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简介：摘要BACKGROUNDSystematic reviews of early rehabilitation within intensive care units have highlighted the need for robust multi-centre randomised controlled trials with longer term follow up. This trial aims to explore the feasibility of earlier and enhanced rehabilitation for patients mechanically ventilated for ≥5days and to assess the impact on possible long term outcome measures for use in a definitive trial.METHODSPatients admitted to a large UK based intensive care unit and invasively ventilated for ≥5 days were randomised to the rehabilitation intervention or standard care on a 1∶1 basis, stratified by age and SOFA score. The rehabilitation intervention involved a structured programme, with progression along a functionally based mobility protocol according to set safety criteria.RESULTS103 out of 128 eligible patients were recruited into the trial, achieving an initial recruitment rate of 80%. Patients in the intervention arm mobilized significantly earlier (8days vs 10 days, P＝0.035), at a more acute phase of illness (SOFA 6 vs 4, P<0.05) and reached a higher level of mobility at the point of critical care discharge (MMS 7 vs 5, P<0.01)．CONCLUSIONWe have demonstrated the feasibility of introducing a structured programme of rehabilitation for patients admitted to critical care.

简介：Theechocardiographyrmchineisapowerfulcomputerthatimagestheheartusingultrasound.Itrevealscardiacanatomyandphysiology,allowingdiagnosisofdiseasesofthemyocardium,valves,pericardiumandaorta,qhefunctionalsignificanceofcoronarydiseasecanbedeterminedusingstressechocardiography(seepage35)andmyocardialpeffusionimaging.TypesofechocardiographyandtheirusesareshowninFigure1.

简介：摘要INTRODUCTIONWe examined the effectiveness of early rehabilitation for the prevention of postintensive care syndrome (PICS), characterised by an impaired physical, cognitive or mental health status, among survivors of critical illness.METHODSWe performed a systematic literature search of several databases (Medline, Embase and Cochrane Central Register of Controlled Trials) and a manual search to identify randomised controlled trials (RCTs) comparing the effectiveness of early rehabilitation versus no early rehabilitation or standard care for the prevention of PICS. The primary outcomes were short-term physical-related, cognitive-related and mental health-related outcomes assessed during hospitalisation. The secondary outcomes were the standardised, long-term health-related quality of life scores (EuroQol 5 Dimension (EQ5D) and the Medical Outcomes Study 36-Item Short Form Health Survey Physical Function Scale (SF-36 PF)). We used the Grading of Recommendations Assessment, Development and Evaluation approach to rate the quality of evidence (QoE)．RESULTSSix RCTs selected from 5105 screened abstracts were included. Early rehabilitation significantly improved short-term physical-related outcomes, as indicated by an increased Medical Research Council scale score (standardised mean difference (SMD): 0.38, 95% CI 0.10 to 0.66, P＝0.009) (QoE: low) and a decreased incidence of intensive care unit-acquired weakness (OR 0.42, 95% CI 0.22 to 0.82, P＝0.01, QoE: low), compared with standard care or no early rehabilitation. However, the two groups did not differ in terms of cognitive-related delirium-free days (SMD: －0.02, 95% CI －0.23 to 0.20, QoE: low) and the mental health-related Hospital Anxiety and Depression Scale score (OR: 0.79, 95% CI 0.29 to 2.12, QoE: low). Early rehabilitation did not improve the long-term outcomes of PICS as characterised by EQ5D and SF-36 PF.CONCLUSIONSEarly rehabilitation improved only short-term physical-related outcomes in patients with critical illness. Additional large RCTs are needed.

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简介：Hypertrophiccardiomyopathy(HCM)isacommongeneticcardiovasculardiseaseandappearsinallethnicgroups.HCMisdiagnosedonthebasisofleftventricularhypertrophy.EchocardiographyisakeytechniqueinthediagnosisofHCM,theprognosisofpatientswithHCM,themanagementstrategyforHCM,andthefollow-upofpatientswithHCM.ThisreviewbrieflydescribesanddiscussesthepracticaluseofestablishedechocardiographytechniquesandthecurrentandemergingechocardiographicmethodsthatcanhelpphysiciansinthecorrectdiagnosticandpathophysiologicalassessmentofpatientswithHCM.

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简介：AbstractBackground:It is crucial to improve the quality of care provided to ICU patient, therefore a national survey of the medical quality of intensive care units (ICUs) was conducted to analyze adherence to quality metrics and outcomes among critically ill patients in China from 2015 to 2019.Methods:This was an ICU-level study based on a 15-indicator online survey conducted in China. Considering that ICU care quality may vary between secondary and tertiary hospitals, direct standardization was adopted to compare the rates of ICU quality indicators among provinces/regions. Multivariate analysis was performed to identify potential factors for in-hospital mortality and factors related to ventilator-associated pneumonia (VAP), catheter-related bloodstream infections (CRBSIs), and catheter-associated urinary tract infections (CAUTIs).Results:From the survey, the proportions of structural indicators were 1.83% for the number of ICU inpatients relative to the total number of inpatients, 1.44% for ICU bed occupancy relative to the total inpatient bed occupancy, and 51.08% for inpatients with Acute Physiology and Chronic Health Evaluation II scores ≥15. The proportions of procedural indicators were 74.37% and 76.60% for 3-hour and 6-hour surviving sepsis campaign bundle compliance, respectively, 62.93% for microbiology detection, 58.24% for deep vein thrombosis prophylaxis, 1.49% for unplanned endotracheal extubations, 1.99% for extubated inpatients reintubated within 48 hours, 6.38% for unplanned transfer to the ICU, and 1.20% for 48-hour ICU readmission. The proportions of outcome indicators were 1.28‰ for VAP, 3.06‰ for CRBSI, 3.65‰ for CAUTI, and 10.19% for in-hospital mortality. Although the indicators varied greatly across provinces and regions, the treatment level of ICUs in China has been stable and improved based on various quality control indicators in the past 5 years. The overall mortality rate has dropped from 10.19% to approximately 8%.Conclusions:The quality indicators of medical care in China’s ICUs are heterogeneous, which is reflected in geographic disparities and grades of hospitals. This study is of great significance for improving the homogeneity of ICUs in China.

简介：BackgroundMyocardialbloodflow(MBF)canbequantifiedwithmyocardialcontrastechocardiography(MCE)duringavenousinfusionofmicrobubble.AminimalMBFisrequiredtomaintaincellmembraneintegrityandmyocardialviabilityinischemiccondition.Thus,wehypothesizedthatMCEcouldbeusedtoassessmyocardialviabilitybythedeterminationofMBF.MethodsandResultsMCEwasperformedat4hoursafterligationofproximalleftanteriordescendingcoronaryarteryin7dogswithconstantvenousinfusionsofmicrobubbles.Thevideointensityversuspulsingintervalplotsderivedfromeachmyocardialpixelwerefittedtoanexponentialfunction:y=A(1-e-βt),whereyisⅥatpulsingintervalt,Areflectsmicrovascularcross-sectionalarea(ormyocardialbloodvolume),and(3reflectsmeanmyocardialmicrobubblevelocity.TheproductofA·β　representsMBF.MBFwasalsoobtainedbyra-diolabeledmicrospheremethodserveredasreference.MBFderivedbyradiolabeledmicrosphere-methodinthere

简介：TheresearchesonCriticalPeriodHypothesis(CPH)aimstoexplaintheimportanceoftheagefactorintheprocessoflearningasecondlanguage.Inthisessay,acriticalreviewofthetheoreticalissuesandempiricalresearchontheCPHwillspreadout.Meanwhile,thediscussionofimplicationandlimitationoftheCPHresearchwillbeconcernedaswell.

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简介：careabout意为“关心；挂念；忧虑”。【经典例句】

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简介：AbstractFamily integrated care (FICare) is a collaborative model of neonatal care which aims to address the negative impacts of the neonatal intensive care unit (NICU) environment by involving parents as equal partners, minimizing separation, and supporting parent-infant closeness. FICare incorporates psychological, educational, communication, and environmental strategies to support parents to cope with the NICU environment and to prepare them to be able to emotionally, cognitively, and physically care for their infant. FICare has been associated with improved infant feeding, growth, and parent wellbeing and self-efficacy; important mediators for long-term improved infant neurodevelopmental and behavioural outcomes. FICare implementation requires multi-disciplinary commitment, staff motivation, and sufficient time for preparation and readiness for change as professionals relinquish power and control to instead develop collaborative partnerships with parents. Successful FICare implementation and culture change have been applied by neonatal teams internationally, using practical approaches suited to their local environments. Strategies such as parent and staff meetings and relational communication help to break down barriers to change by providing space for the co-creation of knowledge, the negotiation of caregiving roles and the development of trusting relationships. The COVID-19 pandemic highlighted the vulnerability within programs supporting parental presence in neonatal units and the profound impacts of parent-infant separation. New technologies and digital innovations can help to mitigate these challenges, and support renewed efforts to embed FICare philosophy and practice in neonatal care during the COVID-19 recovery and beyond.

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