内蒙古地区居民脑出血发病影响因素分析

目的  通过了解内蒙古地区不同特征居民的脑出血(intracerebral hemorrhage, ICH)发病情况, 分析ICH发病的影响因素, 为制定内蒙古地区居民ICH的预防措施提供科学依据。方法  采用多阶段分层整群抽样抽取6个城市(盟市)建立队列研究人群, 随访数据取自2015年12月1日-2021年12月31日, 随访内容包括一般情况、疾病史及治疗史、体格检查和实验室检测。采用单因素和多因素Cox回归分析性别、年龄、血压等因素与ICH发病的关联。结果  共纳入36 367名研究对象, 随访期间首发ICH事件共计385例(1.05%)。多因素Cox回归分析显示: 年龄增加(HR>1.000, P < 0.05)、蒙古族(HR=1.768, P < 0.05)和高血压(HR=1.492, P < 0.05)为ICH发病的危险因素; 女性(HR=0.434, P < 0.05)和高教育水平(HR < 1.000, P < 0.05)为ICH发病的保护因素。结论  在内蒙古地区, 男性、年龄增加、高血压、低教育水平、蒙古族与ICH发病风险相关。     

The diagnostic ability of procalcitonin and interleukin-6 to differentiate infectious from noninfectious systemic inflammatory response syndrome and to predict mortality

PurposeThe purpose of the study was to quantify the ability of procalcitonin (PCT) and interleukin-6 (IL-6) to differentiate noninfectious systemic inflammatory response syndrome (SIRS) and sepsis and to predict hospital mortality.MaterialsWe recruited consecutively adult patients with SIRS admitted to an intensive care unit. They were divided into sepsis and noninfectious SIRS based on clinical assessment with or without positive cultures. Concentrations of PCT and IL-6 were measured daily over the first 3 days.ResultsA total of 239 patients were recruited, 164 (68.6%) had sepsis, and 68 (28.5%) died in hospital. The PCT levels were higher in sepsis compared with noninfectious SIRS throughout the 3-day period (P < .0001). On admission, PCT concentration was diagnostic of sepsis (area under the curve of 0.63 [0.55-0.71]), and IL-6 was predictive of mortality, (area under the curve of 0.70 [0.62-0.78]). Peak IL-6 concentration improved the risk assessment of Sequential Organ Failure Assessment (SOFA) score for prediction of mortality among those who went on to die by an average of 5% and who did not die by 2%ConclusionsProcalcitonin measured on intensive care unit admission was diagnostic of sepsis, and IL-6 was predictive of mortality. Addition of IL-6 concentration to SOFA score improved risk assessment for prediction of mortality. Future studies should include clinical indices, for example, SOFA score, for prognostic evaluation of biomarkers.     

Actuating critical care therapeutics

Viewing the intensive care unit (ICU) as a control system with inputs (patients) and outputs (outcomes), we focus on actuation (therapies) of the system and how to enhance our understanding of status of patients and their trajectory in the ICU. To incorporate the results of these analytics meaningfully, we feel that a reassessment of predictive scoring systems and of ways to optimally characterize and display the patient's “state space” to clinicians is important. Advances in sensing (diagnostics) and computation have not yet led to significantly better actuation, and so we focus on ways that data can be used to improve actuation in the ICU, in particular by following therapeutic burden along with disease severity. This article is meant to encourage discussion about how the critical care community can best deal with the data they see each day, and prepare for recommendations that will inevitably arise from application of major federal and state initiatives in big data analytics and precision medicine.     

Crossing the handover chasm: Clinicians' perceptions of barriers to the early detection and timely management of severe sepsis and septic shock

PurposeThe purpose was to identify barriers to the early detection and timely management of severe sepsis throughout the emergency department (ED), general ward (GW), intermediate care unit (IMC), and the intensive care unit (ICU).Materials and methodsFive multicenter focus group discussions with 29 clinicians were conducted. Discussions were based on a moderation guide were recorded and transcribed. Qualitative analysis was performed according to the principles of the concept mapping method and the framework approach.ResultsThe major causes of the delayed detection and treatment could be summarized in a framework of communication errors and handover difficulties throughout patients' course of treatment, which can be divided into 5 core areas: inadequate histories before hospital admission; poorly coordinated handovers between the ambulance service and the ED; delayed patient transfer between the ED and the GW as well as delays in patient transfers between the GW and the ICU by, for example, a lack of bed capacity and a shortage of staff. Generally, participants from all wards mentioned that the urgency with which septic patients needed to be treated was not communicated.ConclusionsOur study shows the need to improve intra- and interunit handover processes in hospital care, which would ensure a holistic treatment concept, thereby improving patient care.     

Socioeconomic status and event free survival in pediatric acute lymphoblastic leukemia: A population-based cohort study

The impact of socioeconomic status (SES) upon childhood cancer outcomes has not been extensively examined. Our objective was to determine the association between SES and event-free survival (EFS) among children with acute lymphoblastic leukemia (ALL) diagnosed in Ontario, Canada from 1995–2011 (N = 1541) using Cox proportional hazards. Neither neighborhood-level median income quintile, distance from tertiary center, or rural residence significantly predicted EFS in the context of a universal healthcare system. Immigrant children experienced significantly superior EFS; confounding by ethnicity could not be ruled out. Confirmatory studies using additional individual-level SES variables are warranted.     

Differences in masticatory function of subjects with different closing path

PurposeThe purpose of this study was to clarify whether there was a difference in the masticatory function between two masticatory path patterns: a convex closing path and a concave closing path.MethodsFor 80 healthy subjects, the masticatory function (masticatory muscular activity, mandibular movement, and masticatory performance) when chewing a gummy jelly was recorded. Out of the 160 chewing cases (80 subjects chewing on either side), 65 cases (Group I) in which the incisal point opened in a linear or concave manner toward the working side and closed in a convex manner, and 15 cases (Group II) in which the opening path was the same as that in Group I, but the closing followed a concave path, were selected. For the masticatory function, the integral values per unit time of masseter and temporal muscular activities, the gape and masticatory width, the indicators representing the stability of movement path, and the glucose extraction from chewing gummy jelly were measured and compared between the two groups.ResultsThe integral values of muscular activities and the amount of glucose extraction were significantly greater in Group I. The gape and masticatory width were not significantly different between the groups. The values of the indicators representing the stability of path were smaller in Group I than in Group II.ConclusionFrom these results, it was suggested that there was a functional difference between Group I (with a convex closing path) and Group II (with a concave closing path), and that Group I had a superior masticatory function to Group II.