Heart/breathing rate ratio (HBR) as a predictor of mortality in critically ill patients.

Objectives: The early prediction of death is a challenge for medical staff. We evaluated the ability of the heart/breathing rate ratio (HBR) to predict mortality. Methods: This was a single-center retrospective observational study of adult patients who had fever with or without respiratory symptoms, who survived at least 2 h after visiting the hospital, and whose lactate levels and vital signs were tested. We evaluated the distribution of mortality at different HBR levels and compared HBR with lactate. Results: A total of 18,872 fever clinic visits were screened, and 183 patients whose lactate levels were tested were recruited. Patients who had HBR values lower than 4·5 or higher than 5·5 had greater mortality than patients who had HBR values between 4·5 and 5·5 (21·3 % vs. 3·4 %, p = 0·003; 28·9 % vs. 3·4 %, p < 0·001, respectively). In patients whose HBR was <5, the AUROC for HBR for mortality was 0·762 (95 % CI: 0.643-0·880), and that for lactate was 0·701 (95 % CI: 0·564-0·837). In patients whose HBR was ≥5, the AUROC for HBR for mortality was 0·721 (95 % CI: 0·584-0·857), and that for lactate was 0·742 (95 % CI: 0·607-0·848). Conclusions: HBR is helpful for stratifying mortality risk among critically ill patients in acute care clinics for infectious diseases.

Structure-activity relationships of flavonoids as natural inhibitors against E. coli ß-glucuronidase.

Bacterial ß-glucuronidases play key roles in the deconjugation of a variety of endogenous and drug glucuronides, thus have been recognized as important targets to modulate the enterohepatic circulation of various glucuronides. In this study, more than 30 natural flavonoids were collected and their inhibitory effects against E. coli ß-glucuronidase (EcGUS) were assayed. The results demonstrated that some flavonoids including scutellarein, luteolin, baicalein, quercetin and scutellarin displayed strong to moderate inhibitory effects against EcGUS, with the IC50 values ranging from 5.76 µM to 29.64 µM, while isoflavones and dihydroflavones displayed weak inhibitory effects against EcGUS. Further investigation on inhibition kinetics revealed that scutellarein and luteolin functioned as potent competitive inhibitors against EcGUS-mediated PNPG hydrolysis, with the Ki values less than 3.0 µM. Molecular docking simulations demonstrated that scutellarein and luteolin could be well-docked into the catalytic site of EcGUS, while the binding areas of these two natural inhibitors on EcGUS were highly overlapped with that of PNPG on EcGUS. Additionally, the structure-inhibition relationships of natural flavonoids against EcGUS are also summarized, which will be very helpful for the medicinal chemists to design and develop more potent flavonoid-type inhibitors against EcGUS.

[Temperature recrudescence caused by praziquantel treatment after falling to normal automatically in acute schistosomiasis patients: a report of 19 cases].

Nineteen cases of acute schistosomiasis patients whose temperatures had fallen to normal automatically were treated with praziquantel, and their temperatures recrudesced after the treatment. Then they were treated with larger dose of praziquantel according to the scheme of acute schistosomiasis therapy, and all of them were cured.

[Efficiency and safety evaluation of glucose control in critically ill patients].

OBJECTIVE: To evaluate the efficiency and safety of the computerized glucose control protocol in critically ill patients. METHODS: The patients who were admitted to intensive care unit (ICU) from June 2005 through December 2007 were retrospectively analyzed. Based on the glucose-control target, patients were divided into two groups: group A (target range was 4.4-6.1 mmol/L, 857 cases); group B (target range was 7.3-8.3 mmol/L, 894 cases). The computerized protocol of glucose management was applied for blood glucose controlling. RESULTS: A total of 1 751 patients were enrolled, and 26 222 recorded data were analyzed. The mean blood glucose was (5.99+/-0.54) mmol/L and (7.43+/-0.84) mmol/L, respectively, and both of them were controlled within the target range. The incidence of hypoglycemia (<3.3 mmol/L) was 1.65% (197/11,933) in group A and 1.04% (149/14,289) in group B. The incidence of severe hypoglycemia (<2.2 mmol/L) was 0.07 % (8/11 933) and 0.12% (17/14,289) respectively. No adverse events occurred. The number of patients in whom glucose-control target rate was reached was less in patients receiving enteral nutrition (EN, group A 38.77%, group B 19.15%) than those with total parenteral nutrition (TPN) in both two groups (group A 50.81%, group B 23.40%, both P<0.01). However, hyperglycemia (>8.3 mmol/L) incidence in EN patients (group A 13.68%, group B 38.61%) was higher than that in TPN patients (group A 8.77%, group B 29.05%, both P<0.01). No significant correlations were found between hypoglycemia and nutrition support methods (EN or TPN). CONCLUSION: Blood glucose levels could be controlled effectively and safely within a target range without significant increase in the incidence of hypoglycemia, whereas number of determination is decreased, by using the computerized glucose control protocol. However, our protocol needs further improvement, especially in EN patients.

[Changes of insulin receptor in patients with critical illness and hyperglycemia and effect of intensive insulin therapy on it].

OBJECTIVE: To investigate the changes of insulin receptor in critical ill patients with stress hyperglycemia and the effect of intensive glucose control on it. METHODS: Nineteen adult patients were admitted to surgical intensive care unit (SICU) and randomly assigned into two groups: intensive glucose controlled group (to control glucose at 4.4-6.7 mmol/L) and hyperglycemia group (to control glucose at 8.3-10.0 mmol/L). Blood glucose was controlled with using continuing insulin infusion. The expression of insulin receptors (InsR) of peripheral erythrocyte was detected by radioligand assay methods on the morning of day 1, 2, 4, 7 after admitted to SICU. Daily usage of insulin and APACHE II score were recorded. The correlation of number and affinity constant of erythrocyte insulin receptors with daily dosage of insulin and APACHE II were analyzed. RESULTS: The number and affinity constant of erythrocyte insulin receptors was decreased significantly in day 1 and 2 in both groups, and recovered gradually in day 4 and 7, and significant difference was found between the patients with APACHE II > or =15 and those with APACHE II < 15. The number and affinity constant of erythrocyte insulin receptor recovered more quickly in intensive glucose controlled group than in hyperglycemia group. CONCLUSIONS: It indicates that decline of erythrocyte insulin receptor and its function are observed in SICU patients, and it plays a role in stress induced hyperglycemia. Intensive insulin therapy and glucose control may improve function recovery of insulin receptor.

[Impact of intensive insulin therapy on surgical critically ill patients].

OBJECTIVE: To evaluating the effect of different levels of blood glucose control on inflammatory response and prognosis of the patients in surgical intensive care unit (SICU). METHODS: One hundred and eighty-eight patients admitted to SICU were randomly divided into three groups, blood glucose were controlled by insulin infusion. Group A (75 cases): the mean blood glucose (MBG) was maintained at the level of 4.4 - 6.1 mmol/L. Group B (75 cases): MBG was maintained at the level of 6.7 - 8.3 mmol/L. Group C (38 cases): MBG was maintained at the level of 10.0 - 11.1 mmol/L. Blood glucose control was achieved with an effected computerized protocol. The outcome was evaluated by days in ICU, days to wean mechanical ventilation, infection, amount of red blood cell transfusion, hospital mortality and ICU cost. RESULTS: Compared with other groups, hypoglycemia (< 3.3 mmol/L) in Group A was significantly increased (P < 0.05). Compared with Group C, red blood cell transfusion and infection were significantly reduced in Group A and Group B (P < 0.05). Compared with Group C, days of mechanical ventilation and days in ICU in Group A were significantly reduced (P < 0.05). Hospital mortality and ICU cost were reduced in Group A compared with the other groups (P > 0.05). CONCLUSIONS: To maintain blood glucose in normal range with intensive insulin therapy has potential positive impact on SICU patients' outcome and can reduce days in ICU and ICU cost. Further correlation research is needed to determine the best levels of blood glucose in ICU patients.