Tag: statistics

J Cosmet Dermatol. 2025 Feb;24(2):e70046. doi: 10.1111/jocd.70046.

ABSTRACT

BACKGROUND: Rosacea is a chronic skin condition that affects millions of people worldwide, and its management continues to pose a significant challenge in dermatology.

AIM: In this study, we investigated the efficacy and safety of 30% supramolecular salicylic acid (SSA) as a treatment for papulopustular rosacea, with a particular focus on improving skin lesions, reducing persistent erythema, and enhancing skin barrier function.

METHODS: Thirty-four patients diagnosed with papulopustular rosacea were randomly divided into an experimental group treated with 30% SSA and a control group receiving a placebo. Clinical outcomes were evaluated based on lesion reduction rates, investigator severity assessment (ISA) scores, VISIA red area scores, and skin barrier, including trans-epidermal water loss (TEWL), sebum levels, stratum corneum hydration, and pH values.

RESULTS: A total of 34 patients were collected for both the experimental and control groups, with no statistical differences in age or disease severity between the groups (p > 0.05). The effective rate was 68.75% in the experimental group (p < 0.01). After treatment, the ISA score was 1.75 ± 0.68 in the experimental group and 2.40 ± 0.83 in the control group, indicating significant improvement (p < 0.05). The improvement rate of the VISIA redness score was 25.1% in the experimental group (p < 0.01). Among the 17 patients who underwent skin barrier function testing. Skin hydration significantly improved on left cheek (p < 0.05), right cheek (p < 0.01), and nose (p < 0.05) after 30% SSA treatment in experimental group. Sebum levels were significantly reduced on both cheeks and forehead (p < 0.05). No statistical differences were observed in other locations. Skin TEWL and pH value showed no changes.

CONCLUSION: 30% SSA reduced papules and pustules in rosacea, improved persistent erythema, and enhanced stratum corneum hydration in the 30% SSA-treated group compared to the placebo group. No significant differences were observed in TEWL and skin pH values between the two groups. Our findings suggest that 30% SSA is an effective and safe option for managing papulopustular rosacea, offering a well-tolerated alternative to traditional treatments.

PMID:39968706 | DOI:10.1111/jocd.70046

J Diabetes. 2025 Feb;17(2):e70058. doi: 10.1111/1753-0407.70058.

ABSTRACT

AIM: This study aimed to examine microvascular lesions and neurodegenerative changes in diabetic retinopathy (DR) compared to type 2 diabetes mellitus (T2DM) without DR (NDR) using structural MRI and to explore their associations with DR.

METHODS: 243 patients with NDR and 122 patients with DR were included. Participants underwent conventional brain MRI scans, clinical measurements, and fundus examinations. Cerebral small vessel disease (CSVD) imaging parameters were obtained using AI-based software, manually verified, and corrected for accuracy. Volumes of major cortical and subcortical regions representing neurodegeneration were assessed using automated brain segmentation and quantitative techniques. Statistical analysis included T-test, chi-square test, Mann-Whitney U test, multivariate analysis of variance (MANCOVA), multivariate logistic regression, area under the receiver operating characteristic curve (AUC), and Delong test.

RESULTS: DR group exhibited significant differences in 11 CSVD features. Meanwhile, DR showed an atrophy trend in the frontal cortex, occipital cortex, and subcortical gray matter (GM) compared to NDR. After adjustment, DR patients exhibited greater perivascular spaces (PVS) numbers in the parietal lobe (OR = 1.394) and deep brain regions (OR = 1.066), greater dilated perivascular spaces (DPVS) numbers in the left basal ganglia (OR = 2.006), greater small subcortical infarcts (SSI) numbers in the right hemisphere (OR = 3.104), and decreased left frontal PVS (OR = 0.824), total left DPVS (OR = 0.714), and frontal cortex volume (OR = 0.959) compared to NDR. Further, the CSVD model showed a larger AUC (0.823, 95% CI: 0.781-0.866) than the brain atrophy model (AUC = 0.757, 95% CI: 0.706-0.808).

CONCLUSION: Microvascular and neurodegeneration are significantly associated with DR. CSVD is a better imaging biomarker for DR than brain atrophy.

PMID:39968694 | DOI:10.1111/1753-0407.70058

Alzheimers Dement. 2025 Feb 19:e14489. doi: 10.1002/alz.14489. Online ahead of print.

ABSTRACT

INTRODUCTION: Early-onset and late-onset Alzheimer’s disease (EOAD and LOAD, respectively) have distinct clinical manifestations, with prior work based on small samples suggesting unique patterns of neurodegeneration. The current study performed a head-to-head comparison of cortical atrophy in EOAD and LOAD, using two large and well-characterized cohorts (LEADS and ADNI).

METHODS: We analyzed brain structural magnetic resonance imaging (MRI) data acquired from 377 sporadic EOAD patients and 317 sporadicLOAD patients who were amyloid positive and had mild cognitive impairment (MCI) or mild dementia (i.e., early-stage AD), along with cognitively unimpaired participants.

RESULTS: After controlling for the level of cognitive impairment, we found a double dissociation between AD clinical phenotype and localization/magnitude of atrophy, characterized by predominant neocortical involvement in EOAD and more focal anterior medial temporal involvement in LOAD.

DISCUSSION: Our findings point to the clinical utility of MRI-based biomarkers of atrophy in differentiating between EOAD and LOAD, which may be useful for diagnosis, prognostication, and treatment.

HIGHLIGHTS: Early-onset Alzheimer’s disease (EOAD) and late-onset AD (LOAD) patients showed distinct and overlapping cortical atrophy patterns. EOAD patients showed prominent atrophy in widespread neocortical regions. LOAD patients showed prominent atrophy in the anterior medial temporal lobe. Regional atrophy was correlated with the severity of global cognitive impairment. Results were comparable when the sample was stratified for mild cognitive impairment (MCI) and dementia.

PMID:39968692 | DOI:10.1002/alz.14489

Monaldi Arch Chest Dis. 2025 Feb 18. doi: 10.4081/monaldi.2025.3246. Online ahead of print.

ABSTRACT

Patients undergoing endobronchial ultrasound-guided fine needle aspiration may have multiple comorbidities, contributing to higher risks of hypoxia and adverse events, such as arrhythmias. The current study compared the efficacy of two oxygenation modalities: the high-flow nasal cannula (HFNC) vs. conventional oxygen therapy (CNC). Patients were randomized to either the HFNC or the CNC arm. HFNC and CNC were initiated and escalated as per predefined protocols. The number of desaturation events [fall in saturation of peripheral oxygen (SpO2) by 3% from the baseline] and change in levels of transcutaneous CO2 (tcCO2) from baseline were noted. Subgroup analysis was done in patients with cardiopulmonary comorbidities and in patients with SpO2<97%. A total of 122 patients were randomized. Overall, there was no significant difference in the number of desaturation events and change in tcCO2 levels; however, in patients with cardiopulmonary comorbidities (obstructive sleep apnea, heart diseases, and stable chronic obstructive airway disease), 50% in the HFNC arm had no desaturation compared to 11.7% in the CNC arm (p=0.007). 41.17% of patients in the HFNC arm had a rise in tcCO2 levels, compared to 36.11% of patients in the CNC arm (p>0.5). In patients with SpO2<97%, 48.88% in the HFNC arm had no desaturations compared to 14.70% in the CNC arm (p=0.001); there was no statistical difference in rise in tcCO2. Hence, HFNC would be a better modality for oxygenation in patients with a high risk of hypoxia without increasing the risk of hypercapnia.

PMID:39968686 | DOI:10.4081/monaldi.2025.3246

J Sep Sci. 2025 Feb;48(2):e70097. doi: 10.1002/jssc.70097.

ABSTRACT

The aim of this research was the therapeutic drug monitoring for valproic acid in epilepsy patient’s serum samples by the common, sensitive, and accessible HPLC-UV method. Because of the absence of a suitable chromophore in the valproic acid structure, a facile, selective, and cost-effective pre-column derivatization was designed. This catalyst-free ultrasound-assisted derivatization assay can accomplish the derivatization very quickly only in 5.0 min and at a mild temperature of 60°C. 2,4′-Dibromoacetophenone and nonanoic acid was used as derivatizing agent and internal standard, respectively. The effect of sample pH, buffer concentration, ultrasound exposure time, reaction temperature, and derivatizing agent amount were optimized. The proposed method exhibited a good linear range of 5.0-300.0 µg/mL with acceptable correlation coefficients of 0.9981. The limit of detection was as low as 0.4 µg/mL. Also, the limit of quantification was reported as 1.3 µg/mL. Interday and intraday relative standard deviations (n = 10) were 1.1% and 0.3%-7.0%, respectively. In addition, the relative recovery ranged from 100.3% to 107.7%. The measurement of valproic acid was performed in the presence of several epilepsy and non-epilepsy drugs by the developed protocol. This confirmed the specific and accurate determination of valproic acid in the patient’s serum. A comparative evaluation was employed against the precise chemiluminescence immunoassay approach. The correlation coefficient between the two methods was 0.9992, which demonstrated the results were statistically the same.

PMID:39968684 | DOI:10.1002/jssc.70097

Ann Surg. 2025 Feb 19. doi: 10.1097/SLA.0000000000006675. Online ahead of print.

ABSTRACT

OBJECTIVE: To estimate the risk of insurance instability following firearm injury.

BACKGROUND: Health insurance instability is associated with negative clinical outcomes. After nonfatal firearm injury, continuity of health care is particularly important given substantially increased physical, mental, and rehabilitative needs and related healthcare spending.

METHODS: Using 2007-2022 commercial insurance claims data, we studied 3,653 survivors and 17,422 matched controls to investigate the risk of health insurance instability associated with firearm injury. Participants were matched on age, Diagnostic Cost Group risk score, year, month, plan type, drug coverage, sex, metropolitan statistical area, state, and enrollee category.

RESULTS: The mean age of survivors was 30.5 years, 83.7% were male, 39.2% were primary enrollees, with observable characteristics closely balanced between exposed and control groups after matching. Within 1 year of injury, 36.1% of survivors experienced insurance instability compared with 28.1% of matched controls-an attributable risk of 8.0 (95% CI: 5.8, 10.1) and adjusted hazard ratio of 1.34 (95% CI: 1.26, 1.42). For survivors with more severe injuries, 37.3% experienced insurance instability compared with 27.6% of matched controls-an attributable risk of 9.8 (95% CI: 6.7, 12.9) and adjusted hazard ratio of 1.43 (95% CI: 1.31, 1.56). On average, firearm-injured primary enrollees experiencing insurance instability provided coverage for 0.84 dependents (spouses and children) at the time of their insurance status change.

CONCLUSIONS: Firearm injury was followed by increased insurance instability among survivors, with increased risk following more severe injuries. Insurance instability may disrupt care and shift costs to the public through public insurance enrollment and uncompensated care for the uninsured.

PMID:39968652 | DOI:10.1097/SLA.0000000000006675

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2025 Jan;37(1):53-58. doi: 10.3760/cma.j.cn121430-20231109-00960.

ABSTRACT

OBJECTIVE: To investigate the effects of calcitonin gene-related peptide (CGRP) on autophagy in hypoxic/reoxygenated (H/R) cardiomyocytes and its relationship with the phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin (PI3K/Akt/mTOR) signaling pathway.

METHODS: The rat cardiomyocyte cell line H9c2 was routinely cultured in vitro and passaged for experiments when the cells grew to 80% fusion. (1) CGRP dosage screening experiment: the cells were divided into blank control group, H/R group and different dosages of CGRP pretreatment groups. H9c2 cells were placed in a closed hypoxia chamber for 2 hours and then reoxygenated in a conventional incubator for 12 hours to prepare the H/R model. The CGRP pretreatment groups were pretreated with 0.01, 0.1, 0.5, 1, 5, and 10 μmol/L CGRP before the modeling process. The blank control group was not given any treatment. Cell counting kit-8 (CCK-8) was used to detect the cell survival rate, and the most suitable drug dosage was screened out. (2) Intervention experiment: H9c2 cells were divided into blank control group, H/R group, CGRP+H/R group, and CGRP+PI3K target inhibitor ly294002 (LY)+H/R group. H/R group was prepared as cellular H/R model. CGRP (1 μmol/L) alone or in combination with LY (10 μmol/L) was administered to CGRP+H/R group and CGRP+LY+H/R group, respectively, prior to the preparation of cellular H/R model. The blank control group was cultured routinely without treatment. The cell survival rate was detected by CCK-8. The level of lactate dehydrogenase (LDH) release was detected by colorimetric assay. The expressions of autophagy-related proteins [autophagy effector protein Beclin-1, microtubule-associated protein 1 light chain 3-II (LC3-II), autophagy protein p62] and PI3K/Akt/mTOR signaling pathway proteins [phosphorylated Akt (p-Akt), phosphorylated mTOR (p-mTOR)] were detected by Western blotting.

RESULTS: (1) Results of CGRP dosage screening experiment: compared with the blank control group, the cell survival rate of the H/R group decreased significantly; and after giving 0.1, 0.5, 1, 5 μmol/L CGRP for pretreatment, the cell survival rate increased significantly, and intervention effect of 1 μmol/L CGRP was the best, and the difference was statistically significant when compared with that of the H/R group [(74.23±6.18)% vs. (23.43±4.09)%, P < 0.01], so it was used as the intervention dosage for the subsequent experiment. (2) Intervention experiment results: compared with the blank control group, the cell survival rate in the H/R group was significantly reduced, the level of LDH release was significantly increased, the protein expressions of Beclin-1 and LC3-II were significantly increased, and the protein expressions of p62, p-Akt and p-mTOR were significantly reduced, indicating that the death of cardiomyocytes occurred after the treatment of H/R and was accompanied by the elevation of autophagy level, and this process was associated with the activation of PI3K/Akt/mTOR signaling pathway. Compared with the H/R group, CGRP pretreatment increased cell survival rate [(76.02±2.43)% vs. (46.15±3.29)%, P < 0.01], decreased the level of LDH release (U/L: 169.83±11.65 vs. 590.17±34.50, P < 0.01), and down-regulated the protein expressions of Beclin-1 and LC3-II [Beclin-1 protein (Beclin-1/β-actin): 1.27±0.15 vs. 1.93±0.19, LC3-II protein (LC3-II/LC3-I): 1.27±0.13 vs. 1.98±0.18, both P < 0.01], up-regulated the protein expressions of p62, p-Akt, p-mTOR [p62 protein (p62/β-actin): 0.96±0.02 vs. 0.63±0.05, p-Akt protein (p-Akt/Akt): 0.76±0.04 vs. 0.48±0.02, p-mTOR protein (p-mTOR/mTOR): 1.13±0.09 vs. 0.68±0.15, all P < 0.05], suggesting that CGRP was able to reduce the H/R-induced cardiomyocyte injury, and this process was accompanied by a decrease in the level of cellular autophagy and activation of the PI3K/Akt/mTOR signaling pathway. Compared with the CGRP+H/R group, the cell survival rate was significantly lower than that in the CGRP+LY+H/R group [(56.95±6.63)% vs. (76.02±2.43)%, P < 0.01], LDH release level was significantly higher (U/L: 436.00±27.44 vs. 169.83±11.65, P < 0.01), and the protein expressions of Beclin-1 and LC3-II were significantly up-regulated [Beclin-1 protein (Beclin-1/β-actin): 1.63±0.12 vs. 1.27±0.15, LC3-II protein (LC3-II/LC3-I): 1.61±0.13 vs. 1.27±0.13, both P < 0.01], and significantly down-regulated p62, p-Akt, and p-mTOR protein expressions [p62 protein (p62/β-actin): 0.57±0.09 vs. 0.96±0.02, p-Akt protein (p-Akt/Akt): 0.45±0.01 vs. 0.76±0.04, p-mTOR protein (p-mTOR/mTOR): 0.66±0.06 vs. 1.13±0.09, all P < 0.05], suggesting that PI3K-targeted inhibitor was able to reverse the protective effect of CGRP on H/R cells.

CONCLUSIONS: CGRP pretreatment attenuated H/R-induced cardiomyocyte injury, increased cell survival rate, and reduced cellular LDH release. This effect may be achieved through inhibiting the activation of PI3K/Akt/mTOR signaling pathway.

PMID:39968587 | DOI:10.3760/cma.j.cn121430-20231109-00960

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2025 Jan;37(1):48-52. doi: 10.3760/cma.j.cn121430-20240802-00661.

ABSTRACT

OBJECTIVE: To investigate the effects of using different filters in continuous renal replacement therapy (CRRT) on the mortality, inflammatory mediator level and hemodynamics in patients with sepsis-associated acute kidney injury (SA-AKI).

METHODS: A prospective study was conducted. The patients with SA-AKI undergoing first CRRT admitted to the critical care medicine department of General Hospital of Ningxia Medical University from August 2022 to October 2023 were enrolled as the study objects, and they were divided into observation group and control group by random number table method. All patients received routine treatment including anti-infection, optimized volume management and organ function support. On this basis, the observation group was treated with oXiris filter for CRRT, while the control group was treated with ordinary filter for CRRT, and the first treatment time was ≥ 36 hours. General data of the two groups were collected and compared. At the same time, the inflammatory indicators [high-sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT), interleukin-6 (IL-6)], sequential organ failure assessment (SOFA) score, mean arterial pressure (MAP), blood lactic acid (Lac), noradrenaline dosage and other related indicators were collected before CRRT treatment and 24 hours and 48 hours after treatment, and the 7-day and 28-day mortality of patients were recorded.

RESULTS: Finally, 65 patients were enrolled, including 30 in the observation group and 35 in the control group. There were no significant differences in baseline data including age, gender, acute kidney injury (AKI) stage and infection source between the two groups. The 7-day mortality of observation group was significantly lower than that of control group [16.7% (5/30) vs. 42.9% (15/35), P < 0.05]. There was no significant difference in 28-day mortality between the observation group and the control group [36.7% (11/30) vs. 54.3% (19/35), P > 0.05]. There were no significant differences in inflammation indicators, SOFA score, MAP, Lac and norepinephrine dosage before treatment between the two groups. After 24-hour and 48-hour treatment, the hemodynamics of the two groups were stable compared with before treatment, the inflammatory indicators, SOFA score, Lac and norepinephrine dosage were reduced to varying degrees, and MAP was significantly increased. In the observation group, hs-CRP, PCT, IL-6, SOFA score, MAP, and norepinephrine dosage showed statistical significance at 24 hours after treatment as compared with before treatment [hs-CRP (mg/L): 125.0 (105.0, 171.2) vs. 280.5 (213.2, 313.8), PCT (μg/L): 51.0 (20.0, 62.8) vs. 71.0 (10.8, 100.0), IL-6 (ng/L): 1 762.2 (300.8, 4 327.5) vs. 4 447.5 (630.4, 5 000.0), SOFA score: 13.0 (12.0, 14.0) vs. 16.0 (15.0, 17.0), MAP (mmHg, 1 mmHg ≈ 0.133 kPa): 79.00±12.87 vs. 65.20±11.70, norepinephrine dosage (μg×kg^-1×min^-1): 0.82±0.33 vs. 1.63±0.51, all P < 0.05]. In the control group, PCT and MAP showed statistical significance after 48 hours of treatment as compared with before treatment. Compared with the control group, hs-CRP, SOFA score and norepinephrine dosage after 48 hours of treatment in the observation group were significantly decreased [hs-CRP (mg/L): 87.2 (74.2, 126.0) vs. 157.0 (88.0, 200.0), SOFA score: 11.0 (10.0, 12.0) vs. 12.0 (10.0, 14.0), norepinephrine dosage (μg×kg^-1×min^-1): 0.51±0.37 vs. 0.81±0.58, all P < 0.05], MAP was significantly increased (mmHg: 82.00±8.71 vs. 77.77±7.80, P < 0.05).

CONCLUSION: In the treatment of CRRT, oXiris filter can reduce the short-term mortality of SA-AKI patients, lower inflammatory mediators levels and improve hemodynamics, showing therapeutic advantages over conventional filters.

PMID:39968586 | DOI:10.3760/cma.j.cn121430-20240802-00661

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2025 Jan;37(1):36-42. doi: 10.3760/cma.j.cn121430-20240126-00085.

ABSTRACT

OBJECTIVE: To explore the correlation between mechanical power normalized to dynamic lung compliance (Cdyn-MP) and weaning outcomes and prognosis in mechanically ventilated patients.

METHODS: A prospective, observational cohort study was conducted. Patients who underwent invasive mechanical ventilation (IMV) for more than 24 hours and used a T-tube ventilation strategy for extubation in the intensive care unit (ICU) of Lianyungang First People’s Hospital and Lianyungang Second People’s Hospital between January 2022 and December 2023 were enrolled. The collected data encompassed patients’ baseline characteristics, primary causes of ICU admission, vital signs and laboratory indicators during the initial spontaneous breathing trial (SBT), respiratory mechanics parameters within the 4-hour period prior to the SBT, weaning outcomes and prognostic indicators. Mechanical power (MP) and Cdyn-MP were calculated using a simplified MP equation. Univariate and multivariate Logistic regression analyses were utilized to determine the independent risk factors associated with weaning failure in patients undergoing mechanical ventilation. Restricted cubic spline (RCS) analysis and Spearman rank-sum test were employed to investigate the correlation between Cdyn-MP and weaning outcomes as well as prognosis. Receiver operator characteristic curve (ROC curve) was constructed, and the area under the ROC curve (AUC) was computed to evaluate the predictive accuracy of Cdyn-MP for weaning outcomes in mechanically ventilated patients.

RESULTS: A total of 366 patients undergoing IMV were enrolled in this study, with 243 cases classified as successful weaning and 123 cases classified as failed weaning. Among them, 23 patients underwent re-intubation within 48 hours after the successful withdrawal of the first SBT, non-invasive ventilation, or died. Compared with the successful weaning group, the patients in the failed weaning group had significantly increased levels of sequential organ failure assessment (SOFA) score, body temperature and respiratory rate (RR) during SBT, and respiratory mechanical parameters within the 4-hour period prior to the SBT [ventilation frequency, positive end-expiratory pressure (PEEP), platform pressure (Pplat), peak inspiratory pressure (Ppeak), dynamic driving pressure (ΔPaw), fraction of inspired oxygen (FiO₂), MP, and Cdyn-MP], dynamic lung compliance (Cdyn) was significantly reduced, and duration of IMV, ICU length of stay, and total length of hospital stay were significantly prolonged. However, there were no statistically significant differences in age, gender, body mass index (BMI), smoking history, main causes of ICU admission, other vital signs [heart rate (HR), mean arterial pressure (MAP), saturation of peripheral oxygen (SpO₂)] and laboratory indicators [white blood cell count (WBC), albumin (Alb), serum creatinine (SCr)] during SBT of patients between the two groups. Univariate Logistic regression analysis was conducted, and variables with P < 0.05 and no multicollinearity with Cdyn-MP were selected for inclusion in the multivariate Logistic regression model. The results demonstrated that SOFA score [odds ratio (OR) = 1.081, 95% confidence interval (95%CI) was 1.008-1.160, P = 0.030], and PEEP (OR = 1.191, 95%CI was 1.075-1.329, P = 0.001), FiO₂ (OR = 1.035, 95%CI was 1.006-1.068, P = 0.021) and Cdyn-MP (OR = 1.190, 95%CI was 1.086-1.309, P < 0.001) within the 4-hour period prior to the SBT were independent risk factors for weaning failure in patients undergoing IMV. The RCS analysis after adjusting for confounding factors showed that as Cdyn-MP within the 4-hour period prior to the SBT increased, the risk of weaning failure in patients undergoing IMV significantly increased (P < 0.001). The Spearman rank correlation test showed that Cdyn-MP within the 4-hour period prior to the SBT was positively correlated with respiratory mechanical parameters including ΔPaw and MP (r values were 0.773 and 0.865, both P < 0.01), and negatively correlated with Cdyn (r = -0.587, P < 0.01). Cdyn-MP within the 4-hour period prior to the SBT was positively correlated with prognostic indicators such as duration of IMV, length of ICU stay, and total length of hospital stay (r values were 0.295, 0.196, and 0.120, all P < 0.05). ROC curve analysis demonstrated that, within the 4-hour period preceding the SBT, Cdyn-MP, MP, Cdyn, and ΔPaw possessed predictive value for weaning failure in patients undergoing IMV. Notably, Cdyn-MP exhibited superior predictive capability, evidenced by an AUC of 0.761, with a 95%CI ranging from 0.712 to 0.810 (P < 0.001). At the optimal cut-off value of 408.5 J/min×cmH₂O/mL×10^-3, the sensitivity was 68.29%, and the specificity was 71.19%.

CONCLUSION: Cdyn-MP is related to weaning outcomes and prognosis in mechanically ventilated patients, and has good predictive ability in assessing the risk of weaning failure.

PMID:39968584 | DOI:10.3760/cma.j.cn121430-20240126-00085

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2025 Jan;37(1):23-28. doi: 10.3760/cma.j.cn121430-20240329-00298.

ABSTRACT

OBJECTIVE: To explore the implementation effect of hour-1 bundle for sepsis patients based on crisis resource management (CRM) system.

METHODS: A historical control study was conducted. The hour-1 bundle for sepsis based on CRM was used to train 24 nurses in the emergency department from October 2022 to March 2023. Clinical data of sepsis patients admitted to the emergency department of the First People’s Hospital of Zunyi from April 2022 to September 2023 were collected. The patients were divided into three groups based on different stages of CRM system construction: control group (before construction, from April to September in 2022), improvement group (during construction, from October 2022 to March 2023) and observation group (after construction, from April to September in 2023). The baseline data, implementation rate of hour-1 bundle [including blood culture, antibiotic usage, blood lactic acid (Lac) detection, fluid resuscitation, hypertensors usage], identification and diagnosis time, and prognosis parameters [including correction rate of hypoxemia, intensive care unit (ICU) occupancy rate, and 28-day survival rate]. Sepsis cognition survey and non-technical skill (NTS) evaluation of nurses in emergency department were conducted before and after training.

RESULTS: Finally 43 cases were enrolled in the control group, improvement group and observation group, respectively. There was no statistically significant difference in baseline data including the gender, age, primary site, heart rate, systolic blood pressure, acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, mechanical ventilation ratio among the three groups with comparability. With the gradual improvement of the CRM system, the implementation rate of 1-hour bundle was gradually increased, and the implementation rate in the control group, improvement group and observation group were 65.12% (28/43), 74.42% (32/43) and 88.37% (38/43), respectively, with statistically significant difference (P < 0.05). It was mainly reflected in the completion rate of blood culture, antibiotic usage rate, Lac detection rate and hypertensors usage rate within 1 hour, which were significantly higher in the observation group than those in the control group [completion rate of blood culture: 90.70% (39/43) vs. 62.79% (27/43), antibiotic usage rate: 88.37% (38/43) vs. 60.47% (26/43), Lac detection rate: 93.02% (40/43) vs. 72.09% (31/43), hypertensors usage rate: 88.37% (38/43) vs. 60.47% (26/43), all P < 0.05]. The fluid resuscitation rates within 1 hour in the three groups were all over 90%, with no statistically significant difference among the three groups. The recognition and diagnosis time in the observation group was significantly shorter than that in the control group and the improvement group (hours: 0.41±0.15 vs. 0.61±0.21, 0.51±0.18, both P < 0.05), the correction rate of hypoxemia and 28-day survival rate were significantly higher than those in the control group [correction rate of hypoxemia: 95.35% (41/43) vs. 74.42% (32/43), 28-day survival rate: 83.72% (36/43) vs. 60.47% (26/43), both P < 0.05], and ICU occupancy rate was significantly lower than that in the control group [72.09% (31/43) vs. 93.02% (40/43), P < 0.05]. After training in the CRM system, the score of the sepsis awareness survey questionnaire for emergency department nurses was significantly increased as compared with before training (60.42±5.29 vs. 44.17±9.21, P < 0.01), and NTS also showed significant improvement.

CONCLUSION: CRM plays a significant role in promoting the implementation of sepsis hour-1 bundle, which can improve the implementation rate of hour-1 bundle and NTS of medical staff, effectively improve patients’ hypoxemia, reduce patients’ ICU occupancy rate and 28-day risk of death.

PMID:39968582 | DOI:10.3760/cma.j.cn121430-20240329-00298