American journal of translational research
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Few studies have reported the implications of performing endotracheal intubation for critically ill COVID-19 patients admitted to intensive care units (ICUs). Therefore, this study aimed to summarize the outcomes of COVID-19 patients in the ICU following endotracheal intubation and provide a clinical reference for the high-risk procedure. From February 1 to February 18, 2020, we enrolled 59 critically ill COVID-19 patients who received emergency endotracheal intubation in the ICUs of Tongji Hospital. ⋯ Full PPE increased the occurrence of fogging on goggles and myopia glasses. Overall, a higher success rate of intubation was achieved by senior intubators using a videolaryngoscope. Although inconvenient, appropriate ensembles of PPE could prevent nosocomial infections.
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Endobronchial ultrasound-guided sheath (EBUS-GS) and electromagnetic navigation bronchoscopy combined with EBUS (ENB-EBUS) are two diagnostic methods used to obtain lung tissue for biopsy of peripheral lung lesions. This study retrospectively summarized the case data of patients who underwent EBUS-GS or ENB-EBUS, both procedures performed at the respiratory endoscopy center of Tangdu Hospital, and the study compared the diagnostic efficacy and complications of the two methods. The study included 93 patients who underwent EBUS-GS and 26 who underwent ENB-EBUS. ⋯ An analysis of the complications showed that the incidence of complications in the EBUS-GS group was 8.4%, and the incidence of complications in the ENB-EBUS group was 3.8%, with no statistical difference (P>0.05). Both EBUS-GS and ENB-EBUS can be used for the diagnosis of peripheral pulmonary disease. However, the diagnostic rate of EBUS-GS is significantly higher than ENB-EBUS in cases with bronchial signs associated with the lesion, and the diagnostic rate of ENB-EBUS in cases with no bronchial signs was higher than that of EBUS-GS with no statistical difference.
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This study aimed to evaluate the efficacy and safety of remimazolam tosylate versus propofol in patients undergoing colonoscopy. In this multicentered, blinded, randomized, active-controlled, non-inferior phase III trial, 384 eligible patients who were about to undergo colonoscopy were randomized as a ratio of 1:1 into remimazolam and propofol group. Procedure success was assessed and defined as the completion of colonoscopy without administration of rescue sedative agent or more than 5 top-ups of trial drug in any 15 minute-period after initial administration of trial drug. ⋯ Besides, induction time of sedation was increased (P<0.001), while hypotension and respiratory depression was decreased in remimazolam group compared to propofol group; however, time to fully alert (P>0.05) or time to discharge (P>0.05) were unchanged. For safety assessment, total treatment-emergent adverse events were decreased in remimazolam group compared to propofol group (P<0.001); specifically, administration site pain (P<0.001), increased bilirubin (P=0.019), decreased respiratory rate (P<0.001) and decreased SpO2 (P<0.001) were less frequent in remimazolam group compared with propofol group. In conclusion, remimazolam tosylate is non-inferior in sedation efficacy while safer than propofol in patients undergoing colonoscopy.
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This study was designed to assess the levels of human serum amyloid A (SAA) and C-reactive protein (CRP) in patients with coronavirus disease 2019 (COVID-19) to determine their prognostic value in predicting the severity of disease. Patients with COVID-19 who presented with acute respiratory distress syndrome (ARDS) shared distinct characteristics. For example, the patients were older, and had higher levels of inflammatory indicators [i.e., levels of CRP, SAA, procalcitonin (PCT), and interleukin-6; CRP-to-PCT ratio; SAA-to-CRP ratio; and neutrophil-to-lymphocyte ratio (NLR)], higher inflammatory cell counts (i.e., white blood cell count and neutrophil count), and lower lymphocyte counts compared with patients without ARDS. ⋯ For patients with elevated levels of SAA but not CRP, a mild condition was predicted. For patients with elevated levels of both SAA and CRP, and a high NLR, a severe infection was predicted, requiring medical attention. Therefore, CRP and SAA levels demonstrate a prognostic value for predicting the severity of COVID-19.
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Concerns about the potential neurotoxicity of general anesthesia to the developing brain have been increasing in recent years. Animal studies have shown that neonatal exposure to general anesthesia causes both acute neurotoxicity and behavioral abnormalities later in life. ⋯ More importantly, we found that insulin administered through intranasal delivery prior to anesthesia prevented anesthesia-induced over-activation of neuronal apoptosis. This study provides experimental evidence for a potential effective, yet simple, method to prevent anesthesia-induced neurotoxicity in children, especially in infants.