Effects of beta-blockers use on mortality of patients with acute respiratory distress syndrome: a retrospective cohort study.

Introduction: Acute respiratory distress syndrome (ARDS) remains a challenging disease with limited prevention and treatment options. The usage of beta-blockers may have potential benefits in different critical illnesses. This study aimed to investigate the correlation between beta-blocker therapy and mortality in patients with ARDS. Materials and methods: This retrospective cohort study utilized data from the Medical Information Mart for Intensive Care (MIMIC) IV database and focused on patients diagnosed with ARDS. The primary outcome of the study was 30-day mortality. To account for confounding factors, a multivariable analysis was performed. Propensity score matching (PSM) was carried out on a 1:1 ratio. Robust assessments were conducted using inverse probability weighting (IPTW), standardized mortality ratio weighting (SMRW), pairwise algorithms (PA), and overlap weights (OW). Results: A total of 1,104 patients with ARDS were included in the study. Univariate and multivariate Cox regression analyses found that the 30-day mortality for 489 patients (23.7%) who received beta-blockers was significantly lower than the mortality rate of 615 patients (35.9%) who did not receive beta-blockers. After adjusting for potential confounders through PSM and propensity score, as well as utilizing IPTW, SMRW, PA, and OW, the results remained robust, with the hazard ratios (HR) ranging from 0.42 to 0.58 and all p-values < 0.001. Evaluation of the E-values indicated the robustness of the results even in the presence of unmeasured confounding. Conclusion: The findings suggest a potential association between beta-blocker usage and reduced mortality in critically ill patients with ARDS. However, further validation of this observation is needed through randomized controlled trials.

[Time-related association between fluid balance and prognosis in sepsis patients: a cohort study based on MIMIC-IV database].

OBJECTIVE: To investigate time-related association between fluid balance and prognosis in sepsis patients. METHODS: A retrospective cohort study was conducted based on the data of sepsis patients in the Medical Information Database for Intensive Care-IV 2.0 (MIMIC-IV 2.0) from 2008 to 2019. Sepsis patients aged ≥ 18 years who were admitted to intensive care unit (ICU) for at least 2 days were included. The daily fluid balance and cumulative fluid balance (CFB) were calculated from days 1 to 7 after ICU admission. According to CFB,the patients were divided into negative fluid balance group (CFB% < 0%), fluid balance group (0% ≤ CFB% ≤ 10%), and fluid overload group (CFB% > 10%). In-hospital mortality was the primary outcome. Multifactorial Logistic regression was used to analyze time-related association between different CFB and the risk of in-hospital mortality in patients with sepsis during 7 days after ICU admission. In addition, subgroup analysis was performed on patients with septic shock and patients with sepsis who stayed in the ICU for 7 days or longer. RESULTS: A total of 11 437 patients with sepsis were included, of which 6 595 were male and 4 842 were female. The mean age was (64.4±16.4) years. A total of 10 253 patients (89.6%) survived and 1 184 patients (10.4%) died during hospitalization. Compared with the survival group, patients in the death group were older, lighter, had higher sequential organ failure assessment (SOFA), simplified acute physiology score II (SAPS II), longer ICU stay, higher incidence of septic shock, and higher proportion of invasive mechanical ventilation, renal replacement therapy (RRT) and vasoactive drugs. In terms of comorbidities, congestive heart failure, renal disease, liver disease, and malignancy were more common in the death group. The death group had a higher daily fluid balance than the survival group during 7 days after ICU admission, the CFB in the two groups gradually increased with length of ICU stay. After adjusting variables such as age, gender, race, SOFA score, SAPS II score, comorbidities, and the use of invasive mechanical ventilation, RRT and vasoactive drugs, multivariate Logistic regression analysis showed that fluid overload on day 1 after ICU admission was a protective factor for the reduced risk of in-hospital mortality in sepsis patients [odds ratio (OR) = 0.74, 95% confidence interval (95%CI) was 0.64-0.86, P = 0.001]. However, fluid overload on day 3 was a risk factor for in-hospital mortality in sepsis patients (OR = 1.70, 95%CI was 1.47-1.97, P < 0.001) and the risk of in-hospital mortality was significantly increased from day 4 to day 7. Furthermore, the same results were obtained in patients with septic shock and sepsis patients who stayed in the ICU for 7 days or longer. CONCLUSIONS: Fluid overload on day 1 was associated with reduced in-hospital mortality. However, from the third day, fluid overload increases the risk of in-hospital mortality. Thus, managing fluid balance at different times may improve prognosis.

[Field investigation of standardized construction of intensive care unit in county-level public hospitals in Dizhou City, Guizhou Province].

OBJECTIVE: To investigate the standardized construction of critical care departments in different cities and counties of Guizhou province to promote the homogenization development of critical care medicine in Guizhou Province. METHODS: Using research methods such as field investigation and data collection, the public hospitals of 88 counties and urban areas in 9 prefectures and cities of Guizhou province were divided into five routes: southeast, northeast, northwest, southwest, and Guiyang. To design the survey form for the standardized construction of ICU, the e-form was sent to the director of ICU or his/her designated personnel by email or wechat 2-3 days in advance. Check the authenticity of data item by item on site, and leave the hospital after checking the receipt form. RESULTS: From April to July 2021, the survey and research data collection was completed for 146 public hospitals (excluding provincial hospitals) with intensive care departments in 88 counties and cities of 9 dizhou cities in Guizhou Province, including 24 Grade-III Level A hospitals. 122 Grade-II and above hospitals (including 8 Grade-III Level B hospitals, 11 Grade-III comprehensive hospitals, 97 Level-II A hospitals, 3 Level-II B hospitals, and 3 Level-II comprehensive hospitals). 146 public hospitals have a total of 80 983 beds and 104 017 open beds. The department of Critical Care has 2 035 beds. The ratio of actual beds in ICU to total beds in hospital was 2.51%. From 1999 to 2010, 18 (12.33%) established departments, and from 2011 to 2021, 128 (87.67%) established departments. The total area of the discipline is 113 355.48 m2, with an average bed area of 55.70 m2. There were 97 hospitals with 1.5-2.0 m bed spacing, accounting for 66.44%, and 49 hospitals with 2.1- > 2.5 m spacing, accounting for 33.56%. The number of negative pressure wards: 1 in each of 43 hospitals, accounting for 29.45%; 103 hospitals did not have, accounting for 70.55%. The number of single rooms: 288 in 140 hospitals, accounting for 95.89%; 6 hospitals did not have, accounting for 4.11%. Central oxygen supply: 138 hospitals have (94.52%); 8 hospitals did not have, accounting for 5.48%. Natural ventilation: in 129 hospitals with 88.36%; 17 hospitals did not have, accounting for 11.64%. Specialized ICU construction: 66 hospitals, accounting for 45.21%; none in 80 hospitals, accounting for 54.79%. There are 3 712 doctors and nurses in 146 public hospitals. The total number of doctors was 1 041, and the ratio of doctors to beds was 0.51:1. The total number of nurses was 2 675, and the ratio of nurses to beds was 1.31:1. CONCLUSIONS: All 88 counties and districts in 9 prefectures and cities of Guizhou province have established intensive care medicine departments. The standardization of the discipline construction has been significantly improved. Lack of talents is still an important factor restricting the rapid development of the discipline.

[Discussion on the undergraduate education mode of critical care medicine majoring in clinical medicine].

OBJECTIVE: To discuss the feasibility of offering specialized courses of critical care medicine in undergraduate clinical medicine education, so as to alleviate the shortage of critical care medicine staffs and lay a foundation for improving the success rate for the treatment of critical cases. METHODS: The undergraduates majoring in clinical medicine from 2008 to 2011 in Guizhou Medical University (the former Guiyang Medical College) were enrolled. After they had been enrolled in the undergraduate education for 3 years and were ready for Grade four, which meant basic medicine teaching had been completed and clinical medicine teaching was about to start, they were introduced and preached to each discipline, including critical care medicine. The undergraduates were free to choose professional direction of clinical training in Grade four. Students majoring in clinical medicine from 2012 to 2014 were free to choose their major direction when they entered the school. RESULTS: From September 2011 to July 2019, the university had cultivated 246 undergraduates majoring in clinical critical care medicine from 2008 to 2014, and the critical care medicine professional team of affiliated hospital had undertaken 540 teaching hours. By July 2019, all students had graduated on time, with an employment rate of 100%. Forty students took postgraduate programs in our school and other schools, accounting for 16.3%. CONCLUSIONS: Professional education of critical care medicine in the undergraduate course of clinical medicine can mobilize students' interest in learning and subjective initiative, which is conducive to career selection. During the clinical training, the students can identify and timely cure critical care cases in the early stage, and partly alleviate the current shortage of critical care medical staffs.

[Clinical observation on application of different enteral nutrition preparations in patients with severe traumatic brain injury].

OBJECTIVE: To observe the effects of enteral nutrition (EN) emulsion with different components on nutritional index, blood glucose, inflammatory reaction, gastrointestinal tolerance and prognosis in patients with severe traumatic brain injury (sTBI). METHODS: Patients with sTBI [Glasgow coma scale (GCS) < 8] admitted to intensive care unit (ICU) of Affiliated Hospital of Guizhou Medical University from January 2016 to May 2018 were retrospectively analyzed. These patients had received EN, 30 cases of them were fed with Baipuli, 35 cases were fed with Ruineng, and 30 cases were fed with Ruisu. The EN support began within 48 hours after the patients were transferred to ICU, and the energy intake of 83.68-104.60 kJ×kg-1×d-1 was the nutritional support target. The hemoglobin (Hb), lymphocyte count (LYM), serum albumin (Alb), pre-albumin (PA), procalcitonin (PCT), average blood glucose (GLUave) and blood glucose variation coefficient (GLUcv) were observed 7 days after EN support, EN compliance time, gastrointestinal tolerance situations were recorded, and the duration of mechanical ventilation (MV), the length of ICU stay and incidence of nosocomial infection were compared among the three groups. RESULTS: There were no obvious changes in Hb, LYM, Alb, PCT among three groups after treatment on the 7th day, and there was no significant difference among the three groups. The PA of Baipuli group was significantly higher than that in Ruineng and Ruisu groups at 7 days after treatment (mg/L: 275.55±46.18 vs. 238.25±49.59, 240.70±55.59, both P < 0.05), but the GLUave and GLUcv were much higher than those in Ruineng and Ruisu groups [GLUave (mmol/L): 10.02±2.39 vs. 8.53±1.53, 8.98±1.75; GLUcv: (23.59±3.93)% vs. (14.79±3.65)%, (17.88±2.90)%, all P < 0.05]. The indexes of gastrointestinal tolerance in Baipuli group were better than those of Ruineng and Ruisu groups: the target feeding time was reached ahead (days: 4.40±1.20 vs. 5.50±1.07, 5.45±1.02, both P < 0.05), the incidence of gastric retention and digestive tract hemorrhage were both decreased [6.67% (2/30) vs. 31.43% (11/35), 33.33% (10/30); 3.33% (1/30) vs. 14.29% (5/35), 16.67% (5/30), all P < 0.05]. The duration of MV and the length of ICU stay in Ruisu and Baipuli groups were longer than those of Ruineng group [duration of MV (days): 6.94±1.64, 6.79±1.14 vs. 5.93±1.12; the length of ICU stay (days): 9.40±2.18, 10.40±2.35 vs. 7.45±1.83, all P < 0.05]. There was no significant difference in the incidences of nosocomial infection among Ruineng, Ruisu, and Baipuli groups [the incidence of ventilator-associated pneumonia (VAP): 11.43%, 10.00%, 10.00%; catheter related bloodstream infection: 0, 0, 3.33%; urinary tract infection: 5.71%, 6.67%, 6.67%; intracranial infection: 2.86%, 6.67%, 3.33%, all P > 0.05]. CONCLUSIONS: For patients with sTBI, short peptide EN preparations (Baipuli) is much better in gastrointestinal tolerance but it can cause fluctuations of blood glucose; the whole protein EN containing ω-3 fatty acid (Ruineng, Ruisu) has relatively less fluctuation on blood glucose, the duration of MV and the length of ICU stay can be shortened by Ruineng, therefore it is more suitable to be applied for such patients.

[Analysis of treatment with 167 critically ill pregnant women in intensive care unit].

OBJECTIVE: To analyze the pathogenic factors, clinical features and treatment measures of critically ill pregnant women so as to provide experience for improving the success rate of treatment. METHODS: The clinical data of 167 cases of critically ill pregnant women who admitted to intensive care unit (ICU) of the Affiliated Hospital of Guizhou Medical University from January 2013 to December 2017 were collected, and the disease distribution of patients, the causes of postpartum hemorrhage, the treatment situation and the results. Patients were divided into obstetrical complications group, pregnancy complicated with basic diseases group and other complicated diseases group according to disease types, and the treatment status of each group was analyzed. RESULTS: Among 167 critically ill pregnant women, 118 cases (70.6%) were in the obstetric complications group, 26 cases (15.6%) were in the pregnancy complicated with basic diseases group, and 23 cases (13.8%) were in the other complicated diseases group. Nine cases died in 167 critically ill pregnant women, with a mortality rate of 5.4%. Postpartum hemorrhage was the major obstetric complication (35.3%), and the coagulation function of 59 patients with postpartum hemorrhage was significantly improved 48 hours after active hemostasis and reasonable blood transfusion [compared to entering the ICU, prothrombin time (PT, s): 14.49±4.66 vs. 23.39±8.11, activated partial thromboplastin time (APTT, s): 52.94±36.36 vs. 87.35±74.69, fibrinogen (Fib, g/L): 2.91±1.03 vs. 1.03±0.65, platelet count (PLT, ×109/L): 94.85±30.09 vs. 43.15±24.07, all P < 0.01]. Compared with pregnancy complicated basic diseases group and other complicated diseases group, the acute physiology and chronic health evaluation II (APACHE II) scores was reduced significantly in obstetrical complications group (10.41±4.85 vs. 16.46±13.87, 16.90±8.82, both P < 0.05), the length of ICU stay was significantly reduced (hours: 57.83±34.67 vs. 79.64±36.01, 278.30±83.72, both P < 0.05). Compared with other complicated diseases group, the mechanical ventilation time [hours :14 (6, 38) vs. 43 (12, 396)] and mortality (0.8% vs. 13.0%) were significantly decreased in obstetrical complications group (both P < 0.05). CONCLUSIONS: Observe the changes of the condition closely, necessary hemodynamic treatment, respiratory support, and organ function support with critically ill pregnant women can improve the rescue success rate and prognosis.

Hydrogen-rich water attenuates oxidative stress in rats with traumatic brain injury via Nrf2 pathway.

BACKGROUND: Several studies have recently found that oxidative stress plays a pivotal role in the pathogenesis of traumatic brain injury (TBI) and may represent a target in TBI treatment. Hydrogen-rich water was recently shown to exert neuroprotective effects in various neurological diseases through its antioxidant properties. However, the mechanisms underlying its effects in TBI are not clearly understood. The purpose of our study was to evaluate the neuroprotective role of hydrogen-rich water in rats with TBI and to elucidate the possible mechanisms underlying its effects. MATERIALS AND METHODS: The TBI model was constructed according to the modified Feeney weight-drop method. In part 1 of the experiment, we measured oxidative stress levels by observing the changes in catalase (CAT), glutathione peroxidase (GPx), and malondialdehyde (MDA) expressions. We also evaluated nuclear factor erythroid 2-related factor 2 (Nrf2) levels to determine the role of the protein in the neuroprotective effects against TBI. In part 2, we verified the neuroprotective effects of hydrogen-rich water in TBI and observed its effects on Nrf2. All the experimental rats were divided into sham group, TBI group, and TBI + hydrogen-rich water-treated (TBI + HW) group. We randomly chose 20 rats from each group and recorded their 7-d survival rates. Modified neurological severity scores were recorded from an additional six rats per group, which were then sacrificed 24 h after testing. Spectrophotometry was used to measure GPx, CAT, and MDA levels, whereas western blotting, reverse transcription polymerase chain reaction, and immunohistochemistry were used to measure the expression of Nrf2 and downstream factors like heme oxygenase 1 (HO-1) and NAD(P)H quinone oxidoreductase 1 (NQO1). RESULTS: GPx and CAT activity was significantly decreased, and MDA content was increased in the TBI group compared with the sham group at 6 h after TBI. MDA content peaked at 24 h after TBI. Nrf2 nucleoprotein levels were upregulated in the TBI group compared with the sham group and peaked at 24 h after TBI; however, no significant changes in Nrf2 mRNA levels were noted after TBI. Hydrogen-rich water administration significantly increased 7-d survival rates, reduced neurologic deficits, and lowered intracellular oxidative stress levels. Moreover, hydrogen-rich water caused Nrf2 to enter the cell nucleus, which resulted in increases in the expression of downstream factors such as HO-1 and NQO1. CONCLUSIONS: Our results indicate that hydrogen-rich water has neuroprotective effects against TBI by reducing oxidative stress and activating the Nrf2 pathway.

[Effect of hydrogen-rich water on the chondriosome damage and cytokines in brain tissue of rats with traumatic brain injury].

OBJECTIVE: To observe the effect of hydrogen-rich water on the chondriosome damage and cytokines change in brain tissue of rats with traumatic brain injury (TBI). METHODS: Fifty-four health male Sprague-Dawley (SD) rats were divided into three groups by random number table: sham group, trauma group (TBI group), and trauma+hydrogen-rich water group (TBI+HW group), the rats in each group were subdivided into 1, 3 and 7 days subgroups according to the time points after trauma, with 6 rats in each subgroup. The TBI model was reproduced by using a modified Feency method for free fall impact, and the rats in sham group were not given brain impact after craniotomy. The rats in TBI+HW group were given intraperitoneal injection of hydrogen-rich water (5 mL/kg) after TBI model reproduction, and then once a day until being sacrificed; and the rats in sham group and TBI group were given the same amount of normal saline. The neurological severity scores (NSS) for neurologic deficits were calculated at corresponding time points, and then the rats were sacrificed to harvest brain tissue at 3 mm around lesion boundary. The cytokines including tumor necrosis factor-α (TNF-α) and interleukin-1ß (IL-1ß) were determined by enzyme linked immunosorbent assay (ELISA); the protein expressions of Bax, Bcl-2 were determined by Western Blot; the RFU of reactive oxygen species (ROS), mitochondrial membrane potential (MMP) and mitochondrial membrane permeability (MPTP) were determined by fluorescence and enzyme sign method. RESULTS: TBI and TBI+HW groups appeared obvious neurologic damage after injury in rats. NSS scores in TBI and TBI+HW groups showed a decreased tendency with time prolongation after TBI. NSS scores in TBI+HW group at 3 days and 7 days were significantly lower than those of TBI group (NSS score: 9.67±0.82 vs. 11.17±1.17, 6.83±0.75 vs. 8.50±1.04, both P < 0.05). Compared with sham group, the expressions of TNF-α, IL-1ß, RFU of ROS in chondriosome, protein expression of Bax in brain tissue in TBI group and TBI+HW group were significantly increased, peaked at 1 day, then they gradually declined. Each time point of RFU of MMP, MPTP in chondriosome and protein expression of Bcl-2 were significantly decreased, and gradually increased after one-day valley value. Compared with TBI group, the expressions of TNF-α, IL-1ß, RFU of ROS in chondriosome and protein expression of Bax in brain tissue were all declined at corresponding time points [TNF-α (ng/L): 54.14±1.11 vs. 81.49±2.76, IL-1ß (ng/L): 74.53±1.75 vs. 119.44±3.56, ROS (RFU): 92.30±2.46 vs. 121.33±6.57, Bax: 0.89±0.01 vs. 1.10±0.01, all P < 0.01]; RFU of MMP, MPTP in chondriosome and the protein expression of Bcl-2 were all increased at corresponding time points [MMP (RFU): 99.28±3.97 vs. 74.72±3.00, MPTP (RFU): 188.82±4.44 vs. 160.01±2.04, Bcl-2: 0.52±0.02 vs. 0.30±0.02, all P < 0.01]. CONCLUSIONS: The high expressions of cytokines and chondriosome damage were involved in the early TBI. Early treatment with an intraperitoneally injection of hydrogen-rich water can reduce chondriosome damage and inflammation factor release, reduce the nerve cell apoptosis after TBI, and protect brain function.

[Predictive value of red cell distribution width on the prognosis of patients with abdominal sepsis].

OBJECTIVE: To approach the value of red cell distribution width (RDW) on the prognostic assessment of patients with abdominal sepsis. METHODS: The clinical data of adult patients with abdominal sepsis admitted to intensive care unit (ICU) of Affiliated Hospital of Guizhou Medical University from January 2015 to September 2017 were retrospectively analyzed. The patients were divided into survival group and death group according to ICU prognosis. The levels of serum lactate (Lac), procalcitonin (PCT), RDW, and acute physiology and chronic health evaluation II (APACHE II) score within 24 hours were recorded. Receiver operating characteristic (ROC) curve was plotted to analyze the prognostic value of Lac, PCT, RDW and APACHE II score. RESULTS: 162 patients with abdominal sepsis were enrolled, 132 survived, and 30 died. Compared with survival group, the Lac, PCT, APACHE II score, and RDW in death group were significantly increased [Lac (mmol/L): 4.21±2.42 vs. 2.27±1.51, PCT (mg/L): 32.08±12.95 vs. 11.87±8.81, APACHE II score: 30.13±6.42 vs. 23.36±5.29, RDW: (16.64±1.38)% vs. (13.49±2.03)%, all P < 0.01]. ROC curve analysis showed that all indicators could be used to predict the prognosis of abdominal sepsis, with the maximum predictive value of RDW. The area under the ROC curve (AUC) was 0.888, it was greater than that of APACHE II score (AUC = 0.787), Lac (AUC = 0.767) and PCT (AUC = 0.696). When threshold value of RDW was 15.40%, the sensitivity was 83.3%, and the specificity was 85.6%. CONCLUSIONS: RDW can evaluate the prognosis of patients with abdominal sepsis, and its predictive value is greater than traditional evaluation parameters such as APACHE II score, Lac, and PCT.

[Development and construction mode of critical care medicine: 22 years of development and construction of intensive care units of Guizhou Medical University].

OBJECTIVE: To provide decision-making basis for promoting the rapid and healthy development of critical care medicine/intensive care unit (ICU) through discussing the mode of development and construction of the department of ICU. METHODS: The situations of ICU of Affiliated Hospital of Guizhou Medical University from July 1994 to December 2016 were analyzed and summed up. Data of the situations in different development stages included the location and area of the ward, the number of beds, the number of physicians and nurses, the structure of academic titles and educational levels, the number of patients admitted to ICU per year, the proportion of patients used ventilator per year, the mortality, the mode of the discipline management, the number of medical postgraduates and undergraduates trained in the ICU, the number of teaching hours, the achievements, the number of research projects, the number of published monographs and papers, the number of the multicenter trials that we participated in, the construction of the team, the personal honor, and so on. RESULTS: From 1994 to 2016, the department of ICU had three development stages: the initial development stage of the discipline (from July 1994 to March 2005), the standardization development stage of the discipline (from April 2005 to December 2015), the acceleration development stage of the discipline (from December 2015 to December 2016). The scale of the department expanded from an open unit with 6 beds which was shared with the department of cardiothoracic surgery to 6 enclosed units with 90 beds which were managed independently by the intensivists. The area of the department increased from less than 300 m2 to more than 7 000 m2. There were 46 beds in the mixed ICU, which covered an area of 4 210 m2. There was only one physician in 1994 while the number of the physicians increased to 19 in 2016. The number of nurses increased from 4 in 1994 to 69 in 2016. The proportion of highly educated talents significantly increased. Furthermore, from 1994 to 2016, the number of beds increased from 6 to 46; the number of patients admitted to ICU per year increased from 138 to 1 080; and the number of patients used ventilator increased from 24 to 1 057. The mean acute physiology and chronic health evaluation II (APACHE II) score was > 24.0 at admission, while < 12.6 at discharge. From 1997 to 2016, a total of 79 postgraduates had studied in the department, and 390 teaching hours we had undertaken. From 2011 to 2016, a total of 250 undergraduates had studied in the department, and 540 teaching hours we had undertaken. From 1994 to 2016, 8 achievements were obtained, 22 projects were undertook, 4 monographs were published, 6 books were edited that the physicians in the ICU as key editors, 104 papers were published, and 8 national multicenter trials that the physicians in the ICU were as key participants, and multiple team and individual honors were obtained. CONCLUSIONS: The construction of ICU hardware is the basis and prerequisite for the development of the discipline and the construction of ICU software is the soul and motivation of the discipline. The operation indexes of clinical medical treatment, teaching and scientific researches reflect the overall operation status of the discipline and the hospital.

[Predictive value of SOFA, qSOFA score and traditional evaluation index on sepsis prognosis].

OBJECTIVE: Assess the value of several biomarkers and disease severity scores for the prognostic assessment of sepsis. METHODS: The clinical data of adult patients, who met the diagnostic criteria for Sepsis-3 and admitted to the intensive care unit (ICU) of Affiliated Hospital of Guizhou Medical University from January 2015 to December 2016 were retrospectively analyzed. These patients were divided into survival group and death group. The levels of serum lactate (Lac), lactate clearance rate of 24 hours later (24 h LCR), procalcitonin (PCT), quick sequential organ failure assessment (qSOFA) score, SOFA score, simplified acute physiology score II (SAPS II), acute physiology and chronic health evaluation scoring system II (APACHE II) score were determined, and the receiver operating characteristic curve (ROC) were used to analyze the prognostic value of the indicators above. RESULTS: 110 of 152 sepsis patients survived, while the others died. Compared with survival group, serum Lac, PCT, SOFA score, qSOFA score, SAPS II score, APACHE II score of death group were increased, and 24 h LCR was decreased. SAPS II [area under the ROC curve (AUC) = 0.877, P = 0.000, when threshold value was 41.50, sensitivity was 94.3%, specificity was 68.5%], 24 h LCR (AUC = 0.869, P = 0.000, when threshold value was 40.2%, sensitivity was 92.1%, specificity was 75.5%) and SOFA score (AUC = 0.815, P = 0.000, when threshold value was 7.60, sensitivity was 79.9%, specificity was 78.5%) showed better predictive value of sepsis. However, the predictive value of PCT (AUC = 0.759), Lac (AUC = 0.725), qSOFA (AUC = 0.701) and APACHE II score (AUC = 0.680) were poorer (AUC = 0.6-0.8). For sepsis caused by abdominal cavity infection, the most accurate index was SOFA score (AUC = 0.889, P = 0.000, when threshold value was 9.50, sensitivity was 81.2%, specificity was 83.5%), and for sepsis caused by pneumonia, the most accurate index was PCT (AUC = 0.891, P = 0.001, when threshold value was 3.95 mg/L, sensitivity was 84.7%, specificity was 94.1%). CONCLUSIONS: SOFA score and qSOFA score cannot take the place of traditional evaluation index for the evaluation of the prognosis of patients with sepsis.

[The protective effect of mild hypothermia pretreatment against injury to primary cultured cortical neurons induced of rat by glutamate].

OBJECTIVE: To investigate the effect of mild hypothermia preconditioning against ischemia/reperfusion (I/R) injury of cultured primary cortical rats neurons, and to compare the protective effect of mild hypothermia only and with its combination with drugs. METHODS: Cortical neurons of neonatal Sprague-Dawley (SD) rat within 24 hours after birth were harvested and cultured in vitro. On the 3rd day, the cells were cultured in a medium containing 2.5 mg/L cytosine arabinoside to inhibit the growth of glial cells and fibroblast. Having cultured for 6 days they were randomly divided into blank control group, glutamate damaged group (cultured with 200 µmol/L glutamate for 0.5 hour after washing), mild hypothermia preconditioning group (cultured under 33.5 centigrade for 24 hours before injury induced by glutamate), mild hypothermia combining with edaravone preconditioning group, and the hypothermia combining with propofol preconditioning group (medium containing 100 µmol/L edaravone and 3 mg/L propofol). They were cultured under 33.5 centigrade for 24 hours before injury induced by glutamate. After 24 hours of culturing in various medium, apoptosis ratio was observed by flow cytometry. Cell surviving rate was determined with methyl thiazolyl triazolium (MTT), c-fos protein expression was assayed, and morphologic change of cells with hematoxylin-eosin (HE) staining under the microscope, and ultrastructure changes were observed after uranyl acetate and lead citrate staining under transmission electron microscope. RESULTS: The apoptosis ratio and c-fos protein in glutamate damaged group were significantly higher than those in blank control group [apoptosis ratio: (9.85±0.76)% vs. (0.94±0.20)%, c-fos: 6.96±0.75 ng/L vs. 1.65±0.59 ng/L, both P<0.01], the cell surviving rate was significantly lower than that in blank control group [(0.20±0.02)% vs. (0.97±0.03)%, P<0.01]. Mild hypothermia preconditioning reversed surviving rate, apoptosis ratio and c-fos protein, and the effect of hypothermia combining with propofol preconditioning was obviously better [cell surviving rate: (0.80±0.04)% vs. (0.20±0.02)%, apoptosis ratio: (2.26±0.54)% vs. (9.85±0.76)%, c-fos: 2.98±0.46 ng/L vs. 6.96±0.75 ng/L, all P<0.01]. The morphology of cortical neurons in blank control group was normal. Most of the cells in glutamate damaged group showed bluish black cytoplasm with pyknic nuclei, with crumpled axons and of them were fractured, and cell number was obviously decreased. In each pre-conditional group, decrease in cell number was unconspicuous, and only a few cells showed apoptosis. Under transmission electron microscope, it was found that cell membrane, mitochondria and rough endoplasmic reticulum were intact in blank control group, but with reduction in organelles, severely swollen mitochondria, even with formation of vacuole or pyknosis, serious dilation of rough endoplasmic reticulum, with loss of cristae with loss of vacuoles or pyknosis, and marked dilatation of internal reticular endoplasm, and loss of cristae with vacuolation and chromatin were observed under electron microscope in glutamate damaged group. Compared with the glutamate damaged group, these pathologic changes were markedly alleviated in protected groups. CONCLUSIONS: Mild hypothermia preconditioning can inhibit glutamate-induced injury to cortical neurons. The protective effect of mild hypothermia combined with propofol is better.

[The protective effect of propofol pretreatment on glutamate injury of neonatal rat brain slices].

OBJECTIVE: To study the protective effect of propofol precondition against glutamate (Glu) neurotoxicity to neonatal rat cerebrocortical slices. METHODS: Brain slices of Sprague-Dawley (SD) rats were cultured in vitro and observed the morphologic changes. Brain slices were randomly divided into three groups: blank control group, Glu injury group (1 mmol/L Glu for 0.5 hour), propofol precondition group (20 mg/L propofol for 24 hours), each n=12. Changes in pathological and ultra-structure of cells were observed using microscope. Lactate dehydrogenase (LDH) leakage rate was measured. Meanwhile, the expression of glial fibrillary acidic protein (GFAP) was detected by immunohistochemical technology, then the positive cell were counted. RESULTS: Cultured brain slices of cell were intact and survived well. Hematoxylin-eosin (HE) staining, electron microscopy and LDH test results showed that cerebral film neuron severely damage, gliosis, edema, LDH leakage rate in Glu injury group were significantly more severe compared with blank control group [(68.5±2.0)% vs. (16.0±2.5)%, P<0.01]. Reduce the brain slice of the propofol pretreatment group of neuronal cell jury, cell shape recovery significantly reduced LDH leakage rate compared with the Glu injury group [(38.5±2.4)% vs. (68.5±2.0)%, P<0.05]. Immunohistochemical detection of GFAP expression of Glu injury group glial cell body swelling, producing increase in the number of GFAP positive reaction strong, the number of positive cells compared with blank control group was significantly increased (50±5 cells/HP vs. 10±3 cells/HP, P<0.01). The recovery of propofol pretreatment group glial cell morphology, cell processes slender GFAP positive reaction decreased the number of positive cells compared with the Glu injury group was significantly decreased (30±4 cells/HP vs. 50±5 cells/HP, P<0.05). CONCLUSION: Propofol pretreatment has protective effect against Glu injured rat cerebrocortical slices.

[A comparative study on the protection effect of nerve growth factor and edaravone pretreatment against cerebral ischemia/reperfusion injury].

OBJECTIVE: To compare the protective effect of nerve growth factor (NGF) and edaravone (a free radical scavenger) pretreatment against cerebral ischemia/reperfusion (I/R) injury to nerve cells. METHODS: Cortical neurons of Sprague-Dawley (SD) mouse aged shorter than 24 hours were cultured for 7 days, then they were randomly divided into control group, I/R group, NGF of 10, 50, 100 microg/L pretreatment groups and 100 mumol/L edaravone pretreatment group. In pretreatment groups the cells were pretreated with drugs correspondingly. After culturing for 24 hours, glutamate of 200 mumol/L was given into the culture of all groups, except control group, for half an hour. Then culture medium in all groups were renewed with ordinary culture medium, and cultures were continued for 24 hours. The survival rate (by methyl thiazolyl tetrazolium assay), the content of lactate dehydrogenase (LDH, by spectrometry) and the rate of apoptosis (by flow cytometric) were determined. The cellular shape and ultrastructure were observed by hematoxylin-eosin (HE) staining and electronic microscopy correspondingly. RESULTS: The survival rate of nerve cells in NGF groups and edaravone group was significantly higher than that in I/R group [(0.21 + or - 0.04)%, (0.23 + or - 0.04)%, (0.21 + or - 0.04)%, (0.24 + or - 0.04)% vs. (0.19 + or - 0.04)%]. The content of LDH in culture medium and the rate of apoptosis in NGF groups and edaravone group were lower than those in I/R group (P<0.05 or P<0.01). The release rate of LDH in each group was (0.50 + or - 0.06)%, (0.46 + or - 0.07)%, (0.50 + or - 0.02)%, (0.43 + or - 0.06)% vs. (0.56 + or - 0.03)%, respectively. The rate of apoptosis in each group was (10.77 + or - 1.07)%, (10.38 + or - 0.70)%, (13.34 + or - 0.57)%, (9.99 + or - 0.77)% vs. (14.52 + or - 0.77)%, respectively. The cellular shape and ultrastructure of nerve cells in NGF groups and edaravone group were affected much less than that of I/R group. NGF of 50 microg/L pretreatment group gave the best effect among three groups. There was no significant difference between NGF 50 microg/L pretreatment group and edaravone pretreatment group. CONCLUSION: NGF and edaravone pretreatment 24 hours before cerebral I/R give protective effects against cerebral I/R injury. The protective effects are best in NGF of 50 microg/L pretreatment group and edaravone pretreatment group, and there is no significant difference between them.