OBJECTIVE: To investigate the frequency and related factors of ineffective triggering (IT) and double triggering (DT) in patients with acute brain injury undergoing invasive mechanical ventilation. METHODS: A retrospective cohort study was conducted using data from a single-center observational trial. Patients with acute brain injury [traumatic brain injury, stroke, and post-craniotomy for brain tumors] undergoing mechanical ventilation in the intensive care unit (ICU) of Beijing Tiantan Hospital, Capital Medical University between June 2017 and July 2019 were retrospectively analyzed. Demographic and clinical data were collected. Respiratory parameters and waveforms during the first 3 days of mechanical ventilation were recorded, with 15-minute waveform segments collected 4 times daily. Airway occlusion pressure (P_0.1) was measured via end-expiratory hold at the end of each recording. IT and DT were identified based on airway pressure, flow, and esophageal pressure waveforms, and the ineffective triggering index (ITI) and DT incidence were calculated. Multivariate Logistic regression was used to identify factors associated with IT and DT. RESULTS: A total of 94 patients with acute brain injury were ultimately enrolled, including 19 cases of traumatic brain injury (20.2%), 39 cases of stroke (41.5%), and 36 cases of post-craniotomy for brain tumor (38.3%). Supratentorial injury was observed in 49 patients (52.1%), while infratentorial injury was identified in 45 patients (47.9%). A total of 94 patients with 1 018 datasets were analyzed; 684 (67.2%) datasets were on pressure support ventilation (PSV), and 334 (32.8%) were on mandatory ventilation. IT was detected in 810 (79.6%) datasets, with a median incidence of 2.1% (0.3%, 12.0%). Datasets demonstrating IT were characterized by lower P_0.1, higher tidal volume (VT), reduced respiratory rate (RR), and decreased minute ventilation (MV) compared to those without IT. The proportion of datasets exhibiting IT was higher during PSV than in mandatory ventilation [83.8% (573/684) vs. 71.0% (237/334), P < 0.05], while, the prevalence of ITI ≥ 10% was lower [23.8% (163/684) vs. 33.5% (112/334), P < 0.05]. DT was detected in 305 datasets (30%), with a median incidence of 0.6% (0.4%, 1.3%). Datasets exhibiting DT were characterized by higher VT, reduced RR, and lower pressure support levels. The incidence of DT was lower in PSV compared to mandatory ventilation modes [0% (0%, 0.3%) vs. 0% (0%, 0.5%), P < 0.05]. The post-craniotomy for brain tumors group exhibited higher ITI, lower RR, reduced MV, and a greater proportion of infratentorial lesions, compared to the TBI group. The infratentorial lesion group demonstrated higher ITI and incidence of DT compared to the supratentorial lesion group [ITI: 3.1% (0.7%, 17.8%) vs. 1.5% (0%, 8.3%), incidence of DT: 0% (0%, 0.5%) vs. 0% (0%, 0%), both P < 0.05]. After adjusting for confounding factors through multivariate logistic regression analysis, infratentorial lesion [odds ratio (OR) = 2.029, 95% confidence interval (95%CI) was 1.465-2.811, P < 0.001], lower P_0.1 (OR = 0.714, 95%CI was 0.616-0.827, P < 0.001), and mandatory ventilation (OR = 1.613, 95%CI was 1.164-2.236, P = 0.004) were independently associated with IT. Additionally, infratentorial lesion (OR = 1.618, 95%CI was 1.213-2.157, P = 0.001), large tidal volume (OR = 1.222, 95%CI was 1.137-1.314, P < 0.001), lower pressure support levels (OR = 0.876, 95%CI was 0.829-0.925, P < 0.001), and mandatory ventilation (OR = 2.750, 95%CI was 1.983-3.814, P < 0.001) were independently associated with DT. CONCLUSION IT and DT were common in patients with acute brain injury. Infratentorial lesions and mandatory ventilation were independently associated with both IT and DT.
Humans ; Respiration, Artificial/methods* ; Retrospective Studies ; Brain Injuries/therapy* ; Intensive Care Units ; Male ; Female ; Middle Aged ; Brain Injuries, Traumatic/therapy* ; Logistic Models ; Aged ; Adult

The diagnosis of pediatric sepsis still has some controversies.According to the latest guidelines,it is temporarily described as a life-threatening organ dysfunction caused by the host's dysregulated response to infection.Although there is a complete diagnostic and treatment process,its high mortality rate has always been a problem that plagues clinicians.While the diagnosis of adult sepsis is clear,treatment outcomes remain unsatisfactory.The reason lies in the high heterogeneity of sepsis itself,and the same set of diagnostic and treatment methods are not suitable for all patients.Therefore,researchers try to find the rules to classify sepsis.Compared with adults,pediatric sepsis has a more complex pathophysiological mechanism,and the progress of typing research is relatively slow.This review summarized recent advancements in the field by comparing the typing and treatment research of both pediatric and adult sepsis.

The diagnosis of pediatric sepsis still has some controversies.According to the latest guidelines,it is temporarily described as a life-threatening organ dysfunction caused by the host's dysregulated response to infection.Although there is a complete diagnostic and treatment process,its high mortality rate has always been a problem that plagues clinicians.While the diagnosis of adult sepsis is clear,treatment outcomes remain unsatisfactory.The reason lies in the high heterogeneity of sepsis itself,and the same set of diagnostic and treatment methods are not suitable for all patients.Therefore,researchers try to find the rules to classify sepsis.Compared with adults,pediatric sepsis has a more complex pathophysiological mechanism,and the progress of typing research is relatively slow.This review summarized recent advancements in the field by comparing the typing and treatment research of both pediatric and adult sepsis.

Objective To gain an in-depth understanding of the construction and use of the intravenous therapy specialist nurse teams in tertiary general hospitals in China,and to provide a reference for the development and standardized management of the intravenous therapy specialist nurse teams.Methods A convenience sampling method was used to survey tertiary general hospitals across the country in November 2023 using a self-designed questionnaire on the current status of the intravenous therapy specialist nurse teams.Results A total of 1,097 questionnaires were collected,of which 958 were valid,with a response rate of 87.33％.The survey results showed that there were 15,249 intravenous therapy specialist nurses in 958 tertiary general hospitals.These nurses generally had a bachelor's degree(13 346,87.52％)and most had more than 10 years of work experience(10 294,67.51％).Their main tasks included PICC and PORT placement and maintenance.In terms of the management of intravenous therapy specialist nurses,68.37％of hospitals had an open and transparent selection method,and 73.17％of hospitals implemented regular assessments,and 68.79％of hospitals provided retraining opportunities.The certification of intravenous therapy specialist nurses was mostly undertaken by provincial and municipal nursing associations,and the appointment method was the appointment system.In terms of remuneration,67.22％of hospitals reimbursed all training costs,but 47.60％of hospitals had no change in remuneration before and after training.In addition,79.33％of hospitals had intravenous therapy specialist nursing clinics.Intravenous therapy specialist nurses mainly worked throughout the hospital,mostly independently on a part-time basis,and the main charges were treatment costs and material costs.Conclusion The team of intravenous therapy nurses in tertiary general hospitals in China is large in size and has a high level of education.However,hospitals and management departments still need to pay more attention and support to the expansion of the work content,training,assessment,retraining and salary guarantee of intravenous therapy nurses in order to further strengthen the construction of intravenous therapy nurses and promote their sustainable development.

Objective To investigate the effects of doublecortin-like kinase 1(DCLK1)on the malignant biological behaviors,such as proliferation,migration,and invasion,of A549 cell line and their corresponding mechanisms.Methods DCLK1-overexpressing A549 cell lines were established through lentiviral infection,and DCLK1 expression was validated by using RT-PCR and Western blot analysis.Proliferation ability was assessed with CCK-8 and plate cloning assays,and migration and invasion abilities were examined with Transwell assays.The pathway regulated by DCLK1 in lung adenocarcinoma was analyzed on the basis of the TCGA lung adenocarcinoma cohort with pathway enrichment analysis and verified through Western blot analysis.Results DCLK1 overexpression in A549 cells promoted cell proliferation,migration,and invasion.The inhibition of the FAK/PI3K/AKT/mTOR signaling pathway impaired the DCLK1-mediated malignant behavior of A549 cells.Conclusion DCLK1 promotes the malignant behavior of A549 cells through the activation of the FAK/PI3K/AKT/mTOR signaling pathway.

Objective To gain an in-depth understanding of the construction and use of the intravenous therapy specialist nurse teams in tertiary general hospitals in China,and to provide a reference for the development and standardized management of the intravenous therapy specialist nurse teams.Methods A convenience sampling method was used to survey tertiary general hospitals across the country in November 2023 using a self-designed questionnaire on the current status of the intravenous therapy specialist nurse teams.Results A total of 1,097 questionnaires were collected,of which 958 were valid,with a response rate of 87.33％.The survey results showed that there were 15,249 intravenous therapy specialist nurses in 958 tertiary general hospitals.These nurses generally had a bachelor's degree(13 346,87.52％)and most had more than 10 years of work experience(10 294,67.51％).Their main tasks included PICC and PORT placement and maintenance.In terms of the management of intravenous therapy specialist nurses,68.37％of hospitals had an open and transparent selection method,and 73.17％of hospitals implemented regular assessments,and 68.79％of hospitals provided retraining opportunities.The certification of intravenous therapy specialist nurses was mostly undertaken by provincial and municipal nursing associations,and the appointment method was the appointment system.In terms of remuneration,67.22％of hospitals reimbursed all training costs,but 47.60％of hospitals had no change in remuneration before and after training.In addition,79.33％of hospitals had intravenous therapy specialist nursing clinics.Intravenous therapy specialist nurses mainly worked throughout the hospital,mostly independently on a part-time basis,and the main charges were treatment costs and material costs.Conclusion The team of intravenous therapy nurses in tertiary general hospitals in China is large in size and has a high level of education.However,hospitals and management departments still need to pay more attention and support to the expansion of the work content,training,assessment,retraining and salary guarantee of intravenous therapy nurses in order to further strengthen the construction of intravenous therapy nurses and promote their sustainable development.

Objective:To investigate the safety and effectiveness of the laparoscopic hepatectomy guided by three-dimensional visualization technology for treating hepatolithiasis in military flying personnel and to discuss the aeromedical assessment.Methods:The diagnosis and treatment of a military flying personnel with hepatolithiasis admitted to the Air Force Medical Center in December of 2021 and the conclusions of aeromedical assessment were analyzed. The literature was reviewed in combination with the progress of new technologies.Results:This case, a 40-year-old male helicopter aerial machinist, had been found gallbladder stones for 12 years, hepatolithiasis for 8 years, and intermittent right upper abdominal pain for more than 3 months. Ultrasound and CT examination showed multiple gallbladder stones, intrahepatic bile duct stones in the right posterior lobe of the liver with bile duct dilatation. Under the guidance of three-dimensional visualization technology, laparoscopic liver segment 6 precise resection, cholecystectomy, common bile duct exploration and stone removal, and T-tube drainage were performed. The patient was well recovered and waivered to flight after 6 months of the operation. As of the submission date, he has safely flown for 50 h.Conclusions:Laparoscopic anatomical hepatectomy guided by three-dimensional visualization technology in the military flying personnel with hepatolithiasis shows good safety and effect, and those who recover well after surgery can be waivered to flight.

Objective:To explore the clinical utility of metagenomic next-generation sequencing (mNGS) for patients with critically ill atypical rickettsial infections in the early diagnosis and therapy.Methods:From Jan 2020 to Aug 2022, clinical features, blood biochemical results, imaging data and mNGS results in patients with unexplained critical illnesses were collected and analyzed retrospectively. Fisher's exact test was used to compare the positive rate of mNGS and weil felix reaction.Results:All 15 patients with rickettsial disease had fever, 12 cases had headache, but only 3 had a typical rash or scab of diagnostic significance, 6 had septic shock and all had multi-organ dysfunction; blood mNGS tests were positive in 15 cases, of which 10 had Orientia tsutsugamushi detected in their blood and the remaining five had Rickettsia moschata detected in their blood. The positive rate of mNGS was significantly higher than that of the weil felix reaction (15/15 vs 0, P<0.001). All patients were given doxycycline and other treatments after diagnosis, of which 14 improved and were discharged, and one died 1 week after discharge due to critical condition and abandonment of treatment. Conclusion:mNGS can improve the detection rate of atypical rickettsiae in patients with negative routine test results, which can provide valuable reference basis for early diagnosis and early anti-infection treatment of patients with critical rickettsial disease.

Objective:To investigate the safety and efficacy of stent-assisted coil embolization in acute intracranial ruptured wide-necked aneurysms, and explore the safety of different antiplatelet drug regimens during perioperative period and the risk factors for prognoses.Methods:A perspective multicenter study was performed. A total of 417 patients with intracranial ruptured wide-necked aneurysms treated by stent-assisted coil embolization in Neurosurgery Departments of 4 hospitals (First Affiliated Hospital of Wenzhou Medical University [ n=41], Zhujiang Hospital of Southern Medical University [ n=111], Tangdu Hospital of Air Force Military Medical University [ n=100], and Xuanwu Hospital of Capital Medical University [ n=165]) from June 2017 to January 2020 were included. According to the different antiplatelet drugs regimens used in perioperative period, these patients were divided into loaded clopidogrel group ( n=87), loaded clopidogrel combined with aspirin group ( n=212), and tirofiban group ( n=118). Clinical data and perioperative complications of 3 groups were compared. Modified Rankin scale (mRS) was used to evaluate the prognoses of patients at discharge; differences of clinical data between the poor prognosis group and good prognosis group were compared. Independent risk factors for prognoses of patients with intracranial ruptured wide-necked aneurysms were analyzed by multivariate Logistic regression analysis. Receiver operating characteristic (ROC) curve was used to analyze the predictive values of risk factors in poor prognosis. Results:Degrees of aneurysm embolization immediately after surgery: Raymond grading I was noted in 351 patients (84.2%), grading II in 44 patients (10.6%), and grading III in 22 patients (5.2%). Perioperative complications were noted in 44 patients (10.6%), and death was noted in 4 (1%). Intraoperative thrombosis incidence of the loaded clopidogrel group, loaded clopidogrel combined with aspirin group and tirofiban group was 5.7% (5/87), 5.7% (12/212) and 0.8% (1/118); that in tirofiban group was significantly lower than that in the loaded clopidogrel group and loaded clopidogrel combined with aspirin group ( P<0.05). At discharge, 360 patients (86.3%) had good prognosis and 57 patients (13.7%) had poor prognosis. Multivariate Logistic regression analysis showed age≥60 years ( OR=3.407, 95% CI: 1.620-7.166, P=0.001), preoperative Hunt-Hess grading 3 ( OR=11.445, 95% CI: 3.584-36.547, P<0.001), preoperative Hunt-Hess grading 4 ( OR=88.951, 95% CI: 14.519-544.948, P<0.001), preoperative Hunt-Hess grading 5 ( OR=64.949, 95% CI: 12.809-329.325, P<0.001), and multiple stenting ( OR=4.709, 95% CI: 1.215-18.248, P=0.025) were independent risk factors for poor prognosis of these patients. ROC curves showed that area under the curve of combination of age, number of implanted stents, and preoperative Hunt-Hess grading in predicting poor prognosis of these patients was 0.821, with optimal diagnostic threshold of 0.500, sensitivity of 0.667, and specificity of 0.833. Conclusion:Stent-assisted coil embolization is safe and effective in acute intracranial ruptured wide-necked aneurysms; tirofiban is safe as perioperative antiplatelet drug; patients with old age, preoperative Hunt-Hess grading≥3, and multiple stents are prone to have poor prognosis.