The attributable mortality of sepsis for acute kidney injury: a propensity-matched analysis based on multicenter prospective cohort study.

BACKGROUND: Both sepsis and AKI are diseases of major concern in intensive care unit (ICU). This study aimed to evaluate the excess mortality attributable to sepsis for acute kidney injury (AKI). METHODS: A propensity score-matched analysis on a multicenter prospective cohort study in 18 Chinese ICUs was performed. Propensity score was sequentially conducted to match AKI patients with and without sepsis on day 1, day 2, and day 3-5. The primary outcome was hospital death of AKI patients. RESULTS: A total of 2008 AKI patients (40.9%) were eligible for the study. Of the 1010 AKI patients with sepsis, 619 (61.3%) were matched to 619 AKI patients in whom sepsis did not develop during the screening period of the study. The hospital mortality rate of matched AKI patients with sepsis was 205 of 619 (33.1%) compared with 150 of 619 (24.0%) for their matched AKI controls without sepsis (p = 0.001). The attributable mortality of total sepsis for AKI patients was 9.1% (95% CI: 4.8-13.3%). Of the matched patients with sepsis, 328 (53.0%) diagnosed septic shock. The attributable mortality of septic shock for AKI was 16.2% (95% CI: 11.3-20.8%, p < 0.001). Further, the attributable mortality of sepsis for AKI was 1.4% (95% CI: 4.1-5.9%, p = 0.825). CONCLUSIONS: The attributable hospital mortality of total sepsis for AKI were 9.1%. Septic shock contributes to major excess mortality rate for AKI than sepsis. REGISTRATION FOR THE MULTICENTER PROSPECTIVE COHORT STUDY: registration number ChiCTR-ECH-13003934.

Risk factors, clinical features and outcome of new-onset acute kidney injury among critically ill patients: a database analysis based on prospective cohort study.

BACKGROUND: Acute kidney injury (AKI) newly-emerged in intensive care unit (ICU), has not been thoroughly studied in previous researches, is likely to differ from AKI developed before ICU admission. This study aimed to evaluate the incidence, risk factors, clinical features and outcome of new-onset AKI in critically ill patients. METHODS: The data of present study derived from a multicenter, prospective cohort study in17 Chinese ICUs (January 2014 - August 2015). The incidence, risk factors, clinical features and survival analysis of new-onset AKI were assessed. RESULTS: A total of 3374 adult critically ill patients were eligible. The incidence of new-onset AKI was 30.0 % (n = 1012). Factors associated with a higher risk of new-onset AKI included coronary heart disease, hypertension, chronic liver disease, use of nephrotoxic drugs, sepsis, SOFA score, APACHEII score and use of vasopressors. The new-onset AKI was an independent risk factor for 28-day mortality (adjusted hazard ratio, 1.643; 95 % CI, 1.370-1.948; P < 0.001). 220 (21.7 %) patients received renal replacement therapy (RRT), 71 (32.3 %) of them were successfully weaning from RRT. More than half of the new-onset AKI were transient AKI (renal recovery within 48 h). There was no statistical relationship between transient AKI and 28-day mortality (hazard ratio, 1.406; 95 % CI, 0.840-1.304; P = 0.686), while persistent AKI (non-renal recovery within 48 h) was strongly associated with 28-day mortality (adjusted hazard ratio, 1.486; 95 % CI, 1.137-1.943; P < 0.001). CONCLUSIONS: New-onset AKI is common in ICU patients and is associated with significantly higher 28-day mortality. Only persistent AKI, but not transient AKI is associated with significantly higher 28-day mortality.

Association between the modified Nutrition Risk in Critically Ill (mNUTRIC) score and clinical outcomes in the intensive care unit: a secondary analysis of a large prospective observational study.

BACKGROUND: Malnutrition in intensive care unit (ICU) patients is associated with adverse clinical outcomes. The modified nutrition risk in the critically ill score (mNUTRIC) was proposed as an appropriate nutritional assessment tool in critically ill patients, but it has not been fully demonstrated and widely used. Our study was conducted to identify the nutritional risk in ICU patients using the mNUTRIC score and explore the relationship between 28-day mortality and high mNUTRIC scores. METHODS: This study is a secondary analysis, the data were extracted from The Beijing Acute Kidney Injury Trial (BAKIT). In total, 9049 patients were admitted consecutively, and 3107 patients with complete clinical data were included in this study. We divided the study population into high nutritional risk (mNUTRIC score ≥ 5 points) and low nutritional risk (mNUTRIC score < 5 points) groups. The predictive capacity of the mNUTRIC score was studied by receiver operating characteristic (ROC) curve analysis, appropriate cut-off was identified by highest combined sensitivity and specificity using Youden's index. The significance level was set at 5%. RESULTS: Among the 3107 patients, the 28-day mortality rate was 17.4% (540 patients died). Nearly 28.2% of patients admitted to the ICU were at risk of malnutrition, high nutritional risk patients were older (P < 0.001), with higher illness severity scores than low nutritional risk patients. Multivariate analysis revealed that the mNUTRIC score was an independent risk factor for 28-day mortality and mortality increased with increasing scores (p = 0.000). The calculated area under curve (AUC) for the mNUTRIC score was 0.763 (CI 0.740-0.786). According to Youden's index, we found a suitable cut-off > 4 for the mNUTRIC score to predict the 28-day mortality. CONCLUSIONS: Patients admitted to the ICU were at high risk of malnutrition, and a high mNUTRIC score was associated with increased ICU length of stay and higher mortality. More large prospective studies are needed to demonstrate the validity of this score. TRIAL REGISTRATION: This study was registered at www.chictr.org.cn (registration number Chi CTR-ONC-11001875 ). Registered on 14 December 2011.

Plasticity at axon initial segment of hippocampal CA3 neurons in rat after status epilepticus induced by lithium-pilocarpine.

BACKGROUND: The axon initial segment (AIS) is a specialized membrane region in the axon of neurons wherein numerous specific voltage-gated sodium channels (VGSCs) are clustered and action potentials are initiated. The AIS is currently considered as a new plastic hotspot. METHODS: We investigated the alterations in Nav1.6 (SCN8A) and its adapter protein ankyrin G in the AIS of the hippocampal cornu ammonis 3 (CA3) pyramidal cells of rat after status epilepticus induced by lithium-pilocarpine (PISE). RESULTS: Nav1.6 and ankyrin G were colocalized in the AIS of hippocampal CA3 pyramidal neurons. Compared with the control group, the protein and mRNA expression of Nav1.6 increased within 24 h and 60 days after PISE. By contrast, ankyrin G protein expression decreased slightly within 24 h but increased within 60 days, whereas ankyrin G mRNA increased within 24 h and 60 days after PISE. However, the protein and mRNA expression levels of Nav1.6 and ankyrin G within 7 days after PISE did not differ significantly with those of the control. CONCLUSIONS: Nav1.6 and ankyrin G may participate in the plastic changes in the AIS of hippocampus CA3 neurons after PISE and play potential roles in epileptogenesis by regulating neuronal excitability.

[Clinical observational study of anemia in mechanically ventilated patients].

OBJECTIVE: To explore the prognostic effects of anemia among the mechanically ventilated patients. METHODS: A prospective observational study was undertaken in a 12-bed intensive care unit (ICU). Patients requiring mechanical ventilation for at least 72 hours and hemoglobin (Hb)≥100 g/L were enrolled. Serum erythropoietin (EPO), Fe(3+), transferrin (TRF) levels were measured as baseline when they were enrolled and were repeated at day 3, 7 and 14. According to Hb concentration at day 3, patients were divided into anemia group (defined as Hb<100 g/L) and non-anemia group. Serum EPO, Fe(3+), TRF at day 1, 3 and 7, and mean amount of blood transfusion within 14 days, mean volume of blood drawn daily in 3, 7 and 14 days, the survival rate with unassisted breathing at day 28, ICU mortality, length of ICU stay, ventilator days, length of hospital stay and 28-day mortality were compared. RESULTS: Forty mechanically ventilated patients were enrolled and divided into anemia group (n = 18) and non-anemia group (n = 22). It was shown that the anemia group had lower serum Fe(3+) concentration, and higher serum EPO and TRF. The anemia group also had more transfusion [U: 4.0 (2.0, 6.0) vs. 2.0 (0.0, 2.0), P < 0.01], longer length of hospital stay [days: 35.0 (16.5, 51.6) vs. 24.5 (10.0, 35.8), P < 0.05], decreased rate of survival with unassisted breathing at day 28 (44.4% vs. 72.7%, P < 0.05) and higher ICU mortality (44.4% vs. 13.6%, P < 0.05). But there were no significant differences between anemia group and control group in mechanical ventilated days (days: 18.3 ± 10.8 vs. 11.6 ± 8.2, P > 0.05), length of ICU stay [days: 16.5 (8.0, 21.5) vs. 11.0 (5.8, 18.3),P > 0.05] and hospital mortality (61.1% vs. 31.8%, P > 0.05). CONCLUSION: The anemic patients had longer ventilator days, hospital stay, higher ICU mortality, and lower rate of survival with unassisted breathing at day 28.

The attributable mortality of new-onset acute kidney injury among critically ill patients: a propensity-matched analysis based on a multicentre prospective cohort study.

PURPOSE: This study aimed to evaluate the attributable mortality of new-onset acute kidney injury (AKI). METHODS: The data in the present study were derived from a multi-center, prospective cohort study in China that was performed at 18 Chinese ICUs. A propensity-matched analysis was performed between matched patients with and without AKI selected from all eligible patients to estimate the attributable mortality of new-onset AKI. RESULTS: A total of 2872 critically ill adult patients were eligible. The incidence of new-onset AKI was 29.1% (n = 837). After propensity score matching, 788 patients with AKI were matched 1:1 with 788 controls (patients without AKI). Thirty-day mortality was significantly higher among the patients with AKI than among their matched controls (25.5% versus 17.4%, p < 0.001). Subgroup analysis in terms of AKI classification showed that there was no significant difference (p = 0.509) in 30-day mortality between patients with stage 1 AKI and their matched controls. The attributable mortality values of stage 2 and stage 3 AKI were 12.4% [95% confidence interval (CI) 2.6-21.8%, p = 0.013] and 16.1% (95% CI 8.2-23.8%, p < 0.001), respectively. The attributable mortality of persistent AKI was 15.7% (95% CI 8.8-22.4%, p = 0.001), while no observable difference in 30-day mortality was identified between transient AKI patients and their matched non-AKI controls (p = 0.229). CONCLUSION: The absolute excess 30-day mortality that is statistically attributable to new-onset AKI is substantial (8.1%) among general ICU patients. However, neither stage 1 AKI nor transient AKI increases 30-day mortality.

Association of fluid balance trajectories with clinical outcomes in patients with septic shock: a prospective multicenter cohort study.

BACKGROUND: Septic shock has a high incidence and mortality rate in Intensive Care Units (ICUs). Earlier intravenous fluid resuscitation can significantly improve outcomes in septic patients but easily leads to fluid overload (FO), which is associated with poor clinical outcomes. A single point value of fluid cannot provide enough fluid information. The aim of this study was to investigate the impact of fluid balance (FB) latent trajectories on clinical outcomes in septic patients. METHODS: Patients were diagnosed with septic shock during the first 48 h, and sequential fluid data for the first 3 days of ICU admission were included. A group-based trajectory model (GBTM) which is designed to identify groups of individuals following similar developmental trajectories was used to identify latent subgroups of individuals following a similar progression of FB. The primary outcomes were hospital mortality, organ dysfunction, major adverse kidney events (MAKE) and severe respiratory adverse events (SRAE). We used multivariable Cox or logistic regression analysis to assess the association between FB trajectories and clinical outcomes. RESULTS: Nine hundred eighty-six patients met the inclusion criteria and were assigned to GBTM analysis, and three latent FB trajectories were detected. 64 (6.5%), 841 (85.3%), and 81 (8.2%) patients were identified to have decreased, low, and high FB, respectively. Compared with low FB, high FB was associated with increased hospital mortality [hazard ratio (HR) 1.63, 95% confidence interval (CI) 1.22-2.17], organ dysfunction [odds ratio (OR) 2.18, 95% CI 1.22-3.42], MAKE (OR 1.80, 95% CI 1.04-2.63) and SRAE (OR 2.33, 95% CI 1.46-3.71), and decreasing FB was significantly associated with decreased MAKE (OR 0.46, 95% CI 0.29-0.79) after adjustment for potential covariates. CONCLUSION: Latent subgroups of septic patients followed a similar FB progression. These latent fluid trajectories were associated with clinical outcomes. The decreasing FB trajectory was associated with a decreased risk of hospital mortality and MAKE.

Does taking an angiotensin inhibitor increase the risk for COVID-19? - a systematic review and meta-analysis.

Because SARS-COV2 entry into cells is dependent on angiotensin converting enzyme 2 (ACE2) and angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) increase ACE2 activity, the safety of ACEI/ARB usage during the coronavirus disease 2019 (COVID-19) pandemic is a controversial topic. To address that issue, we performed a meta-analysis following The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches of the Embase, MEDLINE, PubMed, and Cochrane Library databases identified 16 case-control studies examining the effect of ACEI/ARB on the incidence of COVID-19 and its severity. ACEI/ARB usage was associated with an increased risk of COVID-19 morbidity (odds ratio (OR) 1.20, 95% confidence interval (CI) 1.07-1.33, P=0.001) among the general population but not in a hypertensive population (OR 1.05, 95% CI 0.90-1.21, P=0.553). ACEI/ARB usage was not associated with an increased risk of COVID-19 morbidity (coefficient 1.00, 95% CI 1.00-1.00, P=0.660) when we adjusted for hypertension in the general population. ACEI/ARB usage was also not associated with an increased risk of severe illness (OR 0.90, 95%CI 0.55-1.47, P=0.664) or mortality (OR 1.43, 95%CI 0.97-2.10, P=0.070) in COVID-19 patients. Our meta-analysis revealed that ACEI/ARB usage was not associated with either the increased risk of SARS-COV2 infection or the adverse outcomes in COVID-19 patients.

Study on the optimization of the decolorization of orange essential oil.

The effects of diatomite, activated clay and acticarbon on the decolorization of orange essential oil were investigated. Single factor and orthogonal tests were performed to determine the optimum discoloring conditions. The results showed that the activated clay exhibited the most satisfactory effect on discoloring. Then it was used as the decolorizer for the decolorization of orange essential oil. The highest decolorization rate (84.5%) was obtained using 10% activated clay at 60 °C for 30 min. The contents of oxygenated compounds (linalool and citral) increased from 1.4 to 3.1% after decolorization. Sensory assessment revealed that the orange essential oil after decolorization using activated clay had a mellow and characteristic orange aroma. Chromaticity analysis showed that it had excellent transparency and yellow color under the optimized condition. Thus, decolorization with activated clay could maintain the quality and prolong the storage of orange essential oil.

[Effect of atorvastatin on carotid intima-medial of thickness of primary hypertension patients of Han nationality in China].

OBJECTIVES: To investigate the efficacy of 10 mg or 20 mg atorvastatin + long acting antihypertensive in carotid intima-medial thickness (IMT). METHODS: 151 patients of Han nationality in South China with mild hypertensive were randomly divided into 3 groups: atorvastatin 10 mg group (n = 50) receive 10 mg atorvastatin and amlodipine + benazepril; atorvastatin 20 mg group (n = 61) receive 20 mg atorvastatin and amlodipine + benazepril; the control group (n = 40) receive amlodipine + benazepril. The patients were detected IMT, vascular function, lipids and inflammatory factor in pretherapy and every 3 months. RESULTS: atorvastatin 10 mg or 20 mg groups have significantly change contrast to control group: (1) IMT was decreased (P < 0.01). (2) Deltadia-P% and Deltadia-N% were increased (P < 0.01). (3) LDL-C level was decreased by 30% in a atorvastatin 10 mg group and 40.48% in 20 mg group respectively (P < 0.01). CONCLUSION: Atorvastatin delays the development of atherosclerosis in hypertensive patients, improves endothelial function, and strengthens the effect of lipid-lowering.

Isolation and functional analysis of sulfite oxidase gene AtSO promoter from Arabidopsis thaliana.

Sulfite oxidase (SO), one of the known molybdenum co-factor-containing enzymes, plays important roles in diverse metabolic processes such as sulfur detoxification and purine catabolism in mammals. But much less is known about the expression and regulatory characterization of sulfite oxidase gene in higher plants. In this report, expression of Arabidopsis SO is characterized in detail by semi-quantitative RT-PCR and histochemical staining. The results showed that the transcripts of AtSO were predominantly detected in Arabidopsis aerial tissues including stems, young leaves, young inflorescences and immature siliques at higher level, but in roots with a lower level. To monitor AtSO expression in plant, the promoter region containing a 1 562-bp genomic sequence from AtSO was isolated and analyzed using methods of bioinformatics. Basing on the distribution of beta-glucuronidase (GUS) activities shown by histochemical staining in transgenic Arabidopsis plants harboring the promoter-uidA fusion construct, it can be concluded that AtSO is expressed mainly in the green tissues/organs in a light-dependent way. In addition, its expression is up-regulated during sulfite treatment. The information from this study may provide useful clue for further functional analysis of plant SO homologs during light-induced development of leaf tissue and/or excessive sulfite/SO(2) gas stresses in higher plants.

Pathogenic bacterial nasopharyngeal colonization and its impact on respiratory diseases in the first year of life: the PATCH Birth Cohort Study.

BACKGROUND: For acute respiratory diseases caused by bacteria, colonization in the respiratory tracts is often the first sign, although nasopharynx is the major source of secretions containing pathogens. To understand the pathogenesis of respiratory tract diseases, it is important to analyze the establishment of nasopharyngeal bacterial colonization. METHODS: Infants with nasopharyngeal swabs were examined at the age of 1, 2, 4, 6 and 12 months for the detection of pathogens, including Streptococcus pneumoniae, Hemophilus influenzae, Moraxella catarrhalis, Streptococcus pyogenes and Staphylococcus aureus. The methods used for detection were bacterial culture and multiplex polymerase chain reaction. RESULTS: From January 2012 to August 2013, a total of 320 neonates were enrolled, and 120 of them completed the first 12-month study. Staphylococcus aureus was the most common pathogen at all 5 time points while the rates declined; in contrast, the other 4 increased during the first year of life. Of our series, the multiplex polymerase chain reaction detection rates were higher than those of bacterial culture. More than 50% of Staphylococcus aureus was methicillin-resistant, and the trend decreased in the same period. In the analysis of factors associated with the development of infant wheeze, infants with maternal atopy [odds ratio (OR): 3.26; 95% confidence interval (CI): 1.20-8.88; P = 0.02] and pneumococcal colonization (OR: 15.64; 95% CI: 3.25-75.35; P = 0.001) had higher rates of wheeze. CONCLUSIONS: Bacterial interactions may result in differing pathogen prevalence in the first year of life. In addition, nasopharyngeal pneumococcal colonization may have an effect on the risk of infant wheeze. The result could help clinicians to clarify the relation between bacterial colonization and respiratory illnesses in infancy.

Risk factors for mortality in patients with septic acute kidney injury in intensive care units in Beijing, China: a multicenter prospective observational study.

OBJECTIVE: To discover risk factors for mortality of patients with septic AKI in ICU via a multicenter study. BACKGROUND: Septic AKI is a serious threat to patients in ICU, but there are a few clinical studies focusing on this. METHODS: This was a prospective, observational, and multicenter study conducted in 30 ICUs of 28 major hospitals in Beijing. 3,107 patients were admitted consecutively, among which 361 patients were with septic AKI. Patient clinical data were recorded daily for 10 days after admission. Kidney Disease: Improving Global Outcomes (KDIGO) criteria were used to define and stage AKI. Of the involved patients, 201 survived and 160 died. RESULTS: The rate of septic AKI was 11.6%. Twenty-one risk factors were found, and six independent risk factors were identified: age, APACHE II score, duration of mechanical ventilation, duration of MAP <65 mmHg, time until RRT started, and progressive KIDGO stage. Admission KDIGO stages were not associated with mortality, while worst KDIGO stages were. Only progressive KIDGO stage was an independent risk factor. CONCLUSIONS: Six independent risk factors for mortality for septic AKI were identified. Progressive KIDGO stage is better than admission or the worst KIDGO for prediction of mortality. This trial is registered with ChiCTR-ONC-11001875.

[Expression and subcellular localization of the ORF4 gene of barley yellow dwarf virus GAV strain in baculovirus-insect cell expression system].

According to published nucleotide sequences, ORF4 gene of barley yellow dwarf virus GAV (BYDV-GAV) was synthesized by reverse transcription-polymerase chain reaction (RT-PCR). The BYDV-GAV ORF4 gene was expressed in baculovirus -insect cell expression system efficiently, and western bolt analysis confirmed its expression product. Confocal laser scanning microscopy showed that GFP: ORF4 fusion protein was associated with the nuclear envelope of insect cells. By expressing the N- and C-terminal regions of ORF4-encoding product (P4) in insect cells combined with structure prediction, it was found that the N-terminal region of P4 containing four a-helices is required for targeting P4 to the nuclear envelope. These results provide a base for biological function of ORF4 gene during systemic infection of BYDV-GAV in host plants further.