1 7 , 1 3 ; 2 40 w w w . r e a n i m a t o l o g y . c o mТенденция к развитию и генерализации инфекции у пациентов с тяжелой термической травмой реали зуется за счет комплексного влияния термической травмы на иммунную систему. Особенно страдает фаго цитарная система, представленная, в первую очередь, нейтрофильными гранулоцитами.Цель исследования: определение динамики изменения функциональной активности нейтрофилов у па циентов с термической травмой, а также ее прогностической значимости при развитии гнойно септических осложнений ожоговой болезни.Материалы и методы. Функциональную активность нейтрофилов оценивали на основе спонтанного и ин дуцированного хемилюминесцентного ответа цельной крови при последовательной стимуляции форбол 12 миристат 13 ацетатом (ФМА) и N формил метионил лейцил фенилаланином (фМЛФ). Было обследовано 34 пациента с ожоговой болезнью при разной тяжести течения ожоговой болезни и в динамике наблюдения.Результаты. Разработанная новая методика была использована для исследования цельной крови паци ентов с ожоговой болезнью, получены данные о функциональной активности нейтрофилов при разной тя жести течения болезни и в динамике. В результате анализа хемилюминесцентных кривых развития респи раторного взрыва нейтрофилов выявлены показатели, характеризующие состояние иммунной системы, а именно: одно-или двухфазный ответ на стимул, удельная активность нейтрофила «быстрой фазы», удель ная активность нейтрофила «медленной фазы».Заключение. Результаты позволили выделить тенденции изменения функциональной активности ней трофилов при ожоговой болезни. Предложены диагностические и прогностические показатели функцио нальной активности нейтрофилов для оценки тяжести болезни и прогноза септического процесса. Ключевые слова: хемилюминесценция; функциональная активность нейтрофилов; ожоговая травма; сепсисA complex effect of thermal trauma on the immune system triggers the tendency to develop and generalize infection in patients with severe thermal trauma. The phagocytic system, which is represented, first of all, by neu trophilic granulocytes, is significantly altered.Objective: to determine the dynamics of changes in the functional activity of neutrophils in patients with thermal trauma, as well as its prognostic significance in the development of purulent septic complications of a burn disease.Materials and methods. The functional activity of neutrophils was assessed by spontaneous and induced chemiluminescence responses of whole blood sequentially stimulated with phorbol 12 myristate 13 acetate ВведениеПроблема лечения ожоговой болезни и ее осложнений не теряет актуальности до настоя щего времени [1]. В структуре летальности тя желообожженных ведущее место занимает ин фекция, приводящая к развитию пневмонии и сепсиса [2]. Развитие и генерализация инфекции у тяжелообожженных реализуется за счет влия ния термической травмы на иммунную систему; в особенности страдает фагоцитарное звено им мунитета [3][4][5]. Дисфункция фагоцитов прояв ляется в нарушении уничтожения бактерий, из менении уровня секреции ин...

One principal reason for ED crowding in Beijing lies in the large numbers of patients who persist in the expectation of receiving ongoing care in the ED for minor illnesses. However, as is true in many nations, one of the other most important root causes of ED crowding is "access block," the inability to promptly move patients deemed by emergency physicians to need inpatient care to an inpatient bed for that care. However, in our system, another challenge, not widely described as a contributor to crowding in other nations, is that doctors assigned to inpatient services have been empowered to refuse to admit patients perceived to have overly "complex" needs. Further, patients with multisystem illnesses or end-stage status, who need ongoing chronic care to manage activities of daily living, have begun to populate Beijing EDs in increasing numbers. This is an issue with various root causes.

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Therapeutic agents for the novel coronavirus disease 2019 (COVID-19) have been proposed, but evidence supporting their use is limited. A machine learning algorithm was developed in order to identify a subpopulation of COVID-19 patients for whom hydroxychloroquine was associated with improved survival; this population might be relevant for study in a clinical trial. A pragmatic trial was conducted at six United States hospitals. We enrolled COVID-19 patients that were admitted between 10 March and 4 June 2020. Treatment was not randomized. The study endpoint was mortality; discharge was a competing event. Hazard ratios were obtained on the entire population, and on the subpopulation indicated by the algorithm as suitable for treatment. A total of 290 patients were enrolled. In the subpopulation that was identified by the algorithm, hydroxychloroquine was associated with a statistically significant (p = 0.011) increase in survival (adjusted hazard ratio 0.29, 95% confidence interval (CI) 0.11–0.75). Adjusted survival among the algorithm indicated patients was 82.6% in the treated arm and 51.2% in the arm not treated. No association between treatment and mortality was observed in the general population. A 31% increase in survival at the end of the study was observed in a population of COVID-19 patients that were identified by a machine learning algorithm as having a better outcome with hydroxychloroquine treatment. Precision medicine approaches may be useful in identifying a subpopulation of COVID-19 patients more likely to be proven to benefit from hydroxychloroquine treatment in a clinical trial.

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Administration of oral talactoferrin was not associated with reduced 28-day mortality in patients with severe sepsis and may even be harmful.

The change bundle approach to performance improvement (guidelines-based) is the key to change in practice. The Surviving Sepsis Campaign/Institute of Healthcare Improvement sepsis change bundles are an excellent example of progress along these lines.