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Aim: The COVID-19 epidemic has caused risk and uncertainty. This study answers whether and how psychological distress and digital sports influence willingness to take the vaccine and precautionary savings. Subject and methods: We conducted a cross-sectional study with an online survey sample of 1016 Shanghai residents who live and work there and are aged between 16–60. All of them experienced the COVID-19 lockdown in Shanghai. We used logistic regressions to examine the relationships between the variables of interest. Results: Three findings were demonstrated. First, psychologically distressed individuals are less inclined to take the vaccine. Second, those engaged in fitness activities via digital media platforms are more willing to get vaccinated. Third, psychologically distressed individuals and digital video-based physical exercisers are more likely to precautionary save. Conclusions: This study contributes to the literature by documenting how people changed their life from the perspective of finance and health during the lockdown and providing practical implications. [ABSTRACT FROM AUTHOR]

Objective To investigate clinical efficacy and optimal therapeutic strategy for ventricular intracranial pressure (ICP) monitoring and process management in patients with traumatic bifrontal contusions (TBC). Methods Total 387 TBC patients between January 2010 and January 2016 were enrolled in 904th Hospital of Chinese PLA, in which 105 patients with TBC who underwent ventricular ICP monitoring (ICP group) and 282 patients with TBC who did not (non - ICP group). Conservative treatment and surgical treatment were performed respectively (unilateral craniotomy for contusion and hematoma removal, bilateral craniotomy for contusion and hematoma removal, and decompressive craniotomy). Rates of successful conservative treatment, ratio of bilateral craniotomy and decompressive craniectomy, length of stay, medical expenses and incidence of related complications were compared between 2 groups. Glasgow Outcome Scale (GOS) was used to assess all patients after 6 months follow-up. Results Compared with non - ICP group, ICP group had a significantly better successful conservative treatment rate [64.76% (68/105) vs. 47.16% (133/282); χ² = 9.493, P = 0.002], lower decompressive craniectomy rate [8.11% (3/37) vs. 23.49% (35/149); χ² = 4.314, P = 0.038]; shorter length of stay [(13.22 ± 1.83) d vs. (18.51 ± 5.08) d; t = 10.410, P = 0.000] and lower medical expenses [(8.34 ± 3.26) ten thousand yuan vs. (9.67 ± 4.42) ten thousand yuan; t = 2.811, P = 0.004]. No significantly difference in operative methods (χ² = 2.673, P = 0.102), pulmonary infection [33.33% (35/105) vs. 39.72% (112/282); χ² = 1.321, P = 0.250], intracranial infection [10.47% (11/105) vs. 8.16% (23/282); χ² = 0.513, P = 0.473], hydrocephalus [3.81% (4/105) vs. 6.74% (19/282); χ² = 1.173, P = 0.279], epilepsy [6.67% (7/105) vs. 10.99% (31/282); χ² = 1.617, P = 0.203] and bradycardia [28.57% (30/105) vs. 34.75% (98/282); χ² = 1.320, P = 0.251]. There were no significant differences in prognosis between 2 groups (χ² = 1.492, P = 0.474). Conclusions Condition of patients with TBC progresses rapidly. Patients should undergo ventricular ICP probe implantation in a timely manner. Although ventricular ICP monitoring do not significantly improve the prognosis of patients, it can increase the success rate of conservative treatment, reduce the rate of decompressive craniectomy, shorten the length of stay, and reduce the medial expenses. Ventricular ICP monitoring warrants further clinical research. [ABSTRACT FROM AUTHOR]

Respiratory muscle ultrasound is used to evaluate the anatomy and function of the respiratory muscle pump. It is a safe, repeatable, accurate, and non-invasive bedside technique that can be successfully applied in different settings, including general intensive care and the emergency department. Mastery of this technique allows the intensivist to rapidly diagnose and assess respiratory muscle dysfunction in critically ill patients and in patients with unexplained dyspnea. Furthermore, it can be used to assess patient-ventilator interaction and weaning failure in critically ill patients. This paper provides an overview of the basic and advanced principles underlying respiratory muscle ultrasound with an emphasis on the diaphragm. We review different ultrasound techniques useful for monitoring of the respiratory muscle pump and possible therapeutic consequences. Ideally, respiratory muscle ultrasound is used in conjunction with other components of critical care ultrasound to obtain a comprehensive evaluation of the critically ill patient. We propose the ABCDE-ultrasound approach, a systematic ultrasound evaluation of the heart, lungs and respiratory muscle pump, in patients with weaning failure. [ABSTRACT FROM AUTHOR]

Introduction: This narrative review summarizes current knowledge on the physiology and pathophysiology of expiratory muscle function in ICU patients, as shared by academic professionals from multidisciplinary, multinational backgrounds, who include clinicians, clinical physiologists and basic physiologists.Results: The expiratory muscles, which include the abdominal wall muscles and some of the rib cage muscles, are an important component of the respiratory muscle pump and are recruited in the presence of high respiratory load or low inspiratory muscle capacity. Recruitment of the expiratory muscles may have beneficial effects, including reduction in end-expiratory lung volume, reduction in transpulmonary pressure and increased inspiratory muscle capacity. However, severe weakness of the expiratory muscles may develop in ICU patients and is associated with worse outcomes, including difficult ventilator weaning and impaired airway clearance. Several techniques are available to assess expiratory muscle function in the critically ill patient, including gastric pressure and ultrasound.Conclusion: The expiratory muscles are the "neglected component" of the respiratory muscle pump. Expiratory muscles are frequently recruited in critically ill ventilated patients, but a fundamental understanding of expiratory muscle function is still lacking in these patients. [ABSTRACT FROM AUTHOR]

Purpose: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of high-flow nasal cannula (HFNC) on reintubation in adult patients. Procedures: Ovid Medline, Embase, and Cochrane Database of Systematic Reviews were searched up to November 1, 2016, for RCTs comparing HFNC versus conventional oxygen therapy (COT) or noninvasive ventilation (NIV) in adult patients after extubation. The primary outcome was reintubation rate, and the secondary outcomes included complications, tolerance and comfort, time to reintubation, length of stay, and mortality. Dichotomous outcomes were presented as risk ratio (RR) with 95% confidence intervals (CIs) and continuous outcomes as weighted mean difference and 95% CIs. The random effects model was used for data pooling. Findings: Seven RCTs involving 2781 patients were included in the analysis. The HFNC had a similar reintubation rate compared to either COT (RR, 0.58; 95% CI, 0.21-1.60; P = .29; 5 RCTs, n = 1347) or NIV (RR, 1.11; 95% CI, 0.88-1.40; P = .37; 2 RCTs, n = 1434). In subgroup of critically ill patients, the HFNC group had a significantly lower reintubation rate compared to the COT group (RR, 0.35; 95% CI, 0.19-0.64; P = .0007; 2 RCTs, n = 632; interaction P = .07 compared to postoperative subgroup). Qualitative analysis suggested that HFNC might be associated with less complications and improved patient’s tolerance and comfort. The HFNC might not delay reintubation. Trial sequential analysis on the primary outcome showed that required information size was not reached. Conclusion: The evidence suggests that COT may still be the first-line therapy in postoperative patients without acute respiratory failure. However, in critically ill patients, HFNC may be a potential alternative respiratory support to COT and NIV, with the latter often associating with patient intolerance and requiring a monitored setting. Because required information size was not reached, further high-quality studies are required to confirm these results. [ABSTRACT FROM AUTHOR]

Rationale: Diaphragm weakness in critically ill patients prolongs ventilator dependency and duration of hospital stay and increases mortality and healthcare costs. The mechanisms underlying diaphragm weakness include cross-sectional fiber atrophy and contractile protein dysfunction, but whether additional mechanisms are at play is unknown.Objectives: To test the hypothesis that mechanical ventilation with positive end-expiratory pressure (PEEP) induces longitudinal atrophy by displacing the diaphragm in the caudal direction and reducing the length of fibers.Methods: We studied structure and function of diaphragm fibers of mechanically ventilated critically ill patients and mechanically ventilated rats with normal and increased titin compliance.Measurements and Main Results: PEEP causes a caudal movement of the diaphragm, both in critically ill patients and in rats, and this caudal movement reduces fiber length. Diaphragm fibers of 18-hour mechanically ventilated rats (PEEP of 2.5 cm H2O) adapt to the reduced length by absorbing serially linked sarcomeres, the smallest contractile units in muscle (i.e., longitudinal atrophy). Increasing the compliance of titin molecules reduces longitudinal atrophy.Conclusions: Mechanical ventilation with PEEP results in longitudinal atrophy of diaphragm fibers, a response that is modulated by the elasticity of the giant sarcomeric protein titin. We postulate that longitudinal atrophy, in concert with the aforementioned cross-sectional atrophy, hampers spontaneous breathing trials in critically ill patients: during these efforts, end-expiratory lung volume is reduced, and the shortened diaphragm fibers are stretched to excessive sarcomere lengths. At these lengths, muscle fibers generate less force, and diaphragm weakness ensues. [ABSTRACT FROM AUTHOR]

Background: Esophageal pressure, used as a surrogate for pleural pressure, is commonly measured by air-filled balloon, and the accuracy of measurement depends on the proper balloon volume. It has been found that larger filling volume is required at higher surrounding pressure. In the present study, we determined the balloon pressure-volume relationship in a bench model simulating the pleural cavity during controlled ventilation. The aim was to confirm whether an optimal balloon volume range existed that could provide accurate measurement at both end-expiration and end-inspiration. Methods: We investigated three esophageal balloons with different dimensions and materials: Cooper, SmartCath-G, and Microtek catheters. The balloon was introduced into a glass chamber simulating the pleural cavity and volume-controlled ventilation was initiated. The ventilator was set to obtain respective chamber pressures of 5 and 20 cmHO during end-expiratory and end-inspiratory occlusion. Balloon was progressively inflated, and balloon pressure and chamber pressure were measured. Balloon transmural pressure was defined as the difference between balloon and chamber pressure. The balloon pressure-volume curve was fitted by sigmoid regression, and the minimal and maximal balloon volume accurately reflecting the surrounding pressure was estimated using the lower and upper inflection point of the fitted sigmoid curve. Balloon volumes at end-expiratory and end-inspiratory occlusion were explored, and the balloon volume range that provided accurate measurement at both phases was defined as the optimal filling volume. Results: Sigmoid regression of the balloon pressure-volume curve was justified by the dimensionless variable fitting and residual distribution analysis. All balloon transmural pressures were within ±1.0 cmHO at the minimal and maximal balloon volumes. The minimal and maximal balloon volumes during end-inspiratory occlusion were significantly larger than those during end-expiratory occlusion, except for the minimal volume in Cooper catheter. Mean (±standard deviation) of optimal filling volume both suitable for end-expiratory and end-inspiratory measurement ranged 0.7 ± 0.0 to 1.7 ± 0.2 ml in Cooper, 1.9 ± 0.2 to 3.6 ± 0.3 ml in SmartCath-G, and 2.2 ± 0.2 to 4.6 ± 0.1 ml in Microtek catheter. Conclusions: In each of the tested balloon, an optimal filling volume range was found that provided accurate measurement during both end-expiratory and end-inspiratory occlusion. [ABSTRACT FROM AUTHOR]

Aim:To determine the risk factors for and the incidence, outcomes, and causative pathogens of post-craniotomy intracranial infection (PCII) in patients with brain tumors. Methods:A retrospective study was performed of 5723 patients with brain tumors who were surgically treated between January 2012 and December 2013 in Beijing Tiantan Hospital. The patients’ demographics, pathohistological diagnoses, surgical procedures, postoperative variables, causative pathogens, and outcomes were evaluated. Results:The overall incidence of PCII was 6.8%, and 82.1% of all cases were diagnosed within two weeks after the craniotomy. Postoperative administration of antibiotics reduced the incidence of PCII. Independent risk factors included clean-contaminated craniotomy, prolonged operation (> 7 h), external cerebrospinal fluid (CSF) drainage/monitoring device placement, and postoperative CSF leakage. Patients ≤ 45 years old were more susceptible to infection. Compared with supratentorial tumors, tumors located in the infratentorial or intraventricular regions were more vulnerable to PCII. Gram-positive bacteria were the most common causative pathogens isolated from the CSF samples, accounting for 82.0% of the PCII cases. Conclusions:Risk factors for PCII can be identified early in the perioperative period. These findings raise the possibility of improving the clinical outcomes of patients with brain tumors who undergo craniotomy. [ABSTRACT FROM PUBLISHER]

Two Ce–Zr–La/Al2O3 composite oxides, CZLA-C and CZLA-B, were synthesized using a co-precipitation method in a continuous stirred-tank reactor (CSTR) and a batch reactor (BR), respectively. Two Rh-based three-way catalysts (TWCs), Rh/CZLA-C and Rh/CZLA-B were obtained by a wet-impregnation method using the two composites as the supports. The physicochemical properties of the samples before and after thermal treatment at 1000 °C were characterized by N2 adsorption–desorption, X-ray diffraction (XRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM), high-resolution transmission electron microscopy (HRTEM), H2-temperature programmed reduction (H2-TPR) and CO chemisorption. The results indicated that CZLA-C shows higher thermal stability than CZLA-B due to a sparsely-agglomerated morphology. Compared with Rh/CZLA-B, Rh/CZLA-C displayed better reducibility and higher thermal stability and exhibited significantly higher activity in the catalytic removal of the simulated gasoline vehicle exhaust emission (NO, CO and C3H8). Our work can provide a facile and economical synthesis route to advanced support materials and catalysts for exhaust emission control. [ABSTRACT FROM AUTHOR]

Background: Pain and agitation are common in patients after craniotomy. They can result in tachycardia, hypertension, immunosuppression, increased catecholamine production and increased oxygen consumption. Dexmedetomidine, an alpha-2 agonist, provides adequate sedation without respiratory depression, while facilitating frequent neurological evaluation.Methods/design: The study is a prospective, randomized, double-blind, controlled, parallel-group design. Consecutive patients are randomly assigned to one of the two treatment study groups, labeled 'Dex group' or 'Saline group.' Dexmedetomidine group patients receive a continuous infusion of 0.6 μg/kg/h (10 ug/ml). Placebo group patients receive a maintenance infusion of 0.9% sodium chloride for injection at a volume and rate equal to that of dexmedetomidine. The mean percentages of time in optimal sedation, vital signs, various and adverse events, the percentage of patients requiring propofol for rescue to achieve/maintain targeted sedation (Sedation-Agitation Scale, SAS 3 to 4) and total dose of propofol required throughout the study drug infusion are collected. The percentage of patients requiring fentanyl for additional rescue to analgesia and total dose of fentanyl required are recorded. The effects of dexmedetomidine on hemodynamic and recovery responses during extubation are measured. Intensive care unit and hospital length of stay also are collected. Plasma levels of epinephrine, norepinephrine, dopamine, cortisol, neuron-specific enolase and S100-B are measured before infusion (T1), at two hours (T2), four hours (T3) and eight hours (T4) after infusion and at the end of infusion (T5) in 20 patients in each group.Discussion: The study has been initiated as planned in July 2012. One interim analysis advised continuation of the trial. The study will be completed in July 2013.Trial Registration: ClinicalTrials (NCT): ChiCTR-PRC-12002903. [ABSTRACT FROM AUTHOR]

Background: Expiratory muscle weakness leads to difficult ventilator weaning. Maintaining their activity with functional electrical stimulation (FES) may improve outcome. We studied feasibility of breath-synchronized expiratory population muscle FES in a mixed ICU population ("Holland study") and pooled data with our previous work ("Australian study") to estimate potential clinical effects in a larger group.Methods: Holland: Patients with a contractile response to FES received active or sham expiratory muscle FES (30 min, twice daily, 5 days/week until weaned). Main endpoints were feasibility (e.g., patient recruitment, treatment compliance, stimulation intensity) and safety. Pooled: Data on respiratory muscle thickness and ventilation duration from the Holland and Australian studies were combined (N = 40) in order to estimate potential effect size. Plasma cytokines (day 0, 3) were analyzed to study the effects of FES on systemic inflammation.Results: Holland: A total of 272 sessions were performed (active/sham: 169/103) in 20 patients (N = active/sham: 10/10) with a total treatment compliance rate of 91.1%. No FES-related serious adverse events were reported. Pooled: On day 3, there was a between-group difference (N = active/sham: 7/12) in total abdominal expiratory muscle thickness favoring the active group [treatment difference (95% confidence interval); 2.25 (0.34, 4.16) mm, P = 0.02] but not on day 5. Plasma cytokine levels indicated that early FES did not induce systemic inflammation. Using a survival analysis approach for the total study population, median ventilation duration and ICU length of stay were 10 versus 52 (P = 0.07), and 12 versus 54 (P = 0.03) days for the active versus sham group. Median ventilation duration of patients that were successfully extubated was 8.5 [5.6-12.2] versus 10.5 [5.3-25.6] days (P = 0.60) for the active (N = 16) versus sham (N = 10) group, and median ICU length of stay was 10.5 [8.0-14.5] versus 14.0 [9.0-19.5] days (P = 0.36) for those active (N = 16) versus sham (N = 8) patients that were extubated and discharged alive from the ICU. During ICU stay, 3/20 patients died in the active group versus 8/20 in the sham group (P = 0.16).Conclusion: Expiratory muscle FES is feasible in selected ICU patients and might be a promising technique within a respiratory muscle-protective ventilation strategy. The next step is to study the effects on weaning and ventilator liberation outcome.Trial Registration: ClinicalTrials.gov, ID NCT03453944. Registered 05 March 2018-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03453944 . [ABSTRACT FROM AUTHOR]

Background: Mechanical thrombectomy has been proven as a standard care for moderate to severe ischemic stroke with anterior large vessel occlusion (LVO); however, whether it is equally effective in mild ischemic stroke (MIS) is controversial.Methods: In this retrospective study, a total of 177 Chinese patients presenting with MIS (NIHSS ≤8) and LVO between January 2014 and September 2017 from seven comprehensive stroke centers were identified. Odds of good outcome with endovascular thrombectomy versus medical treatment were obtained by logistic regression analysis and propensity-score matching method, and a meta-analysis pooled results from six studies (n = 733).Results: Good outcome (mRS: 0-1) was 58.2% (46/79) in the thrombectomy and 46.9% (46/98) in the medical group, which showed no statistical significance before adjustment (P = 0.13; OR = 1.57, 95% CI: 0.86 to 2.86). The adjusted ORs of thrombectomy versus medical group were 3.23 (95% CI, 1.35 to 7.73; P = 0.008) by multivariable logistic analysis, 2.78 (1.12 to 6.89; P = 0.02) by propensity score matching analysis, and 3.20 (1.22 to 8.37; P = 0.01) by propensity score matching analysis with additional adjustments, respectively. Thrombectomy treatment did not result in excessive mortality or symptomatic intracranial hemorrhage after adjustments. The meta-analysis did not confirm the associations between good outcome and endovascular treatment.Conclusions: The current study indicates that endovascular thrombectomy is associated with good functional outcome in MIS patients with LVO, and without additional risk of symptomatic intracranial hemorrhage and mortality. Although the meta-analysis failed to demonstrate its superiority compared to medical treatment, randomized clinical trials are needed. [ABSTRACT FROM AUTHOR]