[Establishment and analysis of an early prognosis model of patients with acute kidney injury in intensive care unit].

OBJECTIVE: To establish a predictive model for the progression of acute kidney injury (AKI) to stage 3 AKI (renal failure) in the intensive care unit (ICU), so as to assist physicians to make early and timely decisions on whether to intervene in advance. METHODS: A retrospective analysis was conducted. Thirty-eight patients with AKI admitted to the intensive care medicine of the Third People's Hospital of Henan Province from January 2018 to May 2023 were enrolled. Patient data including acute physiology and chronic health evaluation II (APACHE II) upon admission, serum creatinine (SCr), blood urea nitrogen (BUN), daily urine output during hospitalization, and the timing of continuous renal replacement therapy (CRRT) intervention were recorded. Based on clinically collected pathological data, standardized creatinine value ratio mean polynomial fitting models were established as the first criterion for judging the progression to stage 3 AKI after data cleansing, screening, and normalization. Additionally, standardized creatinine value ratio index fitting models were established as the second criterion for predicting progression to stage 3 AKI. RESULTS: A total of 38 AKI patients were included, including 25 males and 13 females. The average age was (58.45±12.94) years old. The APACHE II score was 24.13±4.17 at admission. The intervention node was (4.42±0.95) days. Using a dual regression model approach, statistical modeling was performed with a relatively small sample size of statistical data samples, yielding a scatter index non-linear regression model for standardized creatinine value ratio data relative to day "n", with y = 1.246 2x1.164 9 and an R2 of 0.860 1, indicating reasonable statistical fitting. Additionally, a quadratic non-linear regression model was obtained for the mean standardized creatinine value ratio relative to day "n", with y = -0.260 6x2+3.010 7x-1.612 and an R2 of 0.998 9, indicating an excellent statistical fit. For example, using a baseline SCr value of 66 µmol/L for a healthy individual, the dual regression model predicted that the patient would progress to stage 3 AKI within 3-5 days. This prediction was consistent when applied to other early intervention renal injury patients. CONCLUSIONS: The established model effectively predicts the time interval of the progression of AKI to stage 3 AKI (renal failure), which assist intensive care physicians to intervene AKI as early as possible to prevent disease progression.

Serum expression levels of Mb and NT-proBNP and NF-κB expression in neutrophils in patients with MODS and the clinical significance.

This study was designed to investigate the expression of myoglobin (Mb), N-terminal pro-brain natriuretic peptide (NT-proBNP) in serum and the expression of nuclear factor-κB (NF-κB) in neutrophils in patients with multiple organ dysfunction syndrome (MODS) and the clinical significance. From July 2014 to December 2015, 314 patients with severe disease were selected during their stays at the emergency ward of the Third People's Provincial Hospital of Henan Province (Zhengzhou, China). Seventy patients with MODS were selected as MODS group, 108 patients with single organ or system injury were selected as the key prevention group, and 136 patients without obvious organ or systemic injury were selected as prevention group. Serum levels of Mb and NT-proBNP were measured by ELISA. Neutrophils were isolated by flow cytometry, and the activity of NF-κB in neutrophils of MODS patients was measured by electrophoretic mobility shift assay (EMSA). At 1, 7 and 14 days after treatment, the levels of Mb, NT-proBNP and NF-κB in the three groups were significantly reduced compared with pretreatment levels (p<0.05). Logistic regression analysis showed that serum Mb, NT-proBNP and NF-κB activity were positively correlated with the progression of the disease (r=0.809, 0.785 and 0.833, p=0.012, 0.025 and 0.004), and negatively correlated with the treatment time (r=-0.773, -0.734 and -0.815; p=0.033, 0.041 and 0.078). Mb, NT-proBNP and NF-κB may be involved in the pathogenesis and development of MODS, and may play an important role in the prevention and treatment of MODS.

[Effect of enteral nutrition time on pH value of gastric juice and ventilator-associated pneumonia in critically ill patient].

OBJECTIVE: To investigate the effect of enteral nutrition (EN) start time on pH value of gastric juice and ventilator-associated pneumonia (VAP) in critically ill patients with invasive mechanical ventilation, so as to provide reference for the rational selection of EN timing. METHODS: Patients with mechanical ventilation who underwent EN treatment admitted to the intensive care unit (ICU) of the First Affiliated Hospital of Zhengzhou University from January 1st, 2016 to November 30th, 2017 were enrolled, and the inclusion criteria were age ≥ 18 years, acute physiology and chronic health evaluation II (APACHE II) ≤ 15, and nutritional risk screening (NRS 2002) ≥ 3. Patients were divided into two groups according to the start time of EN: early EN group (implementation of EN within 48 hours after mechanical ventilation) and late EN group (implementation of EN after 48 hours after mechanical ventilation). The pH value of gastric juice, VAP incidence, mechanical ventilation time, and the length of ICU stay were compared between the two groups. RESULTS: A total of 108 patients were included, 54 in the early EN group and 54 in the late EN group respectively. The pH value of gastric juice in early EN group was lower than that in late EN group [4.8 (3.8, 5.8) vs. 5.6 (4.6, 6.6), P < 0.01]. There were 8 patients with VAP in the early EN group, 3 of whom were early onset VAP. There were 17 patients with VAP in the late EN group, 10 of whom were early onset VAP. The incidence of VAP and the incidence of premature VAP in the early EN group were significantly lower than those in the late EN group (14.8% vs. 31.5%, 5.6% vs. 18.5%, both P < 0.05). The mechanical ventilation time [days: 7.5 (5.7, 9.0) vs. 8.6 (6.8, 10.7) and the length of ICU stay [days: 10.0 (8.5, 11.7) vs. 11.0 (9.5, 12.6)] in the early EN group were significantly shorter than those in the late EN group (all P < 0.05). CONCLUSIONS: At the same time of protecting gastric mucosa, early EN is helpful to reduce the incidence of VAP, reduce the duration of mechanical ventilation and the length of ICU stay, and improve the prognosis.

[Breast cancer screening of 20,000 women in Guizhou Province].

OBJECTIVE: To assess the appropriateness of breast cancer screening technologies in Guizhou province. METHODS: We conducted a questionnaire survey, physical examinations, and high-frequency color Doppler ultrasound examinations in 20 183 women from 2010 to 2012 in Guizhou province. Biopsy was performed in those with suspected breast cancers. RESULTS: The participants included 12,089 women who received repeated screening and 8,094 women who were given the screening service for the first time. Ten from the former group were identified with breast cancer (82.7/100 thousand), with the majority (80%) at an early stage. Eleven from the latter group were identified with breast cancer (135.9/100 thousand), 36.4% of whom being at an early stage. This resulted in a detection of 104 per 100 thousand breast cancers, with 57.1% at an early stage (0, I stage). The age of the women with breast cancer ranged from 35 to 80 years old. The prevalence peaked at 41-60 years of age, with 71.4% (15/21) falling into this age group (P < 0.05). Solid and cystic masses were found in 246 participants, with a minimum mass of 0.2 cm x 0.3 cm. Of the 228 participants diagnosed with benign masses, 225 (98.7%) were confirmed by biopsy results. The biopsy also confirmed 6 precancerous lesions. CONCLUSION: Guizhou had a prevalence of breast cancer of 104/100 thousand, which peaked at 41-60 years old. The screening method used in this study is appropriate.