Effect of circulating exosomes in patients with sepsis on T cell function / 中华危重病急救医学

OBJECTIVE@#To investigate the effect of circulating exosomes (EXO) on T cell function in patients with sepsis.@*METHODS@#Plasma EXO were obtained by ultracentrifugation from 10 patients with sepsis admitted to the emergency intensive care unit of Guangdong Provincial People's Hospital Affiliated to Southern Medical University. Transmission electron microscopy observation, nanoparticle tracking analysis (NTA), and Western blotting were used to detect EXO markers to identify their characteristics. Furthermore, peripheral blood mononuclear cells (PBMC) were isolated from the peripheral blood of 5 healthy volunteers, primary T cells were sorted by magnetic beads and expanded in vitro. After 24 hours of intervention with different doses (0, 1, 2.5, 5, 10 mg/L) of circulating EXO in patients with sepsis, T-cell activity was assessed using a cell counting kit-8 (CCK-8). The expression of T cell activation indicators CD69 and CD25 were observed using flow cytometry. Additional evaluations were performed on immunosuppressive indicators including the expression of programmed cell death 1 (PD-1) in CD4+ T cells and the proportion of regulatory T cell (Treg).@*RESULTS@#The identification results confirmed that the successful isolation of EXO from the plasma of sepsis patients. The expression level of circulating EXO in sepsis patients was higher than that in healthy control group (mg/L: 48.78±5.14 vs. 22.18±2.25, P < 0.01). After 24 hours of intervention with 5 mg/L of plasma EXO from sepsis patients, T cells activity began to show suppression [(85.84±0.56)% vs. (100.00±0.00)%, P < 0.05]. As the dosage increased, after 24 hours of intervention with 10 mg/L of EXO, T cells activity was significantly suppressed [(72.44±2.36)% vs. (100.00±0.00)%, P < 0.01]. Compared with the healthy control group, after T cells intervention with plasma EXO from sepsis patients, the expression of early activation marker CD69 was significantly reduced [(52.87±1.29)% vs. (67.13±3.56)%, P < 0.05]. Meanwhile, there was an upregulation of PD-1 expression in T cells [(57.73±3.06)% vs. (32.07±0.22)%, P < 0.01] and an increase in the proportion of Treg [(54.67±1.19)% vs. (24.60±3.51)%, P < 0.01]. However, the expression of the late activation marker CD25 remained stable [(84.77±3.44)% vs. (85.93±2.32)%, P > 0.05].@*CONCLUSIONS@#Circulating EXO in sepsis patients induce T cell dysfunction, which may be a novel mechanism lead to immunosuppression in sepsis.

Clinicopathological Characteristics and Prognosis of 35 Cases of Pregnancy-associated Breast Cancer / 肿瘤防治研究

Objective To assess whether pregnancy affects the survival of pregnancy-associated breast cancer (PABC), compared with non-PABC. Methods We retrospectively analyzed the data of PABC patients.PABC cases and non-PABC cases were matched with 1:2 according to T stage, molecular classification, age of onset and year of diagnosis.The Kaplan-Meier method was used to estimate DFS and OS, and Log rank test was used for comparison.Cox regression analysis was used to evaluate the risk factors that affect the prognosis of PABC. Results We enrolled 35 patients in the PABC group (pregnancy: 10;postpartum: 25), and 70 patients in the non-PABC group.The median follow-up time was 68.5 and 70.7 months, respectively.The 5-year DFS was 51.6% in the PABC group, and that of the non-PABC group was 72.8%(χ2=4.72, P=0.029);the 5-year OS of the PABC group and the non-PABC group were similar (χ2=1.769, P=0.183).Cox regression analysis showed that pregnancy was an independent risk factor for DFS of PABC patients (P=0.011). Conclusion Patients with breast cancer during pregnancy have a higher risk of recurrence.Further research is necessary to diagnose pregnancy-associated breast cancer earlier and adopt measures to improve the curative effect.

Dietary selenium enhances the growth and anti-oxidant capacity of juvenile blunt snout bream (Megalobrama amblycephala).

Sodium selenite was added to basal diet at five levels (0.10, 0.42, 0.67, 1.06 and 1.46 mg Se/kg) and fed fish for 8 weeks. The dietary selenium requirement of juvenile blunt snout bream (Megalobrama amblycephala) was quantified. Dietaryseleniums at 0.67-1.06 mg Se/kg improved weight gain rate, specific growth rate and feed efficiency. The optimal amount was 0.96 mg/kg, for which the specific growth rate was 1.798%/day and the weight gain rate was 173.852% (p < 0.05). Se deposition in muscle was increased (p < 0.05) at ≥0.67 mg/kg, but moisture, protein, lipid and ash content were not affected. Physiological status and lipid metabolism were improved by 1.06-1.46 mg/kg dietary selenium based on total protein and albumin in plasma, and total cholesterol and triglycerides (p < 0.05). Activities of hepatic anti-oxidant enzymes catalase, total superoxide dismutase, glutathione peroxidase and reduced glutathione were enhanced at Se1.06 (p < 0.05). However, malondialdehyde content was lowered at Se1.06 (p < 0.05). Expression of anti-inflammatory cytokines, nuclear factor erythroid 2-related factor 2 (Nrf2) and kelch-like ECH-associated protein 1 (Keap-1) in liver were elevated at Se1.06 (p < 0.05), as were mRNA levels of glutathione peroxidase, copper zinc superoxide dismutase and catalase. Expression of pro-inflammatory cytokines, interleukin 8, tumour necrosis factor-α and transforming growth factor-ß were inhibited at 0.67-1.46 mg/kg (p < 0.05). In general, 0.96 mg/kg was optimal, and optimal selenium enhanced antioxidant stress tolerance and anti-inflammatory ability.

The effect of high dose albumin on permeability of blood-brain barrier in brain of rats after ischemic-reperfusion / 中华急诊医学杂志

Objective To determine the effect of high dose albumin on permeability of blood brain barrier (BBB) in brain of rats after ischemic-reperfusion (IR) in order to explore its possible mechanism.Methods Establishment of brain ischemic reperfusion rat model by using middle cerebral artery occlusion (MCAO).Medicine treatment was given by caudal vein injection after 2 hours of MCAO.Thirty-six healthy male SD rats were then randomly (random number) divided into 6 groups (n =6 in each):6 h and 24 h sham-operation groups (Group Sham:operation without ischemia),6 h and 24 h normal saline groups (Group NS:NS injection 5 ml/kg) and 6 h and 24 h albumin group (Group Alb:25 ％ Alb injection 1.25 g/kg).Six hours and 24 hours after the end of reperfusion,rats were measured by Zea-Longa score (neural function deficit) separately.Serum concentration of S100B was examined by the ELISA kit and Evans blue in brain tissue was detected by spectrophotometer.The level of AQP4 was examined by Western blot and immunohistochemistry.All data were analyzed by one-way analysis of variance (ANOVA),The intergroup comparisons were analyzed by the least-significant-difference (LSD) test by using SPSS version 17.0 software.Differences were considered statistically significant if P ＜ 0.05.Results Zea-Longa score significantly increased in both group NS and group Alb at 6 h and 24 h (P =0.000).However,there was no significant difference in ZEA-LONGA score of 6 h and 24 h between group Alb and group NS (P =1.000).The serum concentration of S100B in group NS 6 h was significantly lower than that in group Alb at 6h (196.67±20.11 vs 160.04±14.00,P=0.000),and at24h (2.45±0.07 vs.2.23±0.07,P=0.000).Furthermore,concentration of Evans blue in brain tissue in group Alb was significantly higher than that in group NS at both 6 h (0.97 ± 0.08 vs.0.74 ± 0.06,P =0.000) and 24 h (2.45 ± 0.07 vs.2.23 ± 0.07,P =0.000).The expression of AQP4 in brain tissue was higher in group Alb than that in group NS at both 6 h (0.72 ±.0.11 vs.0.57 ± 0.06,P ＜ 0.01) and 24 h (0.80 ± 0.03 vs 0.61 ± 0.02,P ＜0.01).Conclusions High dose albumin contribute slightly in improvement of neural deficit in rats after IR.On the contrary,it can also aggravate the IR injury,which increases brain edema then increase the permeability of BBB.The mechanism may be associated with over-expression of AQP4 in brain tissue.

Analysis of the clinical effect of noninvasive positive pressure ventilation in the treatment of acute respiratory ;distress syndrome / 中华危重病急救医学

Objective To evaluate the clinical efficacy of noninvasive positive pressure ventilation (NPPV) in the treatment of patients with acute respiratory distress syndrome (ARDS), and to look for the predictors of failure of NPPV. Methods A retrospective observation was conducted. ARDS patients underwent NPPV admitted to emergency intensive care unit (EICU) of Guangdong General Hospital from January 2013 to December 2015 were enrolled. The patients were divided into success group and failure group according to the clinical efficacy. The condition of the patients in the two groups was evaluated, and ARDS classification and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score before treatment were recorded. Etiological composition of ARDS was analyzed. The parameters, including heart rate (HR), respiratory rate (RR), oxygenation index (PaO2/FiO2), arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2) and arterial oxygen saturation (SaO2), were recorded before and 2 hours after the treatment of NPPV. Multivariate logistic regression analysis was conducted for predicting the independent factors inducing the failure of NPPV treatment of patients with ARDS. Results The date of 137 patients with ARDS were collected, excluding the followed patients, 6 with coma, 18 with hemodynamic instability, 5 with severe hypoxia, and 5 with incomplete date. Finally, a total of 103 patients entered the statistics. There were 69 patients in NPPV success group, and 34 in failure group. Compared with success group, APACHE Ⅱ score in the failure group was higher (21.4±6.2 vs. 19.7±8.9), the ratios of patients with severe ARDS and those induced by pulmonary infection were higher [82.4% (28/34) vs. 5.8% (4/69), 32.4% (11/34) vs. 8.7% (6/69), respectively, both P < 0.05]. HR and RR before NPPV in the failure group were significantly higher than those of success group [HR (bpm): 124±13 vs. 117±12, RR (bpm): 39±5 vs. 33±4], and PaO2/FiO2, PaO2, PaCO2, and SaO2 were significantly lower than those of the success group [PaO2/FiO2 (mmHg, 1 mmHg = 0.133 kPa): 104±10 vs. 156±12, PaO2 (mmHg): 53±8 vs. 68±7, PaCO2 (mmHg): 31±5 vs. 37±7, SaO2: 0.83±0.07 vs. 0.91±0.05, all P < 0.05]. It was shown by logistic regression analysis that severe ARDS [odds ratio (OR) = 10.533, 95% confidence interval (95%CI) = 5.847-89.852, P = 0.000], pulmonary infection resulted ARDS (OR = 4.831, 95%CI = 1.688-13.825, P = 0.003) and PaO2/FiO2 < 140 mmHg 2 hours after treatment (OR = 7.049, 95%CI = 1.266-39.236, P = 0.026) were the independent risk factors of NPPV failure for the treatment of patients with ARDS. Conclusions Patients with severe ARDS and pulmonary infection derived ARDS were the risk factors of failure to NPPV in ARDS. Lack of improvement in oxygenation 2 hours after NPPV is the predictor of NPPV failure and change to invasive ventilation.

The effectiveness evaluation of helicopter emergency medical services on transporting critical patients / 中华急诊医学杂志

Objective To explore the advantages and disadvantages of helicopter emergency medical services of South China in the long-distance transport for critical patients.Methods A total of 30 patients who received helicopter emergency medical services by Guangdong Generral Hospital from August 2004 to December 2014 were selected as the observation group,and the other 30 patients with similar conditions who received ground emergency medical services were selected as the control group.To analyses the difference between the two groups in the disease,transport distance,transportation time,costs and compliction by χ2-test,t-test and nonparametric test according types of data.Results There were significantly difference between two groups in transport distances (km) [578.0 (313.0,707.5)vs.214.5 (101.5,313.5),P 0.05).Conclusions Helicopter emergency medical services could shorten the transportation time of critical patients on long distance transportation,and improve the efficiency of first-aid.However,there were many disadvantages that need to be improved in the helicopter emergency medical service of China.

The effect of hypertonic saline on notch signaling pathway in experimentally induced cerebral ischemic rats / 中华急诊医学杂志

Objective To explore whether hypertonic saline would partake in regulating Notch signaling in microglia in experimentally induced cerebral ischemic rats.Methods Male SD rats were randomly divided into sham group, cerebral ischemia group, normal saline group ( NS group ) , 10%hypertonic saline group (10%HS group) , the model of cerebral ischemia were established in all rats except the sham group by using middle cerebral artery occlusion ( MCAO) .After 2 hours of MCAO, the rats were through reperfusion for 24 h.In addition, rats in the normal saline group and 10% HS group were respectively treated with a continuous intravenous injection of normal saline (0.3 mL/h) and 10%HS (0.3 mL/h) by tail vein for 24 h.Immunofluorescence methods, RT-PCR and Western blot were used to detect the expression of Notch1 and intracellular Notch receptor domain ( NICD) .All data was analyzed by one-way analysis of variance ( ANOVA) , The intergroup comparisons were analyzed by the least-significant-difference (LSD) tests.Differences were considered statistically significant if P<0.05.Results Immunofluorescence showed that the expression of Notch1 and NICD were significantly increased in the microglia around peri-ischemia area in cerebral ischemia group and normal saline group compared to sham group;the expression of Notch1 and NICD in the microglia around peri-ischemia area were significantly reduced in 10% HS group compared to ischemia group and NS group.RT-PCR showed that the mRNA expression of Notch1 was significantly increased in ischemia group and NS group compared to sham group ( sham group: 1.000 ± 0.076; ischemia group: 2.203 ±0.283; NS group: 1.616 ±0.185; P <0.01 ); however, it was significantly reduced in 10% HS group compared to ischemia group and NS group ( ischemia group:2.203 ±0.283; NS group: 1.616 ±0.185; 10%HS group: 1.202 ±0.177; P <0.05 ) .Western blot showed that the protein expression of Notch1 was significantly increased in ischemia group and NS group compared to sham group ( sham group: 0.290 ±0.079; ischemia group: 0.750 ±0.029; NS group:0.765 ±0.182;P<0.01);but was significantly reduced in 10%HS group compared to ischemia group and NS group ( ischemia group:0.750 ±0.029; NS group:0.765 ±0.182;10%HS group:0.390 ±0.195;P<0.05 ) .The protein expression of NICD was significantly increased in ischemia group and NS group compared to sham group ( sham group: 0.401 ±0.196; ischemia group: 0.906 ±0.359; NS group:0.847 ±0.153;P<0.01);but was significantly reduced in 10%HS group compared to ischemia group and NS group ( ischemia group:0.906 ±0.359; NS group:0.847 ±0.153;10%HS group:0.561 ±0.165;P<0.05 ) .Conclusion Our results suggest that HS markedly suppresses Notch signaling in microglia around the ischemia tissue area in experimental induced cerebral ischemic rats.

[Esmolol improves clinical outcome and tissue oxygen metabolism in patients with septic shock through controlling heart rate].

OBJECTIVE: To investigate whether esmolol could improve clinical outcome and tissue oxygen metabolism by controlling heart rate (HR) in patients with septic shock. METHODS: A single-center double-blinded randomized controlled trial was conducted. The patients suffering from septic shock received 6-hour early goal directed herapy (EGDT) with pulmonary artery wedge pressure ≥ 12 mmHg (1 mmHg = 0.133 kPa) or central venous pressure CVP) ≥ 12 mmHg requiring norepinephrine to maintain mean arterial pressure (MAP) ≥ 65 mmHg and HR ≥ 95 bpm admitted to intensive care unit (ICU) of Guangdong General Hospital from September 2013 to September 2014 were enrolled. They were randomly divided into esmolol group and control group by computer-based random number generator. All patients received conventional basic treatment, while those in the esmolol group received in addition persistent esmolol infusion by micro pump with dosage of 0.05 mg · kg(-1) · min(-1) with the dosage adjusted to maintain HR lower than 100 bpm within 24 hours. The patients in control group did not receive drug intervention for HR. The primary end-points consisted of length of stay in ICU and 28-day mortality. The secondary end-points included hemodynamic parameters [HR, MAP, CVP, cardiac index (CI), stroke volume index (SVI), systemic vascular resistance index (SVRI)] and tissue oxygen metabolism parameters [central venous oxygen saturation (ScvO2), lactate level (Lac)] before and 24, 48, 72 hours after the treatment. RESULTS: A total of 48 patients with septic shock were enrolled with 24 patients in esmolol group and 24 in control group. (1) The primary end-points: compared with control group, the length of stay in the ICU in the esmolol group was significantly shortened (days: 13.75 ± 8.68 vs. 21.70 ± 6.06, t = 3.680, P = 0.001), and 28-day mortality was significantly lowered [25.0% (6/24) vs. 62.5% (15/24 ), χ2 = 6.857, P = 0.009]. (2) The secondary end-points: there were no significant difference in the hemodynamic and tissue metabolism parameters before treatment between two groups. No significant difference was found between before and after treatment of all above parameters in control group. HR and Lac in the esmolol group were obviously declined, SVI, SVRI, SCvO2 were gradually increased, but no significant difference in MAP, CVP, and CI was found. Compared with the control group, HR in the esomolol group was significantly lowered (bpm: 84.4 ± 3.5 vs. 111.2 ± 7.2, P < 0.01), SVRI and ScvO2 were significantly increased from 24 hours [SVRI (kPa · s · L(-1) ·m(-2)): 137.9 ± 1.6 vs. 126.9 ± 1.3, ScvO2: 0.652 ± 0.017 vs. 0.620 ± 0.017, both P < 0.01]; SVI was significantly increased (mL/m2: 39.9 ± 2.2 vs. 36.8 ± 1.7, P < 0.01) and Lac level significantly declined from 48 hours (mmol/L: 2.8 ± 0.3 vs. 3.4 ± 0.3, P < 0.01). CONCLUSION: The results demonstrate that HR controlled by a titrated esmolol infusion given to septic shock patients was associated with an improvement in tissue metabolism, reduction in the length of ICU stay and lowering of 28-day mortality.

Esmolol improves clinical outcome and tissue oxygen metabolism in patients with septic shock through controlling heart rate / 中华危重病急救医学

ObjectiveTo investigate whether esmolol could improve clinical outcome and tissue oxygen metabolism by controlling heart rate (HR) in patients with septic shock.Methods A single-center double-blinded randomized controlled trial was conducted. The patients suffering from septic shock received 6-hour early goal directed therapy (EGDT) with pulmonary artery wedge pressure≥ 12 mmHg (1 mmHg = 0.133 kPa) or central venous pressure (CVP)≥ 12 mmHg requiring norepinephrine to maintain mean arterial pressure (MAP)≥ 65 mmHg and HR≥95 bpm admitted to intensive care unit (ICU) of Guangdong General Hospital from September 2013 to September 2014 were enrolled. They were randomly divided into esmolol group and control group by computer-based random number generator. All patients received conventional basic treatment, while those in the esmolol group received in addition persistent esmolol infusion by micro pump with dosage of 0.05 mg·kg-1·min-1 with the dosage adjusted to maintain HR lower than 100 bpm within 24 hours. The patients in control group did not receive drug intervention for HR. The primary end-points consisted of length of stay in ICU and 28-day mortality. The secondary end-points included hemodynamic parameters [HR, MAP, CVP, cardiac index (CI), stroke volume index (SVI), systemic vascular resistance index (SVRI)] and tissue oxygen metabolism parameters [central venous oxygen saturation (ScvO2), lactate level (Lac)]before and 24, 48, 72 hours after the treatment.Results A total of 48 patients with septic shock were enrolled with 24 patients in esmolol group and 24 in control group.① The primary end-points: compared with control group, the length of stay in the ICU in the esmolol group was significantly shortened (days: 13.75±8.68 vs. 21.70±6.06,t = 3.680, P = 0.001), and 28-day mortality was significantly lowered [25.0% (6/24) vs. 62.5% (15/24),χ2 = 6.857,P = 0.009].② The secondary end-points: there were no significant difference in the hemodynamic and tissue metabolism parameters before treatment between two groups. No significant difference was found between before and after treatment of all above parameters in control group. HR and Lac in the esmolol group were obviously declined, SVI, SVRI, ScvO2 were gradually increased, but no significant difference in MAP, CVP, and CI was found. Compared with the control group, HR in the esomolol group was significantly lowered (bpm: 84.4±3.5 vs. 111.2±7.2,P< 0.01), SVRI and ScvO2 were significantly increased from 24 hours [SVRI (kPa·s·L-1·m-2): 137.9±1.6 vs. 126.9±1.3, ScvO2: 0.652±0.017 vs. 0.620±0.017, bothP< 0.01]; SVI was significantly increased (mL/m2: 39.9±2.2 vs. 36.8±1.7,P< 0.01) and Lac level significantly declined from 48 hours (mmol/L: 2.8±0.3 vs. 3.4±0.3,P< 0.01).Conclusion The results demonstrate that HR controlled by a titrated esmolol infusion given to septic shock patients was associated with an improvement in tissue metabolism, reduction in the length of ICU stay and lowering of 28-day mortality.

Effects and its mechanisms of hypertonic saline hydroxyethyl starch 200/0.5 solution in rats with ischemic cerebral edema / 中华急诊医学杂志

Objective To investigate effects and its mechanisms of hypertonic saline hydroxyethyl starch 200/0.5 solution on intracranial pressure and brain water content in rats with ischemic cerebral edema.Methods All experiments were conducted in the animal experimental center of Sun Yat-sen University.The 28 male Sprague-Dawle (SD) rats were randomly (random number) divided into hypertonic saline hydroxyethyl starch group,hydroxyethyl starch group,control group and sham operation group,each n =7.Ischemic cerebral edema model was reproduced by middle cerebral artery occlusion (MCAO),followed by reperfusion after ischemia for 2 hours (If the moldel was not successful,other rats were operated to fill the missing models).Then reperfusion after ischemia 2 hours and received hypertonic saline hydroxyethyl starch and hydroxyethyl starch via tail vein at the beginning of reperfusion.The colloidal osmotic pressure (COP) and intracranial pressure (ICP) were evaluated on 0,2,6,12,18,24 hours after the surgery.The water content of the right hemisphere was measured on 24 h after the surgery.Results The ICP of hypertonic saline hydroxyethyl starch group,hydroxyethyl starch group and control group were significantly higher than that of sham operation group on 2,6,12,18,24 h after the surgery.The ICP of hypertonic saline hydroxyethyl starch group was significantly lower than those of hydroxyethyl starch group and control group on 2,6,12,18 and 24 h.But there was no significant difference in ICP of the hydroxyethyl starch group compared with that of control group at all time points.The COP of hypertonic saline hydroxyethyl starch group and hydroxyethyl starch group were significantly higher than the control group and sham operation group at each time point; There was no significant difference in COP (mmHg) of the hydroxyethyl starch group compared with that of hypertonic saline hydroxyethyl starch group at all time points.The brain water content (BWC) of hypertonic saline hydroxyethyl starch group,hydroxyethyl starch group and control group were significantly higher than that of sham operation group on 24 hours after the surgery [(81.24±0.36)％,(83.04±0.10)％,(83.14±0.41)％ vs.(78.37±0.37)％,all P=0.000],BWC of hypertonic saline hydroxyethyl starch group lower than these of hydroxyethyl starch group [(81.24±0.36)％ vs.(83.04 ±0.10) ％,P =0.000] and control group [(81.24 ±0.36)％ vs.(83.14 ±0.41) ％,P =0.000].There was no significant difference in BWC of the hydroxyethyl starch group compared with that of control group [(83.04 ± 0.10) ％ vs.(83.14 ± 0.41) ％,P =0.578].Conclusion Hypertonic saline hydroxyethyl starch solution could significantly ameliorate ischemic cerebral edema and reduce ICP,but the relationship between its elevated COP and reduced ICP has not been confirmed.

Significance of the ratio of plasma vascular endothelial growth factor level to platelet count in the prognosis of patients with sepsis / 中华危重病急救医学

Objective To investigate the clinical value of the ratio of plasma vascular endothelial growth factor level to platelet count (VEGF/PLT) in predicting 28-day prognosis in patients with sepsis.Methods A prospective cohort study was conducted.From September 2009 to March 2013,164 sepsis patients in Intensive Care Unit (ICU) of Guangdong General Hospital were included for study.Patients with age younger than 18 years old,the illness already reaching final stage of chronic diseases,suffering from two or more organs dysfunction within 3 days,acute pancreatitis without infection,or less than 28 days of expected survival time were excluded.Finally,135 patients were included in the further analysis.Peripheral blood samples were collected at admission.Routine blood tests were done,and then VEGF levels in plasma were measured by enzyme linked immunosorbent assay (ELISA).Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores were recorded every day for 7 days.Patients' prognosis was assessed during the following 28 days.The patients were divided into 28-day survival group and non-survival group.Comparison between two groups was done by single factor analysis.Spearman rank correlation was used to analyze the correlation between VEGF levels and PLT.Mutivariate logistic regression analysis was performed to identify the independent risk factor for 28-day prognosis.Receiver operating characteristic curve (ROC curve) was plotted,and the effect of related indexes on predicting 28-day survival was evaluated by area under ROC curve (AUC).Results There were no significant differences in VEGF (ng/L:471.73 ± 198.34 vs.383.49 ± 266.54,t=-1.918,P=0.057),PLT (× 109/L:220.40±127.60 vs.246.42± 100.72,t=1.275,P=0.204),leucocyte counts (× 109/L:12.48 ±4.62 vs.13.70 ±5.97,t=1.063,P=0.292),mean arterial pressure [mmHg (1 mmHg=0.133 kPa):86.50 ± 12.04 vs.91.03 t 13.10,t=1.557,P=0.123] and blood lactic acid (mmol/L:1.79 ± 1.30 vs.1.50 ± 0.60,t=-1.768,P=0.079) at admission between the non-survival group (n=42) and survival group (n=93).VEGF/PLT (2.59 ± 1.44 vs.1.73 ± 1.13,t=-3.756,P=0.000) as well as APACHE Ⅱ scores (15.50 ± 4.50 vs.13.28 ± 4.61,t =-2.022,P=0.045) of the non-survival group were significantly higher than those of survival group,and oxygenation index (PaO2/FiO2) of the non-survival group was significantly lower than that of survival group (kPa:32.38 ± 11.12 vs.37.04 ± 10.97,t=2.278,P=0.024).Correlation analysis showed that the concentration of VEGF was positively correlated with PLT (r=0.271,P=0.001).It was shown by multivariate logistic regression analysis that only VEGF/PLT was the independent risk factor in predicting 28-day prognosis in patients with sepsis [odds ratio (OR) was 1.591,95％ confidence interval (95％CI) 1.164-2.175,P=0.004].AUC of VEGF/PLT was 0.704 ± 0.047 (P=0.000,95％CI:0.611-0.797) for predicting 28-day survival.The optimal cut-off point was 1.32,and the sensitivity and specificity were 81.0％ and 48.4％,respectively.Conclusion VEGF/PLT can be used as one of the indicators to predict 28-day survival in patients with sepsis.

Use of Antibacterials and Drug Resistance in Our Hospital in 2006 / 中国药房

50.0%.CONCLUSION:The extensive use of antibacterials results in increased drug resistance,while rational use of antibiotics is the key of decreasing drug resistance and multidrug resistance.It is of great importance to analyze the variation of bacterial drug resistance in area hospital.