[Sulfur dioxide in the caudal ventrolateral medulla reduces blood pressure and heart rate in rats via the glutamate receptor and NOS/cGMP signal pathways].

This study was designed to investigate the cardiovascular effects of sulfur dioxide (SO2) in the caudal ventrolateral medulla (CVLM) of anesthetized rats and its mechanism. Different doses of SO2 (2, 20, 200 pmol) or artificial cerebrospinal fluid (aCSF) were injected into the CVLM unilaterally or bilaterally, and the effects of SO2 on blood pressure and heart rate of rats were observed. In order to explore the possible mechanisms of SO2 in the CVLM, different signal pathway blockers were injected into the CVLM before the treatment with SO2 (20 pmol). The results showed that unilateral or bilateral microinjection of SO2 reduced blood pressure and heart rate in a dose-dependent manner (P < 0.01). Moreover, compared with unilateral injection of SO2 (2 pmol), bilateral injection of 2 pmol SO2 produced a greater reduction in blood pressure. Local pre-injection of the glutamate receptor blocker kynurenic acid (Kyn, 5 nmol) or soluble guanylate cyclase (sGC) inhibitor 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ, 1 pmol) into the CVLM attenuated the inhibitory effects of SO2 on both blood pressure and heart rate. However, local pre-injection of nitric oxide synthase (NOS) inhibitor NG-Nitro-L-arginine methyl ester (L-NAME, 10 nmol) only attenuated the inhibitory effect of SO2 on heart rate but not blood pressure. In conclusion, SO2 in rat CVLM has cardiovascular inhibitory effects, and its mechanism is related to the glutamate receptor and NOS/cGMP signal pathways.

Relationship between platelet/lymphocyte ratio and prognosis of patients with septic acute kidney injury: A pilot study.

BACKGROUND: To explore the potential role of the platelet/lymphocyte ratio (PLR) as a prognostic marker in septic patients with acute kidney injury (AKI) and to provide theoretical evidence for the epidemiological study of the prognosis of patients with septic AKI in its early stage. METHODS: A pilot study was conducted. A logistic regression analysis was conducted to screen the risk factors, and the selected factors were performed using multiple logistic regression analysis; a Receiver Operating Characteristic curve was used to determine the optimal cutoff value of the PLR and then to calculate the sensitivity and specificity of the PLR ratio. RESULTS: Mechanical ventilation, platelet count, PLR, and arterial blood lactate concentration have a correlation with sepsis (p < 0.05). An elevated PLR is significantly associated with a worse prognosis of sepsis-induced AKI (higher mortality). CONCLUSION: The PLR might be an effective factor in predicting a worse prognosis of septic AKI patients.

Levosimendan does not reduce the mortality of critically ill adult patients with sepsis and septic shock: a meta-analysis.

BACKGROUND: Previous studies on whether or not levosimendan improved the prognosis of patients with sepsis and septic shock have been inconsistent. We aimed to provide an updated analysis of the therapeutic value of levosimendan in adult patients with sepsis and septic shock, in order to provide evidence-based medical evidence for its use. METHODS: PubMed, Embase, Cochrane Library, Wanfang Data, and CNKI were searched until August 2018 without language restriction. Randomized controlled studies of levosimendan with either inotropic drugs or placebo for the treatment of sepsis or septic shock were enrolled. The primary outcome was mortality, and cardiac index and serum lactate levels were the secondary outcomes. RESULTS: A total of 20 randomized controlled studies were included in this meta-analysis, including 1467 patients, with 738 patients in the experimental group (levosimendan group) and 729 patients in the control group (other inotropic drugs or placebo). There were no significant differences in mortality between the levosimendan and control groups (fixed-effect relative risk [RR] = 0.90, 95% confidence interval [CI] [0.79, 1.03], P = 0.13). Levosimendan increased the cardiac index (VMD [weighted mean difference] = 0.51, 95% CI [0.06, 0.95], P = 0.02); and serum lactate levels were lower (VMD = -1.04, 95% CI [-1.47, -0.60], P < 0.00001). CONCLUSIONS: Based on current clinical evidence, levosimendan does not reduce mortality in adult critically ill patients with sepsis and septic shock. Physicians should use levosimendan with caution in patients with sepsis and septic shock.

Development and validation of risk-stratification delirium prediction model for critically ill patients: A prospective, observational, single-center study.

The objective is to develop a model based on risk stratification to predict delirium among adult critically ill patients and whether early intervention could be provided for high-risk patients, which could reduce the incidence of delirium.We designed a prospective, observational, single-center study. We examined 11 factors, including age, APACHE-II score, coma, emergency operation, mechanical ventilation (MV), multiple trauma, metabolic acidosis, history of hypertension, delirium and dementia, and application of Dexmedetomidine Hydrochloride. Confusion assessment method for the intensive care unit (CAM-ICU) was performed to screen patients during their ICU stay. Multivariate logistic regression analysis was used to develop the model, and we assessed the predictive ability of the model by using the area under the receiver operating characteristics curve (AUROC).From May 17, 2016 to September 25, 2016, 681 consecutive patients were screened, 61 of whom were excluded. The most frequent reason for exclusion was sustained coma 30 (4.4%), followed by a length of stay in the ICU < 24 hours 18 (2.6%) and delirium before ICU admission 13 (1.9%). Among the remaining 620 patients (including 162 nervous system disease patients), 160 patients (25.8%) developed delirium, and 64 (39.5%) had nervous system disease. The mean age was 55 ±â€Š18 years old, the mean APACHE-II score was 16 ±â€Š4, and 49.2% of them were male. Spearman analysis of nervous system disease and incidence of delirium showed that the correlation coefficient was 0.186 (P < .01). We constructed a prediction model that included 11 risk factors. The AUROC was 0.78 (95% CI 0.72-0.83).We developed the model using 11 related factors to predict delirium in critically ill patients and further determined that prophylaxis with Dexmedetomidine Hydrochloride in delirious ICU patients was beneficial. Patients who suffer from nervous system disease are at a higher incidence of delirium, and corresponding measures should be used for prevention. TRIAL REGISTRATION: ChiCTR-OOC-16008535.

Lung-protective Ventilation in Patients with Brain Injury: A Multicenter Cross-sectional Study and Questionnaire Survey in China.

BACKGROUND: Over the years, the mechanical ventilation (MV) strategy has changed worldwide. The aim of the present study was to describe the ventilation practices, particularly lung-protective ventilation (LPV), among brain-injured patients in China. METHODS: This study was a multicenter, 1-day, cross-sectional study in 47 Intensive Care Units (ICUs) across China. Mechanically ventilated patients (18 years and older) with brain injury in a participating ICU during the time of the study, including traumatic brain injury, stroke, postoperation with intracranial tumor, hypoxic-ischemic encephalopathy, intracranial infection, and idiopathic epilepsy, were enrolled. Demographic data, primary diagnoses, indications for MV, MV modes and settings, and prognoses on the 60th day were collected. Multivariable logistic analysis was used to assess factors that might affect the use of LPV. RESULTS: A total of 104 patients were enrolled in the present study, 87 (83.7%) of whom were identified with severe brain injury based on a Glasgow Coma Scale ≤8 points. Synchronized intermittent mandatory ventilation (SIMV) was the most frequent ventilator mode, accounting for 46.2% of the entire cohort. The median tidal volume was set to 8.0 ml/kg (interquartile range [IQR], 7.0-8.9 ml/kg) of the predicted body weight; 50 (48.1%) patients received LPV. The median positive end-expiratory pressure (PEEP) was set to 5 cmH2O (IQR, 5-6 cmH2O). No PEEP values were higher than 10 cmH2O. Compared with partially mandatory ventilation, supportive and spontaneous ventilation practices were associated with LPV. There were no significant differences in mortality and MV duration between patients subjected to LPV and those were not. CONCLUSIONS: Among brain-injured patients in China, SIMV was the most frequent ventilation mode. Nearly one-half of the brain-injured patients received LPV. Patients under supportive and spontaneous ventilation were more likely to receive LPV. TRIAL REGISTRATION: ClinicalTrials.org NCT02517073 https://clinicaltrials.gov/ct2/show/NCT02517073.

[The multiplex polymerase chain reaction for detection of ventilator-associated trachea-bronchitis and pneumonia in patients with common pathogens].

OBJECTIVE: To explore the clinical utility of multiple polymerase chain reaction (M-PCR) in the rapid detection of the common pathogens in ventilator-associated trachea - bronchitis (VAT) and ventilator-associated pneumonia (VAP). METHODS: Sputum samples of 75 patients complicated VAT or VAP in surgical intensive care unit (SICU), were examined by bacterial culture, ordinary PCR, the M-PCR detection. The pathogen detection rates among three methods were compared. RESULTS: The Staphylococcus aureus, Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae of the positive detection rates were 50.7%, 45.3%, 30.7%, 41.3% and 58.7% by bacterial culture. By ordinary PCR, the positive detection rates were respectively 88.0%, 89.3%, 78.7%, 85.3% and 93.3%, and by M-PCR, the positive detection rates were respectively 92.1%, 90.7%, 82.7%, 89.3% and 96.0%. The positive rates of five common pathogens of ordinary PCR and M-PCR were higher than those of bacterial culture (all P < 0.05). The M-PCR had merit for rapid detection compared with ordinary PCR. CONCLUSION: Compared with bacterial culture, ordinary PCR and M-PCR yield higher positive rates in identifying five common pathogens of VAT and VAP, meanwhile, it also demonstrated the tendency that M-PCR may save cost and labor power.

[Changes in coagulation and fibrinolysis in the patients with coronary heart disease in acute period and effect of drug intervention].

OBJECTIVE: To investigate the changes in coagulation and fibrinolysis parameters during acute phase of coronary heart disease, and to explore the effects of drug intervention in same period. METHODS: A prospective study was conducted. The changes in plasma von Willebrand factor (vWF), platelet activating factor (PAF), tissue type plasminogen activator (t-PA) of 110 patients with coronary heart disease [50 patients with acute myocardial infarction (AMI), 35 patients with unstable angina pectoris (UAP), 25 patients with ischemic cardiomyopathy (ICM)] were determined immediately at admission and 14 days after treatment. The indexes of 19 healthy individuals were collected as control. At the same time, randomized and double-blind observation of the changes in plasma coagulation and fibrinolysis system indexes including vWF, PAF and t-PA was made in AMI and UAP patients who received conventional treatment (aspirin + low molecular weight heparin) or combination of conventional treatment and clopidogrel for 14 days. RESULTS: The vWF and PAF levels (nmol/L) of AMI and UAP patients at admission were significantly higher than those in healthy control group [vWF: (202.31 ± 27.38)%, (188.65 ± 31.08)% vs. (120.37 ± 18.79)%; PAF: 50.64 ± 13.25, 48.87 ± 13.24 vs. 15.43 ± 9.27, all P < 0.05], however, t-PA (µg/L) was remarkably lower than that in healthy control group (3.52 ± 1.57, 4.03 ± 2.04 vs. 9.54 ± 1.32, both P < 0.01). After 14 days of treatment, the levels of vWF, PAF, t-PA, fibrinogen (Fib, g/L), D-dimer (mg/L) in plasma of AMI and UAP patients were close to those of healthy control group [vWF: (116.56 ± 26.10)%, (111.28 ± 22.31)% vs. (120.37 ± 18.79)%; PAF: 17.48 ± 9.16, 16.23 ± 9.17 vs. 15.43 ± 9.27; t-PA: 7.91 ± 2.42, 9.01 ± 2.01 vs. 9.54 ± 1.32; Fib: 3.64 ± 0.53, 2.74 ± 0.72 vs. 2.92 ± 0.91; D-dimer: 0.370 ± 0.150, 0.288 ± 0.169 vs. 0.255 ± 0.109, all P>0.05]. However, there was no statistical difference in vWF, PAF, t-PA, Fib and D-dimer levels before and after treatment in ICM group compared with healthy control group [vWF: (124.14 ± 21.17)%, (119.44 ± 26.28)% vs. (120.37 ± 18.79)%; PAF: 15.69 ± 7.14, 14.84 ± 9.16 vs. 15.43 ± 9.27; t-PA: 8.62 ± 2.24, 8.07 ± 2.51 vs. 9.54 ± 1.32; Fib: 3.24 ± 0.74, 3.04 ± 0.77 vs. 2.92 ± 0.91; D-dimer: 0.257 ± 0.132, 0.268 ± 0.117 vs. 0.255 ± 0.109, all P>0.05]. Multiple linear regression analysis showed that, in patients with coronary heart disease, PAF be positively correlated with vWF (r = 0.42, P < 0.01), but negatively correlated with t-PA (r = -0.31, P < 0.01). In patients with AMI and UAP, using the treatment of clopidogrel for 14 days, the levels of vWF, PAF, t-PA, Fib and D-dimer in plasma showed no significant differences compared with those of conventional treatment group [vWF: (120.16 ± 16.57)% vs. (118.12 ± 14.32)%; PAF: 12.01 ± 3.70 vs. 13.33 ± 1.10; t-PA: 9.75 ± 1.60 vs. 7.59 ± 2.46; Fib: 2.73 ± 0.49 vs. 3.09 ± 0.50; D-dimer: 0.233 ± 0.101 vs. 0.252 ± 0.088, all P>0.05]. CONCLUSIONS: There were changes in coagulation and fibrinolysis status in patients with AMI and UAP at the initial stage, the level of t-PA was decreased significantly. For patients with AMI and UAP, there were no obvious differences in coagulation and fibrinolysis parameters between combination therapy of clopidogrel and aspirin and aspirin alone.

[Clinical significance of detection of thrombus precursor protein in severe sepsis].

OBJECTIVE: To evaluate the significance of the changes in plasma thrombus precursor protein (TPP) in severe sepsis. METHODS: Enzyme linked immunoadsorbent assay (ELISA) was used in the determination of plasma TPP in 22 patients with severe sepsis group. Prothrombin time (PT), activated partial thromboplastin time(APTT), fibrin(Fib), D-Dimer were also determined and the values were compared with those obtained from 10 patients with infection and 8 healthy normal controls. At the same time, scores of sepsis related organ failure assessment(SOFA), simplified acute physiology score (SAPSII), Marshall criteria were made respectively in patients with severe sepsis on 1,3,5 days after admission to the ICU. Analysis of correlation between TPP and scores was done. RESULTS: (1)The concentration of TPP and positive rate of D-Dimer in severe sepsis were obviously higher than that in the ordinary infection group and normal control group (all P<0.05). But there were no differences in levels of PT, APTT, and Fib among three groups. (2)The concentration of TPP rose continuously in nonsurvivors due to severe sepsis, and it was positively correlated with scores of SOFA, SAPSII, Marshall criteria. CONCLUSION: TPP levels showed a higher specificity and sensitivity in detecting hypercoagulability state in severe than D-Dimer, PT, APTT, Fib assay. It can be used as a diagnostic and prognostic parameter for early hypercoagulability states and outcome of severe sepsis.

[Prospective study of systemic inflammatory response syndrome of patients with nosocomial G- bacteria infection].

OBJECTIVE: To study the characteristics of systemic inflammatory response syndrome (SIRS) of inpatients with nosocomial G- bacteria infection in order to find on effective treatment. METHODS: Eighty-two inpatients of SIRS with lower respiratory tract infection with G- bacteria were studied prospectively until discharge or death. They were divided into two groups: observation group (42 cases) and control group (40 cases). Bacteria culture of sputum and drug sensitivity was performed. Routine treatment was carried out in the control group, and rhubarb and antibiotics with lower endotoxin releasing property were given to the observation group. The course of SIRS, the incidence of MODS, and the mortality were compared. RESULTS: The duration with SIRS in observation group and control group was respectively (6.2+/-1.3) days and (7.4+/-1.2) days, u=3.91, P<0.05; the incidence of MODS was 11.4 percent and 32.3 percent, respectively, chi(2)=4.27, P<0.05. The mortality rates of the patients with SIRS in two groups were 8.6 percent and 29.0 percent, respectively. CONCLUSION: The results indicated that the treatment with rhubarb could obviously reduce the duration of SIRS compared with routine method. The same is true in the incidence of MODS and mortality rate.