ABSTRACT
Objective To investigate the effects of different early enteral nutrient (EN) emulsions of TPF-T and TP on nutritional status and intestinal mucosal barrier in patients with septic shock. Methods From May 2017 to May 2018, 112 patients with septic shock were continuously enrolled in the Department of Intensive Care Unit of the First People's Hospital of Taizhou, and they were randomly divided into a TPF-T group and TP group, each group with 56 cases. After admission, the patients in both groups were all treated according to the 2016 Saving Sepsis Campaign (SSC) Guidelines for septic shock. Both groups were supported with EN, TPT-T group was given TPF-T EN emulsion rich in fish oil, while TP group was supported with standard TP EN emulsion, and the therapeutic course was consecutive 7 days in both groups. The differences in nutritional status, inflammatory response, immune function, intestinal mucosal barrier, gastrointestinal symptoms and prognosis were compared between the two groups. Results After EN, the nutrition indicators such as albumin (Alb), prealbumin (PA), transferrin (TRF) and immune indexes (IgA, IgG), human leukocyte DR antigens (HLA-DR) and D-lactic acid were increased in both groups, reaching the peaks on the 7th day after EN application, Alb, PA, TRF, IgA, IgG, HLA-DR in the TPF-T group were significantly higher than those in the TP group [Alb (g/L): 34.43±5.81 vs. 33.59±5.34, PA (mg/L): 269.83±47.56 vs. 252.67±41.92, TRF (g/L): 3.43±0.64 vs. 3.32±0.81, IgA (mg/L): 159.45±34.56 vs. 143.31±33.81, IgG (mg/L): 4 947.68±871.66 vs. 4 583.75±841.54, HLA-DR: (68.22±9.11)% vs. (62.21±9.69)%], and after EN, the D-lactic acid in the TPF-T group was significantly lower than that in the TP group (mg/L: 30.42±6.79 vs. 33.34±7.31). The inflammatory indicators of tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), procalcitonin (PCT), endotoxin and diamine oxidase (DAO) were all gradually reduced in two groups, reached the lowest levels on the 7th day after EN application, and all the above-mentioned indicators in the TPF-T group were significantly lower than those in the TP group [TNF-α (ng/L):95.43±20.69 vs. 109.59±23.45, CRP (mg/L): 21.33±16.35 vs. 32.36±17.83, PCT (μg/L): 1.24±1.21 vs. 4.18±1.32, endotoxin (U/L): 10.32±2.31 vs. 11.54±2.69, DAO (g/L): 19.45±8.49 vs. 25.47±9.41]. The incidences of gastric retention, diarrhea and paralysis of lower digestive tract in TPF-T group were significantly lower than those in TP group [gastric retention: 14.29% (8/56) vs. 32.14% (18/56), diarrhea: 12.50% (7/56) vs. 35.71% (20/56), paralysis of lower digestive tract: 7.14% (4/56) vs. 23.21% (13/56)], the length of hospital stay was significantly shorter in the TPF-T group than that in the TP group (days: 18.77±5.08 vs. 21.71±6.67, P < 0.05); however, there was no significant difference in mortality between the two groups [14.29% (8/56) vs. 21.43% (12/56), P > 0.05]. Conclusion TPF-T could more effectively maintain nutritional status, reduce inflammatory reaction, improve immunity, protect intestinal mucosal barrier function, and has fewer adverse reactions, which was helpful to improve the prognosis of septic shock patients.
ABSTRACT
Objective To investigate the difference between bronchoalveolar lavage fluid(BALF)and tracheal aspirate(TA)on the use of antibiotics in patients with severe pneumonia.Methods Patients with severe pneumonias admitted to the Department of General Intensive Care Unit of Second Affiliated Hospital of Zhejiang University School of Medicine,between December 2014 and March 2019 were retrospectively analyzed.The difference of effects of BLAF and TA on the use of antibiotics in patients with severe pneumonia were compared and analyzed,as well as the effects of antibiotic de-escalation on patient's mortality were evaluated.The quantitative data were analyzed by independent sample t test and the enumeration data were determined by Chi-square test or Fisher exact probability method.Results Among the 120 patients more bacteria were detected in BALF than in TA(82 vs 60,P＜0.05).More fungi were detected in BALF than in TA(20 vs 3,P＜0.05).Compared with TA,BALF results were more likely to guide the adjustment of antibiotic regimens(41 vs 16,P＜0.05),including guidance for antibiotics de-escalation(27 vs 9,P＜0.05).There was no significant difference in the 14-day mortality,28-day mortality,hospital stay and duration of mechanical ventilation between the two groups(al P＜0.05).Conclusions Compared with TA,BALF,as a pathogens detection method for severe pneumonia,has more advantages in guiding antibiotics administration,including antibiotic de-escalation,which will not increase the mortality of patients.
ABSTRACT
Objective@#To investigate the difference between bronchoalveolar lavage fluid (BALF) and tracheal aspirate (TA) on the use of antibiotics in patients with severe pneumonia.@*Methods@#Patients with severe pneumonias admitted to the Department of General Intensive Care Unit of Second Affiliated Hospital of Zhejiang University School of Medicine, between December 2014 and March 2019 were retrospectively analyzed. The difference of effects of BLAF and TA on the use of antibiotics in patients with severe pneumonia were compared and analyzed, as well as the effects of antibiotic de-escalation on patient’s mortality were evaluated. The quantitative data were analyzed by independent sample t test, and the enumeration data were determined by Chi-square test or Fisher exact probability method.@*Results@#Among the 120 patients, more bacteria were detected in BALF than in TA (82 vs 60, P<0.05). More fungi were detected in BALF than in TA (20 vs 3, P<0.05). Compared with TA, BALF results were more likely to guide the adjustment of antibiotic regimens (41 vs 16, P<0.05), including guidance for antibiotics de-escalation (27 vs 9, P<0.05). There was no significant difference in the 14-day mortality, 28-day mortality, hospital stay and duration of mechanical ventilation between the two groups (all P<0.05).@*Conclusions@#Compared with TA, BALF, as a pathogens detection method for severe pneumania, has more advantages in guiding antibiotics administration, including antibiotic de-escalation, which will not increase the mortality of patients.
ABSTRACT
Objective To investigate the prevalence and epidemiological characteristics of hypothyroidism, possible related lifestyle and metabolic risk factors of hypothyroidism in adults of Gansu province, and to provide scientific evidence for the prevention of hypothyroidism. Methods Stratified multi-stage cluster sampling with probability proportionate to size method was used to collect data from 10071 residents aged 18 to 79 years and who had lived in the local area for more than 5 years. All participants were asked to fill in the questionnaire, and to take physical examination including anthropometric measurements and venous blood samples. Risk factors of hypothyroidism were analyzed by Chi-square test and multivariate logistic regression analysis. Result The prevalence of hypothyroidism was 10.1％ (overt hypothyroidism: 1.5％, subclinical hypothyroidism: 8.7％). Female (12.1％) had a higher percentage when compared to male (7.5％). In addition to the increased odds with older age and female gender, current or previous smoking history (OR: 0.467, 95％CI: 0.289-0.754, P=0.002), salty taste preference (OR:0.355, 95％CI:0.162-0.776, P=0.022) and a frequent seafood intake (OR:0.148, 95％CI:0.057-0.385, P<0.001) were tended to be associated with reduced risk of hypothyroidism. Logistic regression analysis showed that positive thyroid peroxidase antibodies (OR:1.976, 95％CI:1.037-3.768, P=0.039), positive thyroglobulin antibodies (OR:2.419, 95％CI:1.160-5.043, P=0.018) and triglycerides (OR:1.241, 95％CI:1.044-1.474, P=0.014) were associated with increased risk of hypothyroidism. Conclusion The prevalence of hypothyroidism in Gansu province was high, affecting approximately one in ten adults, and majority of which were SCH. Both lifestyle factors and metabolic factor were associated with hypothyroidism. Developing a healthy lifestyle at work and home, and paying attention to the control of blood lipids are conducive to the prevention of hypothyroidism.
ABSTRACT
BACKGROUND: Insulin-like growth factor 1(IGF-1) plays an important role in regulating osteocyte function and bone metabolism. The association of insulin-like growth factor 1 receptor (IGF-1R) gene polymorphisms with osteoporosis in postmenopausal women has not yet been reported.OBJECTIVE: To investigate the correlation between IGF-1R gene rs2229765 single nucleotide polymorphism and osteoporosis in postmenopausal women.METHODS: IGF-1R gene rs2229765 SNPs were detected using PCR-RFLP in 218 patients with postmenopausal osteoporosis and 270 postmenopausal women with normal bone mineral density. The bone mineral density of the lumbar spine, femoral neck and forearm was determined by dual-energy X-ray absorptiometry. Serum IGF-1 level was investigated by ELISA.RESULTS AND CONCLUSION: The AA genotype (29% vs. 17%, P=0.001) and A allele (51% vs. 40%, P=0.000)distributions of the rs2229765 polymorphism in the osteoporosis group were significantly higher than those in the control group. Compared with GG genotype of rs2229765, AA genotype was significantly associated with an increased risk of osteoporosis (OR=2.12, 95%CI=1.27-3.54, P=0.004). The analysis of serum IGF-1 showed that osteoporotic women with rs2229765AA (P=0.007) and GA (P=0.016) genotype were found to have a lower serum IGF-1 level than osteoporotic women with GG genotype. Our results indicate that the IGF-1R gene rs2229765 polymorphism capable of regulating serum IGF-1 level is associated with postmenopausal osteoporosis.
ABSTRACT
Objective To investigate the prevalence of vitamin D deficiency and its associated metabolic risk factors in the healthy adults in Gansu Province, a western province of China.Methods Through stratified, multistage probability population sampling, 11 300 adults (4 740 men and 6 417 women aged 18-79 years) who had been living in their current residence for at least 5 years were arbitrarily chosen from seven representative geographical cities in Gansu Province from June 2014 to December 2015.The data obtained from a questionnaire-based survey, anthropometric and biochemical assessments, and areal bone mineral density measurement were collected and analyzed.Results The overall mean serum 25(OH)D was (16.07±9.40) μg/L.The prevalence of severe deficiency (0.05).Conclusions Vitamin D deficiency is highly prevalent among adult populations in Gansu, northwestern of China, and is largely attributed to younger age and female sex.The cumulative effects of factors including sun exposure, physical activity, and calcium supplementation play an influential role in maintaining vitamin D levels.
ABSTRACT
Objective To study the clinical efficacy of ulinastatin combined with ambroxol hydrochloride in the treatment of acute respiratory distress syndrome (ARDS) complicated with ventilator-associated pneumonia (VAP).Methods One hundred and ten cases of ARDS complicated with VAP were randomly divided into the study group (55 cases) and the control group (55 cases) according to the different treatment method.The two groups accepted symptomatic anti-infective treatment,and the control group was treated with 300mg of ambroxol twice daily,the study group were intravenously infused 200 000U ulinastatin on the basis of the control group,two groups of patients were treated for 1 week.The ventilation indicators,pathogen clearance rate,off-time rate,mechanical ventilation time,respiratory rate,APACHE score,lung injury score and adverse reactions during the treatment were compared between the two groups.Results After treatment,PaO2,PaO2/FiO2,CL,RAW and PIP in the study group were (97.83 ± 12.01)mmHg,(364.25 ±35.77)mmHg,(88.93 ±9.44)mL/cmH2O,(31.45 ±4.87)cmHH2O · L-1 · s-1,(21.43 ± 5.75)cmH2O,respectively,which in the control groupwere (83.25 ± 10.13)mmHg,(238.55 ± 34.29) mmHg,(62.77 ± 8.54) mL/cmH2 O,(37.97 ± 6.54) cmH2 O · L-1 · s-1,(29.12 ± 5.43) cnH2 O,respectively.The P.aO2,PaO2/FiO2,CL in the study group were significantly higher than those in the control group,the RAW,PIP in the study group were significantly lower than those in the control group,the differences were statistically significant (t =6.88,18.81,5.93,7.21,15.42,all P ＜ 0.05).The clearance rate of both Gram-positive lacteria (90.00％)and Gram-negative bacteria (92.00％) in the study group were significantly higher than those in the control group (66.67％ and 70.21％) (x2 =4.81,8.84;P =0.03,0.00).The mean mechanical ventilation time in the study group [(7.15 ± 2.43) days] was significantly shorter than that in the control group [(12.85 ± 3.12) days] (t =10.69,P ＜ 0.05).The respiratory rate,APACHE score and lung injury scores of the two groups were significantly lower than those before treatment (P ＜ 0.05).The respiratory rate,APACHE scores and lung injury scores of the study group [(18.94 ± 6.99) times/min,(12.53 ± 3.14) points,(1.31 ± 0.15) points] were significantly lower than those of the control group [(25.87 ± 6.12) times/min,(16.53 ± 4.42) points,(1.65 ± 0.32) points],the differences were statistically significant (t =5.53,5.47,7.14;P =0.00,0.00,0.00).The off-line success rate and mortality between the two groups had no statistically significant differences (all P ＞ 0.05).Conclusion Ulinastatin combined with ambroxol hydrochloride can significantly improve the respiratory function of ARDS patients complicated with VAP,significantly shorten the duration of mechanical ventilation,improve respiratory function,reduce lung injury and improve pathogens clearance rate,but with no significant impact on mortality.
ABSTRACT
Objective To investigate the effect of Amikacin and prulifloxacin alternate application in the treatment of Lung infections in ICU resistant Acinetobacter Bauman.Methods 82 cases of Lung infections in ICU resistant Acinetobacter Bauman from August 2014 to August 2016 in our hospital were selected and randomLy divided into two groups, 41 cases in control group were given routine treatment, 41 cases in the experimental group were treated with Amikacin and prulifloxacin alternate application, and patients were treated continuous for two weeks.Levels of serum CRP, PCT, WBC, N%, SCR, BUN, AST, ALT, scores of APACHE II and CPIS and clinical efficacy were observed pre-and post-treatment.Results After two weeks, levels of serum CRP, PCT, WBC and N% in experimental group were significantly lower than control group, scores of APACHE II and CPIS were significantly lower than the control group, the total clinical efficiency was higher than the control group(P<0.05), and the levels of serum SCR, BUN, ALT, AST were lower, but had no statistically difference.Conclusion Amikacin and prulifloxacin alternate application in the treatment of Lung infections in ICU resistant Acinetobacter Bauman can reduce the patient's inflammatory reaction and the degree of infection.