C-Reactive protein role in assessing COVID-19 deceased geriatrics and survivors of severe and critical illness

Numerous risk variables, including age, medical co-morbidities, and deranged inflammatory response, lead to higher mortality in a senior population with coronavirus disease 2019. C-reactive protein (CRP), an acute phase inflammatory protein secreted by the liver, was tested in the elderly, showing a diagnostic and prognostic role. However, recent research has shed light on new applications for CRP in geriatrics. It was used as a follow-up marker and as a therapeutic target. Early and accurate identification of patients' risks may mitigate the devastation of the invading virus in older cases and permit the implementation of a quick treatment plan for those most likely to deteriorate.     

1例重型弥漫性轴索损伤伴肺挫裂伤患者的肺康复护理

总结1例重型弥漫性轴索损伤伴肺挫裂伤患者的肺康复护理经验。护理要点包括：组建多学科肺康复管理团队,实施个性化呼吸支持与降阶梯序贯氧疗护理,精准廓清呼吸道,开展一体化的早期肺功能康复锻炼。经过多学科团队合作,患者入院后第12天撤离呼吸机,第17天拔除气管插管,第20天下床活动,第37天顺利出院,随访6个月,患者恢复良好。     

Understanding Hispanic Patient Satisfaction with Telehealth During COVID-19

BackgroundRecent studies have described the use of telehealth for pediatric surgical care during the COVID-19 pandemic. We aimed to evaluate equity in telehealth use by comparing rates of utilization and satisfaction with pediatric surgical telemedicine among Hispanic patients.MethodsWe conducted a retrospective cohort study of patients seen by a surgical subspecialty provider in the outpatient setting at a quaternary pediatric hospital between April 1 and June 30, 2020. Patients evaluated in the same three-month period in 2019 were analyzed as a historic control. Differences in Family Experience Survey (FES) responses based on race and ethnicity and preferred language of care were assessed using univariable and multivariable generalized linear modeling.ResultsThe pandemic cohort included fewer patients of Hispanic ethnicity and fewer Spanish-speakers. After controlling for visit type, comparison of Spanish-speaking and English-speaking patients revealed that Spanish-speaking families had significantly lower scores for FES items that evaluated healthcare provider explaining (IRR 0.74, 95% CI: 0.61–0.90), listening (IRR 0.76, 95% CI: 0.63–0.92), and time spent with the family (IRR 0.73, 95% CI: 0.60–0.89). There were no differences in FES responses based on insurance status or degree of medical complexity.ConclusionsTelehealth services were less commonly used among Hispanic and Spanish-speaking patients. Language may differentially affect family satisfaction with healthcare and telehealth solutions. Strategies to mitigate these inequities are needed and may include strengthening interpreter services and providing language-concordant care.Level of evidenceLevel IV.     

大黄附子汤对重症急性胰腺炎小鼠肠道微皱褶细胞变化的影响

目的研究大黄附子汤对重症急性胰腺炎(SAP)小鼠肠道微皱褶细胞(M细胞)变化的影响，为大黄附子汤临床防治SAP提供理论基础。 方法选取40只健康SPF级C57BL/6J雄性小鼠，随机分为4组(每组10只)：空白对照组、大黄附子汤对照组、SAP组、大黄附子汤治疗组，其中SAP组和大黄附子汤治疗组分别以3.5 g/kg剂量腹腔注射20% L-精氨酸，空白对照组和大黄附子汤对照组注射等剂量的等渗盐水；于造模后12、24、36 h，空白对照组和SAP组给予等渗盐水0.2 mL，大黄附子汤对照组和治疗组给予大黄附子汤0.2 mL灌肠，均于造模完成48 h后处死取材，使用ELISA检测血清淀粉酶、内毒素、IL-1β及TNF-α含量，取回肠及胰腺组织行HE染色、评分，免疫组化染色检测M细胞特异性蛋白GP2并评分。 结果(1)一般情况：对照组腹腔注射后小鼠一般情况好，精神状态良好，能正常进水，四肢活动自如，行动未受影响；SAP组小鼠腹腔注射后一般情况差，精神萎靡，反应迟钝，行动迟缓，呼吸急促，拱背收腹，饮水减少。(2)SAP组淀粉酶、内毒素、IL-1β及TNF-α水平较对照组明显升高(P<0.05)；与SAP组进行对比，大黄附子汤治疗组血清淀粉酶、内毒素、IL-1β及TNF-α水平出现显著下降(P<0.05)。(3)HE染色：SAP组胰腺及回肠组织坏死严重，可见大量白细胞浸润。大黄附子汤治疗组胰腺及回肠组织轻度坏死，可见少量中性粒细胞等白细胞浸润。(4)免疫组化染色：SAP组与对照组相比GP2表达降低(P<0.05)；相较于SAP组，大黄附子汤治疗组GP2的表达水平升高(P<0.05)。 结论大黄附子汤治疗可改善作为肠道免疫应答起始的M细胞数量与功能，增强肠道免疫应答，减轻肠免疫屏障损伤，减少内毒素入血，改善SAP症状。     

Prospective characterization of incident hepatic steatosis in pediatric and adolescent patients after total pancreatectomy with islet autotransplantation

BackgroundHepatic steatosis has been described as a common finding in adults following total pancreatectomy with islet autotransplantation (TPIAT) but it is unknown if this occurs in children and adolescents.ObjectivesTo define the frequency of post-TPIAT hepatic steatosis in a sample of children and adolescents and to identify clinical predictors of incident steatosis post-TPIAT.MethodsIn this prospective study, consecutive participants at least 1-month post-TPIAT underwent a liver MRI with proton density fat fraction (PDFF) and blood draw at our pediatric academic medical center between April 2021 and January 2022. Comparison clinical pre-TPIAT liver MRI or ultrasound and insulin use and graft function data were extracted from the medical record. T-tests were used for the comparison of means across continuous variables between participants with and without post-TPIAT steatosis.ResultsA total of 20 participants (mean: 13 ± 4 years; 12 female) were evaluated. Mean liver PDFF at research MRI was 7.4 ± 6.2% (range: 2–25%). Seven participants (35%) had categorical hepatic steatosis (PDFF>5%) post-TPIAT, five of whom had pre-TPIAT steatosis, reflecting a 13% (2/15; 95% CI: 2–40%) incidence of post-TPIAT steatosis. Participant characteristics were not significantly different between subgroups with and without post-TPIAT steatosis. Mean PDFF at research MRI was not different between graft function subgroups (7.5% optimal/good vs. 7.3% marginal/failure; p = .96).ConclusionOur study shows a moderate prevalence but low incidence of hepatic steatosis in a small sample of children and adolescents post-TPIAT. This study raises questions about a causal relationship between TPIAT and hepatic steatosis.     

纤维支气管镜在PICU重症肺炎患儿治疗中的效果分析

目的分析纤维支气管镜应用于PICU重症肺炎患儿治疗中的效果。方法将我院于2019年9月至2021年6月收治的80例重症肺炎患儿分为2组,即观察组和对照组,对照组予以抗生素、氧疗、止咳祛痰等常规治疗,观察组另予纤维支气管镜灌洗治疗,观察疗效、住院天数、总热程、肺部感染评分(CPIS)变化、白细胞计数(WBC)变化、咳嗽好转时间、啰音消失时间等,统计灌洗治疗前后并发症;择取两组致病菌均为腺病毒患儿进行二次分组--灌洗组及未灌洗组,比较两组疗效、咳嗽好转时间、啰音消失时间、住院时间、总热程,观察支气管镜对腺病毒感染者治疗效果。结果观察组疗效优于对照组,差异存在统计学意义(P<0.05);灌洗组疗效与未灌洗组基本相当(P>0.05)。观察组WBC、CPIS得分均显著低于对照组,总热程、咳嗽有效控制时间、肺部湿啰音消失时间、住院总天数均明显短于对照组,差异均具有统计学意义(P<0.05);灌洗组咳嗽控制时间短于未灌洗组(P<0.05),但总热程、啰音消失时间及住院天数与未灌洗组比较无统计学差异(P>0.05)。灌洗并发症发生率为20.00%,均好转。结论PICU重症肺炎患儿应用纤维支气管镜治疗安全可靠,能明显改善患儿当前症状,但对腺病毒导致的重症肺炎收效甚微。     

西地兰联合胺碘酮治疗急诊重症心衰合并快速性心律失常患者的临床效果分析

目的探析西地兰联合胺碘酮治疗急诊重症心衰合并快速性心律失常患者的临床效果。方法60例急诊重症心衰合并快速性心律失常患者,以电脑Excel表格按照1∶1比例分为对比组和研究组,每组30例,对比组患者采用西地兰治疗,研究组患者采用西地兰联合胺碘酮治疗。比较两组患者治疗前后QT离散度、心功能指标及治疗后临床指标。结果治疗后,两组患者QT离散度均较本组治疗前降低,且研究组患者QT离散度(32.69±2.69)ms低于对比组的(41.32±3.11)ms,差异具有统计学意义(P<0.05)。治疗后,研究组患者心室率(78.51±5.17)次/min低于对比组的(94.23±6.67)次/min,起效时间(18.23±2.11)min短于对比组的(32.11±3.51)min,窦性心律转复率93.33%(28/30)高于对比组的70.00%(21/30),差异具有统计学意义(P<0.05)。治疗后,两组患者左室舒张末期内径、室间隔厚度、左室后壁厚度、左室重量指数、左室射血分数、舒张早期最大流速/舒张晚期最大流速(E/A)、N末端B型脑钠肽前体(NT-proBNP)水平均较本组治疗前改善,且研究组优于对比组,差异具有统计学意义(P<0.05)。结论在急诊重症心衰合并快速性心律失常患者治疗中选择西地兰联合胺碘酮用药方案,能够更好降低QT离散度,提高窦性心律转复率,且心室率更低、起效时间更短,同时,在改善心功能方面效果较显著。