Risk Factors for 28-Day Mortality in a Surgical ICU: A Retrospective Analysis of 347 Cases.

PURPOSE: Advances in surgical techniques and intensive care over the past decades have significantly reduced the mortality rates of critically ill surgical patients. However, evaluations of risk factors associated with mortality in surgical intensive care units (ICUs) are limited. The aim of this study was to analyze the independent risk factors for 28-day mortality of surgical ICU patients. PATIENTS AND METHODS: The clinical data of adult patients who were admitted to the surgical ICU in the First Affiliated Hospital of Xi'an Jiaotong University from June 2013 to June 2017 were collected. Univariate and multivariable logistic regression analyses were performed to examine risk factors associated with 28-day mortality. RESULTS: A total of 347 patients were included in this analysis. The overall 28-day mortality rate was 32.6%. The major causes of surgical ICU admission were gastrointestinal diseases (46.7%), infection (20.5%), trauma (8.9%), respiratory diseases (8.9%) and cardiovascular diseases (6.6%). The univariate analysis showed age, total bilirubin, prothrombin time, international normalized ratio, arterial lactate level, APACHE II and SOFA score at ICU admission were significantly associated with 28-day mortality. In the multivariate analysis, however, age [Odds Ratio (OR): 2.899, 95% CI: 1.427-5.890, P=0.003], hypertension [OR: 3.630, 95% CI: 1.545-8.531, P=0.003], platelet count [OR: 1.004, 95% CI: 1.001-1.007, P=0.015], arterial lactate level [OR: 1.186, 95% CI: 1.088-1.293, P<0.001] and SOFA score [OR: 1.289, 95% CI: 1.131-1.469, P<0.001] were identified as the independent risk factors for 28-day mortality of patients in the surgical ICU. CONCLUSION: In patients admitted to the surgical ICU, age 65 and older, a high arterial lactate level and SOFA score at ICU admission were associated with increased 28-day mortality.

UNC0321 inhibits high glucose induced apoptosis in HUVEC by targeting Rab4.

The vascular complications in heart, brain, kidney and retina are the most common chronic complications of diabetes mellitus (DM). At present, it has become a research hotspot to regulate the abnormal apoptosis of vascular endothelial cells for DM treatment. UNC0321 is a high affinity GPCRs inhibitor, and has potential practical value in chromatin remodeling. In this study, we treated HUVEC with UNC0321 in vitro, and found that UNC0321 inhibit the level of Cleaved-Caspase3 and Bax, thus inhibiting the apoptosis caused by high glucose. In addition, UNC0321 also promoted cell proliferation and migration by activating Akt / mTOR pathway. The transcriptome changes of HUVEC cells cultured with high glucose with or without the treatment of UNC0321 were analysis using sequencing. It was found that Rab4 expression was significantly inhibited after UNC0321 treatment. Subsequently, we overexpressed Rab4 in HUVEC cells cultured with high glucose, and found that overexpression of Rab4 promoted the apoptosis, and inhibited cell proliferation and migration. At the same time, after overexpression of Rab4 in HUVEC cells treated with UNC0321, the number of apoptosis was significantly increased, cell proliferation and migration were inhibited, and the activity of Akt / mTOR pathway decreased. These data suggested that overexpression of Rab4 effectively blocked the inhibition of apoptosis and the increase of cell proliferation induced by UNC0321. In conclusion, we found that UNC0321 inhibits the apoptosis of HUVEC cells caused by high glucose through inhibiting Rab4 expression, providing new potential drugs and targets for the treatment of diabetic vascular complications.

Therapeutic effects of Salvia miltiorrhiza injection combined with telmisartan in patients with diabetic nephropathy by influencing collagen IV and fibronectin: A case-control study.

Involvement of collagen IV (ColIV) and fibronectin (FN) in the occurrence and development of diabetic nephropathy (DN) and the effects of telmisartan and Salvia miltiorrhiza injection in the treatment of the patients were investigated. Two hundred and fifty-eight patients with stage IV DN were selected as the case group, and another 110 normal healthy subjects were incorporated as the control group. Involved patients were subdivided into different groups according to different treatment therapies; patients in the telmisartan group (T group) were given oral telmisartan; patients in the Salvia miltiorrhiza injection + telmisartan (S + T group) were administered with Salvia miltiorrhiza injection combined with telmisartan treatment, and there was a group of patients who received no intervention as the placebo group. After intervention, levels of glycemic indexes and renal damage indexes indicated downwards trends both in the T group and the S + T group when compared to the placebo group; besides, levels in the S + T group were much lower than those in the T group (all P<0.05). Additionally, in comparison among the above three intervention groups, differences in the fasting blood glucose, 2 h post-prandial blood glucose, glycosylated hemoglobin, blood urea nitrogen, serum creatinine and urinary albumin excretion rate were significant after treatment (all P<0.05). Further, before intervention, both Co1IV and FN in the urine were increased in the case group compared to the control group (all P<0.05). After intervention, both levels were apparently decreased. There were remarkable differences of Co1IV and FN levels in the urine when compared among three different intervention groups after treatment (P<0.05). Increased ColIV and FN levels may be partially responsible for the development of DN. Salvia miltiorrhiza injection with telmisartan have beneficial synergistic effects for DN patients through attenuating the increase in ColIV and FN, reversing hyperglycemia state and postponing ultrastructure changes of glomerular basement membrane.

Metformin in combination with rosiglitazone contribute to the increased serum adiponectin levels in people with type 2 diabetes mellitus.

To evaluate how metformin plus rosiglitazone affect serum adiponectin levels in people suffering from type 2 diabetes mellitus (T2DM), 240 patients having T2DM were selected in this cohort study. Included subjects were randomly and equally separated into three subsets: i) Group A (rosiglitazone group); ii) group B (metformin group); and iii) group C (rosiglitazone + metformin group). Furthermore, meta-analysis of previous studies was performed by searching the general search engines and bibliographic databases. Compared with before treatment, the serum amount of adiponectin grew considerably in the three groups after treatment, and the levels in the group C was much greater than those of groups A and B (all P<0.05). Corresponding meta-analysis results suggested post-treatment serum adiponectin level to be greater than pretreatment level in T2DM patients (P<0.001). Further subgroup analyses indicated that combination therapy of metformin and rosiglitazone may increase the amount of serum adiponectin in T2DM sufferers among the majority subgroups (all P<0.05). The combination of metformin and rosiglitazone treatment increased serum adiponectin levels, suggesting that metformin plus rosiglitazone therapy is a suitable choice to treat T2DM.