Mediating role of stressful life events between sleep chronotype and depressive mood in adolescents / 中国学校卫生

Objective@#A longitudinal mediating model was designed to explore the relationship between sleep chronotype and depressive mood with stressful life events as the mediating variable, so as to provide reference basis for preventing depression in adolescents.@*Methods@#From March (T1) to October (T2) 2022, the Munich Chronotype Questionnaire, and Adolescent Self-rating Life Events Checklist and Center for Epidemiologic Studies Depression Scale were administered in 1 251 middle school students in the first and second grades of a middle school in Meishan, Sichuan Province for a follow up study. Two wave of date on sleep time type, stressful life events, and depressive moods were collected.@*Results@#At T1, the detection rate of depressive mood was 22.5% in adolescents but 27.0% at T2.At the same time point, there were significant positive correlations between chronotype, stressful life events and depressive mood ( r=0.06-0.69, P <0.05). Cross lagged model results showed that early sleep chronotype could significantly predict later depressive mood ( β=0.53, P <0.05), and early depressive mood could significantly predict later sleep chronotype ( β=0.01, P <0.01). Longitudinal mediation model analysis showed that T1 sleep chronotype not only directly affected T2 depressive mood (direct effect value=1.421, 95% CI =0.985- 1.858 , P <0.01), but also affect T2 depressive mood through the partial mediating effects of T2 stressful life events (indirect effect value=1.268, 95% CI =0.810-1.726, P <0.05). Although T1 depressive mood was a direct predictor of T2 sleep chronotype (direct effect value=0.025, 95% CI =0.017-0.032), it was not a direct predictor of T2 sleep chronotype by partial intermediate action of T2 stressful life events (indirect effect value=-0.001, 95% CI = -0.006- 0.004, P >0.05).@*Conclusions@#Sleep chronotype can not only directly predict depressive mood of adolescents, but also indirectly affect depressive mood of adolescents through the longitudinal mediating effect of stressful life events. To prevent depression and improve mental health in this population, adolescents should develop the habit of early sleep schedule, and improve their ability to cope with stressful life events.

Efficacy and safety of methylene blue in patients with vasodilatory shock: A systematic review and meta-analysis.

Background: The role of methylene blue (MB) in patients with vasodilatory shock is unclear. The purpose of this systematic review and meta-analysis was to evaluate the efficacy and safety of MB in patients with vasodilatory shock. Methods: We searched MEDLINE at PubMed, Embase, Web of Science, Cochrane, CNKI, CBM and Wanfang Medical databases for all observational and intervention studies comparing the effect of MB vs. control in vasodilatory shock patients. This study was performed in accordance with the PRISMA statement. There were no language restrictions for inclusion. Results: A total of 15 studies with 832 patients were included. Pooled data demonstrated that administration of MB along with vasopressors significantly reduced mortality [odds ratio (OR) 0.54, 95% confidence interval (CI) 0.34 to 0.85, P = 0.008; I 2 = 7%]. This benefit in mortality rate was also seen in a subgroup analysis including randomized controlled trials and quasi-randomized controlled trials. In addition, the vasopressor requirement was reduced in the MB group [mean difference (MD) -0.77, 95%CI -1.26 to -0.28, P = 0.002; I 2 = 80%]. Regarding hemodynamics, MB increased the mean arterial pressure, heart rate and peripheral vascular resistance. In respect to organ function, MB was associated with a lower incidence of renal failure, while in regards to oxygen metabolism, it was linked to reduced lactate levels. MB had no effect on the other outcomes and no serious side effects. Conclusions: Concomitant administration of MB and vasopressors improved hemodynamics, decreased vasopressor requirements, reduced lactate levels, and improved survival in patients with vasodilatory shock. However, further studies are required to confirm these findings. Systematic review registration: Identifier: CRD42021281847.

Repair of coronary artery ostium with a ring-shaped bovine pericardial patch.

As an approach to coronary artery ostial injury in type A aortic dissection and infective endocarditis, we describe a technique of coronary ostial repair using a ring-shaped bovine pericardial patch. The inner and outer rims of the patch were sutured to the involved coronary ostium (to close the ostial tear) and to the aortic wall (to cover the sinus), respectively. Four patients were successfully managed and computed tomographic coronary arteriogram at follow-up showed patent coronary ostia and arteries. The favourable preliminary results imply that this technique is a simple, safe and effective approach to coronary ostial repair in patients with type A aortic dissection or infective endocarditis.

Risk Factors for Postoperative Mortality in Patients with Acute Stanford Type A Aortic Dissection.

OBJECTIVE: The present study explored the risk factors of postoperative mortality in patients with acute Stanford type A aortic dissection (AD). METHODS: The study included 149 patients with acute Stanford type A AD who were treated at the Fourth Hospital of Hebei Medical University, China, from October 2016 to October 2018. The patients were divided into a death (n = 42) and survival group (n = 107) according to individual prognosis. Univariate analysis of all possible related risk factors was conducted; multivariate logistic regression analysis of the potential risk factors that showed statistical differences in the univariate analysis was also performed. RESULTS: The results of the univariate analysis showed that a body mass index (BMI) ≥25 kg/m2, surgery duration, duration of cardiopulmonary bypass, duration of cardiopulmonary bypass assistance, total transfusion of red blood cells, postoperative APACHE II score, sequential organ failure assessment (SOFA) score, low cardiac output, acute kidney injury (AKI), hypoxemia, diffuse intravascular coagulation (DIC), hepatic failure and other related complications, as well as postoperative stay duration in the intensive care unit (ICU), were closely correlated with a poor prognosis among patients. Multivariate logistic regression analysis showed that a BMI ≥25 kg/m2, SOFA score >8, duration of cardiopulmonary bypass assistance >70 minutes, postoperative low cardiac output, and postoperative DIC were independent risk factors for postoperative death in patients with acute Stanford type A AD. CONCLUSION: A BMI ≥25 kg/m2, SOFA score >8, duration of cardiopulmonary bypass assistance >70 min, postoperative DIC, and postoperative low cardiac output were the independent risk factors for postoperative death in acute Stanford type A AD. Intraoperative blood transfusion, postoperative hepatic failure, and AKI, among others, correlated with an increased risk of death but were not independent risk factors for death.

Combined predictive performance of age and neutrophilic percentage on admission for severe novel coronavirus disease 2019.

BACKGROUND: Novel coronavirus disease 2019 (COVID-19) poses a huge threat to the global public health. This study aimed to identify predictive indicators of severe COVID-19. METHODS: We retrospectively collected clinical data on hospital admission of all patients with severe COVID-19 and a control cohort (1:1) of gender- and hospital-matched patients with mild disease from 13 designated hospitals in the Hebei Province between 22 January and 15 April 2020. RESULTS: A total of 104 patients (52 with severe COVID-19 and 52 with mild disease) were included. Only age, fever, duration from symptom onset to confirmation, respiratory rate, percutaneous oxygen saturation (SpO2 ) and neutrophilic percentage were independent predictors of severe COVID-19. Age and neutrophilic percentage performed best in predicting severe COVID-19, followed by SpO2 . 'Age + neutrophilic percentage' (the sum of age and neutrophilic percentage) (area under the curve [AUC] 0.900, 95% confidence interval [CI] 0.825-0.950, P < .001) and 'age and neutrophilic percentage' (the prediction probability of age and neutrophilic percentage for severe type obtained by logistic regression analysis) (AUC 0.899, 95% CI 0.824-0.949, P < .001) had excellent predictive performance for severe type. The optimal cut-off for 'age + neutrophilic percentage' was >119.1 (sensitivity, 86.5%; specificity, 84.6%; Youden index, 0.712). CONCLUSION: The combination of age and neutrophil percentage could effectively predict severe COVID-19. The sum of age and neutrophil percentage was recommended for clinical application because of its excellent predictive value and practicability. TRAIL REGISTRATION: China Clinical Trial Registry, number ChiCTR2000030226. Registered 26 February 2020-Retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=49855.

Accuracy assessment of noninvasive cardiac output monitoring in the hemodynamic monitoring in critically ill patients.

BACKGROUND: The consistency of cardiac output (CO) measured by noninvasive cardiac output monitoring (NICOM), pulse index continuous cardiac output (PiCCO), and ultrasound in the hemodynamic monitoring of critically ill patients was studied. Using the NICOM built-in passive leg raising (PLR) test, stroke volume index variation (∆SVI) was calculated and was used to predict volume responsiveness in patients with circulatory shock (excluding cardiogenic shock). METHODS: Critically ill patients requiring hemodynamic monitoring were admitted during the study period. The CO of each included patient under hemodynamic monitoring was measured by NICOM plus PiCCO or ultrasound, and the consistency of the measured COs was analyzed. By the NICOM built-in PLR test, ∆SVI was calculated and was used to predict volume responsiveness. RESULTS: The CO of 58 patients was measured by NICOM and ultrasound, and the COs measured by these two methods were consistent. The CO of 40 patients was measured by NICOM and PiCCO, and the COs measured by these two methods were consistent. The volume responsiveness of all 98 patients was assessed by the NICOM built-in PLR test. A total of 60 patients had ∆SVI >10%, so they underwent the fluid challenge. Among them, 43 patients were positive by both the NICOM built-in PLR and fluid challenge. When using ∆SVI to predict volume responsiveness in patients with circulatory shock (excluding cardiogenic shock), the area under the receiver operating characteristic curve was 0.754 (95% confidence interval, 0.626-0.856), and the cut-off value was 18% (sensitivity: 88.37%, specificity: 52.94%), indicating that ∆SVI has value in predicting the volume responsiveness of patients with noncardiogenic circulatory shock. CONCLUSIONS: NICOM had good consistency with ultrasound and PiCCO in the hemodynamic monitoring of critically ill patients and can be for hemodynamic monitoring and evaluation in critically ill patients. The ∆SVI obtained by the NICOM built-in PLR test has certain clinical value in predicting the volume responsiveness of patients with circulatory shock (excluding cardiac shock) and provides a method for evaluating the volume responsiveness of critically ill patients.

Clinical characteristics and treatment of critically ill patients with COVID-19 in Hebei.

BACKGROUND: In December, 2019, a novel coronavirus disease 2019 (COVID-19) emerged in Wuhan, China. We aimed to clarify the epidemiology, laboratory examinations, imaging findings, and treatment of critically ill patients with COVID-19 in Hebei province, China. METHODS: In this retrospective study, the demographic, laboratory and imaging, and treatment data of patients with severe COVID-19 treated in 13 designated hospitals in Hebei were collected and analyzed. RESULTS: A total of 319 severe COVID-19 patients were treated at the 13 designated hospitals between 22 January, 2020 and 25 March, 2020. Eventually, 51 critically ill (31 severe cases and 20 critically severe cases) patients were included in the analysis. The patients had an average age of 58.9±13.7 years, and 27 (52.9%) were men. Twenty-one (41.2%) were familial cluster, and 33 (64.7%) had chronic illnesses. The patients in critically severe group had longer duration from symptom to confirmation, more severe infections, more severe lung injury, and a lower percentage of lymphocytes. All 51 patients received antiviral drugs, 47 (92.2%) received antibacterial agents, 49 (96.1%) received traditional Chinese drugs, and 46 (90.2%) received methylprednisolone. The critically severe patients received more fluid and more diuretic treatment; 14 (70.0%) required invasive mechanical ventilation, and 13 (65.0%) developed extrapulmonary complications. CONCLUSIONS: COVID-19 patients who had underlying diseases and longer confirmation times were more likely to progress to critically severe COVID-19. These patients also presented with a higher risk of respiratory depression, circulatory collapse, extrapulmonary complications, and infection.

Valve surgery in combination with cryoablation in the treatment of atrial fibrillation.

OBJECTIVE: To investigate the effectiveness and safety of valve surgery in combination with cryoablation in the treatment of atrial fibrillation. METHODS: Fifty patients who needed to undergo valve surgery because of heart valve disease and sixty-five patients who needed to undergo valve surgery in combination with cryoablation were selected as the research subjects. The perioperative technical characteristics, postoperative curative effect and complications were compared between the two different treatment modalities in our hospital between October 2013 and November 2015. RESULTS: No significant differences were observed between the two groups in valve surgery mode, valve type and postoperative length of hospital stay (P>0.05), but the duration of extracorporeal bypass and aorta occlusion of the observation group was longer than that of the control group (P<0.05). The 3-month, 6-month and one-year atrial fibrillation cardioversion rates of patients in the observation group were superior to those of the control group, and the differences were notable (P<0.05). The improvement of left atrial diameter of the observation group was also superior to that of the control group (P<0.05). The incidence of postoperative complications of the two groups had no significant difference (P>0.05). CONCLUSION: Valve surgery in combination with cryoablation has favorable short-term clinical effect in the treatment of heart valve disease in combination with atrial fibrillation, which is worth promotion.

Patterns and Mechanisms of Artificial Kidney Failure during Continuous Renal Replacement Therapy.

BACKGROUND: We aimed to describe the previously unstudied relationship between circuit pressures and circuit clotting, here labeled as 'artificial kidney failure' (AKF), in patients receiving continuous renal replacement therapy (CRRT). METHODS: We performed an observational study of CRRT-treated critically ill patients to continuously record the multiple CRRT circuit pressures. RESULTS: Three patterns of access outflow dysfunction (AOD) were also noted: severe, moderate and mild. Compared with circuits without AOD, circuits experiencing at least one AOD episode had shorter lifespans (14.2 ± 12.7 vs. 21.3 ± 16.5 h, p = 0.057). This effect was more obvious with moderate or severe AOD (8.7 ± 4.6 vs. 20.6 ± 15.7 h, p = 0.007). If any AOD events occurred within the first 4 h, the sensitivity and specificity in predicting early-immediate AKF were 53.4 and 94.4%, respectively. CONCLUSIONS: Early and intermediate AKF during CRRT is most likely dependent on AOD, which is a frequent event with variable severity.

A Genome-Wide Scan of DNA Methylation Markers for Distinguishing Monozygotic Twins.

Identification of individuals within pairs of monozygotic (MZ) twins remains unresolved using common forensic DNA typing technology. For some criminal cases involving MZ twins as suspects, the twins had to be released due to inability to identify which of the pair was the perpetrator. In this study, we performed a genome-wide scan on whole blood-derived DNA from four pairs of healthy phenotypically concordant MZ twins using the methylated DNA immunoprecipitation sequencing technology to identify candidate DNA methylation markers with capacity to distinguish MZ twins within a pair. We identified 38 differential methylation regions showing within-pair methylation differences in all four MZ pairs. These are all located in CpG islands, 17 of which are promoter-associated, 17 are intergenic islands, and four are intragenic islands. Genes associated with these markers are related with cell proliferation, differentiation, and growth and development, including zinc finger proteins, PRRX2, RBBP9, or are involved in G-protein signaling, such as the regulator of G-protein signaling 16. Further validation studies on additional MZ twins are now required to evaluate the broader utility of these 38 markers for forensic use.

Intensive care nurses' self-reported practice of intravenous fluid bolus therapy.

OBJECTIVE: To describe self-reported practice of fluid bolus therapy by intensive care nurses. RESEARCH METHODOLOGY: Multi-choice questionnaire of intensive care nurses conducted in July, 2014. SETTING: Major university tertiary referral centre. FINDINGS: 141 (64%) intensive care nurses responded. The majority of respondents identified 4% albumin as the commonest fluid bolus type and stated a fluid bolus was 250ml; however fluid bolus volume varied from 100ml to 1000ml. Hypotension was identified as the primary physiological trigger for a fluid bolus. In the hour following a fluid bolus for hypotension almost half of respondents expected an 'increase in mean arterial pressure of 0-10mmHg'; for oliguria, >60% expected an 'increase in urinary output of '0.5-1ml/kg/hour'; for low CVP, 50% expected 'an increase in CVP of 3-4mmHg'; and, for tachycardia, 45% expected a 'decrease in heart rate of 11-20beats/minute'. Finally, 7-10% of respondents were 'unsure' about the physiological response to a fluid bolus. CONCLUSION: Most respondents identified fluid bolus therapy to be at least 250ml of 4% albumin given as quickly as possible; however, volumes from 100 to 1000ml were also accepted. There was much uncertainty about the expected physiological response to fluid bolus therapy according to indication.

Early goal-directed therapy in the management of severe sepsis or septic shock in adults: a meta-analysis of randomized controlled trials.

BACKGROUND: The Surviving Sepsis Campaign guidelines have proposed early goal-directed therapy (EGDT) as a key strategy to decrease mortality among patients with severe sepsis or septic shock. However, its effectiveness is uncertain. METHODS: We searched for relevant studies in Medline, Embase, the Cochrane Library, Google Scholar, and a Chinese database (SinoMed), as well as relevant references from January 1966 to October 2014. We performed a systematic review and meta-analysis of all eligible randomized controlled trials (RCTs) of EGDT for patients with severe sepsis or septic shock. The primary outcome was mortality; secondary outcomes were length of ICU and in-hospital stay, mechanical ventilation support, vasopressor and inotropic agents support, fluid administration, and red cell transfusion. We pooled relative risks (RRs) or weighted mean differences (MDs) with 95% confidence intervals (95% CI) using Review Manager 5.2. RESULTS: We included 10 RCTs from 2001 to 2014 involving 4,157 patients. Pooled analyses of all studies showed no significant difference in mortality between the EGDT and the control group (RR 0.91, 95% CI: 0.79 to 1.04, P = 0.17), with substantial heterogeneity (χ2 = 23.65, I (2) = 58%). In the subgroup analysis, standard EGDT, but not modified EGDT, was associated with lower mortality rate in comparison with the usual care group (RR 0.84, 95%CI: 0.72 to 0.98, P = 0.03). However, EGDT was associated with a higher mortality rate in comparison with the early lactate clearance group (RR 1.52, 95% CI: 1.06 to 2.18, P = 0.02). In the first 6 h, compared with usual care, patients in EGDT received more inotropic agents (P = 0.04), fluid administration (P = 0.05), and red cell transfusion (P < 0.01). There were no significant differences in length of ICU stay (P = 0.73) or in-hospital stay (P = 0.57), ventilation rate (P = 0.53), and vasopressor support (P = 0.63). CONCLUSIONS: EGDT was not associated with a survival benefit among patients with severe sepsis or septic shock. Instead, EGDT was associated with a higher mortality rate in comparison to the early lactate clearance group. Further high-quality RCTs comparing EGDT with early lactate clearance are desirable.

Extended Daily Dialysis Versus Continuous Renal Replacement Therapy for Acute Kidney Injury: A Meta-analysis.

BACKGROUND: Extended daily dialysis (EDD) has been suggested as an effective renal replacement therapy for acute kidney injury. However, results from studies comparing EDD to continuous renal replacement therapy (CRRT) are inconclusive. STUDY DESIGN: A systematic review and meta-analysis was performed by searching in MEDLINE, EMBASE, the Cochrane Library, Google Scholar, and a Chinese database (SinsoMed). SETTING & POPULATION: Patients with acute kidney injury. SELECTION CRITERIA FOR STUDIES: Randomized controlled trials (RCTs) and observational studies were included. EDD was defined as extended hemodialysis or hemodiafiltration for more than 6 but less than 24 hours per session using a conventional hemodialysis machine. INTERVENTION: Renal replacement therapy comparing EDD with CRRT. OUTCOMES: Mortality, kidney recovery, and fluid removal. RESULTS: We included 17 studies from 2000 to 2014: 7 RCTs and 10 observational studies involving 533 and 675 patients, respectively. Meta-analysis of RCTs showed no difference in mortality rates between EDD and CRRT (relative risk, 0.90; 95% CI, 0.74-1.11; P=0.3). However, EDD was associated with lower mortality risk compared with CRRT in observational studies (relative risk, 0.86; 95% CI, 0.74-1.00; P=0.05). There was no evidence of heterogeneity in RCTs (I(2)=0%) or observational studies (I(2)=15%). In both RCTs and observational studies, there were no significant differences in recovery of kidney function, fluid removal, or days in the intensive care unit, and EDD showed similar biochemical efficacy to CRRT during treatment (serum urea, serum creatinine, and serum phosphate). LIMITATIONS: The survival benefit of EDD is dependent on only observational studies and might have been affected by allocation or selection bias. CONCLUSIONS: EDD is associated with similar outcomes to CRRT in RCTs. The finding that EDD is associated with a lower mortality rate relies on data from observational studies, which are potentially subject to allocation or selection bias, making further high-quality RCTs desirable.

Automated electronic monitoring of circuit pressures during continuous renal replacement therapy: a technical report.

BACKGROUND: Automated electronic monitoring and analysis of circuit pressures during continuous renal replacement therapy (CRRT) has the potential to predict failure and allow intervention to optimise function. METHODS: Current CRRT machines can measure and store pressure readings for downloading into databases and for analysis. We developed a procedure to obtain such data at intervals of 1 minute and analyse them using the Prismaflex CRRT machine, and we present an example of such analysis. RESULTS: We obtained data on pressures obtained at intervals of 1 minute in a patient with acute kidney injury and sepsis treated with continuous haemofiltration at 2 L/hour of ultrafiltration and a blood flow of 200 mL/minute. Data analysis identified progressive increases in transmembrane pressure (TMP) and prefilter pressure (PFP) from time 0 until 33 hours or clotting. TMP increased from 104 mmHg to 313 mmHg and PFP increased from from 131 mmHg to 185 mmHg. Effluent pressure showed a progressive increase in the negative pressure applied to achieve ultrafiltration from 0 mmHg to -168 mmHg. The inflection point for such changes was also identified. Blood pathway pressures for access and return remained unchanged throughout. CONCLUSIONS: Automated electronic monitoring of circuit pressure during CRRT is possible and provides useful information on the evolution of circuit clotting.

[Comparison of the effect of fluid resuscitation as guided either by lactate clearance rate or by central venous oxygen saturation in patients with sepsis].

OBJECTIVE: To compare the efficacy of fluid resuscitation as guided by lactate clearance rate (LCR) and central venous oxygen saturation (ScvO2) in patients with sepsis. METHODS: A prospective randomized control study was conducted. Fifty patients diagnosed with severe sepsis or septic shock from January 2011 to February 2012 in department of critical care medicine of Fourth Hospital of Hebei Medical University were enrolled in the study. The patients were randomly divided into two groups according to the sequence (each n=25): ScvO2 group and LCR group. After ICU admission, the patients were treated symptomatically timely, and fluid resuscitation was started as early as possible according to Surviving Sepsis Campaign guidance for management of severe sepsis and septic shock 2008. Central venous pressure (CVP)≥8 mm Hg (1 mm Hg=0.133 kPa), mean arterial pressure (MAP)≥65 mm Hg and ScvO2≥0.70 served as goal values to accomplish the fluid resuscitation therapy in ScvO2 group, while CVP≥8 mm Hg, MAP≥65 mm Hg, LCR≥10% served as goal value to accomplish the fluid resuscitation therapy in LCR group. The general condition and clinical characteristics on arrival in ICU, changes in CVP, MAP, ScvO2, lactate level and/or LCR before (0 hour) and 3, 6, 72 hours after the start of fluid resuscitation and the other related conditions during the therapy were recorded. RESULTS: There was no significant difference in general data or clinical characteristics before the start of therapy, occurrence of organ dysfunction, or treatment measures during different time periods after start of fluid resuscitation. Compared with the condition immediately before fluid resuscitation, at 3 hours after start of fluid resuscitation, CVP were improved in LCR and ScvO2 groups (8.58±1.17 mm Hg vs. 6.33±1.21 mm Hg, 9.08±2.43 mm Hg vs. 5.33±0.98 mm Hg, both P<0.05); at 6 hours after start of fluid resuscitation, heart rate (HR) and respiratory rate (RR) were lowered in LCR and ScvO2 groups (HR: 96±18 bpm vs. 127±13 bpm, 98±13 bpm vs. 116±19 bpm, RR: 23±3 times/min vs. 33±9 times/min, 24±5 times/min vs. 35±6 times/min, all P<0.05), oxygenation index (PaO2/FiO2) was increased in LCR and ScvO2 groups (179±41 mm Hg vs. 86±21 mm Hg, 202±33 mm Hg vs. 95±17 mm Hg, both P<0.05), and there was no significant difference in MAP in both groups. There was no significant difference in all indexes between two groups. In LCR group, 3 hours after start of fluid resuscitation, lactate level was significantly decreased (2.81±0.18 mmol/L vs. 3.43±1.31 mmol/L, P<0.05). Compared with the value 3 hours after start of fluid resuscitation, LCR was significantly improved at 6 hours and 72 hours after start of fluid resuscitation in LCR group [(42.69±8.75)%, (48.87±9.69)% vs. (20.32±4.58)%, both P<0.05]. Compared with that immediately before fluid resuscitation, ScvO2 was significant improved in ScvO2 group at 3 hours after start of fluid resuscitation (0.65±0.04 vs. 0.53±0.06, P<0.05). There was no significant difference in success rate of fluid resuscitation comparing that of 6 hours and that of 72 hours [6 hours: 72% (18/25) vs. 64% (16/25), χ(2)=0.368, P=0.762; 72 hours: 88% (22/25) vs. 88% (22/25) ,χ(2)=0.000, P=1.000], length of ICU stay (8±3 days vs. 10±4 days, t=0.533, P=0.874), length of hospital stay (29±11 days vs. 35±16 days, t=0.692, P=0.531), improvement rate [84% (21/25) vs. 76%(19/25), χ(2)=0.500, P=0.480] or 28-day mortality [20% (5/25) vs. 28% (7/25), χ(2)=0.439, P=0.742] between LCR and ScvO2 groups. CONCLUSIONS: Both LCR and ScvO2 can be taken as the index in confirming the endpoint of fluid resuscitation for patients with severe sepsis and septic shock. Fluid resuscitation therapy under the guidance of LCR is accurate and reliable in patients with severe sepsis and septic shock.

Self-reported use of personal protective equipment among Chinese critical care clinicians during 2009 H1N1 influenza pandemic.

BACKGROUND: Critically ill patients with 2009 H1N1 influenza are often treated in intensive care units (ICUs), representing significant risk of nosocomial transmission to critical care clinicians and other patients. Despite a large body of literature and guidelines recommending infection control practices, numerous barriers have been identified in ICUs, leading to poor compliance to the use of personal protective equipment (PPE). The use of PPE among critical care clinicians has not been extensively evaluated, especially during the pandemic influenza. This study examined the knowledge, attitudes, and self-reported behaviors, and barriers to compliance with the use of PPE among ICU healthcare workers (HCWs) during the pandemic influenza. METHODOLOGY/PRINCIPAL FINDINGS: A survey instrument consisting of 36 questions was developed and mailed to all HCWs in 21 ICUs in 17 provinces in China. A total of 733 physicians, nurses, and other professionals were surveyed, and 650 (88.7%) were included in the analysis. Fifty-six percent of respondents reported having received training program of pandemic influenza before they cared for H1N1 patients, while 77% reported to have adequate knowledge of self and patient protection. Only 18% of respondents were able to correctly identify all components of PPE, and 55% reported high compliance (>80%) with PPE use during patient care. In multivariate analysis, vaccination for 2009 H1N1 influenza, positive attitudes towards PPE use, organizational factors such as availability of PPE in ICU, and patient information of influenza precautions, as well as reprimand for noncompliance by the supervisors were associated with high compliance, whereas negative attitudes towards PPE use and violation of PPE use were independent predictors of low compliance. CONCLUSION/SIGNIFICANCE: Knowledge and self-reported compliance to recommended PPE use among Chinese critical care clinicians is suboptimal. The perceived barriers should be addressed in order to close the significant gap between perception and knowledge or behavior.

A preliminary study on the postoperative survival of patients given aspirin after resection for squamous cell carcinoma of the esophagus or adenocarcinoma of the cardia.

BACKGROUND: We examined the effect of aspirin on survival following resection for squamous cell carcinoma (SCC) of the esophagus or adenocarcinoma of the gastric cardia. METHODS: Patients who underwent esophagectomy for these cancers between May 2000 and December 2002 were allocated to one of three groups and given daily either a low dose of aspirin, placebo, or no tablets. RESULTS: The 5-year survival for all patients on aspirin (445) was 51.2%, placebo (658) 41%, and no tablet (495) 42.3% (P = 0.04 for difference between treatments). The 5-year survival for all SCC patients on aspirin (267) was 49.8%, placebo (433) 42.2%, and no tablet (343) 41.2% (P = 0.26). There was a significant improvement in survival for patients with adenocarcinoma of the cardia on aspirin compared with the two control groups combined (P = 0.029). Survival for T2N0M0 SCC patients was significantly improved with aspirin (71) compared with placebo (167) or no tablet (134) (P = 0.0004). However, there was no significant difference between the survival curves for T2N0M0 adenocarcinoma patients on aspirin (21) and the two control groups combined (65) (P = 0.29). CONCLUSIONS: The results of this preliminary study support further investigation of aspirin as adjuvant therapy to improve survival in subsets of postesophagectomy patients.

The effects of a COX-2 inhibitor meloxicam on squamous cell carcinoma of the esophagus in vivo.

Our previous study showed that aspirin induced apoptosis of esophageal cancer cells in vitro by inhibiting the pathway of NF-kappaB downstream regulation of cyclooxygenase-2. The purpose of this study was to determine if similar changes occurred in vivo in the tumors of patients with SCC of the esophagus who were given a preferential COX-2 inhibitor, meloxicam. Fifty-three patients who had an esophagectomy for SCC were allocated randomly to either a Treatment group (n = 25) or a control group (n = 28). Patients in the Treatment group were given 7.5 mg/day of meloxicam, for between 10 and 14 days before surgery. Patients in the control group did not take any type of NSAID during this time interval. Samples of the tumor taken from the resected specimens were collected. Proliferation and apoptosis were measured by flow cytometry. The concentration of 6-keto-prostaglandin F(1)alpha in cancer tissue was determined by radio-immuno-assay. Expression of COX-2 mRNA was measured with RT-PCR and COX-2 protein levels with Western blot analysis. Nuclear NF-kappaB and cytoplasmic I kappaB protein levels were determined by electrophoretic mobility shift assay and Western blot, respectively. There were significantly more apoptotic cells in the tumors of patients who were using meloxicam. It also decreased the levels of COX-2 mRNA, COX-2 protein and nuclear NF-kappaB protein and increased the cytoplasmic I kappaB protein in the cancer. We conclude that meloxicam induces apoptosis in SCC of the esophagus in vivo by inhibiting the pathway of NF-kappaB downstream regulation of COX-2.

[Effect of diallyl trisulfide on tumor necrosis factor-alpha expression and nuclear factor-KappaB activity in mice with acute lung injury induced by lipopolysaccharide].

OBJECTIVE: To investigate the effect of diallyl trisulfide (DATS) on tumor necrosis factor-alpha (TNF-alpha) expression and nuclear factor-KappaB (NF-KappaB) activity in mice with acute lung injury (ALI) induced by lipopolysaccharide (LPS). METHODS: ALI murine model was reproduced by injection of LPS intraperitoneally. Mice were randomly divided into normal saline control group, ALI group, DATS prevention group, DATS treatment group, and DATS control group. The TNF-alpha levels in the serum and in the supernatant of lung homogenates were measured with enzyme linked immunoadsorbent assay (ELISA). The expression of TNF-alpha mRNA in the lung tissues was detected by reverse transcription polymerase chain reaction (RT-PCR). NF-KappaB activity in the lung tissues was detected by electrophoresis mobility shift assay (EMSA). RESULTS: The levels of TNF-alpha induced by LPS in the serum and the supernatant of lung homogenates were increased markedly at 2 hours in ALI group (both P<0.01), and decreased at 6 hours, but they were still higher than those of the control groups (all P<0.01). They were reduced in DATS prevention group at 2 and 6 hours compared with those of ALI group (P<0.05 or P<0.01), but no change was noted in DATS treatment group (all P>0.05). The expression of TNF-alpha mRNA in the lung tissues of ALI group increased markedly at 2 hours compared with those of control groups (both P<0.01), and it could be down-regulated by pretreatment with DATS (P<0.05). No change in DATS was found in treatment group. NF-KappaB activity in the lung tissue increased in ALI group compared with that of control groups (both P<0.05), and it was markedly reduced in DATS prevention group (P<0.05), but no change was found in DATS treatment group. CONCLUSION: Pretreatment of DATS for ALI in mice could inhibit NF-KappaB activity, TNF-alpha mRNA expression in lung tissues, and decrease the release of TNF-alpha in the serum and the lung homogenates, and they might be the underlying mechanisms of prevention of the occurrence of ALI by DATS.

Aspirin induces apoptosis in oesophageal cancer cells by inhibiting the pathway of NF-kappaB downstream regulation of cyclooxygenase-2.

BACKGROUND: Aspirin has potential in the prevention or treatment of oesophageal cancer, the seventh most common cancer in the world, but its mechanism of action is still not certain. METHODS: The oesophageal squamous cell carcinoma cell line TE-13 was cultured with aspirin at different concentrations or for different times. Proliferation and apoptosis were measured by MTT reduction and flow cytometry. Expression of COX-2 mRNA was measured by RT-PCR and COX-2 protein levels with Western blot analysis. Nuclear NF-kappaB and cytoplasmic IkappaB protein levels were determined by electrophoretic mobility shift assay and Western blot, respectively. RESULTS: Aspirin significantly inhibited cell proliferation and induced apoptosis at concentrations of 1, 4, 8 mmol/L. Aspirin dose-dependently decreased the levels of COX-2 mRNA, COX-2 protein and nuclear NF-kappaB protein and increased the cytoplasmic IkappaB protein. CONCLUSION: We conclude that aspirin inhibits the proliferation of, and induced apoptosis in, the cultured TE-13 SCC cell line. These changes correlate with a reduction in COX-2 mRNA and protein expression, prostaglandin synthesis, an inhibition of NF-kappaB nuclear translocation, and an increase in cytoplasmic IkappaB. These results support the further investigation of the cyclooxygenase pathway in investigating the potential of aspirin and similar drugs in cancer prevention and therapy.