Lipase elevation on admission predicts worse clinical outcomes in patients with COVID-19

Background and objectivesHyperlipasemia is highly prevalent among coronavirus disease 2019 (COVID-19) patients. The aim of this study was to assess the effect of lipase activity, measured at the time of admission, on the clinical course and mortality in COVID-19 patients.MethodsThe population of this study comprised 12,139 patients who were hospitalized due to COVID-19 between June 2020 and June 2021 in a pandemic hospital. Of these, 8819 patients were excluded from the study due to missing data, four patients were excluded due to a diagnosis of acute pancreatitis (according to the revised Atlanta criteria), and 72 patients were excluded due to alcohol use or having a history of chronic pancreatitis. The final study sample consisted of the remaining 3244 COVID-19 patients. Laboratory results, intensive care unit (ICU) follow-up periods, the need for mechanical ventilation, and mortality rates were compared between the normal lipase activity and high lipase activity groups.ResultsThere were 968 (29.8%) patients with high lipase activity at the time of admission. The rate of ICU admission was 36.1% vs. 9.9% (p < 0.001), mechanical ventilation requirement rates were 33.7% vs. 8.3% (p < 0.001), and mortality rates were as 24.6% vs. 6.4% (p < 0.001) in the high lipase activity group compared to the normal lipase activity group. Multivariate regression analysis revealed that high lipase activity was an independent factor in predicting mortality in hospitalized COVID-19 patients (odds ratio [OR]: 3.191, p < 0.001).ConclusionElevated lipase activity without acute pancreatitis at the time of admission in COVID-19 patients was determined as an independent predictor of poor prognosis.     

儿童输液中心患儿家属心理需求调查分析

目的 探讨儿童输液中心患儿家属的心理需求，方法 采用问卷调查的方法。结果 家属对患儿所患疾病知识的了解需求十分强烈，占100%，技术服务需求占93%，65%的家属担心输液时出现不良反应，75%的要求发放保健知识手册，根据上述需求，采取相应的护理措施，家属的满意度达到了99%。结论 通过对家属心理需求调查分析及采取相应措施，能提高服务质量。     

Decreased insulin requirement in relation to GFR in nephropathic Type 1 and insulin-treated Type 2 diabetic patients.

AIMS: In the presence of impaired renal function, patients require less insulin mainly because insulin clearance is prolonged. The aim of this study was to evaluate the insulin requirement related to glomerular filtration rate (GFR) in nephropathic Type 1 and Type 2 diabetic patients. METHODS: In a retrospective study we compared insulin requirement in 20 nephropathic Type 1 diabetic patients and 20 insulin-treated Type 2 diabetic patients from the onset of overt nephropathy until the final stage of renal disease. All patients had proteinuria > 0.5 g/24 h and creatinine clearance >/= 80 ml/min per 1.73 m2 at baseline. Creatinine clearance, urinary protein excretion, glycated haemoglobin and the required insulin doses were determined 3- to 6-monthly, basal C-peptide was measured at the beginning and the end of the observation period. The required insulin doses were evaluated at creatinine clearance rates of 80, 60, 40, 20 and 10 ml/min per 1.73 m2 (or at the initiation of dialysis treatment). RESULTS: The insulin requirement of patients with Type 1 diabetes was reduced from 0.72 +/- 0.16 IU/kg per day at a creatinine clearance rate of 80 ml/min, to 0.45 +/- 0.13 IU/kg per day at a creatinine clearance rate of 10 ml/min (decrement of 38%, P < 0.001). The insulin dose required by Type 2 diabetic patients was reduced from 0.68 +/- 0.28 IU/kg per day at a creatinine clearance rate of 80 ml/min to 0.33 +/- 0.19 IU/kg per day at a clearance rate of 10 ml/min (decrement 51%, P < 0.001). The fall in GFR, urinary protein excretion and glycated haemoglobin levels was similar in the two groups. In patients with Type 2 diabetes, C-peptide levels at the beginning and the end of renal function impairment were 2.2 (0.4-7.3) vs. 2.7 (0.1-4.9) ng/ml (NS). The reduction in insulin requirement was approximately the same in patients with an initial C-peptide level < 1.0 and in those >/= 1.0 ng/ml (decrement 57% vs. 46%). CONCLUSIONS: The reduction in insulin requirement in renal insufficiency is similar in Type 1 and insulin-treated Type 2 diabetic patients. In subjects with Type 2 diabetes, the residual insulin secretion has no impact on the reduction in insulin requirement dependent on the GFR.     

对住院病人医疗服务评价及需求的调查分析

目的 考查医院现有服务结构的合理性和病人对医疗服务的需求。方法 对作者所在医院19个临床科室年龄15岁以上的130名病人进行问卷调查,医疗服务评价内容包括:(1)医院饮食、卫生状况;(2)收费合理性;(3)收费透明度;(4)病人总体满意度。医疗服务需求包括:(1)出院后服务;(2)药物类型;(4)病房类型(4)收费透明度;(5)知情选择。结果(1)医疗服务评价:87.4%病人对卫生状况满意,513%病人认为收费合理,6．7%病人认为收费不合理;37.2%病人认为收费透明度高,8.3%病人认为收费透明度低,大部分病人希望住院部每3~5 d给一次费用报告单;82．8%病人对医疗服务感到满意。表明医疗服务的综合质量虽然得到了病人的普遍赞同,但在饮食服务、收费透明度和收费合理性方面仍有待提高。(2)医疗服务需求:91.3%病人希望出院后一定时间内可免费看门诊或叶通过电话向主管医生咨询有关疾病防治、保健等问题;73．8%病人希望用合资企业生产的或国产药物,26．2%病人喜欢用进口药,仅11.3%病人认为药物越贵治疗效果越好;喜欢住50-70元双人间的病人占40．8%,愿意住30-50元多人间和90~120元单人间的病人比例分别为359%、23.3%;调查人群入住单人间、双人间与多人间的比例为2:39:59,病人需求的理想病房结构是36:41:23．矛盾突出在现在的人间设置得     

孕晚期妇女维生素B_1、B_2、C及能量需要量的研究

以武汉市纺织系统值车工孕晚期妇女43名为研究对象,采用饱和试验法对其维生素B_1,B_2和C需要量进行了初步研究,并对其能量消耗量和摄入量进行了调查。结果表明,维生素B_1最低需要量为1.65mg/d、适宜需要量为1.90mg/d,维生素B_2的最低需要量为1.45mg/d,适宜需要量为1.70mg/d;维生素C的最低需要量为46mg/d,适宜需要量为146mg/d。孕晚期值车工一日能量总消耗为9.5144MJ(2274kcal),一日能量摄入量为10.6566MJ(2547kcaI),能量摄入高于能量消耗1.1422MJ(273kcal)。再次表明,孕晚期妇女能量供给在未孕基础上增加0.8MJ(200kcal/d)是适宜的。     

温州市农村贫困人群卫生服务需求和利用分析

通过对近2000份调查表的分析,评价温州市农村贫困人群在就诊过程中对医疗机构的选择、未就诊原因方面的特点,提出提高卫生服务利用的方法。     

Analgesic dose-response relation in cervical epidural block

The relationship between the age and the spread of analgesia from different epidural anesthetic doses was examined by studying analgesic dose responses in cervical epidural analgesia. Two different anesthetic doses (5ml or 10ml) of 2% mepivacaine were injected into the cervical epidural space at a constant pressure (80mmHg) using an intravenous apparatus, and the spread of analgesia to pinprick was assessed. The significant correlation was found between the patients age and the number of spinal segments blocked (5ml:r = 0.8498, P < 0.01, 10ml:r = 0.5988, P < 0.01). The inverse linear relationship was found between the patients age and the segmental dose requirement (5ml:r = –0.6754, P < 0.01, 10ml:r = –0.5784, P < 0.01). Patients under 39 years of age showed a direct relationship between the dose injected and the number of spinal segments blocked, enabling prediction of the number of segments blocked with a given dose of local anesthetic. Doubling the epidural dose approximately doubled the number of spinal segments blocked. The analgesic dose-response relation in patients over 60 years of age differed from that in patients under 39 years of age and doubling the epidural dose did not double the number of spinal segments blocked. Progressively more extensive analgesia was obtained from a given dose of local anesthetic with advancing age. It was difficult to limit the extent of analgesia by injecting a smaller dose of local anaesthetic in the elderly.(Hirabayashi Y, Matsuda I, Inoue S et al.: Analgesic dose-response relation in cervical epidural block. J Anesth 2: 22–27, 1988)     

Negative accumulated oxygen deficit during heavy and very heavy intensity cycle ergometry in humans

The concept of the accumulated O₂ deficit (AOD) assumes that the O₂ deficit increases monotonically with increasing work rate (WR), to plateau at the maximum AOD, and is based on linear extrapolation of the relationship between measured steady-state oxygen uptake (O₂) and WR for moderate exercise. However, for high WRs, the measured O₂ increases above that expected from such linear extrapolation, reflecting the superimposition of a "slow component" on the fundamental O₂ mono-exponential kinetics. We were therefore interested in determining the effect of the O₂ slow component on the computed AOD. Ten subjects [31 (12) years] performed square-wave cycle ergometry of moderate (40%, 60%, 80% and 90% ), heavy (40%), very heavy (80%) and severe (110% O_{2 peak}) intensities for 10–15 min, where is the estimated lactate threshold and is the WR difference between and O_{2 peak}. O₂ was determined breath-by-breath. Projected "steady-state" O₂ values were determined from sub- tests. The measured O₂ exceeded the projected value after ~3 min for both heavy and very heavy intensity exercise. This led to the AOD actually becoming negative. Thus, for heavy exercise, while the AOD was positive [0.63 (0.41) l] at 5 min, it was negative by 10 min [–0.61 (1.05) l], and more so by 15 min [–1.70 (1.64) l]. For the very heavy WRs, the AOD was [0.42 (0.67) l] by 5 min and reached –2.68 (2.09) l at exhaustion. For severe exercise, however, the AOD at exhaustion was positive in each case: +1.69 (0.39) l. We therefore conclude that the assumptions underlying the computation of the AOD are invalid for heavy and very heavy cycle ergometry (at least). Physiological inferences, such as the "anaerobic work capacity", are therefore prone to misinterpretation.     

Plasma and Urinary Amino Acid-Derived Catabolites as Potential Biomarkers of Protein and Amino Acid Deficiency in Rats

Objective: Dietary intakes must cover protein and essential amino acid (EAA) requirements. For this purpose, different methods have been developed such as the nitrogen balance method, factorial method, or AA tracer studies. However, these methods are either invasive or imprecise, and the Food and Agriculture Organization of the United Nations (FAO, 2013) recommends new methods and, in particular, metabolomics. The aim of this study is to determine total protein/EAA requirement in the plasma and urine of growing rats. Methods: 36 weanling rats were fed with diets containing 3, 5, 8, 12, 15, and 20% protein for 3 weeks. During experimentation, urine was collected using metabolic cages, and blood from the portal vein and vena was taken at the end of the experiment. Metabolomics analyses were performed using LC-MS, and the data were analyzed with a multivariate analysis model, partial least Squares (PLS) regression, and independent component-discriminant analysis (ICDA). Each discriminant metabolite identified by PLS or ICDA was tested by one-way ANOVA to evaluate the effect of diet. Results: PLS and ICDA allowed us to identify discriminating metabolites between different diet groups. Protein deficiency led to an increase in the AA catabolism enzyme systems inducing the production of breakdown metabolites in the plasma and urine. Conclusion: These results indicate that metabolites are specific for the state of EAA deficiency and sufficiency. Some types of biomarkers such as AA degradation metabolites appear to be specific candidates for protein/EAA requirement.     

亚热带地区哺乳妇女能量需要量的观察

以同地区的53名非哺乳育龄妇女作对照,对262名产后0～6月乳母的体重、皮脂、上臂围、基础代谢率(BMR)、能量消耗和摄入量分别进行横向和纵向观察。结果表明,产后乳母体重和皮脂厚度逐渐下降,至第4个月基本稳定,平均减重4.2kg,估计孕期的贮脂大部分已消耗。上臂围无明显变化(P>0.05)。乳母的BMR在产后第1周较高(P<0.01),1～6月无明显变化(P<0.05),但比对照组高4～20％(P<0.05)。乳母在同一标准活动耗能与对照组接近(P>0.05)。轻体力劳动乳母日均活动耗能8.360MJ,估计泌乳耗能为2.807MJ/d。乳母能量摄入量比对照组多2.259MJ/d。作者认为,亚热带产后0～6月乳母在正常哺乳情况下,头4个月每日能量需要量应在平日消耗量基础上增加1.883MJ(450kcal),后雨月增加2.720MJ(650kcal),或整个阶段平均增加2.092MJ/d(500kcal/d),但此值仍需按泌乳量和正常体重变化加以调节。