Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective:To investigate the clinical efficacy and safety of polymyxin B in the treatment of sepsis caused by extensively-drug resistant (XDR) Gram-negative bacteria.Methods:A retrospective analysis of 39 septic patients with XDR Gram-negative bacterial infection treated with polymyxin B in the department of critical care medicine of Xiangya Hospital of Central South University from June 2018 to September 2019 were enrolled. The clinical characteristics, bacterial culture, the sensitivity antibacterial drugs, types and courses of antibiotics, biochemical indexes, and acute physiology and chronic health evaluationⅡ(APACHEⅡ) before and after polymyxin B treatment were collected, to assess microbial clearance and efficacy, drug related adverse effects, and 28-day mortality in septic patients with XDR.Results:Of the 39 septic patients with XDR, 32 (82.1%) were male, with the mean age of (53.6±12.6) years old. The main infection site was pulmonary infection (51.2%), and the treatment courses of polymyxin B were ≥ 5 days. A total of 66 pathogenic bacteria were detected from 39 patients. Among them, with the high estrate of detecting Acinetobacter baumannii of 51.5% (34/66). After treatment with polymyxin B, the results showed that the clearance rate of microorganisms was 65.2% (43/66), the overall effective rate was 59.0% (23/39), and the 28-day all-cause mortality was 41.0% (16/39). There were no significant differences in clinical efficacy and microbial clearance among patients with different treatment groups of polymyxin B [< 10 days, 10-15 days, and > 15 days groups: effective rates were 56.5% (13/23), 54.5% (6/11), 80.0% (4/5), χ2 = 0.999, P = 0.728; the microbial clearance rates were 43.5% (10/23), 54.5% (6/11), and 80.0% (4/5), χ2 = 2.141, P = 0.393]. The effective and microbial clearance rates of the polymyxin B daily doses of 150 mg and 200 mg groups were significantly higher than those of the daily dose of 100 mg [effectiveness: 85.7% (6/7), 87.5% (7/8) vs. 41.7% (10/24); microbial clearance rate: 71.4% (5/7), 87.5% (7/8) vs. 33.3% (8/24), all P < 0.05], however, there were no significant differences in the length of intensive care unit (ICU) stay and mechanical ventilation time among different daily dose groups. The APACHEⅡscore after polymyxin B administration was significantly lower than before administration (all patients: 16.20±9.24 vs. 24.40±4.73, effective patients: 11.30±4.08 vs. 23.00±4.56, both P < 0.05). Four patients with renal injury had an increase in serum creatinine during the administration of polymyxin B, and recovered after discontinuation of the drug without other adverse reactions. Conclusion:Polymyxin B can be used as an effective treatment option for patients with severe infection of XDR Gram-negative bacteria.

Objective To compare the diagnostic efficacy of 68Ga-PSMA-617 PET/CT and multiparameter MRI in the diagnosis of primary tumors of newly diagnosed prostate cancer.and analyze the correlation between SUVmax and clinical parameters of prostate cancer.Methods A retrospective analysis of the clinical data of 104 patients with newly diagnosed prostate cancer who underwent 68Ga-PSMA-617 PET/CT and multi-parametric MRI from June 2017 to April 2018.The final pathological results were used as the gold standard for diagnosis.The age ranged from 42 to 89 years,with an average of (70.4 ± 8.9) years.The median total serum PSA was 18.44 (8.71,48.01)ng/ml.The pathological results were positive in 68 cases and negative in 36 cases.The sensitivity,specificity was calculated,the ROC curve was drawn and AUC value was calculated.The relationship between SUVmax value of prostate cancer and clinical parameters was analyzed.Results The sensitivity of 68Ga-PSMA-617 PET/CT was 95.59％ (65/68) and the specificity was 88.89％ (32/36);the sensitivity of MRI examination was 91.18％ (62/68) and the specificity was 63.89％ (23/36).There were statistical differences between the specificity of the two examination (P =0.012).The ROC curve of 68 Ga-PSMA-617 PET/CT was plotted and the AUC value was 0.954.Among the 104 suspected prostate cancer patients,the median SUVmax of benign prostatic tissue was 3.20(2.83,3.70),and the median SUVmax of prostate cancer tissue was 12.21 (7.48,17.46).Among 68 patients with prostate cancer,there were statistical differences between SUVmax values of prostate cancer tissues with different Gleason scores (P ＜ 0.01),ISUP group (P ＜ 0.01),risk grades (P =0.021),and SUVmax values.There was a positive correlation with Gleason score and ISUP group (r1 =0.7420,P＜0.01;r2 =0.754,P＜0.01).Conclusions The 68Ga-PSMA-617 PET/CT examination had higher diagnostic efficacy than the multiparametric MRI for prostate cancer.The higher the SUVmax value predict the higher grade and higher risk.

Objective: To explore the methodology and efifcacy of transcatheter induced closure in patients with small patent ductus arteriosus (PDA). Methods: A total of 717 PDA patients treated in our hospital from 2005-11 to 2014-08 were summarized and there were 8 patients with small PDA were treated by transcatheter induced closure method including 3 male and 5 female from (1-6) years of age at the mean of (3.9±1.4) years with the body weight of (10-21) kg at the mean of (15.2±3.7) kg. The procedures were performed under local or general anesthesia with right cardiac catheterization and descending aortic arch angiography to observe PDA morphology and to measure PDA diameter at aortic and pulmonary aterial lateral and ductus length. Right catheter along the guide wear was pushed to the narrowest part of PDA and the motion was repeated for several times to stimulate the local area and then, the catheter was kept at PDA aortic lateral about 20 minutes thereafter. Results: Descending aortic arch angiography indicated that no residual shunt at 20 min after catheter partial blockage in all 8 patients, the immediate closure rate was 100%. No patient suffering from re-canalization by 1 year follow-up examination. Conclusion: Transcatheter induced closure of small PDA has minor trauma, no foreign material implantation, with low cost and good effect. It provides a new method for treating such particular type of PDA patients in clinical practice.

OBJECTIVETo evaluate the differences in the autophagy activity of alveolar macrophages between patients with different stages of coal workers' pneumoconiosis (CWP).

METHODSA total of 116 coal workers were investigated in the field. Their lung lavage fluid was collected and purified to obtain alveolar macrophages. The morphological characteristics of autophagy were observed by transmission electron microscopy. The expression of autophagy marker (LC3) and autophagy regulators (Beclin1, mTOR, and p-mTOR) was measured by Western blot. The autophagy activity of alveolar macrophages was compared between dust-exposed subjects and patients with stage I, II, and III CWP.

RESULTSThe autophagy activity of alveolar macrophages differed between patients with different stages of CWP, according to transmission electron microscopy. Patients with stage II CWP had significantly higher protein expression of LC3 II/I and Beclin1 in pulmonary macrophages than those with stage ICWP (P < 0.05); patients with stage III CWP had significantly lower protein expression of LC3 II/I and Beclin1 in pulmonary macrophages than those with stage II CWP (P < 0.05), but had significantly higher protein expression of LC3 II/I and Beclin1 than those with stage I CWP (P < 0.05); patients with stage II CWP had a significantly higher protein expression of Beclin1 than the dust-exposed subjects (P < 0.05). Patients with stage II CWP had significantly lower expression of mTOR and p-mTOR in pulmonary macrophages than the dust-exposed subjects and those with stage I CWP (P < 0.05), while patients with stage III CWP had significantly higher expression of mTOR and p-mTOR than those with stage II CWP (P < 0.05).

CONCLUSIONThe autophagy activity of alveolar macrophages varies between patients with different stages of CWP.

Anthracosis ; pathology ; Apoptosis Regulatory Proteins ; metabolism ; Autophagy ; Beclin-1 ; Biomarkers ; Bronchoalveolar Lavage Fluid ; Coal ; Coal Mining ; Dust ; Humans ; Macrophages, Alveolar ; pathology ; Membrane Proteins ; metabolism ; Microtubule-Associated Proteins ; metabolism ; Occupational Exposure ; Pneumoconiosis ; pathology

Atrioventricular Block ; Heart Septal Defects, Ventricular ; Humans

Objective: To explore the relationship between plasma levels of calcitonin gene related peptide (CGRP) and cardiac function in ventricular septal defect (VSD) children before and after the interventional therapy.
Methods: Our research included 2 groups:VSD group, n=90 containing 43 male and 47 female at the age of (3-12) years and treated in our hospital from 2011-09 to 2012-09, Control group, n=50 healthy children with matched age and gender. The levels CGRP were measured at before and 24 hours, 3 days, 5 days, 3 months after the therapy. The cardiac function as left ventricle end-diastolic diameter (LVEDD), left ventricle end systolic diameter (LVESD), left ventricle end diastolic volume (LVEDV), left ventricle end systolic volume (LVESV) and ejection fraction (EF) were examined by echocardiography at before and after the procedure.
Results: Before interventional procedure, the level of CGRP in VSD group was lower than Control group (35.28 ± 7.25) pg/ml vs (50.90 ± 8.60) pg/ml, t=11.42, P<0.01. In VSD group, the post-procedural levels of CGRP were increased at all time points, the highest level was at 24 hours and the descending started at 3 days after procedure;the levels of CGRP at before and 24 hours, 3 days, 5 days after the procedure were different as (35.28 ± 7.25) pg/ml vs (102.03 ± 11.73) pg/ml, (35.28 ± 7.25) pg/ml vs (93.36 ± 9.12) pg/ml, (35.28 ± 7.25) pg/ml vs (87.91 ± 8.54) pg/ml, t=27.03, 26.93, 24.51, all P<0.01. In VSD group, the LVEDD, LVESD, LVEDV and LVESV decreased gradually at 5 days, 3 months and 6 months after the procedure;the levels of CGRP were signiifcantly related to LVEDD, LVESD, LVEDV, LVESV at before and 5 days, 3 months after the procedure, all P<0.05.
Conclusion: Plasma levels of CGRP closely related to ventricular cavity diameter, which was important for evaluating the cardiac function in VSD children after the interventional therapy.

BACKGROUND: It is difficult to cover aneurysm-like ventricular septal defect (VSD) of large inlet and multiple outlets completely with symmetrical type occluders or eccentric type occluders. OBJECTIVE: To investigate the feasibility of A4B2 occluder devices for covering aneurysm-like VSD, and to observe the effects of proper occhiders selected according to pseudoaneurysm size on coveting aneurysm-like VSD. DESIGN: Case analysis.SETTING: the First Hospital of Hebei Medical University. PARTICIPANTS: From August 2004 to May 2006, 226 patients with the pseudoaneurysm of petimembranous VSD, who underwent interventional therapy in the First Hospital of Hehei Medical University, were recruited in the study. According to the results of the left ventricular angiography, 36 patients of pseudoaneurysm of petimembranous VSD with large inlet and multiple outlets were closured with A4B2 occluder devices. According to the results of the left ventricular angiography, the mean diameter of the left inlet of VSD was (10.6+8.7) mm (ranged from 8 to 21 mm), the mean diameter of the right outlet of VSD was (3.1 ± 2.9) mm (ranged from 2 to 8 ram). Main materials: Occluder device and delivery mechanism were offered by Shanghai Shape Memory Alloy Materials Company and Beijing Starway Medical Technology Inc. They were processed into double disks using nickel-titanium shape memory alloy wires by a special technology to close VSD by a transcatheter approach. The size of the occluder was denoted with the diameter of the waist, and the Size ranged from 4 to 16 mm in the present study. METHODS: All the occluders were transferred by a 7-10 F transferring sheath from right heart system, and the mean diameter of the occluders was (6.364-2.48) nun (ranged from 4 to 16 ram). Fifteen minutes after the procedure, left ventricular angiography and transthoracic echocardiography (TIE) were performed again to evaluate the efficacy. After the procedure, electrocardiogram (ECG) monitoring lasted for 5 successive days in all patients, and ECG and TIE were performed 1, 3, 6 and 12 months later. MAIN OUTCOME MEASURES: Residual shunt, arrhythmia and valve function as well as blood compatibility. RESULTS: Sixteen cases were closured by placing the occhiders into left inlet of VSD, 16 cases were closured by placing the occluders into the pseudoaneurysm completely, and 4 cases were closured at the outlet of the defects. The results of the left ventricular angiography and TTE that performed fifteen minutes after the procedure demonstrated that 32 cases were completely closured and slightly residual shunts (< 3 mm) was found in other 4 patients. And confirmed by TIE, the residual shunts completely disappeared in 2 of the 3 patients 24 hours later while in the other one in 1 month after the procedure. Temporary left bundle branch block was found in 3 cases while temporary right bundle branch block was found in 2 cases, and all of them recovered within one week. Without severe complications, all of the 36 patients were treated successfully with A4B2 (thin waist shape) occluder devices made in China. Critical appraisal in blood compatibility of the implantation materials used in this research had been performed. The hemolysis ratio was less than 5%, the platelet adhesion was less, and the blood coagulation function ,the immune system response( immunoglobulin and complement)and the re-endothelialization of material surface were all normal. CONCLUSION: Transcatheter interventional therapy with domestic A4B2 occluder devices for VSD with pseudoaneurysm is safe, effective, promising, and has fewer complications. The key to the procedure is to select suitable occluders and suitable positions where to plant them according to the size, morphologic characteristics, position, and maturity of the pseudoaneurysm.