1.124, P=0.005), APACHEⅡ score ( OR=1.746, 95% CI: 1.393-2.190, P<0.001), initial shockable rhythm ( OR=0.142, 95% CI: 0.025-0.819, P=0.029), defibrillation ( OR=0.228, 95% CI: 0.060-0.869, P=0.030), cardiopulmonary resuscitation duration ( OR=2.116, 95% CI: 1.487-3.010, P<0.001), and lactate level ( OR=1.392, 95% CI: 1.005-1.927, P=0.047) as independent predictors of poor neurological outcomes in PCABI. A nomogram prediction model was developed based on these factors, achieving an AUC of 0.965 (95% CI: 0.939-0.989) in the training cohort and 0.987 (95% CI: 0.967-1.000) in the internal validation cohort. The nomogram demonstrated significantly superior predictive performance compared to individual predictors ( P<0.001) and exhibited excellent discrimination, calibration, and clinical net benefit. The interactive dynamic nomogram, developed through web-based visualization, further enhanced its applicability in clinical practice. Conclusions:The interactive network dynamic nomogram, developed based on age, APACHEⅡ score, initial shockable rhythm, defibrillation, cardiopulmonary resuscitation duration, and lactate level, demonstrated favorable predictive value for poor neurological outcomes in PCABI. This tool facilitates clinical application and offers a novel strategy for early identification and targeted interventions in high-risk patients.

Objective:Taking emergency department (ED) as a starting point, to analyze the epidemiological characteristics and mortality risk factors of sepsis, and to provide evidences for ED to carry out the strategy of "three early and two lower" for sepsis.Methods:Based on the ED and inpatient medical record management information platform of Tianjin Medical University Gernal Hospital, adult ED patients with sepsis from January 1, 2017 to December 31, 2020 were included according to the third international consensus definitions for sepsis and septic shock in 2016 and the consensus of Chinese experts on early prevention and blocking of sepsis in 2020. The epidemiological characteristics of patients were retrospectively analyzed. Chi-square test was used to compare the difference of age, sex, hospitalization times, length of stay, hospitalization cost and infection location between dead patients and survival patients, and a stepwise logistic regression model was used to analyze the influencing factors of mortality in hospitalized patients with ED sepsis.Results:A total of 7 494 patients with sepsis in ED were included in this study, and the annual and monthly component ratios varied from 3.8‰ to 6.1‰ and 2.0‰ to 9.0‰, respectively. The main characteristics of patients with sepsis in ED were as follows: 40-69 years old (46.0%), male (59.0%), mostly diagnosed with sepsis (96.8%), mainly treated with urban health insurance (59.6%), and ED diagnosis and treatment fees of 2 000-8 000 Yuan (51.1%). The mortality of hospitalized patients with ED sepsis was 24.4% and that of hospitalized patients with septic shock was 28.8%. The main characteristics of hospitalized patients with ED sepsis were as follows: most of them were male (56.2%) patients over 70 years old (56.0%), most of them were diagnosed with sepsis (94.0%) and hospitalized for the first time (76.0%), the median hospitalization time was 15 d, most of them were hospitalized under urban health insurance (65.2%), and the median hospitalization fees was 47 000 Yuan. The risk factors of death were influenced by age and length of stay. Patients aged 70 years or older had a higher risk of death than those aged from 18 to 39 years, and patients with a length of stay of more than 7 d had a lower risk of death than those with a length of stay of shorter than 7 d. The primary infection focus were mainly respiratory and urinary systems, while the death rate of patients with hematological and abdominal infections was relatively high, and the difference was statistically significant ( P<0.01). Respiratory and abdominal infections were risk factors for death in patients with ED sepsis. Conclusions:The composition ratio of sepsis in ED patients is not regular in time, so vigilance of sepsis in elderly men and patients with respiratory system, blood system, urinary system and abdominal infections should be constantly raised. Patients with sepsis who are older, hospitalized more frequently, hospitalized for a shorter time, and infected in the respiratory system or abdomen have a higher risk of death.

Objective:To compare the ability of Vancouver chest pain rule, Triage Rule-out Using high-Sensitivity Troponin accelerated diagnostic protocol and Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol in rapid assessment of patients with chest pain.Methods:Patients with chest pain suggestive of acute coronary syndrome were recruited from January 2017 to February 2017 in Emergency Department of Tianjin Medical University General Hospital. Patients were stratified into various risk groups with Vancouver chest pain rule, Triage Rule-out Using high-Sensitivity Troponin accelerated diagnostic protocol and Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol. The end point was acute myocardial infarction (AMI) within 30 days.Results:A total of 134 patients were enrolled. Fifty-seven patients were preliminary classified as a low risk for suitable discharge by Triage Rule-out Using high-Sensitivity Troponin accelerated diagnostic protocol, and one of them had AMI within 30 days. The sensitivity of stratifying low-risk patient was 83.3%, the specificity was 43.8%, and the negative predictive value was 98.2%. Fifty-one patients were preliminary classified as a low risk for suitable discharge by Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol, and none of them had AMI within 30 days; the sensitivity of stratifying low risk patient was 100%, the specificity was 39.8%, and the negative predictive value was 100%. Twenty-four patients were preliminary classified as a low risk for suitable discharge by Vancouver chest pain rule, and none of them had AMI within 30 days; the sensitivity of stratifying low risk patient was 100%, the specificity was 18.8%, and the negative predictive value was 100%.Conclusions:Using accelerated diagnostic protocols to stratify emergency department patients with chest pain achieved early and safe emergency department discharge. The Emergency Department Assessment of Chest pain Score accelerated diagnostic protocol stratified more than 30% of low-risk patient, with a sensitivity of no less than 98% and a specificity of no less than 99.5%.

Objective To show epidemiological characteristics of adult emergency patients and to provide data support for grading clinics.Methods Adult emergency patients (older than 14 years) from 50 hospitals in Tianjin were included.Name,gender and age of patients,as well as visiting time/department,chief complaint,severity of the disease,prognosis were considered to cross-sectional survey from 8:00,30 Aug 2016 to8:00,31 Aug 2016.Chi-squared test,Fisher's exact test,or t test was used to statistical analysis as appropriate.Results Of 6 569 patients,most originated from medical (n =3 964,60.34％) and surgical (n =2 017,30.31％).Patients' average age was 46.90 ± 18.70 (14-99) years old and there were more patientsaged from 30 to 39 (n =1 285,19.56％).Hospital crowded periods were between 8:00-11:00 and 17:00-22:00.In these periods,average number of patients was more than 300.Concerning the severity of disease,83 patients (1.26％) were in grade 1 (the most severe cases),301 patients (4.58％) in grade 2,1 500 patients (22.83％) in grade 3,and 4 685 patients (71.33％) were in grade 4 (the less severe cases).Most ambulatory patient represented trauma (n =124,35.23％),neurological (n =68,19.32％) and cardiovascular (n =49,13.92％) diseases.However,50.57％ of them were not considered urgent.Conclusions Most patients visited emergency department were nonurgent and originated from medical and surgical department in Tianjin.Crowded periods gathered at 8:00-11:00 and 17:00-22:00.Most ambulatory patients were trauma,neurological and cardiovascular disease;however,half of them was stable and need no emergency intervention.

Objective To investigate the effects of different control methods in cuff pressure (Pcuf) on the incidence of ventilator associated pneumonia (VAP) for the patient receiving mechanical ventilation with implication of artificial airway by oral endotracheal intubation.Methods A total of 80 patients receiving mechanical ventilation with oral endotracheal were numbered according to the order of using mechanical ventilation. Patients with odd numbers were recruited into intervention group (40 cases), while patients with even numbers were included in control group (40 cases). Patients in intervention group used Arto continuous air pressure control device to continuously control the cuff pressure, while the control group used German VBM airbags pressure gauge to measure and regulate cuff pressure three times a day. Sputum specimens of patients were taken and pepsin levels were tested at tracheal intubation, 48 h and 96 h post mechanical ventilation. Pcuf, pepsin levels in sputum specimens and the incidence of VAP were compared between two groups.ResultsAt 96 h post mechanical ventilation, Pcuf of patients in intervention group were in the ideal range (20~30cmH2O) for 479 times, and in control group the number were 389 times. The difference was statistically significant (χ2=124.830,P<0.01). The pepsin levels of sputum specimens in intervention group were (617.32±67.13) and (653.13±71.32) ng/ml at 48 h and 96 h post mechanical ventilation, both of which were significantly lower than those in control group (t=-11.217,-14.500;P<0.01). The incidences of VAP were 25.0% and 47.5% in intervention and control group respectively, with statistically significant difference between two groups (χ2=4.381,P<0.05).Conclusions The continuous air pressure control device can better keep the air pressure in the ideal range and reduce gastric contents aspiration of the patients with mechanical ventilation so as to reduce the incidence of VAP.

Objective To observe the effects of hemoperfusion on homeostasis in patients with acute poisoning.Methods The data of 26 acute poisoning patients treated with hemoperfusion were retrospective analyzed.The clinical data included blood pH,PvCO2,PvO2,blood lactate,potassium,free-calcium,bicarbonate and blood glucose assayed and recorded at 0 min,30 min and 120 min after hemoperfusion.The statistical software SPSS 18.0 was utilized to analyze the statistical differences in the above biomarkers among three different intervals after hemoperfusion.Results At the beginning of hemoperfusion therapy,levels of homeostasis indicators were pH (7.36 ± 0.05),PvCO2 (41.0 ± 8.8) mmHg,PvO2 (37.0 ± 11.8)mmHg,lactate (1.35 ± 1.00) mmol/L,potassium (3.1 ± 0.5) mmol/L,sodium (136.3 ± 4.8)mmol/L,free-calcium (0.95 ± 0.11) mmol/L,blood glucose (7.90 ± 3.47) mmol/L,bicarbonate (22.8±3.3) mmol/L.At30min,the levels of those were (7.36±0.04),(40.0±5.7) mmHg,(41.0±7.5) mmHg,(1.11 ±0.57) mmol/L,(3.1±0.4) mmol/L,(137.3 ±5.4) mmol/L,(0.94 ±0.12) mmol/L,(6.20 ± 1.55) mmol/L,(22.2 ±2.3) mmol/L,respectively.At 120 min,the levels of those were (7.35 ± 0.06),(38.0 ± 6.7) mmHg,(46.0 ± 7.9) mmHg,(0.69 ± 0.52)mmol/L,(3.0±0.4) mmol/L,(137.3±5.0) mmol/L,(0.97±0.10) mmol/L,(5.88±1.43)mmol/L,(22.0± 2.2) mmol/L,respectively.Apparently,there were significant statistical difference in PvO2,lactate and blood glucose (P ＜ 0.05) among three different intervals,and no significant statistical differences in other indicators (P ＞ 0.05).Conclusions There were no significant effects of hemoperfusion on relevant indicators in acute poisoning patients.

Construction of learning-oriented hospital must establish a clear goal,and under the guidance of the target,comrehensive mearures of whole advancement must be adopted and staffs study must be emphasized according to their different needs to motivate them,and meanwhile incentive mechanism should be established to realize the benign circulation and sustainable development of construction of learning-oriented hospital.