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1.
Zhongguo Zhong Xi Yi Jie He Za Zhi ; 35(7): 792-5, 2015 Jul.
Artigo em Zh | MEDLINE | ID: mdl-26380440

RESUMO

OBJECTIVE: To observe the efficacy of Xingnaojing Injection (XI) in treatment of sepsis-associated encephalopathy (SAE). METHODS: Totally 65 SAE patients were retrospectively analyzed at EICU from September 2010 to September 2013. They were assigned to the control group (32 cases) and the treatment group (33 cases) according to whether they received XI. Patients in the control group received anti-infection and symptomatic support, while those in the treatment group were intravenously injected with XI at 20 mL per day for additional 7-10 days. The fever clearance time, Glasgow coma scale (GCS), C-reactive protein (CRP), neuron-specific enolase (NSE), and improvement of electroen-cephalogram (EEG) were observed in the two groups. RESULTS: Compared with the control group, the fever clearance time was shortened, CRP levels decreased, GCS score and efficacy of EEG was alleviated in the treatment group after treatment with statistical difference (P < 0.05). No adverse reaction occurred during medication. CONCLUSION: X1 was safe and effective in treatment of SAE.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Encefalopatia Associada a Sepse/tratamento farmacológico , Proteína C-Reativa/metabolismo , Medicamentos de Ervas Chinesas/administração & dosagem , Humanos , Injeções , Fosfopiruvato Hidratase/metabolismo , Resultado do Tratamento
2.
Front Immunol ; 14: 1143181, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37187741

RESUMO

Background: Secondary hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening disease of immune hyperactivation that arises in the context of infectious, inflammatory, or neoplastic triggers. The aim of this study was to establish a predictive model for the timely differential diagnosis of the original disease resulting in HLH by validating clinical and laboratory findings to further improve the efficacy of therapeutics for HLH. Methods: We retrospectively enrolled 175 secondary HLH patients in this study, including 92 patients with hematologic disease and 83 patients with rheumatic disease. The medical records of all identified patients were retrospectively reviewed and used to generate the predictive model. We also developed an early risk score using multivariate analysis weighted points proportional to the ß regression coefficient values and calculated its sensitivity and specificity for the diagnosis of the original disease resulting in HLH. Results: The multivariate logistic analysis revealed that lower levels of hemoglobin and platelets (PLT), lower levels of ferritin, splenomegaly and Epstein-Barr virus (EBV) positivity were associated with hematologic disease, but young age and female sex were associated with rheumatic disease. The risk factors for HLH secondary to rheumatic diseases were female sex [OR 4.434 (95% CI, 1.889-10.407), P =0.001], younger age [OR 6.773 (95% CI, 2.706-16.952), P<0.001], higher PLT level [OR 6.674 (95% CI, 2.838-15.694), P<0.001], higher ferritin level [OR 5.269 (95% CI, 1.995-13.920), P =0.001], and EBV negativity [OR 27.656 (95% CI, 4.499-169.996), P<0.001]. The risk score included assessments of female sex, age, PLT count, ferritin level and EBV negativity, which can be used to predict HLH secondary to rheumatic diseases with an AUC of 0.844 (95% CI, 0.836~0.932). Conclusion: The established predictive model was designed to help clinicians diagnose the original disease resulting in secondary HLH during routine practice, which might be improve prognosis by enabling the timely treatment of the underlying disease.


Assuntos
Infecções por Vírus Epstein-Barr , Linfo-Histiocitose Hemofagocítica , Doenças Reumáticas , Humanos , Feminino , Masculino , Linfo-Histiocitose Hemofagocítica/etiologia , Linfo-Histiocitose Hemofagocítica/complicações , Infecções por Vírus Epstein-Barr/diagnóstico , Herpesvirus Humano 4 , Estudos Retrospectivos , Doenças Reumáticas/complicações
3.
Zhonghua Xin Xue Guan Bing Za Zhi ; 40(5): 421-6, 2012 May.
Artigo em Zh | MEDLINE | ID: mdl-22883096

RESUMO

OBJECTIVE: To investigate the effects of docosahexaenoic acid (DHA) on large-conductance Ca(2+)-activated K(+) (BK(Ca)) channels and voltage-dependent K(+) (K(V)) channels in rat coronary artery smooth muscle cells (CASMCs), and evaluate the vasorelaxation mechanisms of DHA. METHODS: BK(Ca) and K(V) currents in individual CASMC were recorded by patch-clamp technique in whole-cell configuration. Effects of DHA at various concentrations (0, 10, 20, 40, 60 and 80 µmol/L) on BK(Ca) and K(V) channels were observed. RESULTS: (1) DHA enhanced IBK(Ca) and BK(Ca) tail currents in a concentration-dependent manner while did not affect the stably activated curves of IBK(Ca). IBK(Ca) current densities were (68.2 ± 22.8), (72.4 ± 24.5), (120.4 ± 37.9), (237.5 ± 53.2), (323.6 ± 74.8) and (370.6 ± 88.2)pA/pF respectively (P < 0.05, n = 30) with the addition of 0, 10, 20, 40, 60 and 80 µmol/L DHA concentration, and half-effect concentration (EC(50)) of DHA was (36.22 ± 2.17)µmol/L. (2) IK(V) and K(V) tail currents were gradually reduced, stably activated curves of IK(V) were shift to the right, and stably inactivated curves were shifted to the left in the presence of DHA. IK(V) current densities were (43.9 ± 2.3), (43.8 ± 2.3), (42.9 ± 2.0), (32.3 ± 1.9), (11.7 ± 1.5) and (9.6 ± 1.2)pA/pF respectively(P < 0.05, n = 30)post treatment with 0, 10, 20, 40, 60 and 80 µmol/L DHA under manding potential equal to +50 mV, and EC(50) of DHA was (44.19 ± 0.63)µmol/L. CONCLUSION: DHA can activate BK(Ca) channels and block K(V) channels in rat CASMCs, the combined effects on BK(Ca) and K(V) channels lead to the vasodilation effects of DHA on vascular smooth muscle cells.


Assuntos
Vasos Coronários/citologia , Ácidos Docosa-Hexaenoicos/farmacologia , Canais de Potássio Ativados por Cálcio de Condutância Alta/metabolismo , Miócitos de Músculo Liso/efeitos dos fármacos , Canais de Potássio Cálcio-Ativados/metabolismo , Animais , Vasos Coronários/efeitos dos fármacos , Vasos Coronários/metabolismo , Feminino , Masculino , Miócitos de Músculo Liso/metabolismo , Técnicas de Patch-Clamp , Ratos , Ratos Sprague-Dawley
4.
World J Emerg Med ; 13(1): 27-31, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35003412

RESUMO

BACKGROUND: Elevated troponin I (TnI) is common among trauma patients. TnI is an indicator of myocardial injury, but clinical diagnosis of blunt cardiac injury cannot be based solely on an increase in TnI. Therefore, this study aims to explore the changes and clinical significance of serum TnI in trauma patients. METHODS: The clinical data of consecutive trauma patients admitted to our trauma center between July 1, 2017 and July 31, 2020 were retrospectively analyzed. According to TnI levels within 24 hours of admission, patients were divided into the elevated and normal TnI groups. According to the TnI levels after 7 days of admission, a graph depicting a change in trend was drawn and then analyzed whether TnI was related to in-hospital mortality. RESULTS: A total of 166 patients (69 and 97 cases with elevated and normal TnI, respectively) were included in this study. The average hospital stay, intensive care time, mechanical ventilation time, and in-hospital mortality were higher in the elevated TnI group than in the normal TnI group (P<0.05). The TnI level of trauma patients gradually increased after admission and peaked at 48 hours (7.804±1.537 ng/mL). Subsequently, it decreased, and then recovered to normal within 7 days. However, 13 patients did not recover. Logistic regression analysis revealed that abnormal TnI at 7 days was independently related to in-hospital mortality. CONCLUSIONS: Trauma patients with elevated TnI levels may have a worse prognosis. Monitoring the changes in serum TnI is important, which can reflect the prognosis better than the TnI measured immediately after admission.

5.
Front Med (Lausanne) ; 9: 895923, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35872780

RESUMO

Campylobacter jejuni (C. jejuni), a Gram-negative bacterium, belongs to microaerobic bacteria. We reported a 21-year-old male patient diagnosed with hemophagocytic lymphohistiocytosis (HLH) due to C. jejuni infection, who presented with multiple clinical manifestations of peripheral nerve injury, such as ophthalmoplegia, facial paralysis, and urinary retention during the treatment. Electromyography showed neurogenic injury and the final diagnosis was Guillain-Barre Syndrome (GBS). After treatment of dexamethasone combined with immunoglobulin, the patient was discharged from the hospital with partial recovery of neurological symptoms.

6.
World J Emerg Med ; 13(6): 453-458, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36636572

RESUMO

BACKGROUND: In the event of a sudden shortage of medical resources, a rapid, simple, and accurate prediction model is essential for the 30-day mortality rate of patients with COVID-19. METHODS: This retrospective study compared the characteristics of the survivals and non-survivals of 278 patients with COVID-19. Logistic regression analysis was performed to obtain the "COVID-19 death risk score" (CDRS) model. Using the area under the receiver operating characteristic (AUROC) curve and Hosmer-Lemeshow goodness-of-fit test, discrimination and calibration were assessed. Internal validation was conducted using a regular bootstrap method. RESULTS: A total of 63 (22.66%) of 278 included patients died. The logistic regression analysis revealed that high-sensitivity C-reactive protein (hsCRP; odds ratio [OR]=1.018), D-dimer (OR=1.101), and respiratory rate (RR; OR=1.185) were independently associated with 30-day mortality. CDRS was calculated as follows: CDRS=-10.245+(0.022×hsCRP)+(0.172×D-dimer)+(0.203×RR). CDRS had the same predictive effect as the sequential organ failure assessment (SOFA) and "confusion, uremia, respiratory rate, blood pressure, and age over 65 years" (CURB-65) scores, with AUROCs of 0.984 for CDRS, 0.975 for SOFA, and 0.971 for CURB-65, respectively. And CDRS showed good calibration. The AUROC through internal validations was 0.980 (95% confidence interval [CI]: 0.965-0.995). Regarding the clinical value, the decision curve analysis of CDRS showed a net value similar to that of CURB-65 in this cohort. CONCLUSION: CDRS is a novel, efficient and accurate prediction model for the early identification of COVID-19 patients with poor outcomes. Although it is not as advanced as the other models, CDRS had a similar performance to that of SOFA and CURB-65.

7.
Eur J Radiol ; 148: 110184, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35121332

RESUMO

PURPOSE: 18F-FDG PET/CT has an important role in the evaluation of fever of unknown origin (FUO) and inflammation of unknown origin (IUO). Our study was to investigate the current status of the inclusion of 18F-FDG PET/CT within FUO/ IUO diagnostic work-up and evaluate the cost-effectiveness of it in China. METHODS: A total of 741 FUO/IUO patients admitted to our hospital from January 2012 to December 2019 were retrospectively reviewed. The clinical characteristic, medical expenses to reach diagnosis and the proportion of definite etiological diagnosis achieved upon hospital discharge were compared between patients examined by 18F-FDG PET/CT (18F-FDG PET/CT group) and patients not examined by 18F-FDG PET/CT (non-18F-FDG PET/CT group). RESULTS: The mean age, proportion of critically-ill patients, proportion of rheumatologic diseases, the number of examinations and hospitalisation days to reach diagnosis in the 18F-FDG PET/CT group were significantly higher than those in the non-18F-FDG PET/CT group. The mean medical costs of 18F-FDG PET/CT group were significantly higher than those of non-18F-FDG PET/CT group, whereas the proportion of definite etiological diagnosis achieved upon hospital discharge of 18F-FDG PET/CT group was significantly higher than that of non-18F-FDG PET/CT group. The mean hospitalisation days and mean medical costs before diagnosis were significantly lower in patients who undertook 18F-FDG PET/CT ≤ 7 days after hospital admission than those in patients who undertook 18F-FDG PET/CT > 7 days after hospital admission. CONCLUSIONS: 18F-FDG PET/CT is mostly used in critically-ill and hard-to-diagnose FUO/IUO patients currently in China, which may conceal its cost-effective advantage. While the early use of 18F-FDG PET/CT according to patient characteristics and etiological clues could help to reduce hospitalization stay, limit medical costs, thus producing its diagnostic effect to the great extent.


Assuntos
Febre de Causa Desconhecida , Fluordesoxiglucose F18 , Análise Custo-Benefício , Febre de Causa Desconhecida/diagnóstico por imagem , Febre de Causa Desconhecida/etiologia , Humanos , Inflamação/complicações , Inflamação/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Estudos Retrospectivos
8.
Pain Res Manag ; 2021: 7849623, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34733377

RESUMO

Objective: Serratus anterior plane block (SAPB) provides effective thoracic analgesia. This systematic review and meta-analysis was conducted to assess the safety and efficacy of SAPB for postoperative analgesia after breast surgery. Methods: A systematic literature search was performed using Embase, PubMed, Web of Science, and the Cochrane Library for eligible randomised controlled trials. The primary outcomes involved the administration of intraoperative and postoperative opioids. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used for rating the quality of evidence for making recommendations. Results: Overall, 13 studies comprising 826 patients met the inclusion criteria (412 in the SAPB group and 414 in the control group). Patients treated with SAPB exhibited a significantly lower postoperative opioid consumption (mean difference, -38.51 mg of oral morphine equivalent; 95% confidence interval (CI), -60.97 to -16.05; P < 0.01; I 2 = 100%), whereas no difference was observed in the intraoperative opioid consumption (mean difference, -9.85 mg of oral morphine equivalent; 95% CI, -19.52 to -0.18; P=0.05; I 2 = 94%). In addition, SAPB significantly decreased the occurrence of postoperative nausea and vomiting (risk ratio, 0.32; 95% CI, 0.19-0.55; P < 0.05;I 2 = 38%) and reduced pain scores during the postoperative period (1 h: standardised mean difference (SMD), -1.23; 95% CI, -2.00 to -0.45; I 2 = 92%; 2 h: SMD, -0.71; 95% CI, -1.00 to -0.41; I 2 = 48%; 4 h: SMD, -1.52; 95% CI, -2.77 to -0.27; I 2 = 95%; 6 h: SMD, -0.80; 95% CI, -1.51 to -0.08; I 2 = 81%; 8 h: SMD, -1.12; 95% CI, -1.98 to -0.27; I 2 = 92%; 12 h: SMD, -0.78; 95% CI, -1.21 to -0.35; I 2 = 83%; and 24 h: SMD, -0.71; 95% CI, -1.20 to -0.23; I 2 = 87%; P < 0.05 for all). Conclusion: SAPB was safe and effective after breast surgery to relieve postsurgical pain. However, additional well-developed trials are required to validate these findings.


Assuntos
Analgesia , Neoplasias da Mama , Bloqueio Nervoso , Analgésicos Opioides/uso terapêutico , Feminino , Humanos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Ultrassonografia de Intervenção
9.
Medicine (Baltimore) ; 100(51): e28245, 2021 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-34941095

RESUMO

RATIONALE: There is evidence that tigecycline has broad-spectrum antibiotic activity against a variety of complicated infections. However, adverse effects are inevitable, including gastrointestinal side effects such as nausea, vomiting, and diarrhea; in 2006, acute pancreatitis was also brought into the side-effect list after postmarketing surveillance. Here, we present a case of tigecycline-induced acute pancreatitis. PATIENT CONCERNS: An 87-year-old female patient with urinary tract infection received an intravenous drip of tigecycline for 6 days, after which she developed abdominal distension, vomiting, abdominal pain, and abdominal rigidity. DIAGNOSIS: The patient was suspected to have tigecycline-induced acute pancreatitis. INTERVENTIONS: Tigecycline was discontinued immediately, and the patient received a series of immediate treatments including an indwelling gastric tube for continuous gastrointestinal decompression and inhibition of gastric acid and pancreatic enzyme secretion. OUTCOMES: Following initial interventions, we observed that the patient's symptoms improved significantly, and abdominal distension, vomiting, abdominal pain, and abdominal rigidity were slightly relieved. After 5 days of follow-up, blood lipase and amylase levels decreased to normal levels. Unfortunately, the patient developed convulsions during the use of multiple antibiotics after 1 week and then died of septic shock and acute liver failure. LESSONS: Acute pancreatitis caused by tigecycline is rare. However, in the application of antibiotics, the possibility of adverse effects must be considered, and antibiotics should be used reasonably. If the patient has relevant symptoms, it is necessary to stop using tigecycline immediately, carry out symptomatic treatment, and change to other types of antibiotics for antibacterial treatment.


Assuntos
Dor Abdominal/induzido quimicamente , Antibacterianos/efeitos adversos , Pancreatite/induzido quimicamente , Tigeciclina/efeitos adversos , Vômito/induzido quimicamente , Dor Abdominal/tratamento farmacológico , Doença Aguda , Idoso de 80 Anos ou mais , Evolução Fatal , Feminino , Humanos , Pancreatite/tratamento farmacológico , Tigeciclina/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Vômito/tratamento farmacológico
10.
Leuk Res Rep ; 16: 100258, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34367907

RESUMO

Acute promyelocytic leukemia (APL) is a highly curable hematology malignancy. The major factor influence prognosis of APL is early deaths (ED) during the course of induction therapy, especially in high-risk APL. Therefore, effective reduction of white blood cells and correction of coagulation abnormalities are the key points of treatment for high-risk APL. Due to COVID19 pandemic in China since Jan 2020, some patients with hematologic malignancies suspected of COVID-19 infection had been isolated and traditional intravenous chemotherapy drugs is not available in isolated wards. We had explored a regimen of an oral etoposide to reduce the tumor burden for high-risk APL and dual induction with retinoic acid (ATRA) and oral arsenic realgar-Indigo nautralis formula (RIF), and finally two cases of high-risk APL patients received complete remission in one month. It is indicated that pure oral induction regimen: oral etoposide, ATRA and RIF provides a novel therapy in outpatient clinics.

11.
World J Emerg Med ; 12(1): 18-23, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33505545

RESUMO

BACKGROUND: A pandemic of coronavirus disease (COVID-19) has been declared by the World Health Organization (WHO) and caring for critically ill patients is expected to be at the core of battling this disease. However, little is known regarding an early detection of patients at high risk of fatality. METHODS: This retrospective cohort study recruited consecutive adult patients admitted between February 8 and February 29, 2020, to the three intensive care units (ICUs) in a designated hospital for treating COVID-19 in Wuhan. The detailed clinical information and laboratory results for each patient were obtained. The primary outcome was in-hospital mortality. Potential predictors were analyzed for possible association with outcomes, and the predictive performance of indicators was assessed from the receiver operating characteristic (ROC) curve. RESULTS: A total of 121 critically ill patients were included in the study, and 28.9% (35/121) of them died in the hospital. The non-survivors were older and more likely to develop acute organ dysfunction, and had higher Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) scores. Among the laboratory variables on admission, we identified 12 useful biomarkers for the prediction of in-hospital mortality, as suggested by area under the curve (AUC) above 0.80. The AUCs for three markers neutrophil-to-lymphocyte ratio (NLR), thyroid hormones free triiodothyronine (FT3), and ferritin were 0.857, 0.863, and 0.827, respectively. The combination of two easily accessed variables NLR and ferritin had comparable AUC with SOFA score for the prediction of in-hospital mortality (0.901 vs. 0.955, P=0.085). CONCLUSIONS: Acute organ dysfunction combined with older age is associated with fatal outcomes in COVID-19 patients. Circulating biomarkers could be used as powerful predictors for the in-hospital mortality.

12.
JCI Insight ; 6(4)2021 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-33444289

RESUMO

BackgroundMitochondrial DNA (MT-DNA) are intrinsically inflammatory nucleic acids released by damaged solid organs. Whether circulating cell-free MT-DNA quantitation could be used to predict the risk of poor COVID-19 outcomes remains undetermined.MethodsWe measured circulating MT-DNA levels in prospectively collected, cell-free plasma samples from 97 subjects with COVID-19 at hospital presentation. Our primary outcome was mortality. Intensive care unit (ICU) admission, intubation, vasopressor, and renal replacement therapy requirements were secondary outcomes. Multivariate regression analysis determined whether MT-DNA levels were independent of other reported COVID-19 risk factors. Receiver operating characteristic and area under the curve assessments were used to compare MT-DNA levels with established and emerging inflammatory markers of COVID-19.ResultsCirculating MT-DNA levels were highly elevated in patients who eventually died or required ICU admission, intubation, vasopressor use, or renal replacement therapy. Multivariate regression revealed that high circulating MT-DNA was an independent risk factor for these outcomes after adjusting for age, sex, and comorbidities. We also found that circulating MT-DNA levels had a similar or superior area under the curve when compared against clinically established measures of inflammation and emerging markers currently of interest as investigational targets for COVID-19 therapy.ConclusionThese results show that high circulating MT-DNA levels are a potential early indicator for poor COVID-19 outcomes.FundingWashington University Institute of Clinical Translational Sciences COVID-19 Research Program and Washington University Institute of Clinical Translational Sciences (ICTS) NIH grant UL1TR002345.


Assuntos
COVID-19/diagnóstico , Ácidos Nucleicos Livres/sangue , DNA Mitocondrial/sangue , Índice de Gravidade de Doença , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , COVID-19/mortalidade , COVID-19/terapia , COVID-19/virologia , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Terapia de Substituição Renal/estatística & dados numéricos , Respiração Artificial/estatística & dados numéricos , Fatores de Risco , SARS-CoV-2/isolamento & purificação , Vasoconstritores/uso terapêutico
13.
bioRxiv ; 2020 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-32766574

RESUMO

Mitochondrial DNA (MT-DNA) are intrinsically inflammatory nucleic acids released by damaged solid organs. Whether the appearance of cell-free MT-DNA is linked to poor COVID-19 outcomes remains undetermined. Here, we quantified circulating MT-DNA in prospectively collected, cell-free plasma samples from 97 subjects with COVID-19 at the time of hospital presentation. Circulating MT-DNA were sharply elevated in patients who eventually died, required ICU admission or intubation. Multivariate regression analysis revealed that high circulating MT-DNA levels is an independent risk factor for all of these outcomes after adjusting for age, sex and comorbidities. Additionally, we found that circulating MT-DNA has a similar or superior area-under-the curve when compared to clinically established measures of systemic inflammation, as well as emerging markers currently of interest as investigational targets for COVID-19 therapy. These results show that high circulating MT-DNA levels is a potential indicator for poor COVID-19 outcomes.

14.
Chin Med J (Engl) ; 132(14): 1660-1665, 2019 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-31261199

RESUMO

BACKGROUND: Acute kidney injury (AKI) is a serious and fatal complication of acute myocardial infarction (AMI). It has high short- and long-term mortality rates and a poor prognosis but is potentially preventable. However, the current incidence, risk factors, and outcomes of AKI in the Chinese population are not well understood and would serve the first step to identify high-risk patients who could receive preventative care. METHODS: The medical data of 1124 hospitalized patients diagnosed with AMI from October 2013 to September 2015 were reviewed. AKI was defined according to the 2012 Kidney Disease Improving Global Outcomes criteria. All the patients were divided into either the AKI group or the non-AKI group. A univariate comparison analysis was performed to identify possible risk factors associated with AKI. A multiple logistic regression analysis was used to identify the independent risk factors for AKI in patients with AMI. RESULTS: Overall, the incidence of AKI was 26.0%. The mortality rate of the AKI group was 20.5%, and the mortality rate of the non-AKI group was 0.6% (P < 0.001). Logistic regression analysis showed that the independent risk factors for AKI in patients with AMI included: age (>60 years old) (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02-1.05, P = 0.000), hypertension (OR 2.51, 95% CI 1.62-3.87, P = 0.000), chronic kidney disease (OR 3.52, 95% CI 2.01-6.16, P = 0.000), Killip class ≥3 (OR 5.22, 95% CI 3.07-8.87, P = 0.000), extensive anterior myocardial infarction (OR 3.02, 95% CI 1.85-4.93, P = 0.000), use of furosemide (OR 1.02, 95% CI 1.02-1.03, P = 0.000), non-use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker (OR 1.58, 95% CI 1.04-2.40, P = 0.032). These factors provided an accurate tool to identify patients at high risk of developing AKI. CONCLUSIONS: Approximately 26.0% of patients undergoing AMI developed AKI, and the development of AKI was strongly correlated with in-hospital mortality. The risk factors for AKI in patients with AMI were determined to help identify high-risk patients and make appropriate clinical decisions.


Assuntos
Injúria Renal Aguda/etiologia , Infarto do Miocárdio/complicações , Injúria Renal Aguda/patologia , Idoso , Feminino , Frequência Cardíaca/fisiologia , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/patologia , Fatores de Risco
15.
World J Clin Cases ; 6(13): 659-665, 2018 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-30430121

RESUMO

Herein we report a case of acute liver failure (ALF) and hemophagocytic lymphohistiocytosis (HLH) induced by varicella infection, successfully rescued by a combination therapy of acyclovir, supportive care, and immunosuppression with dexamethasone and etoposide. A previously healthy 16-year-old boy presented with generalized rash, fever, severe abdominal pain, and abnormal liver function within 4 d. Chickenpox was suspected, and acyclovir and intravenous immunoglobulin were started on admission. However, the patient's condition deteriorated overnight with soaring transaminases, severe coagulopathy and encephalopathy. On the fourth day of admission, pancytopenia emerged, accompanied by hypofibrinogenemia and hyperferritinemia. The patient was diagnosed with ALF. He also met the diagnostic criteria of HLH according to the HLH-2004 guideline. Polymerase chain reaction (PCR) amplifications of varicella-zoster virus (VZV) were positive, confirming that VZV was a causative trigger for ALF and HLH. In view of the devastating immune activation in HLH, immunosuppression therapy with dexamethasone and etoposide was administered, in addition to high dose acyclovir. The patient's symptoms improved dramatically and he finally made a full recovery. To our knowledge, this is only the second report of a successful rescue of ALF associated with HLH, without resorting to liver transplantation. The first case was reported in a neonate infected by herpes simplex virus-1. However, survival data in older children and adults are lacking, most of whom died or underwent liver transplantation. Our report emphasizes the clinical vigilance for the possible presence of HLH, and the necessity of extensive investigation for underlying etiologies in patients presenting with indeterminate ALF. Early initiation of specific therapy targeting the underlying etiology, and watchful immunosuppression such as dexamethasone and etoposide, together with supportive therapy, are of crucial importance in this life-threatening disorder.

17.
Zhonghua Yi Xue Za Zhi ; 87(13): 898-901, 2007 Apr 03.
Artigo em Zh | MEDLINE | ID: mdl-17650400

RESUMO

OBJECTIVE: To evaluate the clinical usefulness of impedance pneumography in determining the tube placement during endotracheal intubation. METHODS: Thirty-six endotracheally-intubated patients for elective operations underwent general anesthesia and endotracheal intubation, and then a second identical tube was inserted into the esophagus under laryngoscopic control. The ventilation circuit was then attached either to tracheal or esophageal tube. The tube position was determined by 2 blinded examiners, one experienced and the other inexperienced, using three methods: impedance pneumography, capnography, and auscultation. The order of the tubes tested and the order of the methods used were randomized. The observation results and the time needed to determine were recorded by another assistant. RESULTS: Of the 216 tests conducted, both examiners correctly diagnosed the position of the tube using impedance pneumography and capnography. In the auscultation method there were two false-negative results (with the tracheal tube identified as esophageal) and one false-positive (with the esophageal tube identified as tracheal) by the experienced examiner, while five false-negative results (with the tracheal tube identified as esophageal) and nine false-positive (with the esophageal tube identified as tracheal) by the inexperienced examiner. With the sensitivity and specificity of impedance pneumography as standards (100%), the sensitivity and specificity of the capnography were both 100% too, and the sensitivity and specificity of the auscultation method were 90% and 86% respectively, both significantly lower than those of the other 2 methods (all P<0.01). Capnography needed 3.4 s+/-1.3 s and 3.7 s+/-1.4 s to verify tracheal intubation and esophageal intubation respectively, both significantly longer than those of the auscultation methods (1.7 s+/-0.7 s and 2.5 s+/-1.7 s) and impedance pneumography (1.6+/-0.3 and 2.1+/-1.1s, all P<0.01). It took less time for impedance pneumography and auscultation to verify the tracheal intubation than to verify esophageal intubation (both P<0.01). CONCLUSION: Impedance pneumography is one of the reliable methods for diagnosing tracheal tube position.


Assuntos
Anestesia Geral/métodos , Intubação Intratraqueal/métodos , Pulmão/fisiopatologia , Auscultação , Capnografia , Impedância Elétrica , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Testes de Função Respiratória/métodos
18.
Curr Med Res Opin ; 22(1): 75-82, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16393433

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of oseltamivir treatment in a population at high risk for influenza. RESEARCH DESIGN AND METHODS: This was a randomized, open-label, controlled trial involving Chinese patients with chronic respiratory diseases (chronic bronchitis, obstructive emphysema, bronchial asthma or bronchiectasis) or chronic cardiac disease. Patients showing symptoms of influenza were randomly assigned to receive oral oseltamivir 75 mg twice daily for 5 days (oseltamivir group), or symptomatic treatment (control group) within 48 h after symptom onset. MAIN OUTCOME MEASURES: The main outcome measures were duration and severity of illness in influenza-infected patients. Other outcome measures included incidence of complications, antibiotic use, hospitalization and total medical cost. RESULTS: Of the 118 recruited patients, 56 were identified as influenza-infected through laboratory tests (oseltamivir, N = 27; control, N = 29). Relative to symptomatic treatment, oseltamivir significantly reduced the duration of influenza symptoms by 36.8% (p = 0.0479), and the severity by 43.1% (p = 0.0002). In addition, oseltamivir significantly reduced the duration of fever by 45.2% (p = 0.0051), and the time to return to baseline health status by 5 days (p = 0.0011). The incidence of complications (11% vs. 45%, p = 0.0053) and antibiotic use (37% vs. 69%, p = 0.0167) were also significantly lower in the oseltamivir group compared with the control group. The cost of treating influenza and its complications was comparable between the two groups (p = 0.2462). CONCLUSIONS: Oseltamivir is effective and well tolerated in high-risk patients with chronic respiratory or cardiac diseases. It can reduce the duration and severity of influenza symptoms and decrease the incidence of secondary complications and antibiotic use, without increasing the total medical cost.


Assuntos
Acetamidas/uso terapêutico , Antivirais/uso terapêutico , Influenza Humana/tratamento farmacológico , Acetamidas/efeitos adversos , Acetamidas/economia , Povo Asiático , China/epidemiologia , Feminino , Humanos , Influenza Humana/epidemiologia , Masculino , Pessoa de Meia-Idade , Oseltamivir , População , Risco , Resultado do Tratamento
19.
Beijing Da Xue Xue Bao Yi Xue Ban ; 38(3): 276-9, 2006 Jun 18.
Artigo em Zh | MEDLINE | ID: mdl-16778971

RESUMO

OBJECTIVE: To evaluate the criteria of severity assessment of the Chinese Community-Acquired Pneumonia (CAP) Guidelines, and provide the evidence for carrying out the Guidelines completely. METHODS: The medical records of 473 patients with CAP in our hospital from July 1, 2002 to June 30, 2004 were prospectively collected and analyzed with SPSS 10.0. Chi-square test and multinomial logistic regression to analyze the influence of risk factors listed in the Guidelines on the outcome of the patients in this cohort. RESULTS: (1) The mortality in severe pneumonia group was 28.9%; hospitalized group, in qualified, and 0% in disqualified hospitalized groups; (2) The frequencies of some factors were few in the study, such as previous splenectomy, presence of cavity, ect; (3)There were 13 factors found to be significantly different between survivors and nonsurvivors, such as age>65 yrs, diabetes mellitus, chronic renal failure, etc; of which 7 were independent risk factors associated with death (P<0.05). CONCLUSION: (1) The severity assessment criteria of the Chinese CAP Guidelines can differentiate patients with different risks; (2) The Guidelines should be continuously and implemented under evidence based guidance updated.


Assuntos
Infecções Comunitárias Adquiridas/terapia , Pneumonia/terapia , Guias de Prática Clínica como Assunto/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , China , Estudos de Coortes , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/mortalidade , Feminino , Fidelidade a Diretrizes , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pneumonia/diagnóstico , Pneumonia/mortalidade , Fatores de Risco , Taxa de Sobrevida
20.
Am J Surg ; 210(4): 749-54, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26130268

RESUMO

BACKGROUND: Several studies indicate that lymph node (LN) ratio (LNR) is more predictive than the traditional LN-positive stratification (pNs). We assessed whether LNR can provide additional prognostic information on node-positive breast cancer patients, particularly with breast cancer subtypes (BCS). METHODS: We retrospectively reviewed the medical records of 2,049 patients with primary breast cancer treated between January 2006 and December 2011 and identified 511 subjects with positive axillary LN. Clinicopathological findings, types of treatment, and the 5-year overall survival (OS) were included. RESULTS: The results of multivariate analysis of the cohort showed that the correlations of pNs and LNR in regard to OS were P < .001 and P < .001, respectively, with adjustment for tumor characteristics and treatment factors. Moreover, our data revealed that LNR was more predictive in luminal A, luminal B, and luminal human epidermal growth factor receptor 2 in a comparison of pNs and LNR with regard to OS among BCS. CONCLUSION: LNR and pNs are important prognostic factors with regard to OS for patients with node-positive breast cancer, but LNR has a more correlated value in BCS.


Assuntos
Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Excisão de Linfonodo , Adulto , Idoso , Idoso de 80 Anos ou mais , Axila , Neoplasias da Mama/terapia , Feminino , Humanos , Mastectomia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
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