Risk Factor Analysis and Risk Prediction Model Construction of Pressure Injury in Critically Ill Patients with Cancer: A Retrospective Cohort Study in China.

BACKGROUND The aim of this study was to analyze the risk factors of pressure injury (PI) in critically ill patients with cancer to build a risk prediction model for PI. MATERIAL AND METHODS Between January 2018 and December 2019, a total of 486 critically ill patients with cancer were enrolled in the study. Univariate analysis and binary logistic regression analysis were used to explore risk factors. Then, a risk prediction equation was constructed and a receiver operator characteristic (ROC) curve analysis model was used for prediction. RESULTS Of the 486 critically ill patients with cancer, 15 patients developed PI. Risk factors found to have a significant impact on PI in critically ill patients with cancer included the APACHE II score (P<0.001), semi-reclining position (P=0.006), humid environment/moist skin (P<0.001), and edema (P<0.001). These 4 independent risk factors were used in the regression equation, and the risk prediction equation was constructed as Z=0.112×APACHE II score +2.549×semi-reclining position +2.757×moist skin +1.795×edema-9.086. From the ROC curve analysis, the area under the curve (AUC) was 0.938, sensitivity was 100.00%, specificity was 83.40%, and Youden index was 0.834. CONCLUSIONS The PI risk prediction model developed in this study has a high predictive value and provides a basis for PI prevention and treatment measures for critically ill patients with cancer.

Combined blood purification for treating acute fatty liver of pregnancy complicated by acute kidney injury: a case series.

Acute fatty liver of pregnancy (AFLP) complicated by acute kidney injury (AKI) is serious and life-threatening for the mother. The present study aimed to determine the clinical efficacy of combined blood purification treatment (CBPT) in patients with AFLP complicated by AKI. The CBPT involves plasma exchange (PE) combined with continuous venovenous hemofiltration (CVVH). The subjects were 17 patients with AFLP complicated by AKI. The CBPT was implemented based on the timely termination of pregnancy and general treatment. Changes in clinical manifestations, laboratory tests, liver ultrasounds, as well as Sequential Organ Failure Assessment (SOFA) and Glasgow scores were evaluated. The efficacy and adverse reactions of the CBPT were also assessed. The CBPT was smoothly performed without any obvious adverse reaction. After treatment, the clinical manifestations, laboratory examinations, and liver ultrasonography significantly improved. Therefore, the SOFA scores correspondingly decreased 1 week after treatment [9 (range 5-11) vs. 3 (range 0-10), P = 0.002], and the median was close to normal by the second week. The clearance rate of the total bilirubin in PE was significantly higher than that in CVVH (37.2 vs. 7.9%, P = 0.000). The incidence of acute pulmonary edema in CVVH was less than that in PE (0 vs. 41.2%, P = 0.007). Finally, the maternal mortality was 5.88% (95% CI: 0-29%). Overall, we think that CBPT aids in the recovery of liver and kidney function. Different blood purification methods may be combined to integrate and maximize their advantages to improve the prognoses of patients with serious AFLP.

[Relation between bone matrix proteins and monocyte chemoattractant protein-1 in renal small artery in diabetic nephropathy rats].

OBJECTIVE: To observe the expressions of bone matrix proteins and monocyte chemoattractant protein-1 ((MCP-1) in the renal arteriole of diabetic nephropathy (DN) rats and analyze their correlations and roles in diabetic nephropathy. METHODS: Adult Sprague-Dawley male rats were used to establish the animal model of diabetic nephropathy induced by peritoneal injection of 55 mg/kg of streptozocin. Calcium deposit around the renal arteriole was observed by alizarin red staining. The protein and mRNA levels of core-bind factor alpha 1 (cbfalpha1), bone morphogenetic protein 2 (BMP-2) and matrix Gla protein (MGP) in renal arteriole of DN rats were detected by immunohistochemistry, in-situ hybridization and real-time PCR. The biochemical indices were detected by routine test. RESULTS: 1. Blood glucose and Urine protein of 24 h were significantly increased in the renal arteriole of DN rats versus the control rats (P < 0.05), serum creatinine (SCr) and phosphorus were significantly increased from 12 weeks. 2. Little deposit of calcium salt was observed in the renal arteriole of DN rats at the 4th week and a large amount of deposit was observed at 24th week, but no calcium deposit was observed in control rats. 3. Cbfalpha1 and BMP-2 expressions were significantly increased in the renal arteriole of DN rats from 4 to 24 weeks vs. the control rats. MGP mRNA expression in the renal arteriole of DN rats was significantly decreased from 4 to 24 weeks. MCP-1 expression was obviously upregulated in the renal arteriole of DN rats at 24th week versus that at 4th and 12th week. No MCP-1 expression was observed in the renal arterioles of control rats. MCP-1 were positively correlated with the expression of cbfalpha1 and BMP-2. CONCLUSION: Bone matrix proteins has already expressed in renal arteriole before the formation of vascular calcification. MCP-1 can affect the expression of cbfalpha1, BMP-2; cbfalpha1, BMP-2, MGP and MCP-1 may be involved in the formation of vascular lesions of DN.

[Effects of high glucose on expression of core binding factor alpha1 and osteocalcin in vascular smooth muscle cells].

OBJECTIVE: To investigate the effects of high glucose on expression of core binding factor alpha1 (cbfalpha-1) and osteocalcin (OC) in vascular smooth muscle cells (VSMCs), and discuss the mechanism of small vessels calcification induced by high glucose (GS) in vitro. METHODS: The primary cultured VSMCs from rats' aortic segments were divided into three groups, including normal control group (5 mmol/L D-glucose), high glucose group (25 mmol/L D-glucose) and mannitol group (5 mmol/L D-glucose plus 25 mmol/L mannitol). We measured quantitatively the calcium deposition in VSMCs and investigated the calcium extent of VSMCs by alizarin red stain in each group. The mRNA levels of cbfalpha-1 and OC were measured by real-time PCR, and the protein expression levels of cbfalpha-1 and OC were examined by Western blot. The activity of alkaline phosphatase was measured by alkaline phosphatase activity testing kit, and the protein level of alpha-smooth muscle actin (a-SMA) was detected by immunohistochemistry. RESULTS: When compared with the normal group and mannitol group, the high glucose group showed that the calcium deposition and calcium extent of VSMCs increased obviously, the mRNA and protein levels of cbfalpha-1 and OC also increased significantly (P < 0.05), while the protein level of alpha-SMA decreased (P < 0.05), which were in a dose-dependent manner. The level of alkaline phosphatase activity of VSMCs was approximately doubled in high glucose group. CONCLUSION: The mechanism of high glucose induced calcification in VSMCs may be due to the increased expression of cbfalpha-1 and OC. High glucose decrease the expression of alpha-SMA in VSMCs, which could induce the transdifferentiation from RVSMCs to osteoblast-like cells.

[Effects of valsartan on the renal vascular endothelial growth factor and its receptor flk-1 of diabetic rats].

OBJECTIVE: To explore effects of valsartan on expression changes of vascular endothelial growth factor (VEGF) and its receptor Flk-1 in diabetic rat kidney. METHODS: To establish the diabetic nephropathy (DN) rat models and divide the experiment rats into three groups--the DN group, the valsartan group and the control group, and use the reverse transcriptase polymerase chain reaction (RT-PCR), Western Blotting and immunohistochemical techniques to detect the expression of VEGF and Flk-1, and detect the urine protein and glomerular area and volume, then analyze the relationship of the data. RESULTS: The mRNA and protein expression of VEGF and Flk-1, the urine protein and glomerular area and volume in the DN were higher than those in the control group and valsartan group (P < 0.05). VEGF and Flk-1 were positively correlated with the urine protein and glomerular area and volume (P < 0.05). CONCLUSION: VEGF and Flk-1 play an important role in the pathogenesis of DN, of which over-expression may lead to the damage of kidney. The angiotensin II receptor antagonist--valsartan can protect kidney through the non-hemodynamic mechanism of inhibiting the abnormal expression of VEGF and Flk-1.

[Expression of VEGF in kidney of diabetic rats].

OBJECTIVE: To investigate the expression of vascular endothelial growth factor (VEGF) in the kidney of diabetic rats and probe its relationship with the development of diabetic nephropathy (DN). METHODS: Diabetes mellitus was induced in SD rats by Streptozotocin. The renal tissues of rats were taken out at 2, 4, 8, 12, 16, 20 and 24 weeks after operation. The expression of VEGF was assessed by immunohistochemistry methods. VEGF mRNA in kidney was detected by RT-PCR at the same time points. The levels of VEGF mRNA and immunostaining were quantified by computer image analysis. The relationships of VEGF with the indices of renal damage, including renal/body weight, urinary protein excretion, glomerular volume and glomerular area, were analyzed. RESULTS: The expression of VEGF mRNA in diabetic kidney was significantly up-regulated after operation from 2 weeks to 24 weeks with the peak level at 20 weeks, when compared with control at the same time-points. The positive results of VEGF staining in diabetic glomeruli was increasingly observed after operation from 2 weeks to 24 weeks, with the peak at 20 weeks. The positive results of VEGF staining in diabetic tubuli was increasingly seen from 2 weeks to 24 weeks, with the peak at 8 weeks. CONCLUSION: VEGF level is increased continuously in the diabetic kidney of rat. The increased expression of VEGF is mainly located in the glomeruli at the early and middle stages, and is in the tubuli at the middle and late stages. VEGF expression in the diabetic kidney of rat is related to the development of renal changes.

[The expression and significance of the angiopoietin-1 in the kidney of diabetic rats].

OBJECTIVE: To explore the expression and significance of angiopoietin-1 (Ang-1) in the renal tissue of diabetic rats. METHODS: The SD rats were divided into the diabetic and control groups. The diabetic group was treated by streptozotocin. The expression of Ang-1 in renal tissue was detected by RT-PCR and immunohisochemistry at 2, 4, 8, 12, 16, 20 and 24 weeks. The level of Ang-1 was quantified by computer image analysis. The relationship between Ang-1 and the index of renal damage including renal/body weight, urinary protein excretion, glomerular volume, and glomerular area was analyzed. RESULTS: Ang-1 mRNA in diabetic renal tissue was significantly upregulated at 4 and 8 weeks, compared with diabetic group at other time points or control group at the same time points, and then downregulated gradually after 12 weeks. The level of Ang-1 mRNA decreased significantly as compared with control group at 24 week. Ang-1 was outstandingly expressed in glomeruli. From 4-week to 24-week, the number of Ang-1 staining in diabetic glomeruli increased significantly as compared with control group, being maximal at 4 and 8 weeks, and subsequently decreased after 12 week. Ang-1 level was correlated with renal/body weight, glomerular volume, glomerular area, and urine protein excretion, respectively. CONCLUSION: The change of Ang-1, which is early upregulation and late downregulation, exists in diabetic renal tissue. The unusual expression of Ang-1 is partly connected with the renal changes of diabetic rats.

Exploring on the elderly health management model in tropic area.

In this article, based on the characteristics of tropical area, we analyze the beneficial and the disadvantage of tropical area to human health, points out the existing problems in elderly health management pattern in the tropics area, accordingly we discuss how to establish tropical characterized elderly health management, and put forward constructive suggestions.

Angiopoietin-like 2 has auxo-action in atherosclerosis by promoting atherosclerotic calcification.

OBJECTIVE: To study the effects of angiopoietin-like 2 (Angptl2) on atherosclerotic calcification in aortic artery of ApoE-/- mice. METHODS: Twelve 6-week-old male mice were randomly divided into control group (n=6) and interventional group (n=6), the control group were fed with high fat diet and the interventional group were fed with high fat diet and at the eighth week interventional group mice were infused (intravenously) with purified recombinant Angptl-2 once a week for one month. All mice were sacrificed when the mice were 16 weeks old, blood was collected and plasma triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDLC) were measured, aortic sections were stained with hematoxylin and eosin (HE) or Von Kossa and were observed under microscope. Calcium content and alkaline phosphatase activity of aorta were measured to measure the degree of vascular calcification. The expressions of Runx2 protein and mRNA levels in aortic sections of mice were detected by immunohistochemistry, Western Blot and qRT-PCR respectively. RESULTS: The plasma TG, TC and LDLC level in interventional group was significantly higher than that in control group and the expression of Runx2 in aortic had the similar results. HE staining demonstrated significant thickening of the intima, with typical atherosclerotic plaque formation in interventional group mice, and Von Kossa staining showed spotty black clumps of aortic calcification under the fibrous cap plaque, while control group had atherosclerotic plaques without significant calcium deposits formation; The quantitative analysis showed that aortic vascular wall calcium and alkaline phosphatase activity were significantly higher in the intervention group than that of the control group (P<0.01). CONCLUSIONS: Angptl-2 could increase ApoE-/- mice plasma lipid level, it also facilitate the expression of Runx2, calcium content and ALP activity in aortic and then accelerate atherosclerotic calcification. Our experiments demonstrated that Angptl2 could accelerate atherosclerotic calcification. It reminded us that by controlling or decreasing the Anglt-2 level in plasma could help inhibit atherosclerotic calcification and then provides a new target to prevent coronary heart disease.

[Expression level of cubilin in the rat model of diabetic nephropathy].

OBJECTIVE: To observe the expression level of Cubilin in the renal tubules of rats with STZ-induced diabetic nephropathy, to assess its correlation with 24 hours' albuminuria, and to investigate the mechanisms of tubular dysfunction at the early stage of diabetic nephropathy. METHODS: Diabetic nephropathy was induced in Sprague-Dalwley rats by intraperitoneal injection of STZ, while the rats of normal group were injected with normal saline. Biochemical indices of blood and urine specimens were observed in both groups at weeks 2, 4 and 6 respectively. The renal expression levels of Cubilin in the two groups were determined by immunohistochemistry and RT-PCR. RESULTS: The expression level of Cubilin in the diabetic nephropathy group was significantly decreased at week 2 after operation (P < 0.05), and it continued to decrease from week 2 to week 6. Also there was significant difference between each two time-points (P < 0.05), and the Cubilin expression level was negatively correlated with albuminuria (P < 0.01). CONCLUSION: The decreased expression level of Cubilin in early-stage diabetic nephropathy rats may partly contribute to the development of microalbuminuria. Cubilin can be regarded as one of the early markers when tubular dysfunction develops in the case of diabetic nephropathy.

Expression of soluble vascular endothelial growth factor receptor-1 and placental growth factor in fetal growth restriction cases and intervention effect of tetramethylpyrazine.

OBJECTIVE: To investigate the expression of soluble vascular endothelial growth factor receptor-1 (sFlt-1) and placental growth factor (PLGF) in the fetal growth restriction (FGR) cases and the intervention mechanism of tetramethylpyrazine. METHODS: A total of 60 fetal growth restriction cases that admitted to our hospital were randomly divided into ligustrazine intervention group (group A) and nutritional support group (group B). A total of 50 healthy pregnant women were also enrolled as control group (group C). Expression level of maternal serum sFlt1, PLGF and fetal growth parameters including HC, AC, FL, BPD, EFW as well as placenta PLGF, sFlt-1 mRNA expression were recorded and compared among the three groups. A total of 15 SD rats were selected and were divided into three groups, TMP group, alcohol and tobacco group and blank control group. Three groups of rats were dissected on the twentieth day of gestation. RESULTS: Expression level of sFlt-1 and PLGF in group A was not significantly different from that of group C (P>0.05); but significant difference in SFlt1 and PLGF expression level was observed between group C and group B (P<0.05). Before treatment, HC, AC, FL, BPD and EFW of group A and group B were significant lower than those of group C, but after treatment, those parameters in group A were significantly improved (P<0.05). In the animal experiment there was no significant difference in sFlt-1 between treatment group and FGR group without treatment or control group (P>0.05). There was significant difference in PLGF between FGR group with treatment and FGR group without treatment or control group (P<0.01). CONCLUSIONS: PLGF level is decreased and sFlt-1 increased in patients suffered from fetal growth restriction, and FGR rats show increased sFlt-1 and decreased PLGF, thus they can be indicator of the fetal growth restriction. Ligustrazine can effectively improve sFlt-1, PLGF expression level in fetal growth restriction cases, which can be used as treatment for FGR.

[Application of propofol sedation in patients undergoing continuous venous-venous haemodiafiltration].

OBJECTIVE: To study the use of propofol sedation in patients undergoing continuous venous-venous haemodiafiltration (CVVHDF) and assess the curative effects. METHODS: A retrospective study was conducted. Data from 74 patients with continuous sedation of propofol in emergency intensive care unit (ICU) from April 2009 to June 2011 were analyzed. There were 26 cases suffering from acute renal failure in CVVHDF group and 48 critical cases in non-CVVHDF group. Propofol administration duration, dose, the clearance rate and the average recovery time in both groups were analyzed, and plasma concentrations of propofol at inflow side and outflow side of CVVHDF circuit in 26 patients with CVVHDF were determined. RESULTS: Compared with non-CVVHDF group, it took a longer administration time (298.37±28.73 hours vs. 173.44±17.27 hours, P<0.05) and higher dose (35.89±0.76 g vs. 21.82±0.62 g, P<0.05) in CVVHDF group. There were no statistical significances on clearance rate at 2, 6, 24 hours after administration (2 hours: 13.85±1.15 ml/min vs. 14.41±1.21 ml/min, 6 hours: 5.92±0.52 ml/min vs. 6.32±0.59 ml/min, 24 hours: 4.75±0.41 ml/min vs. 5.33±0.45 ml/min) and recovery time (8.89±1.46 minutes vs. 8.47±1.37 minutes) between CVVHDF and non-CVVHDF groups (all P>0.05). Plasma concentrations of propofol at inflow side and outflow side of CVVHDF circuit were not different after propofol administration in 26 CVVHDF patients. CONCLUSIONS: Compared with patients in non-CVVHDF group, the patients who received propofol in CVVHDF required higher total dosage and longer delivery time to maintain a good sedation. In both two groups clearance rate of propofol and maintenance of a stable blood concentration were the same. The use of a proper dose of propofol in CVVHDF did not affect wake up time of the patients, there were no complications.