To construct and validate a simple and easily administered scoring tool for the prediction of short-term prognostic survival in adult patients with sepsis. This study is a retrospective and prospective cohort study. A total of 382 patients with sepsis. 274 sepsis patients from January 2020 to December 2020 were collected as the modeling group and 54 sepsis patients from January 2021 to December 2021 and April to May 2022 in the hospital were randomly collected as the validation group. They were divided into survival and non-survival groups according to the outcome. The receiver operating characteristic (ROC) curves were plotted with subgroup analysis. The resulting models were tested using the Hosmer-Lemeshow test. The prognostic value of the variables on prognosis was expressed using the area under the receiver operating characteristic curve (AUC). A scoring tool was constructed and tested for the prognostic value of this score in the validation group. The model had an AUC of 0.880 [95% CI (0.838-0.922), P < 0.001], model sensitivity of 81.15%, and specificity of 80.26% for predicting short-term prognosis in patients with sepsis. Further simplifying the model scoring rules and adding the lactate variable, the AUCs was 0.876 [95% CI (0.833-0.918)], P < 0.001], sensitivity was 78.69%, specificity was 82.89%, and scoring criteria were established. the AUCs of the internally validated model in 2021 and 2022 were 0.968 [95% CI (0.916 to 1.000), P < 0.001] and 0.943 [95% CI (0.873 to 1.000), P < 0.001], indicating that the constructed scoring tool has a good predictive value for short-term survival outcomes in patients with sepsis. Age, shock, lactate, lactate/albumin ratio (L/A), and interleukin-6 (IL-6) are five risk factors for adult sepsis prognosis in an early emergency. This scoring tool is developed to quickly assess the short-term survival outcome in adult sepsis patients. It is straightforward and easy to administer. It also has a high prognostic predictive value.The Chinese Clinical Trial Registry (ChiCTR2200058375).

Introduction: Double sequential external defibrillation (DSED) in cardiopulmonary resuscitation has shown different results in comparison with standard defibrillation in the treatment of refractory ventricular fibrillation (RVF). This review aims to compare the advantages of DSED with standard defibrillation in the treatment of refractory ventricular fibrillation.Materials and methods: PubMed, Embase, Web of Science, and Cochrane Library were searched from inception to May 1, 2022. Studies included adult patients who developed RVF. The study used random-effects and fixed-effects models for meta-analysis, which was reported by risk ratio (RR) with 95% confidence interval (CI), mean difference (MD), or standardized mean difference (SMD). The risk of bias in individual studies was assessed using the Robins-I tool for observational studies and the Cochrane Risk of Bias 2 (ROB-2) tool for clinical trials. Primary outcomes included the termination of RVF, prehospital return of spontaneous circulation (ROSC), survival to hospital admission, survival to hospital discharge, and good neurological recovery. Secondary outcomes included age, total defibrillation attempts, emergency medical system arrival time, and dose of epinephrine and amiodarone used.Results: In this systematic review and meta-analysis, 10 studies containing 1347 patients with available data on treatment outcomes were included. The pooled estimate was (RR 1.03, 95% CI, 0.89 to 1.19; Z = 0.42, P = 0.678 > 0.05) for Termination of RVF, (RR 0.84, 95% CI, 0.63 to 1.11; Z = 1.23, P = 0.219 > 0.05) for ROSC, (RR 0.86, 95% CI, 0.69 to 1.06; Z = 1.4, P = 0.162 > 0.05) for survival to hospital admission, (RR 0.77, 95%CI, 0.52 to 1.15; Z = 1.26, P = 0.206 > 0.05) for survival to hospital discharge, (RR 0.65, 95%CI, 0.35 to 1.22; Z = 1.33, P = 0.184 > 0.05) for good neurologic recovery, (MD −1.01, 95%CI, −3.07 to 1.06; Z = 0.96, P = 0.34 > 0.05) for age, (MD 2.27, 95%CI, 1.80 to 2.73; Z = 9.50, P = 0.001 < 0.05) for total defibrillation attempts, (MD 1.10, 95%CI, −0.45 to 66; Z = 1.39, P = 0.16 > 0.05) for emergency medical system arrival time, (SMD 0.34, 95%CI, 0.17 to 0.50; Z = 4.04, P = 0.001 < 0.05) for epinephrine, and (SMD −0.30, 95%CI, −0.65 to −0.05; Z = 1.66, P = 0.1 > 0.05) for amiodarone.Conclusion: We discovered no differences between DSED and standard defibrillation in termination of RVF, prehospital return of spontaneous circulation, survival to hospital admission, survival to hospital discharge, good neurological outcome, emergency medical system arrival time, and amiodarone doses in patients with RVF. There were some differences in the number of defibrillations and epinephrine doses utilized during resuscitation.Systematic review registration: [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=329354], identifier [CRD42022329354].

Background: There is still a lack of large-scale clinical studies and evidence-based evidence to prove the relationship between serum amyloid A (SAA) and the severity and prognosis of patients with new coronavirus pneumonia (COVID-19). Methods: We searched PubMed, Cochrane Library, Excerpta Medica Database, and Web of Science for original articles from December 1, 2019 to December 19, 2020. Search criteria include free text search, explosive MESH/EMTREE terms, and all synonyms for SAA and COVID-19. There are no language restrictions on the searched documents. Statistical methods were performed using Stata 14.0 software, and RevMan 5.4 software provided by the Cochrane Collaboration for meta-analysis. The 10 included studies in the literature were classified according to the severity of the novel coronavirus treatment guidelines, with mild/moderate categorized as nonsevere and severe/critical as severe, and the data were meta-analyzed using multiple subgroup standard deviations combined. Severe and nonsevere were finally divided into 2 groups, and the combined data were meta-analyzed according to the standardized mean difference. Results: The results of the meta-analysis given by random effects showed that SAA levels were significantly higher in severe vs nonsevere (standardized mean difference 1.20 [95% confidence interval 0.91–1.48]), which was statistically significant (P < .001). The 3 literatures studied (random effect size 0.11 [95% confidence interval 0.05–0.19]; I² = 56.68%) and were statistically significant, z = 5.46 P < .01, suggesting that the risk of death occurs at higher levels with increasing SAA values, with the risk of death in the severe group being 11% higher than in the nonsevere group. Conclusion: SAA can be considered as a biomarker for predicting the severity and prognosis of COVID-19. SAA can be used for early warning of the poor prognosis of COVID-19 and for monitoring the recovery process, which has important clinical value.

Background. Transnasal Humidified Rapid‐Insufflation Ventilatory Exchange (THRIVE) has received increasing attention and application as an effective noninvasive mode of ventilation in the treatment of clinical anesthesia and critically ill patients. The conclusions reached in clinical studies of THRIVE and facemask oxygenation are still controversial, and the main objective of this systematic review is to determine the advantages of THRIVE over facemask oxygenation in intensive care units, respiratory medicine, and perioperative preoxygenation. Methods. PubMed, Embase, Web of Science, and Cochrane Library have search restrictions. The search library was full of English language articles from the first publication to 15 July 2021. Eligible randomized controlled study designs were included. 245 records were screened, and 5 studies met the inclusion criteria, enrolling a total of 235 patients. Results. Studying the THRIVE group compared to the facemask group, three studies analyzing intubation time showed that there is no difference in the effect of THRIVE and facemasks (MD ‐1.22, 95% CI ‐7.23 to 4.78, and P = 0.69 > 0.05). Three studies analyzing apnea showed that there was no difference between the two groups (SMD 1, 95% CI ‐0.76 to 2.76, and P = 0.27 > 0.05). Three studies analyzing PaO₂ after preoxygenation showed that THRIVE is more effective than facemasks (MD 72.58, 95% CI 31.25 to 113.90, Z = 3.44, and P < 0.001). Two studies analyzing oxygen saturation SpO₂ after successful intubation showed that there was no difference in the effectiveness (MD 0.09, 95% CI ‐1.03 to 1.22, and P = 0.87 > 0.05). Two studies analyzing PCO₂ after complete paralysis or intubation preoxygenation showed that there was no difference between the two groups (MD 2.76, 95% CI ‐1.74 to 7.26, and P = 0.23 > 0.05). Conclusions. THRIVE does not have a greater advantage over a facemask in improving apnea time, oxygenation time, PCO₂, and SpO₂, but it has an advantage in improving arterial partial pressure of oxygen (PaO₂) after preoxygenation, which can improve PaO₂ well. This trial is registered with the protocol registration number CRD42021268143.

Patients with type 1 diabetes mellitus have been at heightened risk for developing atrial fibrillation. We aimed to investigate whether this association is causal using Mendelian randomization. Using publicly available genome-wide association studies data, we selected single nucleotide polymorphisms significantly associated with type 1 diabetes mellitus as instrumental variables. We employed inverse variance-weighted, weighted median, MR-Egger regression, simple mode, and weighted mode methods within a two-sample Mendelian randomization framework to assess the causal relationship between type 1 diabetes mellitus and atrial fibrillation. We evaluated the pleiotropy and heterogeneity levels of the included genetic instruments using MR-PRESSO, MR-Egger intercept test, Cochran's Q test, funnel plots, and leave-one-out plots. Causal impact of type 1 diabetes mellitus on atrial fibrillation: Inverse variance weighted (odds ratio [OR] = 0.996, 95 % confidence interval [CI]: 0.985-1.007, P = 0.498). MR-Egger (OR = 1.000, 95 % CI: 0.985-1.016, P = 0.963). Weighted median (OR = 0.985, 95 % CI: 0.973-0.998, P = 0.022). Simple mode (OR = 1.007, 95 % CI: 0.974-1.040, P = 0.698). Weighted mode (OR = 0.995, 95 % CI: 0.984-1.005, P = 0.298). MR-Egger intercept test (P = 0.437). There was no evidence of pleiotropy among the genetic instrumental variables included in the analysis. In Mendelian randomization analysis, we did not find evidence of a causal relationship between genetically determined type 1 diabetes mellitus in European ancestry populations and atrial fibrillation.

Rationale: Intentional or unintentional exposure to asphyxiating gases is a significant public health concern worldwide. Argon poisoning is fatal, and its onset is primarily due to neurological damage. Patient concerns: A 22-year-old man was admitted to the hospital for argon gas poisoning. While working in a plant containing argon gas, he suddenly lost consciousness, recovered consciousness slightly after on-site treatment, answered questions, and had impaired memory, sensory dullness, normal cognition, and symptoms of dizziness and headache. Diagnosis: Asphyxiating gas poisoning (argon gas poisoning), metabolic encephalopathy, and hepatic insufficiency. Interventions: Immediately after admission, the patient was treated with nasal cannula oxygen 3 L/min and hyperbaric oxygen therapy once a day. Mecobalamin tablets 500 μg were given orally 3 times a day. Oral Ginkgo biloba extract tablets 40 mg 3 times a day. Outcome: The patient was discharged after treatment with hyperbaric oxygen therapy and nerve-nourishing drugs, with no discomfort, clear consciousness, and good memory, and was followed up by telephone for 2 consecutive months, and the patient is now in good condition with no discomfort. Lesson: This case describes the pathogenesis, neurological damage, and rescue process of argon gas poisoning. Argon poisoning was found to damage bilateral cerebellar hemispheres and bilateral hippocampal regions, affecting the patient’s consciousness and memory, and was found to cause abnormal liver function and heart rate disorders.