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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.

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]

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., Author(s): Pieter R. Tuinman [sup.1] [sup.2], Annemijn H. Jonkman [sup.1], Martin Dres [sup.3], Zhong-Hua Shi [sup.1] [sup.4], Ewan C. Goligher [sup.5] [sup.6], Alberto Goffi [sup.5] [sup.7], Chris de Korte [sup.8], [...]

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., Author(s): Zhong-Hua Shi [sup.1] [sup.2], Annemijn Jonkman [sup.1], Heder de Vries [sup.1], Diana Jansen [sup.3], Coen Ottenheijm [sup.4], Armand Girbes [sup.1], Angelique Spoelstra-de Man [sup.1], Jian-Xin Zhou [sup.2], Laurent Brochard [...]

【Abstract】Objective: To investigate the clinical features and treatment strategy of dissymmetric bilateral frontal contusion, and to summarize our experience in treat-ing these patients by minimally invasive surgery. Methods: Over the past 3 years, we have treated a total of 31 patients with dissymmetric bilateral frontal contusion using endoscopy-assisted unilateral cerebral falx incision. Other 30 patients treated by routine bilateral approaches within the same period were taken as control. Results: Seventeen cases (54.8%) in the unilateral operation group survived and were in good condition, 8 (25.8%) had moderate disability, 4 (12.9%) had severe disability, 1 (3.2%) was in vegetative state, and 1 (3.2%) died. Compared with the control group, the Glasgow Out-come Scale score was not significantly different in the uni-lateral operation group, but the operation time, blood trans-fusion volume, the length of hospital stay, the incidences of mental disorder and olfactory nerve injury were greatly reduced in the unilateral operation group. Conclusions: Endoscopy-assisted unilateral cerebral falx incision can shorten the operation time, reduce surgical trauma and complications in treatment of patients with dis-symmetric bilateral frontal contusion. It can obviously di-minish the chance of delayed intracerebral hematoma and subsequently minimize the incidences of subfalcial and centrencephalic herniation. Key words: Brain injuries; Intracranial hemorrage, traumatic; Endoscopy; Surgically procedures, minimally invasive

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]