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1.
Clin Rheumatol ; 39(11): 3479-3488, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32372293

RESUMO

OBJECTIVE: The etiologies of acute respiratory failure in patients with systemic rheumatic diseases (SRDs) requiring intensive care remain unknown. This study was undertaken to investigate the etiologies and outcomes. METHODS: A medical records review study was performed of 259 adult SRDs patients with respiratory failure admitted to medical ICU across a 5-year period. The etiologies were classified as infection, SRD exacerbation, and undetermined. The factors associated with ICU mortality were identified with multivariate logistic regression analysis. RESULTS: The etiologies of respiratory failure included infection (n = 209, 80.7%), SRD exacerbation (n = 71, 27.4%), and undetermined (n = 21, 8.1%). The most common pathogen was Pneumocystis jirovecii (39.8%), followed by Aspergillus spp. (33.2%), and cytomegalovirus (23.2%). The ICU mortality rate was 59.8%. A high acute physiology and chronic health evaluation II score (OR 1.118, 95% CI 1.054 to 1.186, p < 0.001), a PaO2/FiO2 ratio < 100 mmHg (OR 3.918, 95% CI 2.199 to 6.892, p < 0.001), and a diagnosis of dermatomyositis/polymyositis (OR 4.898, 95% CI 1.949 to 12.309, p = 0.001), vasculitis (OR 3.007, 95% CI 1.237 to 7.309, p = 0.015), and Pneumocystis pneumonia (OR 2.345, 95% CI 1.168 to 4.705, p = 0.016) were associated with increased mortality. CONCLUSIONS: Opportunistic infections and SRD exacerbation were the most common etiologies of acute respiratory failure in patients with SRDs requiring ICU admission, with high ICU mortality. Development of a standard protocol for differential diagnosis in this population might help initiate definitive therapy and improve clinical outcome. Key Points • Infections, especially with opportunistic infections, were the leading cause of acute respiratory failure in critically ill rheumatology patients, with high mortality. • Severity of illness, certain types of rheumatic diseases, and opportunistic fungal infections were associated with increased mortality. • Using a comprehensive diagnostic workup might help to confirm the infective etiology and improve outcome.


Assuntos
Insuficiência Respiratória , Reumatologia , Adulto , Cuidados Críticos , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Registros Médicos , Insuficiência Respiratória/epidemiologia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia
3.
Chin Med J (Engl) ; 132(17): 2039-2045, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31425273

RESUMO

BACKGROUND: With the publication of Sepsis-3 definition, epidemiological data based on Sepsis-3 definition from middle-income countries including China are scarce, which prohibits understanding of the disease burden of this newly defined syndrome in these settings. The purpose of this study was to describe incidence and outcome of Sepsis-3 in Yuetan sub-district of Beijing and to estimate the incidence rate of Sepsis-3 in China. METHODS: The medical records of all adult residents hospitalized from July 1, 2012 to June 30, 2014 in Yuetan sub-district of Beijing were reviewed. Patients with sepsis-3 and severe sepsis/septic shock were identified. The incidence rates and mortality rate of sepsis-3 and sepsis/septic shock were calculated, incidence rates and in-hospital mortality rates were normalized to the population distribution in the 2010 National Census. Population incidence rate and case fatality rate between sexes were compared with the Z test, as the data conformed to Poisson distribution. RESULTS: Of the 21,191 hospitalized patients, 935 patients were diagnosed with Sepsis-3, and 498 cases met severe sepsis/septic shock criteria. The crude annual incidence rate of Sepsis-3 in Yuetan sub-district was 363 cases per 100,000 population, corresponding to standardized incidence rates of 236 cases per 100,000 population per year, respectively. The overall case fatality rate of Sepsis-3 was 32.0%, the crude population mortality rates of Sepsis-3 was 116 cases per 100,000 population per year, the standardized mortality rate was 67 cases per 100,000 population per year, corresponding to a speculative extrapolation of 700,437 deaths in China. The incidence rate and mortality rate of Sepsis-3 were significantly higher in males, elderly people, and patients with more comorbidities. The 62.1% of patients with Sepsis-3 had community-acquired infections, compared with 75.3% of infected patients without Sepsis-3 (P < 0.001). The most common infection in patients with Sepsis-3 was lower respiratory tract infection. When compared with patients with Sepsis-3, patients diagnosed as severe sepsis/septic shock were more likely to have higher case fatality rate (53.4% vs. 32.0%, P < 0.001) CONCLUSIONS:: This study found the standardized incidence rate of 236 cases per 100,000 person-year for Sepsis-3, which was more common in males and elderly population. This corresponded to about 2.5 million new cases of Sepsis-3 per year, resulting in more than 700,000 deaths in China. CLINICAL TRIAL REGISTRATION: NCT02285257, https://clinicaltrials.gov/ct2/show/record/NCT02285257.


Assuntos
Sepse/epidemiologia , Choque Séptico/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Pequim/epidemiologia , Mortalidade Hospitalar , Humanos , Pessoa de Meia-Idade , Sepse/mortalidade , Choque Séptico/mortalidade
4.
Intensive Care Med ; 44(7): 1071-1080, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29846748

RESUMO

PURPOSE: A population-level description and analysis of sepsis-related mortality in China is key to the planning and assessment of interventional strategies. METHODS: Retrospective analysis of multiple cause of death (MCOD) recorded in the population-based national mortality surveillance system (NMSS) of China. All sepsis-related deaths occurring in 605 disease surveillance points (DSPs) covering 323.8 million population across China were included in our study. Age-standardized mortality and national estimate of sepsis-related deaths were estimated using the census population in 2010 and 2015, respectively. RESULTS: In 2015, a total of 1,937,299 deaths occurring in any of the 605 DSPs and standardized sepsis-related mortality rate was 66.7 (95% confidence interval [CI] 66.4-67.0) deaths per 100,000 population. This produced a national estimate of 1,025,997 sepsis-related deaths. Sepsis-related mortality rates exhibited significant geographic variation. In multilevel analysis, male sex (rate ratio [RR] 1.582, 95% CI 1.570-1.595), increasing age (RR 1.914 for 5-year group, 95% CI 1.910-1.917), and presence of comorbidity (RR 2.316, 95% CI 2.298-2.335) were independently associated with increased sepsis-related mortality. Higher disposable income (RR 0.717 for the fourth interquartile range vs. the first interquartile range, 95% CI 0.515-0.978) and mean years of education (RR 0.808 for the fourth interquartile range vs. the first interquartile range, 95% CI 0.684-0.955) were negatively associated with sepsis-related mortality. However, population-based hospital doctors were not significantly associated with sepsis-related mortality. CONCLUSIONS: The standardized sepsis-related mortality rate in China was high and varied according to socioeconomic indices, even though some uncertainty remained.


Assuntos
Sepse , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Criança , Pré-Escolar , China/epidemiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Vigilância da População , Estudos Retrospectivos , Sepse/mortalidade , Adulto Jovem
5.
Crit Care ; 22(1): 20, 2018 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-29374489

RESUMO

BACKGROUND: Pharmacologic stress ulcer prophylaxis (SUP) is recommended in critically ill patients with high risk of stress-related gastrointestinal (GI) bleeding. However, as to patients receiving enteral feeding, the preventive effect of SUP is not well-known. Therefore, we performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of pharmacologic SUP in enterally fed patients on stress-related GI bleeding and other clinical outcomes. METHODS: We searched PubMed, Embase, and the Cochrane database from inception through 30 Sep 2017. Eligible trials were RCTs comparing pharmacologic SUP to either placebo or no prophylaxis in enterally fed patients in the ICU. Results were expressed as risk ratio (RR) and mean difference (MD) with accompanying 95% confidence interval (CI). Heterogeneity, subgroup analysis, sensitivity analysis and publication bias were explored. RESULTS: Seven studies (n = 889 patients) were included. There was no statistically significant difference in GI bleeding (RR 0.80; 95% CI, 0.49 to 1.31, p = 0.37) between groups. This finding was confirmed by further subgroup analyses and sensitivity analysis. In addition, SUP had no effect on overall mortality (RR 1.21; 95% CI, 0.94 to 1.56, p = 0.14), Clostridium difficile infection (RR 0.89; 95% CI, 0.25 to 3.19, p = 0.86), length of stay in the ICU (MD 0.04 days; 95% CI, -0.79 to 0.87, p = 0.92), duration of mechanical ventilation (MD -0.38 days; 95% CI, -1.48 to 0.72, p = 0.50), but was associated with an increased risk of hospital-acquired pneumonia (RR 1.53; 95% CI, 1.04 to 2.27; p = 0.03). CONCLUSIONS: Our results suggested that in patients receiving enteral feeding, pharmacologic SUP is not beneficial and combined interventions may even increase the risk of nosocomial pneumonia.


Assuntos
Úlcera Duodenal/prevenção & controle , Nutrição Enteral/métodos , Antagonistas dos Receptores H2 da Histamina/uso terapêutico , Úlcera Péptica/prevenção & controle , Gestão de Riscos/métodos , Infecções por Clostridium/epidemiologia , Infecções por Clostridium/prevenção & controle , Cuidados Críticos/métodos , Úlcera Duodenal/tratamento farmacológico , Úlcera Duodenal/mortalidade , Hemorragia Gastrointestinal/prevenção & controle , Antagonistas dos Receptores H2 da Histamina/farmacologia , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/tendências , Úlcera Péptica/tratamento farmacológico , Úlcera Péptica/mortalidade , Respiração Artificial/métodos , Respiração Artificial/tendências , Fatores de Tempo
6.
Ann Intensive Care ; 7(1): 114, 2017 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-29168046

RESUMO

BACKGROUND: Serum procalcitonin (PCT) concentration is used to guide antibiotic decisions in choice, timing, and duration of anti-infection therapy to avoid antibiotic overuse. Thus, we performed a systematic review and meta-analysis to seek evidence of different PCT-guided antimicrobial strategies for critically ill patients in terms of predefined clinical outcomes. METHODS: We searched for relevant studies in PubMed, Embase, Web of Knowledge, and the Cochrane Library up to 25 February 2017. Randomized controlled trials (RCTs) were included if they reported data on any of the predefined outcomes in adult ICU patients managed with a PCT-guided algorithm or according to standard care. Results were expressed as risk ratio (RR) or mean difference (MD) with accompanying 95% confidence interval (CI). DATA SYNTHESIS: We included 13 trials enrolling 5136 patients. These studies used PCT in three clinical strategies: initiation, discontinuation, or combination of antibiotic initiation and discontinuation strategies. Pooled analysis showed a PCT-guided antibiotic discontinuation strategy had fewer total days with antibiotics (MD - 1.66 days; 95% CI - 2.36 to - 0.96 days), longer antibiotic-free days (MD 2.26 days; 95% CI 1.40-3.12 days), and lower short-term mortality (RR 0.87; 95% CI 0.76-0.98), without adversely affecting other outcomes. Only few studies reported data on other PCT-guided strategies for antibiotic therapies, and the pooled results showed no benefit in the predefined outcomes. CONCLUSIONS: Our meta-analysis produced evidence that among all the PCT-based strategies, only using PCT for antibiotic discontinuation can reduce both antibiotic exposure and short-term mortality in a critical care setting.

7.
Chin Med J (Engl) ; 130(17): 2041-2049, 2017 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-28836546

RESUMO

BACKGROUND: The Space Glucose Control (SGC) system is a computer-assisted device combining infusion pumps with the enhanced Model Predictive Control algorithm to achieve the target blood glucose (BG) level safely. The objective of this study was to evaluate the efficacy and safety of glycemic control by SGC with customized BG target range of 5.8-8.9 mmol/L in the critically ill patients. METHODS: It is a randomized controlled trial of seventy critically ill patients with mechanical ventilation and hyperglycemia (BG ≥ 9.0 mmol/L). Thirty-six patients in the SGC group and 34 in the routine glucose management group were observed for three consecutive days. Target BG for both groups was 5.8-8.9 mmol/L. The primary outcome was the percentage time in the target range. RESULTS: The percentage time within BG target range in the SGC group (69 ± 15%) was significantly higher than in the routine management group (52 ± 24%; P< 0.01). No measurement was ≤2.2 mmol/L, and there was only one episode of hypoglycemia (2.3-3.3 mmol/L) in each group. The average BG was significantly lower in the SGC group (7.8 ± 0.7 mmol/L) than in the routine management group (9.1 ± 1.6 mmol/L, P< 0.001). Target BG level was reached earlier in the SGC group than routine management group (2.5 ± 2.9 vs. 12.1 ± 15.3 h, P= 0.001). However, the SGC group performed worse for daily insulin requirement (59.8 ± 39.3 vs. 28.4 ± 36.7 U, P= 0.001) and sampling interval (2.0 ± 0.5 vs. 3.7 ± 0.5 h, P< 0.001) than the routine management group did. Multiple linear regression showed that the intervention group remained a significant individual predictor (P < 0.001) of the percentage time in target range. CONCLUSIONS: The SGC system, with a BG target of 5.8-8.9 mmol/L, resulted in effective and reliable glycemic control with few hypoglycemic episodes in critically ill patients with mechanical ventilation and hyperglycemia. However, the workload was increased. TRIAL REGISTRATION: http://www.clinicaltrials.gov, NCT 02491346; https://www.clinicaltrials.gov/ct2/show/NCT02491346?term=NCT02491346&cond=Hyperglycemia&cntry1=ES%3ACN&rank=1.


Assuntos
Hiperglicemia/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Adulto , Idoso , Algoritmos , Glicemia/efeitos dos fármacos , Estado Terminal , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
8.
BMC Infect Dis ; 16(1): 528, 2016 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-27686235

RESUMO

BACKGROUND: Pneumocystis jiroveci pneumonia (PJP) in non-HIV patients is still a challenge for intensivists. The aim of our study was to evaluate mortality predictors of PJP patients requiring Intensive care unit (ICU) admission. METHODS: Retrospectively review medical records of patients with diagnosis of PJP admitted to four ICUs of two academic medical centers from October 2012 to October 2015. RESULTS: Eighty-two patients were enrolled in the study. Overall hospital mortality was 75.6 %. Compared with survivors, the non-survivors had older age (55 ± 16 vs. 45 ± 17, p = 0.014), higher APACHE II score (20 ± 5 vs. 17 ± 5, p = 0.01), lower white blood cell count (7.68 ± 3.44 vs. 10.48 ± 4.62, p = 0.005), less fever (80.6%vs. 100 %, p = 0.033), more hypotension (58.1 % vs. 20 %, p = 0.003), more pneumomediastinum (29 % vs. 5 %, p = 0.027). Logistic regression analysis demonstrated that age [odds ratio (OR)1.051; 95 % CI 1.007-1.097; p = 0.022], white blood cell count [OR 0.802; 95 % CI 0.670-0.960; p = 0.016], and pneumomediastinum [OR 16.514; 95 % CI 1.330-205.027; p = 0.029] were independently associated with hospital mortality. CONCLUSIONS: Mortality rate for non-HIV PJP patients requiring ICU admission was still high. Poor prognostic factors included age, white blood cell count and pneumomediastinum.

9.
IEEE J Biomed Health Inform ; 18(6): 1822-30, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25375679

RESUMO

Despite patients with Alzheimer's disease (AD) were reported of revealing gait disorders and balance problems, there is still lack of objective quantitative measurement of gait patterns and balance capability of AD patients. Based on an inertial-sensor-based wearable device, this paper develops gait and balance analyzing algorithms to obtain quantitative measurements and explores the essential indicators from the measurements for AD diagnosis. The gait analyzing algorithm is composed of stride detection followed by gait cycle decomposition so that gait parameters are developed from the decomposed gait details. On the other hand, the balance is measured by the sway speed in anterior-posterior (AP) and medial-lateral (ML) directions of the projection path of body's center of mass (COM). These devised gait and balance parameters were explored on twenty-one AD patients and fifty healthy controls (HCs). Special evaluation procedure including single-task and dual-task walking experiments for observing the cognitive function and attention is also devised for the comparison of AD and HC groups. Experimental results show that the wearable instrument with the designed gait and balance analyzing system is a promising tool for automatically analyzing gait information and balance ability, serving as assistant indicators for early diagnosis of AD.


Assuntos
Acelerometria/instrumentação , Doença de Alzheimer/fisiopatologia , Marcha/fisiologia , Monitorização Ambulatorial/instrumentação , Processamento de Sinais Assistido por Computador/instrumentação , Idoso , Algoritmos , Vestuário , Feminino , Pé/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Ambulatorial/métodos , Tronco/fisiologia
10.
Phys Chem Chem Phys ; 16(45): 25111-20, 2014 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-25332133

RESUMO

The effects of the spatial arrangement of the conjugated side chains of two-dimensional polymers on their optical, electrochemical, molecular-packing, and photovoltaic characteristics were investigated. Accordingly, novel polythiophenes with horizontally (PBTTTV-h) and vertically (PBTTTV-v) grafted terthiophene­vinylene (TTV) conjugated side chains were synthesized that display two and one UV-vis peaks, respectively; the difference is due to the different constitutions of the conjugated side-chains. Because the spatial arrangement affects the molecular self-assembly, PBTTTV-h shows stronger crystallinity than PBTTTV-v, which enhances the charge mobility in devices. Moreover, PBTTTV-h has a lower HOMO energy level (−5.49 eV) than PBTTTV-v (−5.40 eV). Bulk heterojunction solar cells fabricated from PBTTTV-h/PC71BM and PBTTTV-v/PC71BM exhibit power conversion efficiencies of 4.75% and 4.00%, respectively, and Voc values of 800 and 730 mV, respectively, under AM1.5G illumination (100 mW cm(−2)). Thus, the architecture of the TTV conjugated side chains affects the optical, electrochemical, and photovoltaic properties; this study provides more ideas for improving 2-D conjugated polymers for semiconductor devices.

11.
Yi Chuan ; 27(6): 908-14, 2005 Nov.
Artigo em Chinês | MEDLINE | ID: mdl-16378938

RESUMO

The mouse hairless gene is a crucial nuclear receptor gene associated with the structure of hair and skin. It encodes a putative zinc finger transcription factor, and is a transcriptional corepressor for thyroid hormone receptors. Hairless gene plays a critical role in maintaining the delicate balance between cell proliferation, differentiation, and apoptosis in the hair follicle as well as in the interfollicular epidermis, and is concerned with the control of hair growth cycling. This study was designed to clone and analyze the cDNA encoding Hr from Kunming mouse. The RT-PCR method was developed to clone the Hr cDNA. A full-length cDNA and CDS sequences of Kunming mouse were 4104bp and 3546bp, respectively, which has been accepted by GenBank (Accession Number: AY547391). Accession number of protein encoded by AY547391 sequence in GenBank is AAT45233 , composed of 1181 amino acid residues. The Hr cDNA of Kunming mouse was cloned and sequenced for the first time. The identities of CDS of Hr gene were 99.9%, 94.4%, 83.1%, 78.1%, 81.9% and 82.1% by homologous comparison among Kunming mouse and other six species, and that were 99.9%, 92.2%, 81.7%, 70.8%, 79.9% and 80.1% respectively in amino acid sequences. The results suggested a high degree of conservation and thus functional significance of the Hr gene among different mammalian taxons. The results derived from information searching by Blast program revealed that there were 4 SNP sites and one deletion mutation in the sequences of hairless gene mRNAs between Kunming mice and that collected in GenBank. Three SNP sites did not alter the related amino acids encoded. Two SNP proved to be polymorphism mutant sites with amino acids changes. The results provided new data for SNPs in Hr gene.


Assuntos
DNA Complementar/genética , Camundongos/genética , Fatores de Transcrição/genética , Sequência de Aminoácidos , Animais , Sequência de Bases , Clonagem Molecular , DNA Complementar/química , Éxons , Deleção de Genes , Genótipo , Dados de Sequência Molecular , Filogenia , Polimorfismo de Nucleotídeo Único , Análise de Sequência de DNA , Fatores de Transcrição/classificação
12.
J Invest Dermatol ; 124(6): 1200-5, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15955095

RESUMO

A novel autosomal recessive mutation arose spontaneously in a breeding colony of Chinese Kunming mice. The characteristics of these mutant mice include progressive irreversible hair loss soon after birth, rhinocerotic appearance, and shorter life span. Histological evaluation of skin revealed the homogeneous enlargement of utriculi, and the formation of several rows of large cysts. Sequencing the complete cDNA of the hairless gene identified two polymorphisms and a homozygous transition for a G-->A at nucleotide position 3110 (exon 12) leading to the substitution of tryptophan by a nonsense codon, designated W911X. This allele was named rhinocerotic and short-lived, with the symbol hr(rhsl). Addition of hairless gene mutation into the expanding hairless mutation database allows further development of genotype/phenotype correlations towards understanding inherited atrichia.


Assuntos
Códon sem Sentido , Polimorfismo Genético , Fatores de Transcrição/genética , Animais , Sequência de Bases , Citosina , Guanina , Camundongos , Camundongos Pelados , Camundongos Endogâmicos BALB C , Camundongos Mutantes , Dados de Sequência Molecular , Fenótipo , Pele/patologia , Triptofano
13.
Yi Chuan Xue Bao ; 29(3): 221-5, 2002.
Artigo em Chinês | MEDLINE | ID: mdl-12182075

RESUMO

Using brother-sister inbreeding with forced heterozygosity to breed a new segregating inbred strain which carry mutant hairless gene. Then, genetic monitoring was conducted by the skin grafting test, coat color test and biochemical marker analysis, and its basic biological characteristics were studied with corresponding methods. The Results are that the Yuyi Hairless Mice (YYHL) with unique biological characteristics have been bred successfully and have progressed to 30th generation since 1991. Thirteen biochemical markers loci on nine chromosomes coding biochemical markers measured with electrophoresis were all homogenous. The skin grafting test showed that no dropping graft was found during 100 days after transplanting, implying the YYHL was of isohistogeneicity. Analysis of coat color genes indicated that the hair color of first generation hybrid crossed between YYHL and DBA/2 was all agouti suggesting that the coat color genes of the YYHL were homogenous. The gene type is AABBccDD. All these showed that the YYHL have been an inbred strain reaching the international standards.


Assuntos
Camundongos Pelados/genética , Animais , Feminino , Cor de Cabelo/genética , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos DBA , Transplante de Pele
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