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.

Patients who initiated peritoneal dialysis (PD) in Sichuan Provincial People's Hospital from January 1, 2001 to December 31, 2013 were enrolled in the single center and retrospective study. Clinical and laboratory data were collected to analyze the long-term survival rates, technique survival rates and associated influencing factors. Patients were followed up until December 31, 2021 or endpoints occurred (death or stopping PD treatment). Kaplan-Meier survival curves were used to estimate survival rates and technique survival rates. Cox proportional hazards regression model was used to analyze the risk factors of death and technique failure in PD patients. A total of 373 patients were enrolled in the study, with age of (52.1±15.8) years old and 199 (53.4%) males. During the follow-up, 154 (41.3%) patients died, 72 (19.3%) patients transferred to hemodialysis, and 40 (10.7%) patients received kidney transplant. Kaplan-Meier survival curves revealed that overall survival rates of PD patients at 1, 3, 5, 7, and 10 years were 92.2%, 76.6%, 66.0%, 52.4% and 38.6%, respectively. Technique survival rates were 93.5%, 84.8%, 74.2%, 62.8% and 44.5% at 1, 3, 5, 7, and 10 years, respectively. Multivariate Cox regression model results showed that age ( HR=1.055, 95% CI 1.039-1.073, P<0.001), transfer from hemodialysis ( HR=2.212, 95% CI 1.514-3.231, P<0.001), episodes of peritonitis ( HR=2.141, 95% CI 1.194-3.837, P=0.011), Charlson comorbidity index ( HR=1.525, 95% CI 1.305-1.783, P<0.001), and baseline albumin ( HR=0.951, 95% CI 0.925-0.978, P<0.001) were independent influencing factors of survival in PD patients. Episodes of peritonitis ( HR=2.327, 95% CI 1.274-4.250, P=0.006) and Charlson comorbidity index ( HR=1.244, 95% CI 1.035-1.496, P=0.020) were independent influencing factors of technique survival in PD patients. PD patients have good early survival rates and technical survival rates, but long-term outcomes need to be further improved. Peritonitis is a major risk factor for low long-term survival rates and technical survival rates in PD patients.

To establish the experts consensus on the management of delirium in critically ill patients.A special committee was set up by 15 experts from the Chinese Critical Hypothermia-Sedation Therapy Study Group.Each statement was assessed based on the GRADE (Grading of Recommendations Assessment,Development,and Evaluation) principle.Then the Delphi method was adopted by 36 experts to reassess all the statements.(1) Delirium is not only a mental change,but also a clinical syndrome with multiple pathophysiological changes.(2) Delirium is a form of disturbance of consciousness and a manifestation of abnormal brain function.(3) Pain is a common cause of delirium in critically ill patients.Analgesia can reduce the occurrence and development of delirium.(4) Anxiety or depression are important factors for delirium in critically ill patients.(5) The correlation between sedative and analgesic drugs and delirium is uncertain.(6) Pay attention to the relationship between delirium and withdrawal reactions.(7) Pay attention to the relationship between delirium and drug dependence/ withdrawal reactions.(8) Sleep disruption can induce delirium.(9) We should be vigilant against potential risk factors for persistent or recurrent delirium.(10) Critically illness related delirium can affect the diagnosis and treatment of primary diseases,and can also be alleviated with the improvement of primary diseases.(11) Acute change of consciousness and attention deficit are necessary for delirium diagnosis.(12) The combined assessment of confusion assessment method for the intensive care unit and intensive care delirium screening checklist can improve the sensitivity of delirium,especially subclinical delirium.(13) Early identification and intervention of subclinical delirium can reduce its risk of clinical delirium.(14) Daily assessment is helpful for early detection of delirium.(15) Hopoactive delirium and mixed delirium are common and should be emphasized.(16) Delirium may be accompanied by changes in electroencephalogram.Bedside electroencephalogram monitoring should be used in the ICU if conditions warrant.(17) Pay attention to differential diagnosis of delirium and dementia/depression.(18) Pay attention to the role of rapid delirium screening method in delirium management.(19) Assessment of the severity of delirium is an essential part of the diagnosis of delirium.(20) The key to the management of delirium is etiological treatment.(21) Improving environmental factors and making patient comfort can help reduce delirium.(22) Early exercise can reduce the incidence of delirium and shorten the duration of delirium.(23) Communication with patients should be emphasized and strengthened.Family members participation can help reduce the incidence of delirium and promote the recovery of delirium.(24) Pay attention to the role of sleep management in the prevention and treatment of delirium.(25) Dexmedetomidine can shorten the duration of hyperactive delirium or prevent delirium.(26) When using antipsychotics to treat delirium,we should be alert to its effect on the heart rhythm.(27) Delirium management should pay attention to brain functional exercise.(28) Compared with non-critically illness related delirium,the relief of critically illness related delirium will not accomplished at one stroke.(29) Multiple management strategies such as ABCDEF,eCASH and ESCAPE are helpful to prevent and treat delirium and improve the prognosis of critically ill patients.(30) Shortening the duration of delirium can reduce the occurrence of long-term cognitive impairment.(31) Multidisciplinary cooperation and continuous quality improvement can improve delirium management.Consensus can promote delirium management in critically ill patients,optimize analgesia and sedation therapy,and even affect prognosis.

Objective To investigate the clinical pathologic features of a distinct variant of focal cortical dysplasia (FCD) characterized by neuronal loss of layer four.Methods Between 2005 and 2017,approximately 3 000 surgeries were performed for the treatment of intractable epilepsy at Xuanwu Hospital,Capital Medical University and Yuquan Hospital,Tsinghua University.Retrospective analysis of clinic-pathological data of patients with epilepsy surgery was made and histological manifestations of neuronal loss of cortical layer four were included in this study.Results In this cohort,25 patients (22 males and three females) were identified with early onset pharmaco-resistant epilepsy and regionally circumscribed neuronal loss of cortical layer four in surgical specimens from the occipital lobe.Histologically,except for neuronal loss in cortical layer four in all cases,glial scar lesions were found in some patients.Thus the histology of those cases can be subdivided into two groups:group A (13 cases):neuronal loss of cortical layer four without glial scar lesions;and group B (12 cases):neuronal loss of cortical layer four with glial scar lesions.Due to the prominent horizontal disorganization of cortical layering and lack of any other microscopically visible principle lesion,group A should be classified hitherto as FCD International League Against Epilepsy (ILAE) type Ⅰ b,however,group B with scar lesions and cortical dysplasia around the main leision,should be classified as FCD ILAE type Ⅲd.This retrospective analysis of clinical histories revealed a perinatal distress in 20 patients (80％),suggesting an acquired pathomechanism.Magnetic resonance imaging revealed abnormal signals in the occipital lobe in all patients,and signal changes suggestive of encephalomalacia were found in 18 patients.Surgical treatment achieved favorable seizure control (Engel class Ⅰ and Ⅱ) in 18 patients (75％ among 24 available follow up).Comparion of the two groups with age at epilepsy onset (group A:5.00±2.76,group B:5.01±3.78),the proportion of perinatal distress (group A:11/13,group B:9/12) and the follow-up results (favorable seizure control of the two groups was 9/13,9/11 respectively) showed that there was no statistically significant difference between the two groups.Conculsion Neuronal loss of cortical layer four in the occipital lobe should be classified as a distinct variant of FCD ILAE type Ⅲd.

Critical ultrasonography(CUS) is different from the traditional diagnostic ultrasound,the examiner and interpreter of the image are critical care medicine physicians.The core content of CUS is to evaluate the pathophysiological changes of organs and systems and etiology changes.With the idea of critical care medicine as the soul,it can integrate the above information and clinical information,bedside real-time diagnosis and titration treatment,and evaluate the therapeutic effect so as to improve the outcome.CUS is a traditional technique which is applied as a new application method.The consensus of experts on critical ultrasonography in China released in 2016 put forward consensus suggestions on the concept,implementation and application of CUS.It should be further emphasized that the accurate and objective assessment and implementation of CUS requires the standardization of ultrasound image acquisition and the need to establish a CUS procedure.At the same time,the standardized training for CUS accepted by critical care medicine physicians requires the application of technical specifications,and the establishment of technical specifications is the basis for the quality control and continuous improvement of CUS.Chinese Critical Ultrasound Study Group and Critical Hemodynamic Therapy Collabration Group,based on the rich experience of clinical practice in critical care and research,combined with the essence of CUS,to learn the traditional ultrasonic essence,established the clinical application technical specifications of CUS,including in five parts:basic view and relevant indicators to obtain in CUS;basic norms for viscera organ assessment and special assessment;standardized processes and systematic inspection programs;examples of CUS applications;CUS training and the application of qualification certification.The establishment of applied technology standard is helpful for standardized training and clinical correct implementation.It is helpful for clinical evaluation and correct guidance treatment,and is also helpful for quality control and continuous improvement of CUS application.

Objective To study the relationship between serum carbohydrate antigen 19-9 (CA19-9) and blood glucose level in patients with type 2 diabetes (T2DM).Methods Totally 784 T2DM patients and 197 healthy controls were enrolled in this study.Age,duration,body mass index (BMI),systolic blood pressure (SBP),diastolic blood pressure (DBP),levels of fasting blood glucose (FBG),postprandial blood glucose (PBG),hemoglobin A1c (HbA1c),total cholesterol (TC),triglyceride (TG),low-density lipoprotein cholesterol (LDL-C),high density lipoprotein cholesterol (HDL-C),blood uric acid,C peptide and CA 19-9 were recorded.Patients were divided into different groups according to the levels of HbA1 c and CA 19-9.The relationship between CA19-9 and influencing factors was analyzed.Results CA19-9 level was increased in T2DM patients compared with healthy controls [(22.08±14.94) U/mlvs.(10.24±6.31) U/ml,t=12.10,P＜0.001].The levels of SBP,DBP,FBG,PBG,C peptide,TC,TG,LDL and UA were higher and HDL C level was lower in T2DM patients than in healthy controls (all P＜0.05).The levels of FBG,PBG and CA19-9 were increased along with the increase of HbA1c level in T2MD patients with HbA1c level under 6.5％,T2MD patients with HbA1c level from 6.5％ to 7.5％,T2MD patients with HbA1c level over 7.5％ [FBG:(6.36±3.70) mmol/L,(9.01±4.01) mmol/L,(11.96±4.73) mmol/L;PBG:(9.69±3.21) mmol/L,(12.18±5.54) mmol/L,(15.27±5.08) mmol/L; CA19 9 (14.33±11.72) U/ml,(18.76±14.39) U/ml,(25.96±17.52) U/ml,respectively,all P＜0.05].The levels of FBG,HbA1c and pancreatic cancer incidence were higher in patients with elevated CA19-9 than with normal CA19-9 [(11.71±5.48)mmol/L vs.(9.78±4.38)mmol/L,(7.49±4.12)％ vs.(6.33±3.70)％,0％ vs.7.8％,t=-3.51,2.55,x2=83.58,allP＜0.05].Pearson correlation analysis showed that CA19-9 level was positively correlated with the levels of HbA 1 c and FBG in T2DM patients (r=0.281,0.134,both P＜0.05).Multiple Logistic regression analysis showed that the levels of FBG and HbA1c were correlated with the increase of CA19 9 in T2DM patients(OR=0.801,0.947,P=0.019,0.026).Conclusions Serum CA19-9 level is significantly increased in T2DM patients compared with the healthy people.Serum CA19-9 level is correlated with blood glucose control.

Objective To explore the clinical value of multi-slice CT enhancement perfusion imaging (MSCTPI) in diagnosis and differential diagnosis of thyroid disease. Methods Thirty-three patients with benign thyroid diseases were enrolled in the benign group, and were divided into subgroups of nodular goiter (n=17) and thyroid adenoma (n=16), while 10 patients with thyroid carcinoma were enrolled in the malignant group. All patients underwent routine CT scanning and MSCTPI with GE LightSpeed 16-detector row CT scanner. Time-density curve (TDC) of common carotid for benign thyroid diseases and thyroid carcinoma was depicted. Perfusion parameters of blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability surface area product (PS) were obtained automatically. All parameters were statistically analyzed among groups. Results TDC showed single peak in common carotid artery, with small peak of speed up and slow down in benign group, while with baseline segment, up above, down segment and horizontal segment in thyroid carcinoma. There was statistical difference between benign and malignant groups in BF, BV, MTT and PS value (P=0.001, <0.001, 0.003 and <0.001, respectively). No significant difference of BV and MTT was found between subunits of benign and thyroid carcinoma (all P>0.05). BF was significantly different in benign and maligant groups (P<0.05), whereas PS in thyroid carcinoma and nodular goiter was significant different (P<0.05). No statistical difference of BF, BV, MTT and PS was detected between nodular goiter and thyroid adenoma. Conclusion MSCTPI can exactly show the blood flow features of thyroid. The analysis of BF, BV, MTT and PS is helpful for differential diagnosis between benign thyroid disease and thyroid carcinoma.

Objective To investigate the relationship between CRP, plasminogen activator inhibitor type 1 (PAI-1) levels, PAI-1 gene promoter 4G/5G polymorphism and the type of acute myocardial infarction (ST elevation myocardial infarction, STEMI vs the non-ST elevation Myocardial infarction, NSTEMI). Methods One hundred seventy-six consecutive patients with AMI were included for the study, of whom 60 had STEMI and 56 had NSTEMI, and 60 adults without cardiovascular and cerebrovascular disease were selected as controls. Blood samples were obtained from patients within 6 h of AMI and the plasma PAI-1, CRP, and the gene polymorphism were measured. Results Plasma levels of PAI-1 and CRP were higher in AMI groups, compared those in the control group, and plasma levels of PAI-1 were significantly higher in patients with STEMI compared to those with NSTEMI (80.12ng/ml VS.73.01ng/ml, P <0.01), while CRP levels were not significantly different between patient with STEMI and NSTEMI (3.87±0.79 mg/ml VS.4.01±0.69mg/ml, P>0.05). PAI-1 levels presented a significant correlation with CRP levels in the NSTEMI subjects. However, PAI-1 and CRP levels could explain the lack of a significant relationship between them in control and STEMI subjects.The frequencies of 4G/4G genotype in the AMI group were higher than those in the control group and higher in patient with STEMI than in patient with NSTEMI. Plasma levels of PAI-1 in subjects with 4G/4G genotype were significantly increased as compared to those in subjects with 4G/5G and 5G/5G genotype. Conclusions Plasma PAI-1 levels were associated with different myocardial infarction type, and PAI-1 promoter 4G/5G polymorphisms and CRP may be related to plasma PAI-1 levels.

Objective To elucidate the characteristics of the apoptosis of ovarian cell in DahlS hypertensive rats .Methods Sixty DahlS hytertensive femal rats(5 weeks old) were devided into 3 experimental groups and 3 control groups randomly,then the rats fed with 8% salt and normal forage respectively.Materials were gathered at 11,13,15 weeks old sacrifice.The apoptosis characteristics of granulosa cell and corpus luteum cell were studied by light,electron microscopy in situ end labelling techriqe,flowcytometry,etc.Results As hypertensive coures prolongation resut in the following conditions:⑴By light microscope,granulosa cell(GC) of developing follicles arranged inorderly and loosing ,the number of follicle atresia increased and corpus luteum decreased.⑵In TUNEL staining,apoptosis was mainly observed in granulosa cell of developing follicles,and it could not observed in corpus luteum cells. ⑶By electron microscope,the apoptosis of granulosa cell and corpus luteum cell assume typical characteristics as cytoplasm,a little nucleous,abnormal cytoblast,chromatin condensed and edged,appeared concetraction band,etc.It could also be observed that mitochondrion ridge had dearranged,the nmuber of smooth endoplasmic reticular(SER) decreased,and the change of lipid's lamellae was serious.⑷Flow cytometry assay showed the apoptosis rate of ovarian cell increased gradually,experimental groups of 13,15 weeks old(6 42?1 06)%,(6 67?2 11)% increased significantly as compared with controls(1 26?0 57)%,(1 46?0 73)%(t=3 027,3 085,P