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Objective:To investigate the different outcomes of two types of acute kidney injury (AKI) according to standard of Kidney Disease: Improving Global Outcomes-AKI (KDIGO-AKI), and to analyze the risk factors that affect the prognosis of intensive care unit (ICU) patients in China.Methods:A secondary analysis was performed on the database of a previous study conducted by China Critical Care Clinical Trial Group (CCCCTG), which was a multicenter prospective study involving 3 063 patients in 22 tertiary ICUs in 19 provinces and autonomous regions of China. The demographic data, scores reflecting severity of illness, laboratory findings, intervention during ICU stay were extracted. All patients were divided into pure AKI (PAKI) and acute on chronic kidney disease (AoCKD). PAKI was defined as meeting the serum creatinine (SCr) standard of KDIGO-AKI (KDIGO-AKI SCr) and the estimated glomerular filtration rate (eGFR) at baseline was ≥ 60 mL·min -1·1.73 m -2, and AoCKD was defined as meeting the KDIGO-AKI SCr standard and baseline eGFR was 15-59 mL·min -1·1.73 m -2. All-cause mortality in ICU within 28 days was the primary outcome, while the length of ICU stay and renal replacement therapy (RRT) were the secondary outcome. The differences in baseline data and outcomes between the two groups were compared. The cumulative survival rate of ICU within 28 days was analyzed by Kaplan-Meier survival curve, and the risk factors of ICU death within 28 days were screened by Cox multivariate analysis. Results:Of the 3 063 patients, 1 042 were enrolled, 345 with AKI, 697 without AKI. The AKI incidence was 33.11%, while ICU mortality within 28 days of AKI patients was 13.91% (48/345). Compared with PAKI patients ( n = 322), AoCKD patients ( n = 23) were older [years old: 74 (59, 77) vs. 58 (41, 72)] and more critical when entering ICU [acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score: 23 (19, 27) vs. 15 (11, 22)], had worse basic renal function [eGFR (mL·min -1·1.73 m -2): 49 (38, 54) vs. 115 (94, 136)], more basic complications [Charlson comorbidity index (CCI): 3 (2, 4) vs. 0 (0, 1)] and higher SCr during ICU stay [peak SCr for diagnosis of AKI (μmol/L): 412 (280, 515) vs. 176 (124, 340), all P < 0.01]. The mortality and RRT incidence within 28 days in ICU of AoCKD patients were significantly higher than those of PAKI patients [39.13% (9/23) vs. 12.11% (39/322), 26.09% (6/23) vs. 4.04% (13/322), both P < 0.01], while no significant difference was found in the length of ICU stay. Kaplan-Meier survival curve analysis showed that the 28-day cumulative survival rate in ICU in AoCKD patients was significantly lower than PAKI patients (Log-Rank: χ2 = 5.939, P = 0.015). Multivariate Cox regression analysis showed that admission to ICU due to respiratory failure [hazard ratio ( HR) = 4.458, 95% confidence interval (95% CI) was 1.141-17.413, P = 0.032], vasoactive agents treatment in ICU ( HR = 5.181, 95% CI was 2.033-13.199, P = 0.001), and AoCKD ( HR = 5.377, 95% CI was 1.303-22.186, P = 0.020) were independent risk factors for ICU death within 28 days. Conclusion:Further detailed classification (PAKI, AoCKD) based on KDIGO-AKI SCr standard combined with eGFR is related to ICU mortality in critical patients within 28 days.
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Objective To explore the value of metagenomic next-generation sequencing (mNGS) in the diagnosis and treatment of severe pneumonia after renal transplantation .Methods A total of 38 patients with severe pneumonia after renal transplantation from October 2017 to December 2018 were selected and divided into experimental group (A ,n= 15)and control group (B ,n= 23) based upon whether mNGS of bronchoalveolar lavage fluid was employed for detecting pathogenic microorganisms .Positive rate ,clinical acceptance rate ,hospitalization time ,hospitalization expenses and 28-day mortality rate of two methods were compared .Results Positive rate and clinical acceptance rate of mNGS were higher in experimental group than those in traditional experimental and control groups ( P < 0 .05 ) . Hospitalization time , hospitalization expenses and 28-day mortality of experimental group were lower than those of control group (P< 0 .05) .No significant inter-group difference existed in 90-day mortality (P> 0 .05) .Conclusions For patients with severe pneumonia after renal transplantation , mNGS of bronchoalveolar lavage fluid can improve positive rate of etiological diagnosis and clinical acceptance rate and reduce hospitalization time , hospitalization expenses and 28-day mortality .
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Objective To systematically evaluate the therapeutic effect of pulse high volume hemofiltration (PHVHF) for treatment of patients with sepsis. Methods Databases such as PubMed in American National Medical Library, Holland medical abstract Embase, the Cochrane Library, China National Knowledge Internet (CNKI), China Biological Medical Literature Database (CBM), VIP, WanFang databases, etc. were searched by computer to retrieve randomized controlled trials (RCTs) on PHVHF for treatment of patients with sepsis, and the retrieval time ranged from the creation of database to March 25, 2017. Both groups of patients received conventional treatments, including antibiotics, fluid resuscitation, vasoactive agents as well as other organ function support treatments to maintain the basic vital signs stable. Patients in PHVHF group received PHVHF besides conventional treatment, while the patients in control group received conventional treatment or any other continuous renal replacement therapy (CRRT) mode with PHVHF excluded. The literatures accepted should at least include one of the following changes of outcome indicators, such as overall mortality, the levels of inflammatory mediators eliminated, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score, service life of filter, amount of replacement fluids used. Two researchers independently screened literatures, extracted data, and assessed the methodological quality of included studies. Meta-analysis was conducted by using RevMan 5.3 software and the publication bias was evaluated by visually inspecting funnel plots. Results A total of 11 RCTs involving 410 patients met eligibility criteria, of which 204 patients in the PHVHF group and 206 patients in the control group. In the control group 5 RCTs used other CRRT modes, and 6 RCTs applied the conventional therapy. Meta-analyses showed that interleukin-6 [IL-6, standard mean difference (SMD) = -0.80, 95% confidence interval (95%CI) = -1.56 to -0.06, P = 0.04], tumor necrosis factor-α (TNF-α, SMD = -0.78, 95%CI = -1.33 to -0.23, P = 0.006), APACHE Ⅱ scores [mean difference (MD) = -3.80, 95%CI = -5.08 to -2.52, P < 0.000 01] were obviously lower than those in control group, but no significant statistical significance in mortality was seen between the two groups [relative risk (RR) = 0.72, 95%CI = 0.49 - 1.07, P = 0.10]. Further subgroup analyses suggested that compared with conventional treatment group, in PHVHF group mortality (RR = 0.40, 95%CI = 0.16 - 0.95, P = 0.04), IL-6 (SMD =-1.87, 95%CI = -3.58 to -0.16, P = 0.03), TNF-α (SMD = -1.32, 95%CI = -2.24 to -0.40, P = 0.005), and APACHE Ⅱscore (MD = -4.29, 95%CI = -6.02 to -2.56, P < 0.000 01) were significantly decreased; however, only a significantly decreased APACHE Ⅱ score (MD = -2.95, 95%CI = -4.56 to -1.35, P = 0.000 3) was observed in PHVHF group compared to that in subgroup of other CRRT modes. Conclusions Compared with using conventional therapy alone, using PHVHF combined with conventional therapy for treatment of patients with sepsis can more effectively improve their prognosis, and PHVHF can be the efficacious alternatives of other CRRT modes especially the HVHF. However, due to the limited quantity and quality of the included studies, further high-quality, multicenter, large-scale RCTs are needed to verify the above conclusion.
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To explore the application of protein fingerprint technique and differential diagnosis in bacteriological negative pulmonary tuberculosis and pneumonia ,60 patients with bacteriological negative pulmonary tuberculosis ,60 patients with pneumonia ,and 60 healthy volunteers were selected from known clinical cases .Surface strengthening laser desorption ioniza-tion time of flight mass spectrometry (SELDI ToF Ms) and protein chip technology were applied to detect serum proteins ,and analyze their protein peaks by Ciphergen protein chip 3 .1 .1 software .Comparison of the serum protein fingerprinting data from the pool of 180 patients and healthy volunteers showed significant difference in 5 protein peaks (1 028 .49 ,4 796 .56 ,7 564 .77 , 8 048 .02 ,and 11 526 .75 m/z) identified between pulmonary tuberculosis and pneumonia (P<0 .01) .The total effective rate of the 5 protein peaks as a diagnosis model for differential diagnosis of bacteriological negative pulmonary tuberculosis and pneumonia was 84 .2% (101/120) ,the specificity was 82 .5% (52/63) ,the sensitivity was 85 .9% (49/57) ,the positive pre-dictive value was 86 .7% (52/60) ,and the negative predictive value was 81 .7% (49/60) .The total effective rate of the diagno-sis model for differential diagnosis of bacteriological negative pulmonary tuberculosis ,pneumonia and healthy volunteers was 89 .4% (161/180) .The specificity was 100% (60/60) ,the sensitivity was 84 .2% (101/120) ,the positive predictive value was 100% (101/101) ,and the negative predictive value was 75 .9% (60/79) .Protein fingerprinting technology is advanta-geous of being a simple method ,quick detection ,and requires less amount of sample .It is an effective means to screening the tuberculosis specific markers .We found the good diagnosis model through the detection of serum protein by protein fingerprint-ing technology .
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Objective To find out the differences in gene expression of spleen tissue in septic rats by using DNA microarrays.Methods Thirty male Wistar rats were randomly (random number) and equally divided into control group and sepsis group,and septic rat model was induced by cecal ligation puncture (CLP).The rats of control group were only subjected to a simulated operation without CLP.Gene expression profiles were studied by using RatRef-12 gene chip.Rat gene expression profile was showed by using microarray to detect the changes in gene expression pattern of rat spleen tissue after CLP.And subsequently,by using relevant computer software to screen and analyze,the comparison of differences in gene expression between the sepsis group and control group was made.Results Of 22 523 genes,205 differential genes were found between sepsis group and control group,accounting for 0.910％.Among them 98 genes showed up-regulation,with 48 known functional genes,and 107 genes showed down-regulation,with 64 known functional genes.The function of such different genes were associated mainly with apoptosis,inflammation and energy metabolism of spleen cells.Conclusions Splenic dysfunction may be attibuted to the abnormal expression of relevant genes subjected to apoptosis,inflammation and alteration of energy metabolism.It may be the cause of immunosuppression in the later stage of sepsis.
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Objective To explore the effect of UTI (Ulinastatin) preconditioning on gene expression profiles of spleen tissue in septic rats by DNA microarray technology. Methods Forty-five male Wistar rats were equally divided into sham group,sepsis group and UTI group by means of random number table.In UTI group the rats were treated with intramuscular injection of UTI( 105 U/kg) one hour before cecal ligation and puncture.In sepsis group and sham group intramuscular balanced solution (5 ml/kg) was given.Cecal ligation and puncture was used to reproduce septic rat model. Gene expression profile was studied by using RatRef-12 Rat gene expression profile microarray to detect the changes in gene expression pattern of rat spleen tissue after cecal ligation and puncture.Then using related computer software was used to screen and analyze the relationship between the Sepsis/UTI group and sham group. Results In 22 523 genes,205 differential genes were found between sepsis group and sham group,accounting for 0.910％.Among them 98 genes were up-regulated,with 48 known functional genes and 32 genes only showed in this group;107 genes were down-regulated,with 64 known functional genes and 34 genes only showed in it.197 differential genes were found in UTI group and sham group,accounting for 0.875％.Among them 114 genes were up-regulated,with 35 known functional genes and 19 genes only showed in this group; 83 genes were down-regulated,with 49 known functional genes and 19 genes only showed in it. Conclusions Abnormal expression of genes in the spleen tissue of rats with sepsis owing to excessive inflammation and immune suppression were partly relieved by UTI preconditioning.UTI pretects spleen at genetic level.
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Objective To investigate the gene-expression profile in kidney of rats during late sepsis (24hours) by using microarray technology in order to offer some clue to revealing the pathogenetic mechanism of sepsis at gene level. Method A total of 30 Wistar rats were selected and divided into model group and control group randomly(random number). The rats of control group were sham operated and the rats of model group received cecal ligature and puncture (CLP) operation. The biomarkers of renal function were assayed and the histopathological changes of kidney in rats were observed under transmission electron microscope 24 hours after operation. Gene chips containing 22 107 rat-genes cDNA were used to exmine gene-expression in kidney of septic rats to sieve the genes with different expressions with software. Data were analyzed by using SPSS version 11.0 software package.Statistical analyses of two independent samples carried out by using t -test. Results Compared with the control group, the levels of blood urea nitrogen (BUN) and creatinine (Cr) of sepsis group were higher (P ＜ 0.01 ). The histopathological changes in kidney of rats demonstrated the establishment of sepsis model successful 24 hours later.Compared with the control group, there were 325 genes with differential expression in model group. Among the known-functional genes, there were 100 up-regulated and 64 down-regulated. Sorted by biological function, the genes were mainly related to metabolism, immunoresponse, cellular signal transduction, apoptosis, ion channel,growth factor and so on. Conclusions A sequence of genes expressed differentially in kidney of rats with late sepsis. Microarray technology played an important role in the research into sepsis mechanisms.
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Objective To establish the animal model of acute intracranial hypertension,investigate the changes of transeranial Doppler patterns in raised intraeranial pressure so that the necessary experimental evidence will be provided to clinical experience for monitoring intraeranial pressure (ICP) and cerebral perfusion pressure (CPP) using transeranial Doppler non-invasively. Methods Acute intraeranial hypertension was induced by inflating the balloon inserted into the epidural space. Blood flow velocity of basilar artery was measured with transcranial Doppler and intracranial pressure as well as cerebral perfusion pressure was measured. Results With progressive increase of intracranial pressure five characteristic flow patterns were observed, appearing in the following order: high resistance pattern, systolic flow, retrograde diastolic flow, very small systolic flow and zero flow. Conclusions Analysing patterns of TCD may be helpful for evaluating ICP and CPP qualitatively. The animal model is simple and strict so that it is worthy of being spreadcd.
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Objective To investigate the effect of Helium-oxygen mechanical ventilation on histomorphology in acute lung injury(ALI)animal models.Methods To investigate the changes of histomorphology in ALI rat models caused by sepsis by comparing air-oxygen mixture mechanical ventilation with helium-oxygen mixture mechanical ventilation.Results Helium-oxygen mechanical ventilation has no influence on the change of lung histomorphology.Conclusion Helium-oxygen mixture mechanical ventilation could not improve lung histomorphology.Helium-oxygen mixture mechanical ventilation has no protective effect on ALI animal models.
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Objective To investigate the effects of Helium-oxygen mechanical ventilation on respiratory mechanics and oxygenation in ALI animal models.Methods To investigate the changes of respiratory mechanics and oxygenated indexs in acute lung injury rat models caused by sepsis at different PEEP by comparing air-oxygen mixture mechanical ventilation with helium-oxygen mixture mechanical ventilation.Results 1.Helium-oxygen mechanical ventilation could not improve respiratory mechanical indexs in ALI animal models(airway peak pressure、mean airway pressure、platform pressure、dynamic compliance、airway resistance、flow rate of peak value).On the contrary,in the condition of high level of PEEP,some indexs became worse,such as depress of dynamic compliance(P
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Objective To investigate the effct of continuous blood purification(CBP)on endotoxin receptor and signal transduction of patients with multiple organ dysfunction syndrome(MODS).Methods Thirty patients with MODS were selected and treated with low volume and high volume haemofiltration.Plasma level of TNF-?、IL-6 were messured before and after CBP at 6h,1d,3d.Express of PMN CD14mRNA,CD14 protein and activity of NF-?B were also observed.Results CBP had no effect on TNF-?,and plasma IL-6 decreased significantly(P
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Objective To observe the effect of diliazem on cerebral oxygen metabolism during the period of blood pressure lowering in hypertensive urgencies.Methods 30 patients of hypertensive urgencies were randomized into two groups with 15 cases each.Group Ⅰ was administered with nitroglycerin.Group Ⅱ was administered with diliazem.Nitroglycerin was injected from 2.5?g/(kg?min).Group Ⅱ were received intravenous injection of diltiazem 5~10 mg,and then were continuously infusion by 5~15?g/kg/min with mictosyringe.Blood gas analysis was carried out by taking blood samples from right internal jugular vein bulb and radial artery,and D(a-jv)O2 and CEO2 were calculated before,during and after induced blood pressure lowering 0.5,1,2,3 hours.Results Compared with those in group Ⅰ,SjvO2 increased significantly in group Ⅱ(P0.05).Conclusion Diltiazem can decrease cerebral metabolism,improve oxygenation and play a role in cerebral protection in hypertensive urgencies.
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Objective To understand the distribution of nosocomial infection pathogens and drug - resistance in intensive care unit of our hospital for providing the guidance of clinical rational administration and preventing the hospital infection. Methods Pathogenic bacteria were isolated from the patients who suffered from nosocomial infection in intensive care unit from January of 2008 to December of 2008. They were tested by microbe VITEK and drug - sensitive reagent. Rate of drug resistance of the pathogenic bacteria was analyzed. Results Gram - negative bacilli( G- ) accounted for 47.67% of the isolated pathogenic bacteria,and most were Acinetobacter baumannii (21.65%) , Pscudomonas aeruginosa( 8.00% ) , Stenotropham onasm altophilia(6.33% ) and Klebsiella pneumoniae (4.00%). Grampositive cocci ( G~+ ) accounted for 9.56 % , and most were Staphylococcus aureus (5.56%) and Enterococcus faecium ( 1.44 % ). The rnycetes occupied the 42. 78% of the pathogens. The main pathogenic bacteria were Candida albicans (24. 44% ) and Candida albicans ( 10.89% ). The rate of drug resistance of Gram - negative bacilli( G~- ) was high as a whole,while the rate of mycetes was low. Conclusion Enhance monitoring on pathogenic bacteria distribution and drug resistance analyses of nosocomial infection in ICU could benefit for the guide of clinical rational administration and depressing multidrug - resistant bacteria.
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Objective To investigate the effect of Ulinstatin(UTI) on oxygenation and gastric intramucosal pH in dogs with sepsis. Methods Sepsis was induced by intravenous infusion of lipopolysaccharide of E.coli.055:B5 to dogs,and the twenty dogs were divided into control group and ulinastatin group.Ulinastatin was administered in the ulinastatin group.The oxygen delivery(DO2),oxygen consumption(VO2), oxygen extraction(O2ER), plasma lactate levels and gastric intramucosal pH(pHi) were monitored. Results In early sepsis dogs,DO2,VO2,O2ER and plasma lactate levels increased significantly. Gastric intramucosal pH(pHi) decreased significantly. After the treatment with ulinastatin,DO2,VO2,O2ER and plasma lactate levels decreasd(P
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To examine the protective action and therapeutic effect of anisodamine on acute lung injure and its molecular mechanism,63 rats were randomly divided into three groups :normal control group(NS),lipopolysaccharide (LPS) group and anisodamine (ADM) group.Rat model of acute lung injure(ALI) was produced by injecting LPS(5mg/kg) into the tail vein.The lung index(LI),WBC count,the percentage of polymorphonuclear leukocyte(PMN) in the bronchoalveolar lavage fluid(BALF) were observed at 0,1,3,5 hours(T 0,T 1,T 2,T 3).The concentration of TNF-? were measured both in BALF and plasma at four time points.The expression of P65 was analyzed by immunohistochmical method five hours after injecting LPS.The results showed that LI of ADM group were significantly lower than that of LPS group at T 2 after injecting LPS(P