Deep fluid activity is widespread in large oil-gas basins around the world. Deep fluids, as the links between internal and external factors of a basin, run in the way of organic-inorganic interactions through the oil-gas formation and aggregation. Herein, the identification characteristics of deep fluids in sedimentary basins as well as their influence on oil-gas reservoir formation and geothermal resource are summarized. The deep fluids of sedimentary basins are identified from three aspects, including mineral composition, fluid inclusions, and geochemical characteristics. The effects of deep fluid activities on oil-gas reservoir formation are manifested in two key aspects of matter and energy. As for the matter effects, deep fluids can improve the primary productivity of sedimentary basins and carry abundant inorganic hydrogen, which contributes to improving the hydrocarbon productivity through hydrogenation. As for the energy effects, the heat energy of deep fluids can promote the mature evolution from organic matter to oil and gas. During this process, the heating of deep fluids will cause the oil-generation window depth of the hydrocarbon source rocks to become thinner, and it will also generate very high pressure, which will promote the discharge of abundant hydrocarbons formed by the hydrocarbon source rocks. Furthermore, deep fluids can directly form volcanic rock oil-gas reservoirs. And another manifestation of deep fluid energy is geothermal. And the thermal energy of deep fluids can directly form hot dry rocks, which is the most important existing form of geothermal resources. The geological exploration of hot dry rocks should be supported by further geochemical and geophysical research.
Assist/control (A/C) ventilation may induce delirium in patients with acute respiratory distress syndrome (ARDS). We conducted a trial to determine whether initial synchronized intermittent mandatory ventilation with pressure support (SIMV + PS) could improve clinical outcomes in these patients.Intubated patients with moderate ARDS were enrolled and we compared SIMV + PS with A/C. Identical sedation, analgesia and ventilation strategies were performed. The co-primary outcomes were early (≤72 h) partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2) and incidence of delirium. The secondary outcomes were all-cause in-hospital mortality, dosages of analgesics and sedatives, incidence of patient-ventilator asynchrony, and duration of mechanical ventilation and hospital stay.We screened 2,684 patients and 40 patients were enrolled in our study. In SIMV + PS, early (≤72 h) PaO2/FiO2 was greater improved than that at baseline and that in A/C (P<0.05) with lower positive end-expiratory pressure (PEEP) (8.7±3.0 vs. 10.3±3.2, P<0.001) and FiO2 (58%±18% vs. 67%±19%, P<0.001). We found more SIMV + PS success (defined as SIMV + PS successfully applied without switching to A/C) (100.0% vs. 16.7%, P<0.001), less male (46.3% vs. 85.7%, P=0.015) and pulmonary etiology of ARDS (53.8% vs. 92.9%, P=0.015), and lower PEEP (9.1±3.1 vs. 10.3±3.3, P=0.004) and FiO2 (58%±19% vs. 71%±19%, P<0.001) in survival patients. However, there were no significant differences in incidence of delirium and mortality, dosages of analgesics and sedatives, incidence of patient-ventilator asynchrony, duration of mechanical ventilation and hospital stay (P>0.05).In patients with moderate ARDS, SIMV + PS can safely and effectively improve oxygenation, but does not decrease mortality, incidence of delirium and patient-ventilator asynchrony, dosages of analgesics and sedatives, and duration of mechanical ventilation and hospital stay.
Venous thromboembolism (VTE) is a common complication for critically ill patients. Intermittent pneumatic compression (IPC) is recommended for patients with high risk of bleeding. We aim to evaluate the effectiveness of IPC for thromboprophylaxis in critically ill patients. We searched PubMed, Embase, and ClinicalTrials for randomized controlled trials (RCTs) and observational studies that evaluated IPC in critically ill patients. RevMan 5.3 software was used for the meta-analysis. A total of 10 studies were included. The IPC group significantly reduced the VTE incidence compared with no thromboprophylaxis group (risk ratio [RR]: 0.35, confidence interval [CI]: 0.18-0.68, P = .002) and the IPC group also showed lower VTE incidence than the graduated compression stockings (GCS) group (RR: 0.47, CI: 0.24-0.91, P = .03). There were no significant differences between using IPC and low-molecular-weight heparin (LMWH) for VTE incidence (RR: 1.26, CI: 0.72-2.22, P = .41), but LMWH showed significantly more bleeding events. Intermittent pneumatic compression as an adjunctive treatment did not further reduce VTE incidence (RR: 0.55, CI: 0.24-1.27, P = .16). Intermittent pneumatic compression can reduce the incidence of VTE for critically ill patients, which is better than GCS and similar to LMWH, but it has no significant advantage as an adjunct therapy for thromboprophylaxis.
Fat embolism syndrome (FES) is a rare life-threatening complication, which commonly affects the lung. Currently, the most widely accepted criteria for the diagnosis of FES are the Gurd and Wilson Criteria established nearly 40 years ago, but without pulmonary images involved. Our study aims to analyse the pulmonary computed tomography (CT) findings seen in FES.
Case presentation
This report enrolled four cases of FES with lung involvement. The mainly symptoms and signs included dyspnea, disturbance of consciousness, anemia, thrombocytopenia and, most notably, ground-glass opacities, septal thickening, ill-defined centrilobular nodules, and patchy consolidation were demonstrated on bilateral lungs. Combining the clinical manifestations and laboratory tests, the diagnosis of FES was confirmed. With the treatment of steroids, anti-coagulation and supportive treatment, the four patients9 symptoms were relieved, abnormalities in chest CT were absorbed significantly and the patients were finally discharged.
Conclusions
There are several common manifestations of FES in pulmonary CT images, and the lung parenchymal features give more information for the diagnosis of FES than the pulmonary vessel findings. Given the absence of a gold standard diagnostic test for FES, further investigation to explore new diagnostic criteria of FES involving pulmonary radiological features is needed in the future.
Pleural effusion is observed in a subset of patients with acute pulmonary embolism (APE) and may be linked to clinical outcome, but findings from previous studies have been inconsistent. This study aimed to investigate the prevalence and clinical significance of pleural effusion in Chinese patients with APE.Clinical data from hospitalized patients with APE were retrospectively collected and the prevalence of pleural effusion was determined. The relationship between the presence of pleural effusion and clinical outcome of APE was analyzed by Cox proportional hazards regression and Kaplan-Meier survival analysis.The study enrolled 635 patients with APE. The prevalence of pleural effusion was 57.01% (362/635). Patients with pleural effusion had significantly higher in-hospital mortality (9.9% vs. 4.8%, P<0.05) and longer length of hospital stay (LOS) (19.99 vs. 15.31 days, P<0.05) than whose without pleural effusion. However, pleural effusion was not an independent risk factor for in-hospital mortality in patients with APE by multivariate Cox proportional hazards regression analysis [hazard ratio (HR) =1.70, 95% confidence interval (CI): 0.73-3.92, P=0.216] and Kaplan-Meier survival analysis (P=0.174).Pleural effusion is a frequent occurrence in patients with APE and therefore merits greater attention from clinicians; however, it is not an independent risk factor for in-hospital mortality.
This study investigated the impact of clinicians' work-family conflict on their job burnout, and further explored the effects of supervisor support and colleague support to mitigate work-family conflict and job burnout. Individual test was used in order to collect accurate research data. Results showed that the levels of clinicians' work-family conflict and job burnout are high, and have significant differences among different job titles and hospitals. Multiple Regression Analysis found that both work-family conflict and family-work conflict are significant predictors of job burnout. And, supervisor support and colleague support are supportive resources to ease work-family conflict and job burnout.
Astragaloside IV (AS-IV) is an inartificial saponin separated from astragalus membranaceus, which has exhibited key anti-tumor regulation in some cancers. Circular RNAs (circRNAs) are important regulators in malignant development of gastric cancer (GC). Herein, we focused on the molecular mechanism of AS-IV with circRNA dihydrolipoamide S-succinyltransferase (circDLST) in GC. CircDLST, microRNA-489-3p (miR-489-3p), and eukaryotic translation initiation factor 4A1 (EIF4A1) levels were detected by quantitative real-time polymerase-chain reaction and western blot. Cell functions were assessed by cell counting kit-8 assay, ethynyl-2'-deoxyuridine assay, colony formation assay, and transwell assay. The interaction between miR-489-3p and circDLST or EIF4A1 was analyzed by dual-luciferase reporter assay. Xenograft tumor assay was adopted to check the role of circDLST and AS-IV in vivo. CircDLST and EIF4A1 were upregulated but miR-489-3p was downregulated in GC cells. AS-IV restrained cell proliferation and metastasis in GC cells by downregulating circDLST. CircDLST served as a miR-489-3p sponge, and miR-489-3p inhibition reversed anti-tumor function of AS-IV. EIF4A1 was a target for miR-489-3p and circDLST sponged miR-489-3p to regulate EIF4A1. AS-IV suppressed GC cell progression via circDLST-mediated downregulation of EIF4A1. Also, AS-IV recued tumor growth in vivo via targeting circDLST to regulate miR-489-3p/EIF4A1 axis. AS-IV inhibited the development of GC through circDLST/miR-489-3p/EIF4A1 axis.
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