Clinical characteristics and risk factors of tigecycline-associated hypofibrinogenaemia in critically ill patients.

PURPOSE: To analyze the clinical features and risk factors of tigecycline-associated hypofibrinogenaemia and study whether cefoperazone/sulbactam combined with tigecycline aggravates coagulopathy or hypofibrinogenaemia. METHODS: A retrospective case-control study of patients with severe infection who were treated with tigecycline was conducted. Patients were assigned to the hypofibrinogenaemia group (< 2.0 g/L) and normal fibrinogen (normal) group (≥ 2.0 g/L) to assess the clinical features of patients with tigecycline-associated hypofibrinogenaemia. The traits of patients treated with cefoperazone/sulbactam in the hypofibrinogenaemia group were also analyzed. RESULTS: In total, 127 patients were enrolled in the study, including 71 patients with hypofibrinogenaemia and 56 patients with normal fibrinogen levels. Hypofibrinogenaemia developed at a median of 6 (4-8) days after tigecycline treatment, and the fibrinogen level returned to normal at a median of 3 (3-5) days after tigecycline discontinuation. In the multivariate analysis, intra-abdominal infection (p = 0.005), fibrinogen level at tigecycline initiation (p < 0.001), maintenance dose (p = 0.039), and treatment duration (p = 0.002) were found to be related to hypofibrinogenaemia. Treatment with cefoperazone/sulbactam was not associated with hypofibrinogenaemia (p = 0.681), but patients treated with cefoperazone/sulbactam had a higher incidence of coagulopathy (p = 0.009) and needed more blood products (p = 0.003) than those treated without cefoperazone/sulbactam. CONCLUSION: Tigecycline-associated hypofibrinogenaemia often developed on the 6th (4th-8th) day of tigecycline use and was associated with intra-abdominal infection, fibrinogen level at tigecycline initiation, maintenance dose, and treatment duration of tigecycline but not cefoperazone/sulbactam.

Efficacy of ceftazidime-avibactam in the treatment of carbapenem-resistant Klebsiella pneumoniae infections: Focus on solid organ transplantation recipients.

INTRODUCTION: Ceftazidime-avibactam (CAZ-AVI) is a new option to treat KPC- and OXA-48 carbapenem-resistant Klebsiella pneumoniae (CRKP) infections. However, clinical evidence is limited regarding its use in treating CRKP infections, especially in solid organ transplantation (SOT) recipients. In this study, we assessed the efficacy of CAZ-AVI in treating CRKP infections in both the general population and the SOT recipients in comparison with other antibiotic regimens. METHODS: This is a single-centre retrospective cohort study of patients admitted between January 1, 2018 and June 30, 2021 with the diagnosis of CRKP infections receiving either CAZ-AVI or other regimens ≥ 72 hours and clinical outcomes were analysed. RESULTS: Of 200 patients with CRKP infections, 67 received CAZ-AVI, 133 received other regimens, and 50 were SOT recipients. In the SOT cohort, 30 patients received CAZ-AVI, and 20 received other regimens. The overall 30-day mortality was 38% in the SOT cohort. Compared with patients receiving other regimens, CAZ-AVI therapy resulted in lower 30-day mortality (23.3% vs. 60%, P = 0.014) and 90-day mortality (35.7% vs. 86.7%, P = 0.003), higher clinical cure (93.3% vs. 40%, P < 0.001) and microbiological clearance. Similar promising results of CAZ-AVI were also shown in the whole population cohort. Moreover, clinical outcomes of SOT recipients receiving CAZ-AVI were not inferior to those without SOT. CONCLUSIONS: CAZ-AVI therapy was associated with better clinical outcomes in CRKP infections in both the general population and SOT recipients. Considering the limitations of the present study, well-conducted RCTs are still warranted to confirm these findings.

Clinical characteristics of 34 COVID-19 patients admitted to intensive care unit in Hangzhou, China.

OBJECTIVE: This study summarizes and compares clinical and laboratory characteristics of 34 patients admitted to the intensive care unit (ICU) for complications from coronavirus disease 2019 (COVID-19) at the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China from Jan. 22 to Mar. 5, 2020. METHODS: A total of 34 patients were divided into two groups, including those who required noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) with additional extracorporeal membrane oxygenation (ECMO) in 11 patients. Clinical features of COVID-19 patients were described and the parameters of clinical characteristics between the two groups were compared. RESULTS: The rates of the acute cardiac and kidney complications were higher in IMV cases than those in NIV cases. Most patients had lymphocytopenia on admission, with lymphocyte levels dropping progressively on the following days, and the more severe lymphopenia developed in the IMV group. In both groups, T lymphocyte counts were below typical lower limit norms compared to B lymphocytes. On admission, both groups had higher than expected amounts of plasma interleukin-6 (IL-6), which over time declined more in NIV patients. The prothrombin time was increased and the levels of platelet, hemoglobin, blood urea nitrogen (BUN), D-dimer, lactate dehydrogenase (LDH), and IL-6 were higher in IMV cases compared with NIV cases during hospitalization. CONCLUSIONS: Data showed that the rates of complications, dynamics of lymphocytopenia, and changes in levels of platelet, hemoglobin, BUN, D-dimer, LDH and IL-6, and prothrombin time in these ICU patients were significantly different between IMV and NIV cases.

[The clinical application of remote critical care network].

OBJECTIVE: To discuss and evaluate whether a remote critical care program network can improve clinical and economic performance across multiple intensive care units (ICUs). METHODS: The consultative center composed of intensivists and physician extenders to provide remote consultations for the critical patients. Supporting software, including electronic data display and communication interface were available both in the ICU center and at the remote sites. Clinical and economic performance after 1 year application of the program was compared with the performance before the intervention. RESULTS: During January 2008 to July 2009, there had been 63 hospitals in Zhejiang Province joined the network. A total of 1 617 patients had received remote critical care consultations. One hundred and seventy-three remote teaching ward rounds and 72 lectures had been conducted on the network during this period. The before-and after-data comparison for 23 hospitals which had joined the network for longer than 1 year showed that, the program had decreased ICUs raw mortality by 11.6% (12.9% vs. 14.6%), and reduced transfer rate by 38.3% (2.9% vs. 4.7%), and ICUs bed occupancy rate increased by 6.1% (83.4% vs. 78.6%). CONCLUSION: The application of a remote critical care program was associated with improved clinical outcomes of critically ill patients and hospital financial performance.

Salidroside and FG-4592 ameliorate high glucose-induced glomerular endothelial cells injury via HIF upregulation.

Increasing research indicates that hyperglycemia plays a crucial role in the progression of diabetic nephropathy (DN); however, effective treatment for preventing or slowing DN progression are seriously lacking. Although salidroside (SAL) has been demonstrated to have a positive anti-diabetic effect, the cellular mechanisms remain unclear. FG-4592, a novel prolyl hydroxylase inhibitor, was used to regulate HIF-1α and HIF-2α expression. The present study aimed to explore the underlying mechanisms of SAL and FG-4592 on high glucose (HG)-induced rat glomerular endothelial cells (rGECs) injury. HG-cultured rGECs were used to induce a diabetic environment. An MTT assay, RT-qPCR, Western blot, flow cytometry, and immunofluorescent staining were performed to investigate the effects of SAL on HG-induced rGECs injury. FG-4592 and SAL protected rGECs against HG-induced injury by increasing cellular viability and reducing the cell apoptosis rate. SAL and FG-4592 downregulated PHD-2 expression and upregulated HIF-1α and HIF-2α expression. In conclusion, our findings suggest that SAL and FG-4592 ameliorate HG-induced rGEC injury by upregulating HIF expression, indicating that SAL and FG-4592 might be favorable for further DN-treatment.

Intra-abdominal pressure monitoring in predicting outcome of patients with severe acute pancreatitis.

BACKGROUND: Severe acute pancreatitis (SAP) is a serious disease with many complications, high mortality and poor prognosis. It is characterized by rapid deterioration and poses one of the most difficult challenges in clinical practice. Previous investigations suggest that SAP is one of the main causes of intra-abdominal pressure (IAP) increase. The aim of this study was to evaluate the utility of IAP-monitoring in predicting the severity and prognosis of SAP. METHODS: Eighty-nine patients with SAP who had been treated from February 2001 to December 2005 were studied. Since bladder pressure accurately reflects IAP, we measured it instead of IAP. Bladder pressure was measured at the time of admission and every 12 hours in the course of the disease, 9 consecutive times in all. The APACHE II scores of all patients were obtained within 24 hours after admission. According to a maximum bladder pressure <10 cmH2O, all patients were divided into two groups, mildly-elevated and severely-elevated. Mortality and mean APACHE II scores in the two groups were calculated. In addition, the mean bladder pressure and APACHE II scores in survivors were compared with those in deaths. RESULTS: Sixty-eight of the 89 patients were in the severely-elevated group. Mortality and mean APACHE II scores in this group were much higher than those in the mildly-elevated group (mortality, 39.71% vs. 9.52%; mean APACHE II score, 23.15+/-7.42 vs. 15.95+/-5.35, P<0.01). The mean bladder pressures and APACHE II scores in deaths were significantly greater than those in survivors (mean bladder pressure, 14.1+/-3.8 vs. 9.2+/-2.3 cmH2O, P<0.01; mean APACHE II score, 27.83+/-4.87 vs. 18.37+/-6.74, P<0.01). CONCLUSION: It is suggested that IAP may be used as a marker of the severity and prognosis of SAP.

Effects of crude rhubarb on intestinal permeability in septic patients.

The therapeutic effect of crude rhubarb on intestinal permeability was investigated in septic patients. Forty septic patients were enrolled in this study and randomly divided into two groups: the crude rhubarb treatment group (n = 18) and the control group (n = 22). The same treatments were given to both groups except that the crude rhubarb treatment group was administrated with crude rhubarb powders (3 g, tid, p.o). The levels of procalcitonin, D-lactate in plasma and lactulose/mannitol (L/M) ratio in the urine were determined on the first day and the sixth day after treatment with or without crude rhubarb. There were no significant differences in procalcitonin, L/M ratio and D-lactate on the first day between the crude rhubarb treatment group and the control group (p > 0.05). However, the ratio of L/M on the sixth day for the control group was 0.167 +/- 0.036, while that of the crude rhubarb treatment group was 0.062 +/- 0.013 (p < 0.05). Moreover, the levels of procalcitonin and D-lactate in the crude rhubarb treatment group were obviously lower than those in the control group on the sixth day (procalcitonin: 4.11 +/- 1.40 microg/L vs. 2.21 +/- 0.61 mug/L; D-lactate: 0.24 +/- 0.06 ng/L vs. 0.09 +/- 0.03 ng/L, p < 0.05, both). These data confirmed that crude rhubarb's effects on septic patients of ameliorating intestinal permeability.

[Impact of intravenous nutrition on plasma free amino acid spectrum and immune function for patients with sepsis].

OBJECTIVE: To investigate the impact of intravenous nutrition on plasma free amino acid spectrum and immune function for patients with sepsis. METHODS: Forty severe sepsis patients were divided into two groups: Group B (amino acids + glucose + fat emulsion) and Group A (glucose + fat emulsion), 20 healthy individuals were enrolled as control group. The concentration of free amino acid and immune globulin were determined after 3 days. RESULTS: In Group A, the levels of valine, leucine, isoleucine, alanine, serine, glutamic acid, histidine, proline and glycine were decreased; while the levels of threonine, cysteine, the ratio of phenylalanine and tyrosine (Phe/Tyr) were higher than those in control group. Meanwhile, peripheral blood IgM, complement C3 and C4 were decreased. In group B, all amino acid levels were improved, but the level of alanine, serine, glutamic acid, histidine and proline still lower than those in control group. Similarly, the levels of IgM, complement C3 and C4 in group B were increased. CONCLUSION: Intravenous nutrition can support the basal requirement of amino acid and improve the immune function of patients with sepsis.

[Effects of raw rhubarb on plasma D-lactate and procalcitonin expressions in patients with sepsis].

OBJECTIVE: To investigate the effects of raw rhubarb (RR) on levels of plasma D-lactate and procalcitonin in patients with sepsis. METHODS: Forty patients with sepsis enrolled were randomly divided into two groups, the RR group (n=18, treated with RR 9 g/d) and the control group (n=22, treated with conventional treatment). Plasma procalcitonin and D-lactate were determined before and after treatment. RESULTS: Before treatment, there was no significant difference in the levels of plasma procalcitonin and D-lactate between the two groups (procalcitonin: 6.50 +/- 2.37 microg/L vs 6.98 +/- 2.89 microg/L; D-lactate: 0.18 +/- 0.05 mmol/L vs 0.19 +/- 0.06 mmol/L, P > 0.05). However, after treatment, two indexes in the RR group were significantly lower than those in the control group (procalcitonin: 4.11 +/- 1.40 microg/L vs 2.21 +/- 0.61 microg/L; D-lactate: 0.24 +/- 0.06 ng/L vs 0.09 +/- 0.03 ng/L, both P < 0.05). CONCLUSION: RR could ameliorate the intestinal permeability and reduce the shifting of intestinal bacteria, so as to ease the condition of disease in patients with sepsis.

[Effect of fluid resuscitation on adhesion molecule and hemodynamics in patients with severe sepsis].

OBJECTIVE: To explore the effects of fluid resuscitation on adhesion molecule and hemodynamics in patients with severe sepsis. METHODS: Thirty-eight patients with severe sepsis were randomly divided into 2 groups: rapid fluid resuscitation group and general treatment group. Before and after fluid resuscitation, heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), lactic acid content, plasma P-selection and intercellular adhesion molecule-1 (ICAM-1) contents were determined. RESULTS: There were no statistically significant differences in sex, age, resuscitation time and acute physiology and chronic health evaluation II (APACHE II) score between the two groups. Compared with general treatment group, more liquid volume but less aramine dosage were used (both P<0.05), MAP and CVP were increased after fluid resuscitation in rapid fluid resuscitation group (all P<0.05). The expression of P-selection, HR, contents of ICAM-1 and lactic acid were decreased (all P<0.05), and all of those were better than those of before fluid resuscitation. CONCLUSION: Early rapid fluid resuscitation can improve hemodynamics and decrease the expression of adhesion molecule to retard the development of sepsis.

[Effect of Chrysanthemum morifolium Ramat on apoptosis of bovine aortic smooth muscle cells]

OBJECTIVE: To observe the effect and the mechanism of Chrysanthemum morifolium Ramat on apoptosis of bovine aortic smooth muscle cells. METHODS: Vascular smooth muscle cells were isolated from thoracic aorta of fetal calf and cultured, then incubated with different concentration of Chrysanthemum morifolium Ramat. Apoptosis was measured by flow cytometry. SOD and MDA were measured by spectrophotometer. RESULTS: We found that: (1) the number of apoptotic cells was reduced from (4.425+/-0.624)% to (2.875+/-0.640)% in Chrysanthemum morifolium Ramat group, in a concentration dependent manner; (2) the value of SOD was increased from (1.683+/-0.149)X10(4) U/L to (2.297+/-0.230)X104 U/L and the value of MDA was reduced from(166.454+/-56.805)&mgr;mol/L to (73.068+/-27.203)&mgr;mol/L in Chrysanthemum morifolium Ramat group, also in a concentration dependent manner. CONCLUSION: Chrysanthemum morifolium Ramat can inhibit apoptosis of vascular smooth muscle cells in a concentration-dependent manner.