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Predictive accuracy of Sepsis-3 definitions for mortality among adult critically ill patients with suspected infection
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作者 Qi-Hong Chen Jun Shao +4 位作者 Wei-Li Liu Hua-Ling Wang Lei Liu Xiao-Hua Gu Rui-Qiang Zheng 《中华医学杂志:英文版》 SCIE CAS CSCD 2019年第10期1147-1153,共7页
Background: Sepsis-3 definitions have been published recently;however, their diagnostic value remains controversial. This study was to assess the accuracy of Sepsis-3 definitions compared to Sepsis-1 definitions by st... Background: Sepsis-3 definitions have been published recently;however, their diagnostic value remains controversial. This study was to assess the accuracy of Sepsis-3 definitions compared to Sepsis-1 definitions by stratifying mortality among adult critically ill patients with suspected infection. Methods: A multicenter, prospective cohort study was conducted from November 10, 2017 to October 10, 2018, in five Intensive Care Units (ICUs) at four teaching hospitals. Thirty-day mortality was compared across categories for both Sepsis-3 definitions and Sepsis-1 definitions, which were evaluated by logistic regression analysis followed by measurement of the area under the receiver operating characteristic curve (AUROC) for predicting 30-day mortality rates. Results: Of the 749 enrolled patients, 644 (85.9%) were diagnosed with sepsis according to the Sepsis-1 definitions. Among those patients, 362 were diagnosed with septic shock (362/749, 48.3%). However, according to the Sepsis-3 definitions, there were 483 patients with a diagnosis of sepsis (483/749, 64.5%), among whom 299 patients were diagnosed with septic shock (299/749, 39.9%). According to the Sepsis-3 definitions, sepsis (sepsis and septic shock) patients had higher 30-day mortality (41.8%) than sepsis patients according to the Sepsis-1 definitions (31.8%,χ^2 = 5.552, P = 0.020). The AUROC of systemic inflammatory response syndrome (SIRS) and quick sequential organ failure assessment (qSOFA) scores with regard to 30-day mortality rates were 0.609 (0.566-0.652) and 0.694 (0.654-0.733), respectively. However, the AUROC of SOFA scores (0.828 [0.795-0.862]) were significantly higher than that of SIRS or qSOFA scores (P < 0.001). Conclusion: In adult critically ill patients with suspected infection, the Sepsis-3 definitions were relatively accurate in stratifying mortality and were superior to the Sepsis-1 definitions. 展开更多
关键词 INFECTION Critically ill patients Sepsis-3 SEPTIC shock MORTALITY
生病的“fall ill”
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作者 李琼霞 《考试与评价(英语高二专刊)》 2018年第9期8-8,37共2页
fall ill生病 【经典例句】When she fell ill, her daughter took over the business from her.她患病期间生意曾由她女儿代管。He used to be in good health, but he fell ill suddenly last week.他身体一直很好,但上星期突然病倒了。
关键词 ILL 生病 BUSINESS WHEN 经典例句 OVER from 患病期间
Vitamin D status and its influence on outcomes following major burn injury and critical illness
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作者 Khaled Al-Tarrah Martin Hewison +1 位作者 Naiem Moiemen Janet M.Lord 《烧伤与创伤》 2018年第2期82-92,共11页
Vitamin D deficiency is common among the general population. It is also observed in up to 76% of critically ill patients.Despite the high prevalence of hypovitaminosis D in critical illness, vitamin D is often overloo... Vitamin D deficiency is common among the general population. It is also observed in up to 76% of critically ill patients.Despite the high prevalence of hypovitaminosis D in critical illness, vitamin D is often overlooked by medical staff as the clinical implications and consequences of vitamin D deficiency in acute contexts remain to be fully understood.Vitamin D has a broad range of pleotropic effects on various processes and systems including the immuneinflammatory response. 1α,25-dihydroxyvitamin D (1,25(OH)2D), has been shown to promote a tolerogenic immune response limiting deleterious inflammatory effects, modulation of the innate immune system, and enhancement of anti-microbial peptides. Vitamin D deficiency is frequently observed in critically ill patients and has been related to extrinsic causes (i.e., limited sunlight exposure), magnitude of injury/illness, or the treatment started by medical doctors including fluid resuscitation. Low levels of vitamin D in critically ill patients have been associated with sepsis, organ failure, and mortality. Despite this, there are subpopulations of critical illness, such as burn patients, where the literature regarding vitamin D status and its influence on outcomes remain insufficient. Thermal injury results in damage to both burned and non-burned tissues, as well as induces an exaggerated and persistent immune-inflammatory and hypermetabolic response. In this review, we propose potential mechanisms in which burn injury affects the vitamin D status and summarizes current literature investigating the influence of vitamin D status on outcomes. In addition, wereviewed the literature and trials investigating vitamin D supplementation in critically ill patients and discuss the therapeutic potential of vitamin D supplementation in burn and critically ill patients. We also highlight current limitations of studies that have investigated vitamin D status and supplementation in critical illness. Thermal injury influences vitamin D status. More studies investigating vitamin D 展开更多
关键词 VITAMIN D Critical care BURNS TRAUMA Thermal INJURY Critically ILL
Management of early mobilization in intensive care units:a multicenter cross-sectional study 预览
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作者 Yan-Ping Zhu Li-Xia Xia Guo-Hong Li 《护理前沿(英文)》 CAS 2018年第4期291-299,共9页
Objective:The aim of this study was to assess the management of early mobilization (EM) in Chinese intensive care units (ICUs).Methods:This survey used a cross-sectional,observational design.A total of 65 tertiary and... Objective:The aim of this study was to assess the management of early mobilization (EM) in Chinese intensive care units (ICUs).Methods:This survey used a cross-sectional,observational design.A total of 65 tertiary and secondary hospitals were enrolled by convenience sampling and investigated using self-designed questionnaires.Results:We identified 69 ICUs in Jiangsu,China(response rate:94.2%).74.2% (1,004/1,353) of the nurses and nursing managers from 65 ICUs reported mobility practice.For the mobility level,98.1% (1,327) reported use of in-bed exercise,5.7% (77) sitting on a side of bed,21.7% (294) transfer to chair,and 2.4% (33) walking.The most frequently reported barriers to early mobility were unplanned extubation,nursing resource,and absence of physical therapist.Nurses’educational backgrounds,nursing experience,the lack of nursing resources,absence of physician,and the weakness of patient were the factors that influenced ICU early rehabilitation(P<0.01).Conclusions:Although implementation rates for EM in critically ill patients are high,the activity level is generally poor in most of the involved ICUs. 展开更多
关键词 early MOBILIZATION CRITICAL CARE critically ILL patients MANAGEMENT clinical practice
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伊犁河谷观赏植物繁殖体形态特征及其环境响应
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作者 李雪峰 张玲卫 +3 位作者 陈艳锋 刘会良 张道远 赵瑞超 《干旱区研究》 CSCD 北大核心 2017年第6期1353-1361,共9页
为探明干旱区"湿岛"植物繁殖体的环境适应性和繁殖对策,提高对"湿岛"生态系统植被的认识,选取伊犁河谷地区35种常见观赏植物,研究其繁殖体的形态特征。结果表明:35种植物中,繁殖体单粒重可分为4个级别,从0.05 mg(牛至)到45.96 m... 为探明干旱区"湿岛"植物繁殖体的环境适应性和繁殖对策,提高对"湿岛"生态系统植被的认识,选取伊犁河谷地区35种常见观赏植物,研究其繁殖体的形态特征。结果表明:35种植物中,繁殖体单粒重可分为4个级别,从0.05 mg(牛至)到45.96 mg(忍冬)不等,其中0.10-0.99 mg的有12种(34.29%);繁殖体三维平均方差,从0.002(龙芽草)到0.14(伊犁郁金香)不等,74.29%的繁殖体呈卵圆形或圆球形,三维平均方差小于0.09;具有典型附属物的共9种(25.71%),分别属于玄参科、蔷薇科、唇形科、伞形科、毛茛科等;具有黏液繁殖体的有2种。不同科植物繁殖体重量不同,其中,蔷薇科显著高于唇形科,而不同生活型植物繁殖体重量差异不显著。 展开更多
关键词 观赏植物 繁殖体 形态特征 黏液 附属物 伊犁
Keystone and the Divine King:A Study on the Nyikang of the Shilluk and Divine Kingship 预览
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作者 Wang Wenlan Zhang Yahui 《民族学刊》 2016年第3期98-102,共5页
In his famous book The Golden Bough,]ames Frazer mentioned one special custom found along the shores of Lake Nemi in Italy. The forest king who lived beside Lake N e m i, was not only once a prisoner, but also the mur... In his famous book The Golden Bough,]ames Frazer mentioned one special custom found along the shores of Lake Nemi in Italy. The forest king who lived beside Lake N e m i, was not only once a prisoner, but also the murderer of his predecessor. W hy did the K ing have to be kille d ? How could he be k ille d ? This was the very starting point of James Frazer’s divine kingship study. This was in contrast to the common idea held in many cultures, that kings, or even gods, would die. 展开更多
关键词 divine KINGSHIP Nyikang CUSTOM to k ILL the KING ( regicide) DUAL structure
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Glycemic management in critically ill patients 预览
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作者 Eden A Nohra Jarot J Guerra Grant V Bochicchio 《世界外科手术杂志》 2016年第3期30-39,共10页
Hyperglycemia associated with critical illness,also called“stress hyperglycemia”or“stress diabetes”,is a consequence of many pathophysiologic hormonal responses including increased catecholamines,cortisol,glucagon... Hyperglycemia associated with critical illness,also called“stress hyperglycemia”or“stress diabetes”,is a consequence of many pathophysiologic hormonal responses including increased catecholamines,cortisol,glucagon,and growth hormone.Alterations in multiple biochemical pathways result in increased hepatic and peripheral insulin resistance with an uncontrolled activation of gluconeogenesis and glycogenolysis.Hyperglycemia has a negative impact on the function of the immune system,on the host response to illness or injury,and on infectious and overall outcomes.The degree of glucose elevation is associated with increased disease severity.Large randomized controlled trials including the Van den Berghe study,the NICE-SUGAR trial,VISEP and GLUCONTROL have shown that the control of glucose levels in critically ill patients has implications on outcome and that both hyperglycemia and hypoglycemia are detrimental and should be avoided.Glucose variability has also been shown to be detrimental.Aggressive glucose control strategies have changed due to the concerns of hypoglycemia and therefore intermediate target glucose control strategies are most often adopted.Different patient populations may vary with regards to optimal glucose targets,timing and approach for glucose control,and with regards to the prognostic significance of glucose excursions and variability.Medical,surgical,and trauma patients may benefit at different rates from glucose control and the approach may need to be adapted to various medical settings and to correspond to the workflow of health providers.Effect modifiers for the success of insulin therapy for hyperglycemia include the methods of nutritional supplementation and exogenous glucose administration.Further research is required to improve insulin protocols for glucose control,to further define glucose targets,and to enhance the accuracy of glucose measuring technologies. 展开更多
关键词 HYPERGLYCEMIA HYPOGLYCEMIA Critically ILL INTENSIVE CARE unit GLUCOSE control
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Association between infections caused by multidrug-resistant gram-negative bacteria and mortality in critically ill patients 预览
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作者 Elisabeth Paramythiotou Christina Routsi 《世界重症医学杂志》 2016年第2期111-120,共10页
The incidence of gram-negative multidrug-resistant(MDR)bacterial pathogens is increasing in hospitals and particularly in the intensive care unit(ICU)setting.The clinical consequences of infections caused by MDR patho... The incidence of gram-negative multidrug-resistant(MDR)bacterial pathogens is increasing in hospitals and particularly in the intensive care unit(ICU)setting.The clinical consequences of infections caused by MDR pathogens remain controversial.The purpose of this review is to summarize the available data concerning the impact of these infections on mortality in ICU patients.Twenty-four studies,conducted exclusively in ICU patients,were identified through PubMed search over the years 2000-2015.Bloodstream infection was the only infection examined in eight studies,respiratory infections in four and variable infections in others.Comparative data on the appropriateness of empirical antibiotic treatment were provided by only seven studies.In ten studies the presence of antimicrobial resistance was not associated with increased mortality;on the contrary,in other studies a significant impact of antibiotic resistance on mortality was found,though,sometimes,mediated by inappropriate antimicrobial treatment.Therefore,a direct association between infections due to gram-negative MDR bacteria and mortality in ICU patients cannot be confirmed.Sample size,presence of multiple confounders and other methodological issues may influence the results.These data support the need for further studies to elucidate the real impact of infections caused by resistant bacteria in ICU patients. 展开更多
关键词 Critically ill patients INFECTIONS MULTIDRUG resistance GRAM-NEGATIVE PATHOGENS MORTALITY
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慢性精神病患者的院内康复效果的临床价值探讨 预览 被引量:1
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作者 孟琳琳 《临床医药文献杂志(电子版)》 2016年第30期5917-5918,共2页
目的 研究慢性神经病患者的治疗过程实施康复治疗的效果,从而找出更好帮助慢性神经病患者的恢复自理能力,促进康复的办法。方法 选取2013年1月~2015年1月我院收治的慢性神经病患者100例,随机均分为对照组和实验组,各50例,对照组采取常... 目的 研究慢性神经病患者的治疗过程实施康复治疗的效果,从而找出更好帮助慢性神经病患者的恢复自理能力,促进康复的办法。方法 选取2013年1月~2015年1月我院收治的慢性神经病患者100例,随机均分为对照组和实验组,各50例,对照组采取常规治疗的方法。实验组在常规护理的基础上,实施院内康复治疗,康复治疗过程包括心理治疗,娱乐活动参与,制作工艺品的活动等个性化康复治疗,治疗后比较两组患者前后康复情况。主要包括:恢复情况、生活质量及患者满意度。结果 护理后实验组患者比对照组恢复情况要好,满意度更高,治疗后生活质量更好,差异有统计学意义(P〈0.05)。结论 慢性精神病的患者中实施院内康复程序能够有效加快患者自理能力的恢复,提高患者护理满意度,且有利于提高治疗后生活质量水平,值得在临床推广和应用。 展开更多
关键词 慢性精神病 康复 临床价值
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Fluid and electrolyte overload in critically ill patients:An overview 预览
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作者 Bruno Adler Maccagnan Pinheiro Besen AndréLuiz Nunes Gobatto +2 位作者 Lívia Maria Garcia Melro Alexandre Toledo Maciel Marcelo Park 《世界重症医学杂志》 2015年第2期116-129,共14页
Fluids are considered the cornerstone of therapy for many shock states,particularly states that are associated with relative or absolute hypovolemia.Fluids are also commonly used for many other purposes,such as renal ... Fluids are considered the cornerstone of therapy for many shock states,particularly states that are associated with relative or absolute hypovolemia.Fluids are also commonly used for many other purposes,such as renal protection from endogenous and exogenous substances,for the safe dilution of medications and as“maintenance”fluids.However,a large amount of evidence from the last decade has shown that fluids can have deleterious effects on several organ functions,both from excessive amounts of fluids and from their non-physiological electrolyte composition.Additionally,fluid prescription is more common in patients with systemic inflammatory response syndrome whose kidneys may have impaired mechanisms of electrolyte and free water excretion.These processes have been studied as separate entities(hypernatremia,hyperchloremic acidosis and progressive fluid accumulation)leading to worse outcomes in many clinical scenarios,including but not limited to acute kidney injury,worsening respiratory function,higher mortality and higher hospital and intensive care unit lengthof-stays.In this review,we synthesize this evidence and describe this phenomenon as fluid and electrolyte overload with potentially deleterious effects.Finally,we propose a strategy to safely use fluids and thereafter wean patients from fluids,along with other caveats to be considered when dealing with fluids in the intensive care unit. 展开更多
关键词 FLUID therapy Critically Ill Oliguria Waterelectrolyte balance Central VENOUS pressure RESUSCITATION Acute kidney injury DIURETICS Multiple organ dysfunction SYNDROME Systemic inflammatory response SYNDROME
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Opening the doors of the intensive care unit to cancer patients:A current perspective 预览
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作者 Silvio A Nmendys-Silva Erika P Plata-Menchaca +1 位作者 Eduardo Rivero-Sigarroa Angel Herrera-Gómez 《世界重症医学杂志》 2015年第3期159-162,共4页
The introduction of new treatments for cancer and advances in the intensive care of critically ill cancer patients has improved the prognosis and survival.In recent years,the classical intensive care unit(ICU)admissio... The introduction of new treatments for cancer and advances in the intensive care of critically ill cancer patients has improved the prognosis and survival.In recent years,the classical intensive care unit(ICU)admission comorbidity criteria used for this group of patients have been discouraged since the risk factors for death that have been studied,mainly the number and severity of organic failures,allow us to understand the determinants of the prognosis inside the ICU.However,the availability of intensive care resources is dissimilar by country,and these differences are known to alter the indications for admission to critical care setting.Three to five days of ICU management is warranted before making a final decision(ICU trial)to consider keep down intensive management of critically ill cancer patients.Nowadays,taking into account only the diagnosis of cancer to consider ICU admission of patients who need full-supporting management is no longer justified. 展开更多
关键词 Intensive CARE unit Critical CARE setting CANCER PATIENTS Critically ILL CANCER PATIENTS ORGAN FAILURES
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Heparin induced thrombocytopenia in critically ill:Diagnostic dilemmas and management conundrums 预览
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作者 Sachin Gupta Ravindranath Tiruvoipati +2 位作者 Cameron Green John Botha Huy Tran 《世界重症医学杂志》 2015年第3期202-212,共11页
Thrombocytopenia is often noted in critically ill patients.While there are many reasons for thrombocytopenia,the use of heparin and its derivatives is increasingly noted to be associated with thrombocytopenia.Heparin ... Thrombocytopenia is often noted in critically ill patients.While there are many reasons for thrombocytopenia,the use of heparin and its derivatives is increasingly noted to be associated with thrombocytopenia.Heparin induced thrombocytopenia syndrome(HITS)is a distinct entity that is characterised by the occurrence of thrombocytopenia in conjunction with thrombotic manifestations after exposure to unfractionated heparin or low molecular weight heparin.HITS is an immunologic disorder mediated by antibodies to heparin-platelet factor 4(PF4)complex.HITS is an uncommon cause of thrombocytopenia.Reported incidence of HITS in patients exposed to heparin varies from 0.2%to up to 5%.HITS is rare in ICU populations,with estimates varying from 0.39%-0.48%.It is a complex problem which may cause diagnostic dilemmas and management conundrum.The diagnosis of HITS centers around detection of antibodies against PF4-heparin complexes.Immunoassays performed by most pathology laboratories detect the presence of antibodies,but do not reveal whether the antibodies are pathological.Platelet activation assays demonstrate the presence of clinically relevant antibodies,but only a minority of laboratories conduct them.Several anticoagulants are used in management of HITS.In this review we discuss the incidence,pathogenesis,diagnosis and management of HITS. 展开更多
关键词 HEPARIN THROMBOCYTOPENIA Critically ILL Diagnosis Management
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人教新课标必修4 Units1—5重点单词归纳讲解
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作者 刘本龙 《考试与评价(英语人教新课标高考版)》 2015年第20期12-15,共4页
1.behavevt.&vi举动。表现n.behavior行为,举止。习性【拓展】behave oneself举止规矩,有礼貌;behave weH/badly towards sb.对某人态度好/不好;do behave规矩点;behave in/out of character行为与自身特性相符/不相符;b... 1.behavevt.&vi举动。表现n.behavior行为,举止。习性【拓展】behave oneself举止规矩,有礼貌;behave weH/badly towards sb.对某人态度好/不好;do behave规矩点;behave in/out of character行为与自身特性相符/不相符;behave oneseff ill没有礼豹Behave yourself;don’t make a fool of yourself.注意你的举止,别闹出笑话来。 展开更多
关键词 新课标 CHARACTER 讲解 归纳 单词 MAKE 举止 ILL
轧机主传滑动轴承劣化对策及维修技术 预览 被引量:1
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作者 屠海 《酒钢科技》 2014年第3期83-86,99共5页
从轧机主传动系统静压滑动轴承的结构及工作特点分析入手.探讨了轧机主传动静压滑动轴承的劣化趋势对策及维修方法,为一些现场缺乏电机静压滑动轴承基础资料技术人员,提供出一个好方法及方向,使轴承维护人员对精密轴瓦有了深度认识... 从轧机主传动系统静压滑动轴承的结构及工作特点分析入手.探讨了轧机主传动静压滑动轴承的劣化趋势对策及维修方法,为一些现场缺乏电机静压滑动轴承基础资料技术人员,提供出一个好方法及方向,使轴承维护人员对精密轴瓦有了深度认识.提高了对轴承的维护效率。 展开更多
关键词 轧机 静压滑动轴承 维护 使用寿命 离线维护 在线维护
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基于社会网络分析的国内馆际互借研究分析 预览
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作者 宋秀芬 《科技广场》 2014年第5期142-145,共4页
本文以CNKI为数据源,基于文献计量的角度,对2000-2013年国内馆际互借领域发表的论文进行分析,利用社会网络分析方法生成国内馆际互借的研究成果年限分布表、关键词共现矩阵和关键词共现图谱,剖析了国内馆际互借领域的研究前沿与研究热点。
关键词 馆际互借 社会网络分析 共现网络 UCINET
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在梦想之路上阔步前行——光荣与梦想 预览
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作者 赵麟 《广播歌选》 2014年第11期34-35,共2页
歌曲《光荣与梦想》借鉴了斯拉夫进行曲的曲风,整体气质充满了奋进的斗志和力量,曲调、歌词加之合Ill,9表演形式,令作品充满了一种在梦想之路上蓄势待发、披荆斩棘、阔步前行的气势。
关键词 《光荣与梦想》 表演形式 ILL 作者
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ILL实验室:以服务之名
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作者 唐琳 《科学新闻》 2014年第4期38-39,共2页
很少有研究机构像ILL一样将“服务”二字贯彻得如此深入骨髓:从名字所赋予的意义,到为城市经济与文化做出的贡献。 很少有研究机构将“服务”二字贯彻得如此深入骨髓:从名字所赋予的意义,到供全球科学家使用的大科学装置,再到为... 很少有研究机构像ILL一样将“服务”二字贯彻得如此深入骨髓:从名字所赋予的意义,到为城市经济与文化做出的贡献。 很少有研究机构将“服务”二字贯彻得如此深入骨髓:从名字所赋予的意义,到供全球科学家使用的大科学装置,再到为城市经济与文化做出的贡献…… 展开更多
关键词 “服务” ILL 实验室 经济与文化 研究机构 大科学 科学家 意义
趣味屋
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《小学生导读》 2014年第7期80-81,共2页
我I有一个好主意idea。 墨水ink不能喝drink。 生病ill了就吃些药片pill吧。
关键词 趣味 IDEA ILL 墨水
“完全”的艺术与“完全”的人
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作者 陈秀云 《新世纪剧坛》 2014年第1期29-31,共3页
“说到底,只有当人是完全意义上的人,他才游戏;只有当人游戏时,他才完全是人。”ill席勒在《审美教育书简》中提出了这样的命题,那就是通过“游戏”来塑造“完全”的人。当我们探寻席勒命题是否适用的时候,必须回答,何为“完全... “说到底,只有当人是完全意义上的人,他才游戏;只有当人游戏时,他才完全是人。”ill席勒在《审美教育书简》中提出了这样的命题,那就是通过“游戏”来塑造“完全”的人。当我们探寻席勒命题是否适用的时候,必须回答,何为“完全”的人?他所言的“游戏”即“艺术”在人性完满的路上究竟会有何作为? 展开更多
关键词 “艺术” 审美教育 游戏 ILL 命题 席勒
If的用法
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作者 方明 《初中生辅导》 2013年第8期32-33,共2页
在中考中,if出现题型较多。现将用法列出,有助于我们更好地掌握它。I、if引导条件状语从句的时候,译为“如果,假如”,主句用将来时,从句用一般时。Ill gothereifitgfine.如果天气晴朗,我就去那里。I wontgohomeifitrainstomorro... 在中考中,if出现题型较多。现将用法列出,有助于我们更好地掌握它。I、if引导条件状语从句的时候,译为“如果,假如”,主句用将来时,从句用一般时。Ill gothereifitgfine.如果天气晴朗,我就去那里。I wontgohomeifitrainstomorrow.如果明天下雨我就不回家。 展开更多
关键词 用法 条件状语从句 IF 将来时 ILL IF 中考 下雨
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