A 47-Year-old Asian female with tracheobronchial space-occupying lesions caused by chronic lymphocytic leukemia.

CASE PRESENTATION: A 47-year-old Asian woman was admitted with worsening chest tightness and dyspnea for 10 days. Computed tomography (CT) showed changes in the trachea and segmental bronchi. Pulmonary function results suggestive of severe obstructive ventilatory dysfunction. Bronchoscopic findings showed the presence of multiple nodular lesions in the patient's trachea and left and right main bronchi. Bronchoscopic biopsy, lymph node biopsy and bone marrow aspiration flow cytometry test results led to a definitive diagnosis of chronic lymphocytic leukemia (CLL), staged as Binet stage B and Rai stage 2.

Phytoestrogen arctigenin preserves the mucus barrier in inflammatory bowel diseases by inhibiting goblet cell apoptosis via the ERß/TRIM21/PHB1 pathway.

Intestinal mucus barrier dysfunction is closely involved in the pathogenesis of inflammatory bowel diseases (IBD). To investigate the protective effect and underlying mechanism of arctigenin, a phytoestrogen isolated from the fruits of Arctium lappa L., on the intestinal mucus barrier under colitis condition. The role of arctigenin on the intestinal mucus barrier and the apoptosis of goblet cells were examined by using both in vitro and in vivo assays. Arctigenin was demonstrated to promote the mucus secretion and maintain the integrity of mucus barrier, which might be achieved by an increase in the number of goblet cells via inhibiting apoptosis. Arctigenin selectively inhibited the mitochondrial pathway-mediated apoptosis. Moreover, arctigenin elevated the protein level of prohibitin 1 (PHB1) through blocking the ubiquitination via activation of estrogen receptor ß (ERß) to competitively interact with PHB1 and disrupt the binding of tripartite motif 21 (TRIM21) with PHB1. ERß knock down in the colons of mice with DSS-induced colitis resulted in significant reduction of the protection of arctigenin and DPN against the mucosal barrier. Arctigenin can maintain the integrity of the mucus barrier by inhibiting the apoptosis of goblet cells through the ERß/TRIM21/PHB1 pathway.

Pterostilbene pre-treatment reduces LPS-induced acute lung injury through activating NR4A1.

CONTEXT: Pterostilbene (PTE), a common polyphenol compound, exerts an anti-inflammatory effect in many diseases, including acute lung injury (ALI). OBJECTIVE: This study explores the potential mechanism of PTE pre-treatment against lipopolysaccharide (LPS)-induced ALI. MATERIALS AND METHODS: Sixty Sprague-Dawley rats were divided into control, ALI, 10 mg/kg PTE + LPS, 20 mg/kg PTE + LPS, and 40 mg/kg PTE + LPS groups. At 24 h before LPS instillation, PTE was administered orally. At 2 h before LPS instillation, PTE was again administered orally. After 24 h of LPS treatment, the rats were euthanized. The levels of inflammatory cells and inflammatory factors in the bronchoalveolar lavage fluid (BALF), the expression of nuclear receptor subfamily 4 group A member 1 (NR4A1), and the nuclear factor (NF)-κB pathway-related protein levels were detected. NR4A1 agonist was used to further investigate the mechanism of PTE pre-treatment. RESULTS: After PTE pre-treatment, the LPS induced inflammation was controlled and the survival rate was increased to 100% from 70% after LPS treatment 24 h. For lung injury score, it decreased to 1.5 from 3.5 after treating 40 mg/kg PTE. Compared with the control group, the expression of NR4A1 in the ALI group was decreased by 20-40%. However, the 40 mg/kg PTE pre-treatment increased the NR4A1 expression by 20-40% in the lung tissue. The results obtained with pre-treatment NR4A1 agonist were similar to those obtained by pre-treatment 40 mg/kg PTE. CONCLUSIONS: PTE pre-treatment might represent an appropriate therapeutic target and strategy for preventing ALI induced by LPS.

Case report of a 28-year-old man with aortic dissection and pulmonary shadow due to granulomatosis with polyangiitis.

BACKGROUND: Granulomatosis with polyangiitis (GPA) is characterised by the main violation of the upper and lower respiratory tract and kidney. GPA is considered a systemic vasculitis of medium-sized and small blood vessels where aortic involvement is extremely rare. CASE PRESENTATION: A 28-year-old male was admitted to the hospital due to 4 h of chest pain. Computed tomography scan of the aorta showed a thickened aortic wall, pulmonary lesions, bilateral pleural effusion and pericardial effusion. The aortic dissection should be considered. An emergency operation was performed on the patient. Surgical biopsies obtained from the aortic wall showed destructive changes, visible necrosis, granulation tissue hyperplasia and a large number of acute and chronic inflammatory cells. Nearly a year later, the patient was re-examined for significant pulmonary lesions. His laboratory studies were significantly positive for anti-neutrophilic antibody directed against proteinase 3. Finally, the diagnosis of GPA was obviously established. CONCLUSIONS: Although GPA rarely involves the aorta, we did not ignore the fact that GPA may involve large blood vessels. In addition, GPA should be included in the systemic vasculitis that can give rise to aortitis and even aortic dissection.

[Study on Chemical Constituents and Content Determination of Feifukang Mistura].

Objective: To identify the main chemical constituents and to determine the content in Feifukang mistura. Methods: HPLC-MS technique was used to profile and identify the chemical constituents by comparing the retention time,MS data with the reference standard. The content determination of all the chemical constituents were carried on a HPLC system. Results: Five compounds were separated from Feifukang mistura,which were identified as neomangiferin,mangiferin,calycosin-7-O-glucoside,calycosin,and schizandrol A. The standard curves of them showed good linearity on the range of 2. 08 ~ 104. 0 µg/m L,2. 00 ~ 100. 0 µg/m L,2. 00 ~ 100. 0µg/m L,2. 09 ~ 104. 5 µg/m L,and 1. 98 ~ 99. 0 µg/m L,respectively. The average recoveries were all in the range of 91. 3 ~ 103. 8%. Conclusion: The methods of chemical constituents identification and content determination were established,which may offer better revealing the material basis and controlling quality of Feifukang mistura.

Sulindac has strong antifibrotic effects by suppressing STAT3-related miR-21.

Pulmonary fibrosis (PF) is a disease with an unknown cause and a poor prognosis. In this study, we aimed to explore the pathogenesis of PF and the mechanism of sulindac in attenuating bleomycin (BLM)-induced PF. The rat PF model was induced by BLM and verified through histological studies and hydroxyproline assay. The severity of BLM-induced PF in rats and other effects, such as the extent of the wet lung to bw ratios, thickening of alveolar interval or collagen deposition, was obviously ameliorated in sulindac-treated rat lungs compared with BLM-induced lungs. Sulindac also reversed the epithelial mesenchymal transition (EMT) and inhibited the PF process by restoring the levels of E-cadherin and α-smooth muscle actin (SMA) in A549 cells. Our results further demonstrated that the above effects of sulindac might be related to regulating of interferon gamma (IFN-γ) expression, which further affects signal transducers and activators of transcription 3 (STAT3) and phosphorylated STAT3 (p-STAT3) levels. Moreover, higher miR-21 levels with the decreased E-cadherin and increased α-SMA expressions were found in transforming growth factor-ß1-treated A549 cells, which can be reversed by sulindac. Collectively, our results demonstrate that by decreasing IFN-γ-induced STAT3/p-STAT3 expression to down-regulate miR-21, sulindac could significantly reverse EMT in A549 cells and prevent BLM-induced PF.

Simvastatin downregulates expression of TGF-ßRII and inhibits proliferation of A549 cells via ERK.

Lung cancer is the leading cause of cancer-related death worldwide. Transforming growth factor-ß receptor II (TGF-ßRII) plays an important role in the regulation of proliferation and progression in cancer. Statins have been documented to exhibit anticancer and cancer chemopreventive properties. However, the effects and mechanisms of simvastatin on the development of lung cancer are still unclear. In the present study, quiescent A549 cells were treated in vitro with fetal bovine serum (FBS) in the presence or absence of simvastatin. MTT, Western blot, and real-time qPCR were used to detect cell viability, activation of ERK, and expression of TGF-ßRII at the protein and RNA level. Our results demonstrated that simvastatin inhibited activation of ERK, downregulated expression of TGF-ßRII, and suppressed A549 cell proliferation. Furthermore, the effects of simvastatin can be reversed by farnesyl pyrophosphate (FPP). Therefore, these results suggest that simvastatin may inhibit A549 cell proliferation and downregulate TGF-ßRII expression by inhibiting activation of ERK. Our findings may advance the current understanding of the effects of simvastatin on cancer progression and contribute to the study of cancer treatment.

Effects of ultrasound-guided radial artery catheterization: an updated meta-analysis.

BACKGROUND: Previous meta-analyses have shown that ultrasound guidance is an effective technique for radial artery catheterization. However, these reports neglected to include several non-English language studies. Therefore, an updated meta-analysis including more eligible studies was performed to assess the effectiveness of ultrasound-guided radial artery catheterization. METHODS: Eligible studies were identified by systematically searching PubMed, EMBASE, Wanfang, and China National Knowledge Infrastructure literature databases. The outcome measure was the rate of first-attempt success. Two investigators identified the randomized controlled trials (RCTs) for inclusion and independently extracted data from these RCTs. The quality of the included studies was evaluated using the Jadad score. The relative risk (RR) for dichotomous outcomes and the 95% confidence intervals (CIs) were calculated and pooled using a random-effects model. RESULTS: Eleven RCTs involving 803 patients met the inclusion criteria. Ultrasound-guided radial artery catheterization was generally associated with a 47% improvement, as compared with the palpation technique, in terms of the rate of first-attempt success (RR, 1.47; 95% CI, 1.22-1.76; P < .0001). Specifically, the ultrasound-guided technique significantly improved the rate of first-attempt success for adult (RR, 1.39; 95% CI, 1.13-1.72; P = .002) and pediatric (RR, 1.68; 95% CI, 1.15-2.47; P = .008) patients. CONCLUSIONS: Adult and pediatric patients benefited from ultrasound-guided radial artery catheterization in terms of the rate of first-attempt success. Given the potential bias and significant heterogeneity of the available data in the present study, further investigation is required to confirm the present findings and to identify other effects of the ultrasound-guided technique.

Calculus bovis inhibits M2 tumor-associated macrophage polarization via Wnt/ß-catenin pathway modulation to suppress liver cancer.

BACKGROUND: Calculus bovis (CB), used in traditional Chinese medicine, exhibits anti-tumor effects in various cancer models. It also constitutes an integral component of a compound formulation known as Pien Tze Huang, which is indicated for the treatment of liver cancer. However, its impact on the liver cancer tumor microenvironment, particularly on tumor-associated macrophages (TAMs), is not well understood. AIM: To elucidate the anti-liver cancer effect of CB by inhibiting M2-TAM polarization via Wnt/ß-catenin pathway modulation. METHODS: This study identified the active components of CB using UPLC-Q-TOF-MS, evaluated its anti-neoplastic effects in a nude mouse model, and elucidated the underlying mechanisms via network pharmacology, transcriptomics, and molecular docking. In vitro assays were used to investigate the effects of CB-containing serum on HepG2 cells and M2-TAMs, and Wnt pathway modulation was validated by real-time reverse transcriptase-polymerase chain reaction and Western blot analysis. RESULTS: This study identified 22 active components in CB, 11 of which were detected in the bloodstream. Preclinical investigations have demonstrated the ability of CB to effectively inhibit liver tumor growth. An integrated approach employing network pharmacology, transcriptomics, and molecular docking implicated the Wnt signaling pathway as a target of the antineoplastic activity of CB by suppressing M2-TAM polarization. In vitro and in vivo experiments further confirmed that CB significantly hinders M2-TAM polarization and suppresses Wnt/ß-catenin pathway activation. The inhibitory effect of CB on M2-TAMs was reversed when treated with the Wnt agonist SKL2001, confirming its pathway specificity. CONCLUSION: This study demonstrated that CB mediates inhibition of M2-TAM polarization through the Wnt/ß-catenin pathway, contributing to the suppression of liver cancer growth.

[The effect of early goal lactate clearance rate on the outcome of septic shock patients with severe pneumonia].

OBJECTIVE: To observe the clinical effects of 10%, 30% lactate clearance rate and early goal-directed therapy (EGDT) as 6-hour resuscitation goals directing treatment in septic shock patients with severe pneumonia. METHODS: In this randomized, perspective study, septic shock patients with severe pneumonia were divided into control group and experimental group, which included 10% lactate clearance rate group and 30% lactate clearance rate group, adopting random number method. The control group was treated with 6-hour EGDT strategy, and the experimental groups were treated with 10% lactate clearance rate protocol and 30% lactate clearance rate protocol respectively, beside the EGDT. RESULTS: There were 19 patients in control group, and 43 patients in experimental group, which included 22 patients in 10% lactate clearance rate group and 21 patients in 30% lactate clearance rate group. Patients were well matched by basic features. After 48 hours, the acute physiology and chronic health evaluation II (APACHE II ) score of both 10% lactate clearance rate group (13.76 ± 6.00, P < 0.05) and 30% lactate clearance rate group (13.60 ± 6.18, P < 0.05) were lower than that of control group (18.15 ± 6.62). There were no differences in time of mechanical ventilation (hours) between control group and experimental group (10% group 136.90 ± 100.02, 30% group 97.00 ± 75.20, control group 152.32 ± 96.51, P > 0.05). The length in intensive care unit (ICU, days) of 10% and 30% lactate clearance rate groups were significantly shorter than control group (10% group 7.94 ± 6.00, 30% group 7.51 ± 3.99, control group 11.31 ± 5.97, both P < 0.05). The three groups had no differences in 7-day mortality rate (10% group 18.18%, 30% group 14.29%, control group 21.05%, all P > 0.05), but the 28-day mortality of 10% and 30% lactate clearance rate groups were significantly lower than control group (10% group 36.36%, 30% group 28.57%, control group 63.16%), especially in 30% lactate clearance rate group (P < 0.05). CONCLUSION: For the septic shock patients with severe pneumonia, prompt archiving EGDT strategy and 6-hour lactate clearance more than 30% were associated with an optimal outcome.

Astaxanthin induces mitochondria-mediated apoptosis in rat hepatocellular carcinoma CBRH-7919 cells.

We designed to study the role of mitochondria in astaxanthin-induced apoptosis in hepatocellular carcinoma cells. Effect of astaxanthin on cell proliferation was studied by using methyl thiazolyl tetrazolium (MTT) in three tumor cell lines (CBRH-7919, SHZ-88 and Lewis) and normal human hepatocyte HL-7702 cell. Cell apoptosis rate, changes of mitochondrial morphology, mitochondrial transmembrane potential and electron transport chain were evaluated respectively. Expressions of B cell lymphoma/leukemia-2 (Bcl-2) and Bcl-2 associated X protein (Bax) were detected by Western blot. Results as following, astaxanthin had little effect on HL-7702 cell, however its inhibition was most pronounced in CBRH-7919 cell line with an IC50 of 39 µM. This dose of astaxanthin and CBRH-7919 cell line were chosen for further studies. Astaxanthin could induce cell apoptosis and mitochondrial membrane damage. The mitochondrial transmembrane potential and function of electron transport chain were decreased. The expression of Bcl-2 protein was down-regulated but that of Bax protein was up-regulated. In conclusion, astaxanthin showed anticancer effect by inducing cell apoptosis through the regulation of mitochondrial-dependent manner.

Dihydroartemisinin alleviates oxidative stress in bleomycin-induced pulmonary fibrosis.

AIMS: Dihydroartemisinin has been shown to inhibit the development of pulmonary fibrosis in rats, but its mechanism has yet to be elucidated. This study aimed to determine the mechanisms of dihydroartemisinin in bleomycin-induced pulmonary fibrosis in a rat model. MAIN METHODS: Morphological changes and collagen deposition were analyzed via hematoxylin-eosin staining and Masson staining and the expression of biotic-factor-related oxidative stress in lung tissues was assayed with standard assay kits. The expressions of α-SMA, E-cadherin, and Nrf2/HO-1 were detected by Western blot and RT-PCR, and the cell morphology and proliferation of cultured type II alveolar epithelial cells (AECs) were assessed via microscopy and immunocytochemical assay. KEY FINDINGS: Dihydroartemisinin treatment significantly decreased the level of oxidative stress and collagen synthesis and inhibited AECs differentiation in bleomycin-induced pulmonary fibrosis compared to the control group (P < 0.001). SIGNIFICANCE: Our results indicated that dihydroartemisinin might decrease oxidative damage to attenuate lung injury and fibrosis.

Epidemic hemorrhagic fever complicated with late pregnancy: A case report.

RATIONALE: Hantaviruses cause two forms of diseases in humans, namely hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome. Hantavirus infections can occur in pregnant women, and could influence the maternal and fetal outcomes, although this is a rare finding, even in endemic areas. PATIENT CONCERNS: In this report, we describe anunusual case involving a pregnant woman with HFRS who was in a state of shock. DIAGNOSES: Hemorrhagic fever with renal syndrome and septic shock. INTERVENTIONS: Timely termination of pregnancyalong with correction of the shock is very important to curb the inflammation and reduce organ damage. OUTCOMES: Although HFRS in pregnancy could pose a serious threat to the lives of the mother and the child. Our patient was successfully treated. LESSONS: Early and accurate diagnosis, anti-shock treatment, and timely termination of pregnancyare the key aspects of therapy for HFRS with late pregnancy.

Leucine-derived cyanoglucosides from the aerial parts of Sorbaria sorbifolia (L.) A. Braun.

Six new cyanoglucosides, 2S-cardiospermin-5-benzoate (1), 2R-cardiospermin-5-p-hydroxybenzoate (2), 2S-cardiospermin-5-cis-p-coumarate (3), isocardiospermin-5-p-hydroxybenzoate (4), sutherlandin-5-p-hydroxybenzoate (5), and sutherlandin-5-cis-p-coumarate (6), together with 17 known compounds were isolated from Sorbaria sorbifolia. The structures of the new compounds were elucidated by extensive spectroscopic methods, including 1D and 2D NMR, HR-ESI-MS and ECD experiments. The biosynthetic relationship of 1-9 was also discussed. The cyanoglucosides (1-9) and 15 exhibited moderate inhibitory effect on nitric oxide production of RAW264.7 macrophages stimulated by lipopolysaccharide (LPS).

Cerebrospinal Fluid Orexin A Levels and Autonomic Function in Kleine-Levin Syndrome.

STUDY OBJECTIVES: Kleine-Levin syndrome (KLS) is a rare disorder of relapsing sleepiness. The hypothesis was that the syndrome is related to a change in the vigilance peptide orexin A. METHODS: From 2002 to 2013, 57 patients with relapsing hypersomnolence were clinically assessed in a referral academic center in Beijing, China, and 44 (28 males and 16 females; mean age 18.3 ± 8.9 y (mean ± standard deviation, range 9-57 y) were determined to have clinical and behavioral criteria consistent with KLS. Cerebrospinal fluid orexin A levels and diurnal blood pressure were measured in relapse versus remission in a subgroup of patients. RESULTS: Presenting symptoms included relapsing or remitting excessive sleepiness-associated parallel complaints of cognitive changes (82%), eating disorders (84%); depression (45%); irritability (36%); hypersexuality (18%); and compulsions (11%). Episodes were 8.2 ± 3.3 days in duration. In relapse, diurnal values for blood pressure and heart rate were lower (P < 0.001). In a subgroup (n = 34), cerebrospinal fluid orexin A levels were ∼31% lower in a relapse versus remission (215.7 ± 81.5 versus 319.2 ± 95.92 pg/ml, P < 0.001); in three patients a pattern of lower levels during subsequent relapses was documented. CONCLUSIONS: There are lower orexin A levels in the symptomatic phase than in remission and a fall and rise in blood pressure and heart rate, suggesting a role for orexin dysregulation in KLS pathophysiology.

Reduced expression levels of let-7c in human breast cancer patients.

Circulating microRNAs (miRNAs) are important in the diagnosis of a number of diseases, since serum or plasma miRNAs are more stable compared with miRNA isolated from blood samples. The aim of the present study was to investigate the association between the expression levels of serum let-7c miRNA and the clinical diagnosis of breast cancer (BC). The circulating let-7c levels of 90 BC patients and 64 healthy controls were determined by performing a reverse transcription-quantitative polymerase chain reaction assay. The results demonstrated that let-7c expression was downregulated in the BC tissues compared with the paracarcinoma control tissues. In addition, the let-7c expression in the serum of BC patients was significantly lower compared with the healthy controls (P<0.01). Using a cutoff value of 0.374×103 copies/ml, the serum expression levels of let-7c exhibited 87.5% sensitivity and 78.9% specificity for distinguishing BC patients from healthy controls (area under the receiver operating characteristic curve, 0.848; 95% confidence interval, 0.785-0.911). Furthermore, the results demonstrated that the serum expression levels of let-7c were significantly higher in premenopausal compared with postmenopausal patients (P<0.05), supporting the hypothesis that postmenopausal status may affect the serum expression levels of let-7c. However, no statistically significant differences were detected in the serum levels of let-7c between ER (or PR)-positive and -negative patients. Therefore, the current study hypothesized that serum let-7c may be used as a novel and valuable biomarker for the diagnosis of BC.

Arsenic trioxide prevents rat pulmonary fibrosis via miR-98 overexpression.

AIMS: This study aimed to investigate the pathogenesis mechanisms of bleomycin (BLM)-induced pulmonary fibrosis (PF) in Sprague-Dawley rats and explore the anti-fibrotic role of arsenic trioxide (As2O3) in preventing PF. MAIN METHODS: Intratracheal instillation of BLM was performed to establish PF rat models. The treatment group was treated with As2O3 (0.4 mg/kg/day). Morphological changes were observed by hematoxylin-eosin and Masson staining. Related proteins were determined by immunohistochemistry, immunofluorescence, and Western blot. MicroRNA detection was performed by quantitative real-time polymerase chain reaction. KEY FINDINGS: As a novel miRNA in PF, miR-98 decreased in the fibrotic lung tissues. Based on microRNA analysis software, we found that Stat3-3'-UTR is targeted by miR-98. Then, we found that Stat3 was activated with PF development and the expression of Stat3 and p-Stat3 was significantly increased in BLM-induced PF at day 28 compared with saline-treated rats. Our results showed that both Stat3 and p-Stat3 were significantly decreased in miR-98-treated A549 cells compared with that in mu-98-treated cultures or untreated controls. The fibrotic marker α-SMA was upregulated, whereas E-cadherin was inhibited in fibrotic lung tissues. The ratio of apoptotic factors Bax/Bcl-2 increased with the development of fibrosis. Furthermore, As2O3 treatment prevented lung interstitial thickening and inhibited the collagen type I and hydroxyproline, thereby preventing the development of PF. As2O3 also significantly down-regulated α-SMA but increased E-cadherin and miR-98 levels. SIGNIFICANCE: The study revealed that arsenic trioxide prevented rat PF by up-regulation of miR-98 and inhibition of its downstream Stat3 signals.

Low-dose heparin as treatment for early disseminated intravascular coagulation during sepsis: A prospective clinical study.

The present study aimed to investigate whether low-dose heparin improves the condition of patients suffering from early disseminated intravascular coagulation (pre-DIC) during sepsis. In total, 37 patients were randomly divided into low-dose heparin intervention and control groups. The heparin group received a low-dose of heparin for 5-7 days, while the other group received only saline. The two groups were treated for sepsis. Blood samples were collected at various times and acute physiology and chronic health evaluation (APACHE)-II scores were recorded at day 1 and 7. In addition, the number of days applying mechanical ventilation and in the intensive care unit (ICU) were recorded, as well as the 28-day mortality rate. APACHE-II scores in the two groups decreased following treatment, however, scores in the heparin group decreased more significantly. Prothrombin fragment and thrombin-antithrombin complex levels in the heparin group were significantly decreased. In addition, the number of days applying a ventilator was fewer and the total stay in ICU was significantly shorter compared with the control group. Significantly fewer complications were observed in the heparin group, however, there was no significant difference in the 28-day mortality rate. In conclusion, low-dose heparin improves the hypercoagulable state of sepsis, which subsequently reduces the incidence of DIC or multiple organ dysfunction syndrome, decreasing the number of days of mechanical ventilation and hospitalization.

[Risk factors and early diagnosis of acute kidney injury in patients with sepsis].

OBJECTIVE: To analyze related risk factors of sepsis complicated acute kidney injury (AKI), and to explore the precaution equation for early clinical diagnosis. METHODS: A retrospective review of patients with sepsis complicating AKI admitted to intensive care unit (ICU) of Affiliated Hospital of Binzhou Medical University from April 2011 to April 2013 were enrolled. Fifty-eight sepsis patients without AKI were enrolled as control. Eleven indexes including age, mean arterial pressure (MAP) score, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score, 24-hour urine volume, 24-hour net liquid intake score, serum creatinine (SCr) score, blood urea nitrogen (BUN), oxygenation index, blood lactic acid score and plasma albumin were collected as possible risk factors for AKI in sepsis patients. The risk factors and calculation of the critical value were analyzed by multiple factor logistic regression analysis. RESULTS: Nine factors with statistical significance for AKI in sepsis patients analyzed with univariate analysis were substituted in logistic regression model including MAP score, SOFA score, APACHEII score, 24-hour urine volume, 24-hour net liquid intake score, SCr score, BUN, oxygenation index, blood lactic acid score. After variable screening SCr score, MAP score, 24-hour net liquid intake score and blood lactic acid score were substituted in regression equation: Y=0.237X1 + 0.139X2 + 0.057X3 + 0.051X4 (X1, X2, X3, X4 typified SCr score, MAP score, blood lactic acid score and 24-hour net liquid intake score), F=125.897, P=0.000. The diagnostic cutoff appeared as 0.778. The sensitivity, the specificity, the Youden index, positive predictive value and negative predictive value were 80%, 100%, 0.8, 100% and 74%, respectively. CONCLUSIONS: SCr score, MAP score, blood lactic acid score and 24-hour net liquid intake score were risk factors of sepsis complicating AKI. When the value higher than 0.778 from regression equation Y=0.237X1 + 0.139X2 + 0.057X3 + 0.051X4, it hinted there was risk related to AKI in sepsis patients. The equation can help the clinicians diagnose sepsis and AKI earlier.

[The influence of volume load on prognosis of patients with sepsis induced acute kidney injury].

OBJECTIVE: To investigate the influence of volume load on the prognosis of patients with sepsis induced acute kidney injury (AKI). METHODS: A retrospective study was conducted. Patients with sepsis induced AKI from intensive care unit (ICU) of Binzhou Medical College Hospital from October, 2009 to September, 2011, were studied. 28-day mortality, 28-day renal-recovery rate, ICU stay days and mechanical ventilation rate were compared between negative fluid balance group and positive fluid balance group according to the fluid balance in first 72 hours. The influence of continuous renal replacement therapy (CRRT) on the volume load and the prognosis of patients with sepsis induced AKI were also studied. RESULTS: One hundred and sixty patients were enrolled. Compared with positive fluid balance group (n=79), 28-day-mortality [37.0% (30/81) vs. 68.4% (54/79), P<0.01], ICU stay time (10.1±4.9 days vs. 12.4±8.0 days, P<0.05) and mechanical ventilation rate [50.6% (41/69) vs. 68.4% (54/819), P<0.01] were lower in negative fluid balance group (n=81). According to Acute Kidney Injury Net (AKIN) staging standard, in stage 1, 2, and 3 of AKI (n=49, n=52, n=59), the day volume of first 72 hours of patients undergoing CRRT were lower than that of patients not undergoing CRRT (-10 ml vs. 716 ml, 324 ml vs. 778 ml, 521 ml vs. 1177 ml, all P<0.05). The 28-day mortality of patients undergoing CRRT was lower than that of patients not undergoing CRRT in stage 2 of AKI [38.7% (12/31) vs. 66.7% (14/21), P<0.05]. CONCLUSIONS: There is a relationship between fluid balance and prognosis of sepsis induced AKI, and 28-day-mortality can be reduced by negative fluid balance. CRRT can regulate fluid balance and improve the prognosis of sepsis induced AKI.