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| 1 | Anticoagulation with direct thrombin inhibitors during extracorporeal membrane oxygenation显示文摘Use of extracorporeal membrane oxygenation to support patients with critical cardiorespiratory illness is increasing.Systemic anticoagulation is an essential element in the care of extracorporeal membrane oxygenation patients.While unfractionated heparin is the most commonly used agent,unfractionated heparin is associated with several unique complications that can be catastrophic in critically ill patients,including heparin-induced thrombocytopenia and acquired antithrombin deficiency.These complications can result in thrombotic events and subtherapeutic anticoagulation.Direct thrombin inhibitors(DTIs)are emerging as alternative anticoagulants in patients supported by extracorporeal membrane oxygenation.Increasing evidence supports DTIs use as safe and effective in extracorporeal membrane oxygenation patients with and without heparininduced thrombocytopenia.This review outlines the pharmacology,dosing strategies and available protocols,monitoring parameters,and special use considerations for all available DTIs in extracorporeal membrane oxygenation patients.The advantages and disadvantages of DTIs in extracorporeal membrane oxygenation relative to unfractionated heparin will be described. | Barry Burstein Patrick M Wieruszewski Yan-Jun Zhao Nathan Smischney | 2019 | World Journal of Critical Care Medicine2019，8，6： | 12 |
| 2 | Effect of age on aortic atherosclerosis显示文摘Objective To examine the association of atherosclerosis burden in the survivors of an asymptomatic elderly cohort study and its relationship to other coronary risk factors (specifically, age) by evaluating aortic atherosclerotic wall burden by magnetic resonance imaging (MRI). Methods A total of 312 participants in an ongoing observational cohort study underwent cardiac and descending thoracic aorta imaging by MRI. Maximum wall thickness was measured and the mean wall thickness calculated.Wall/outer wall ratio was used as a normalized wall index (NWI) adjusted for artery size difference among participants. Percent wall volume (PWV) was calculated as NWI ×100.Results In this asymptomatic cohort (mean age: 76 years), the mean (SD) aortic wall area andwall thicknesswere 222 ±45 mm2 and 2.7 ±0.4 mm, respectively. Maximum wall thickness was 3.4 ±0.6 mm, and PWV was 32% ±4%. Women appeared to have smaller wall area,but after correcting for their smaller artery size, had significantly higher PWV than men (P = 0.03). Older age was associatedwith larger wall area (P = 0.04 for trend) with similar PWVs. However, there were no statistically significant associations between standard risk factors,Framingham global risk, or metabolic syndrome status, therapy for cholesterol or hypertension, coronary or aortic calcium score, and the aortic wall burden. Aortic calcificationwas associated with coronary calcification. Conclusions Asymptomatic elderly in this cohort had a greater descending thoracic aortic wall volume that correlated with age, andwomen had a significantly increased PWV compared to men. In these survivors, the atherosclerotic aortic wall burden was not significantly associated with traditional risk factors or with coronary or aortic calcium scores or coronary calcium progression. Results suggest that age, or as yet unidentified risk factor(s), may be responsible for the increase in atherosclerosis. | Michael A. Chen Miwa Kawakubo Patrick M. Colletti Dongxiang Xu Laurie LaBree Dustin Robert Detrano Stanley P Azen Nathan D. Wong Xue-Qiao Zhao | 2013 | Journal of Geriatric Cardiology2013，10，2： | 6 |
| 3 | AME证据系列001--转化医学协会:脓毒症诊断和早期识别的临床实践指南显示文摘脓毒症是一种由感染引起的异质性疾病,感染触发了一系列复杂的局部或者全身的免疫炎症反应,引起多器官功能衰竭,发病率和病死率显著升高。由于至今仍然没有诊断脓毒症的金标准,所以脓毒症的临床诊断仍是一个难题。因此,脓毒症的临床诊断需要不断改变来满足临床和研究的要求。然而,尽管有许多新型的生物标记和筛选工具去预测脓毒症发生的风险,但是这些措施的诊断价值和有效性不足以让人满意,并且没有充分的证据去建议临床使用这些新技术。因此,脓毒症的临床诊断标准需要定期更新去适应不断产生的新证据。这篇综述旨在呈现当前脓毒症的诊断和早期识别方面的最新研究证据。临床运用不同的诊断方法的推荐意见依赖于推荐、评价、发展和评估分级体系(Grades of Recommendation Assessment,Development and Evaluation,GRADE),因为大部分的研究是观察性研究,并没有对这些方法进行可靠评估,采用的是两步推理方法。未来需要更多研究来确认或者反驳某一特殊的指标检测,同时应该直接采用相关病人的结果数据。 | Zhongheng Zhang Nathan J.Smischney Haibo Zhang Sven Van Poucke Panagiotis Tsirigotis Jordi Rello Patrick M.Honore Win Sen Kuan Juliet June Ray Jiancang Zhou You Shang Yuetian Yu Christian Jung Chiara Robba Fabio Silvio Taccone Pietro Caironi David Grimaldi Stefan Hofer George Dimopoulos Marc Leone Sang-Bum Hong Mabrouk Bahloul Laurent Argaud Won Young Kim Herbert D.Spapen Jose Rodolfo Rocco 张建成(译) 尚游(译) 钟鸣(校) | 2016 | 临床与病理杂志2016，36，10： | 5 |
| 4 | Local Variability in Temperature, Humidity and Radiation in the BaekduDaegan Mountain Protected Area of Korea显示文摘A novel embedded sensor network records changes in key climatic-environmental variables over a range of altitude in the BaekduDaegan Mountain (BDM) of Gangwon Province in Korea, a protected mountain region with unique biodiversity undergoing climate change research. The investigated area is subdivided into three horizontal north-south study areas. Three variables, temperature (T, ℃), relative humidity (RH, %), and light intensity (LI, lumens m -2 , or lux, lx), have been continuously measured at hourly intervals from June, 2010 to September, 2011 using HOBO H8 devices at 10 fixed study sites. These hourly observations are aggregated to monthly, seasonal and annual mean values, and results are summarized to inaugurate a long-term climate change investigation. A region wide T difference in accordance with altitude, or lapse rate, over the interval is calculated as 0.4℃100 m -1 . T lapse rates change seasonally, with winter lapse rates being greater than those of summer. RH is elevated in summer compared to other seasons. LI within forestland is lower during summer and higher during other seasons. The obtained results could closely relate to the vegetation type and structure and the terrain state since data loggers were located in forestland. | CHAE Heemun LEE Hyunju LEE Sangsin CHEONG Yukyong UM Gijeung MARK Bryan PATRICK Nathan | 2012 | Journal of Mountain Science2012，9，5： | 5 |
| 5 | Phase II trial of Sorafenib in conjunction with chemotherapy and as maintenance therapy in extensive-stage small cell lung cancer显示文摘 | Neelesh Sharma Nathan Pennell Myles Nickolich Balazs Halmos Patrick Ma Tarek Mekhail Pingfu Fu Afshin Dowlati | 2014 | Investigational New Drugs2014，，2： | 2 |
| 6 | High mobility group box protein‐1 promotes cerebral edema after traumatic brain injury via activation of toll‐like receptor 4显示文摘 | Melissa D. Laird Jessica S. Shields Sangeetha Sukumari‐Ramesh Donald E. Kimbler R. David Fessler Basheer Shakir Patrick Youssef Nathan Yanasak John R. Vender Krishnan M. Dhandapani | 2014 | Glia2014，，1： | 1 |
| 7 | A Method for Calibrating Deterministic Forecasts of Rare Events显示文摘 | Marsh Patrick T Kain John S Lakshmanan Valliappa Clark Adam J Hitchens Nathan M Hardy Jill | 2012 | EN2012，，2： | 1 |
| 8 | Epigenetic and Genetic Influences on DNA Methylation Variation in Maize Populations[W]显示文摘 | Steven R. Eichten Roman Briskine Jawon Song Qing Li Ruth Swanson-Wagner Peter J. Hermanson Amanda J. Waters Evan Starr Patrick T. West Peter Tiffin Chad L. Myers Matthew W. Vaughn Nathan M. Springer | 2013 | The Plant Cell2013，，8： | 1 |
| 9 | Use of opioid analgesics in the treatment of cancer pain: evidence-based recommendations from the EAPC显示文摘 | Augusto Caraceni Geoffrey Hanks Stein Kaasa Michael I Ben- nett Cirmia Brunelli Nathan Chemy Ola Dale Franco De Conno Marie Fallon Magdi Hanna Dagny Faksvfig Haugen Gitte Juhl Samuel King PadKlepstad Eivor A Laugsand Marco Maltoni Se- bastiano Mercadante Maria Nabal Alessandra Pigni Lukas Rad- bmch Colette Reid Per Sjogren Patrick C Stone Davide Tassi- nail Giovambattista Zeppetella | 2012 | Lancet Oncol2012，13，2： | 1 |
| 10 | Epigenetic and Genetic Influences on DNA Methylation Variation in Maize Populations[W]显示文摘 | Steven R. Eichten Roman Briskine Jawon Song Qing Li Ruth Swanson-Wagner Peter J. Hermanson Amanda J. Waters Evan Starr Patrick T. West Peter Tiffin Chad L. Myers Matthew W. Vaughn Nathan M. Springer | 2013 | The Plant Cell2013，，8： | 1 |
| 11 | Isolation and characterization of a new Vesivirus from rabbits显示文摘 | José M. Martín-Alonso Douglas E. Skilling Lorenzo González-Molleda Gloria del Barrio ángeles Machín Nathan K. Keefer David O. Matson Patrick L. Iversen Alvin W. Smith Francisco Parra | 2005 | Virology2005，，2： | 1 |
| 12 | Avoidance of Electrode Related MRI Artifact during Staged Deep Brain Stimulator Implantation显示文摘 | Cole Giller Shyamal Mehta Nathan Yanasak Patrick Jenkins | 2012 | J Neurol Surg A Cent Eur Neurosurg2012，，05： | 1 |
| 13 | Thoracic Endografting Reduces Morbidity and Remodels the Thoracic Aorta in DeBakey III Aneurysms显示文摘 | Bradley G. Leshnower Wilson Y. Szeto Alberto Pochettino Nimesh D. Desai Patrick J. Moeller Derek P. Nathan Benjamin M. Jackson Edward Y. Woo Ronald M. Fairman Joseph E. Bavaria | 2012 | The Annals of Thoracic Surgery2012，，： | 1 |
| 14 | Forest gradient response in Sierran landscapes: the physical template显示文摘 | Dean L. Urban Carol Miller Patrick N. Halpin Nathan L. Stephenson | 2000 | Landscape Ecology2000，，7： | 1 |
| 15 | Vasopressin in vasoplegic shock:A systematic review显示文摘BACKGROUNDVasoplegic shock is a challenging complication of cardiac surgery and is oftenresistant to conventional therapies for shock. Norepinephrine and epinephrine arestandards of care for vasoplegic shock, but vasopressin has increasingly been usedas a primary pressor in vasoplegic shock because of its unique pharmacology andlack of inotropic activity. It remains unclear whether vasopressin has distinctbenefits over standard of care for patients with vasoplegic shock.AIMTo summarize the available literature evaluating vasopressin vs non-vasopressinalternatives on the clinical and patient-centered outcomes of vasoplegic shock inadult intensive care unit (ICU) patients.METHODSThis was a systematic review of vasopressin in adults (≥ 18 years) with vasoplegicshock after cardiac surgery. Randomized controlled trials, prospective cohorts,and retrospective cohorts comparing vasopressin to norepinephrine, epinephrine,methylene blue, hydroxocobalamin, or other pressors were included. The primaryoutcomes of interest were 30-d mortality, atrial/ventricular arrhythmias, stroke,ICU length of stay, duration of vasopressor therapy, incidence of acute kidneyinjury stage II-III, and mechanical ventilation for greater than 48 h.RESULTSA total of 1161 studies were screened for inclusion with 3 meeting inclusioncriteria with a total of 708 patients. Two studies were randomized controlled trials and one was a retrospective cohort study. Primary outcomes of 30-d mortality,stroke, ventricular arrhythmias, and duration of mechanical ventilation weresimilar between groups. Conflicting results were observed for acute kidney injurystage II-III, atrial arrhythmias, duration of vasopressors, and ICU length of staywith higher certainty of evidence in favor of vasopressin serving a protective rolefor these outcomes.CONCLUSIONVasopressin was not found to be superior to alternative pressor therapy for any ofthe included outcomes. Results are limited by mixed methodologies, small overallsample size, and heterogenous populations. | Andrew J Webb Mohamed O Seisa Tarek Nayfeh Patrick M Wieruszewski Scott D Nei Nathan J Smischney | 2020 | World Journal of Critical Care Medicine2020，9，5： | 0 |
| 16 | Inhaled volatile anesthetics in the intensive care unit显示文摘The discovery and utilization of volatile anesthetics has significantly transformed surgical practices since their inception in the mid-19th century.Recently,a paradigm shift is observed as volatile anesthetics extend beyond traditional confines of the operating theatres,finding diverse applications in intensive care settings.In the dynamic landscape of intensive care,volatile anesthetics emerge as a promising avenue for addressing complex sedation requirements,managing refractory lung pathologies including acute respiratory distress syndrome and status asthmaticus,conditions of high sedative requirements including burns,high opioid or alcohol use and neurological conditions such as status epilepticus.Volatile anesthetics can be administered through either inhaled route via anesthetic machines/devices or through extracorporeal membrane oxygenation circuitry,providing intensivists with multiple options to tailor therapy.Furthermore,their unique pharmacokinetic profiles render them titratable and empower clinicians to individualize management with heightened accuracy,mitigating risks associated with conventional sedation modalities.Despite the amounting enthusiasm for the use of these therapies,barriers to widespread utilization include expanding equipment availability,staff familiarity and training of safe use.This article delves into the realm of applying inhaled volatile anesthetics in the intensive care unit through discussing their pharmacology,administration considerations in intensive care settings,complication considerations,and listing indications and evidence of the use of volatile anesthetics in the critically ill patient population. | Erin D Wieruszewski Mariam ElSaban Patrick M Wieruszewski Nathan J Smischney | 2024 | World Journal of Critical Care Medicine2024，13，1： | 0 |
| 17 | Clonidine use during dexmedetomidine weaning:A systematic review显示文摘BACKGROUND Dexmedetomidine is a centrally acting alpha-2A adrenergic agonist that is commonly used as a sedative and anxiolytic in the intensive care unit(ICU),with prolonged use increasing risk of withdrawal symptoms upon sudden discontinuation.As clonidine is an enterally available alpha-2A adrenergic agonist,it may be a suitable agent to taper off dexmedetomidine and reduce withdrawal syndromes.The appropriate dosing and conversion strategies for using enteral clonidine in this context are not known.The objective of this systematic review is to summarize the evidence of enteral clonidine application during dexmedetomidine weaning for prevention of withdrawal symptoms.AIM To systematically review the practice,dosing schema,and outcomes of enteral clonidine use during dexmedetomidine weaning in critically ill adults.METHODS This was a systematic review of enteral clonidine used during dexmedetomidine weaning in critically ill adults(≥18 years).Randomized controlled trials,prospective cohorts,and retrospective cohorts evaluating the use of clonidine to wean patients from dexmedetomidine in the critically ill were included.The primary outcomes of interest were dosing and titration schema of enteral clonidine and dexmedetomidine and risk factors for dexmedetomidine withdrawal.Other secondary outcomes included prevalence of adverse events associated with enteral clonidine use,re-initiation of dexmedetomidine,duration of mechanical ventilation,and ICU length of stay.RESULTS A total of 3427 studies were screened for inclusion with three meeting inclusion criteria with a total of 88 patients.All three studies were observational,two being prospective and one retrospective.In all included studies,the choice to start enteral clonidine to wean off dexmedetomidine was made at the discretion of the physician.Weaning time ranged from 13 to 167 h on average.Enteral clonidine was started in the prospective studies in a similar protocolized method,with 0.3 mg every 6 h.After starting clonidine,patients remained on dexmedetomidine for a median of 1-28 h.Following the termination of dexmedetomidine,two trials tapered enteral clonidine by increasing the interval every 24 h from 6 h to 8h,12h,and 24 h,followed by clonidine discontinuation.For indicators of enteral clonidine withdrawal,the previously tolerable dosage was reinstated for several days before resuming the taper on the same protocol.The adverse events associated with enteral clonidine use were higher than patients on dexmedetomidine taper alone with increased agitation.The re-initiation of dexmedetomidine was not documented in any study.Only 17(37%)patients were mechanically ventilated with median duration of 3.5 d for 13 patients in one of the 2 studies.ICU lengths of stay were similar.CONCLUSION Enteral clonidine is a strategy to wean critically ill patients from dexmedetomidine.There is an association of increased withdrawal symptoms and agitation with the use of a clonidine taper. | Sanu Rajendraprasad Molly Wheeler Erin Wieruszewski Joseph Gottwald Lindsey A.Wallace Danielle Gerberi Patrick M Wieruszewski Nathan J Smischney | 2023 | World Journal of Critical Care Medicine2023，12，1： | 0 |
| 18 | 超声引导下留置持续外周神经阻滞导管的院外管理:620例患者的经验总结显示文摘背景持续外周神经阻滞(continuous peripheral nerve block,CPNB)是骨科手术术后镇痛的最佳选择,但鉴于对置管相关并发症的顾虑,该方法并不常规用于门诊患者,同时在此情况下很难保证患者随时与医生进行联系。本研究对620例按照预设方案接受CPNB的门诊病例进行了分析。方法所有导管均在超声直视下置入。每个患者在手术前都接受充分的口头和书面指导,手术后由麻醉医生提供随时的电话随访服务。所有患者手术后第1天都会在家中接到电话随访。另外,每个患者出院后两周内要接受外科医生复查。结果620例病例中,190例为肌间沟(臂丛神经)置管,206为髂筋膜(股神经)置管,224例为腘窝(坐骨神经)置管。2例患者(0.3%)出现神经阻滞相关的并发症;其症状在手术后6周内得到了缓解;26例患者(4.2%)需要麻醉医生的手术后干预;1例患者返回医院拔除导管。结论此项对大样本门诊患者接受CPNB治疗的研究发现,仅有极少部分患者需要麻醉医生干预。同样,患者可以在家中自行管理和拔除导管而不需要额外随访。这一发现说明给予充分的手术前指导以及与医生进行电话沟通,患者可以舒适地在家中管理并拔除CPNB导管。 | Jeffrey D. Swenson, MD Nathan Bay, MD Evelyn Loose, MD Byron Bankhead, MD Jennifer Davis, MD imothy C. Beals, MD Nathaniel A. Bryan, MD Robert T. Burks, MD Patrick E. Greis, MD 王倩(译) 王天龙(校) | 2008 | 麻醉与镇痛2008，4，1： | 0 |
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