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Objective:To investigate the different outcomes of two types of acute kidney injury (AKI) according to standard of Kidney Disease: Improving Global Outcomes-AKI (KDIGO-AKI), and to analyze the risk factors that affect the prognosis of intensive care unit (ICU) patients in China.Methods:A secondary analysis was performed on the database of a previous study conducted by China Critical Care Clinical Trial Group (CCCCTG), which was a multicenter prospective study involving 3 063 patients in 22 tertiary ICUs in 19 provinces and autonomous regions of China. The demographic data, scores reflecting severity of illness, laboratory findings, intervention during ICU stay were extracted. All patients were divided into pure AKI (PAKI) and acute on chronic kidney disease (AoCKD). PAKI was defined as meeting the serum creatinine (SCr) standard of KDIGO-AKI (KDIGO-AKI SCr) and the estimated glomerular filtration rate (eGFR) at baseline was ≥ 60 mL·min -1·1.73 m -2, and AoCKD was defined as meeting the KDIGO-AKI SCr standard and baseline eGFR was 15-59 mL·min -1·1.73 m -2. All-cause mortality in ICU within 28 days was the primary outcome, while the length of ICU stay and renal replacement therapy (RRT) were the secondary outcome. The differences in baseline data and outcomes between the two groups were compared. The cumulative survival rate of ICU within 28 days was analyzed by Kaplan-Meier survival curve, and the risk factors of ICU death within 28 days were screened by Cox multivariate analysis. Results:Of the 3 063 patients, 1 042 were enrolled, 345 with AKI, 697 without AKI. The AKI incidence was 33.11%, while ICU mortality within 28 days of AKI patients was 13.91% (48/345). Compared with PAKI patients ( n = 322), AoCKD patients ( n = 23) were older [years old: 74 (59, 77) vs. 58 (41, 72)] and more critical when entering ICU [acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score: 23 (19, 27) vs. 15 (11, 22)], had worse basic renal function [eGFR (mL·min -1·1.73 m -2): 49 (38, 54) vs. 115 (94, 136)], more basic complications [Charlson comorbidity index (CCI): 3 (2, 4) vs. 0 (0, 1)] and higher SCr during ICU stay [peak SCr for diagnosis of AKI (μmol/L): 412 (280, 515) vs. 176 (124, 340), all P < 0.01]. The mortality and RRT incidence within 28 days in ICU of AoCKD patients were significantly higher than those of PAKI patients [39.13% (9/23) vs. 12.11% (39/322), 26.09% (6/23) vs. 4.04% (13/322), both P < 0.01], while no significant difference was found in the length of ICU stay. Kaplan-Meier survival curve analysis showed that the 28-day cumulative survival rate in ICU in AoCKD patients was significantly lower than PAKI patients (Log-Rank: χ2 = 5.939, P = 0.015). Multivariate Cox regression analysis showed that admission to ICU due to respiratory failure [hazard ratio ( HR) = 4.458, 95% confidence interval (95% CI) was 1.141-17.413, P = 0.032], vasoactive agents treatment in ICU ( HR = 5.181, 95% CI was 2.033-13.199, P = 0.001), and AoCKD ( HR = 5.377, 95% CI was 1.303-22.186, P = 0.020) were independent risk factors for ICU death within 28 days. Conclusion:Further detailed classification (PAKI, AoCKD) based on KDIGO-AKI SCr standard combined with eGFR is related to ICU mortality in critical patients within 28 days.
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Objective To investigate the effects of artesunate (AS) on septic lung injury in mice and to study the modulation of heme oxygenase-1 (HO-1) in lung in order to clarify the mechanism of AS action.Methods Sixty male Kunming mice were randomly (random number) divided into four groups: Sham group (n =15), CLP group (n =15), AS + CLP group (n =15) and AS + ZnPP + CLP group (n =15).Cecal ligation and puncture (CLP) method was employed to induce septic lung injury.AS (15 mg/ kg) was injected into the abdomen of mice 2 hours before the CLP procedures, and ZnPP Ⅸ, an inhibitor of HO-1, was intraperitoneally injected in dose of 40 μmol/kg 1 hour after the AS injection.The equivalent volume of normal saline was intraperitoneally injected instead in mice of Sham group and CLP group.The mice were sacrificed 24 hours after the CLP procedures.The TNF-α, IL-6 in serum were assayed by ELISA method.The lung injury score and wet/dry ratio were measured.The western blotting and immunohistochemistry methods were used to determine HO-1 protein expression in lung tissue.The protein level of nuclear factor-E2-related factor-2 (Nrf-2), an important transcriptional factor of HO-1 in lung tissue was also analyzed by western blotting.One-way analysis of variance (ANOVA) was used for comparisons among the groups, and SNK-q (Student-Newman-Keuls) test was performed for further comparison, and difference was statistically significant at P ＜ 0.05.Results The TNF-α (pg/mL) (54.37 ± 15.59 vs.627.45 ± 117.03, P ＜ 0.05), IL-6 (pg/mL) (81.53 ± 26.89 vs.898.52 ± 222.78, P ＜ 0.05) in serum was increased, and the lung protein exudation, pulmonary edema (wet/dry weight ratio: 4.27 ± 0.22 vs.6.78 ±0.73, P ＜ 0.05), pulmonary pathology injury (lung injury score: 2.20 ± 0.2 vs.13.25 ± 2.67, P ＜ 0.05) were aggravated by CLP.The HO-1 and Nrf-2 were up-regulated in lung tissue in CLP group compared with the sham group (P ＜ 0.05).After the intervention of AS, the HO-1 and Nrf-2 were further increased (P＜0.05), theTNF-α (pg/mL) (627.45 ±117.03 vs.307.88 ±72.33, P＜0.05), IL-6 (pg/mL) (898.52 ± 222.78 vs.413.47 ± 115.14, P ＜ 0.05) in serum, lung protein exudation, pulmonary edema (wet/dry weight ratio: 6.78 ± 0.73 vs.5.05 ± 0.61, P ＜ 0.05), pulmonary pathology injury (lung injury score: 13.25 ± 2.67 vs.4.95 ± 1.46, P ＜ 0.05) were attenuated compared with the CLP group.However, the protective role of AS in the septic lung injury in mice was partly reversed by ZnPP, and no significant difference was detected between the AS + CLP + ZnPP and CLP group (lung injury score: 12.15 ± 2.95 vs.13.25 ± 2.67, P ＞ 0.05;wet/dry weight ratio: 6.78 ± 0.73 vs.6.29 ± 0.82, P ＞ 0.05).Conclusions AS plays protective roles in septic lung injury, and it is attributed to limiting lung inflammation via up-regulation of HO-1.
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Objective To summarize and analyze the epidemiological and clinical characteristics of hemorrhagic fever patients with renal syndrome (HFRS),so as to provide a basis for prevention and treatment.Methods The epidemiological and clinical data of 104 HFRS patients,who were treated in the First Affiliated Hospital of Harbin Medical University in 2014,were collected.The HFRS patient's age,sex,urban and rural areas,occupation and time of onset distributions,summary onset clinical manifestations,laboratory findings,treatment and outcome were analyzed retrospectively.Results Average age of the 104 cases of HFRS patients was 43.46 years old,the youngest was 12 years old and the oldest was 80 years old.Most of the patients were 30-＜50 years old,which was accounted for 54.81％ (57/104),and most of the patients were male,which was accounted for 78.85％ (82/ 104).Most of the patients lived in rural areas,which was accounted for 81.73％ (85/104).Most patients were onset in November,accounted for 19.23％ (20/104),and the least was in August,accounted for 2.88％ (3/104),and was sporadic in the rest of the year.For the clinical classification,the light type and the moderate type were the largest part,98 cases,accounted for 94.23％,while the severe type and the critically severe type were 6 cases,accounted for 5.77％.The clinical manifestations were as follows:fever majority in 94 cases,accounted for 90.38％,fatigue,aches and pain in 89 cases,accounted for 85.57％;polyuria in 88 cases,accounted for 84.62％;chemosis in 86 cases,accounted for 82.69％;skin bleeding,petechiae in 84 cases,accounted for 80.77％;oliguria in 81 cases,accounted for 77.88％.Laboratory test results were as following:87 cases of blood platelet (PLT) reduced (83.65％),74 cases of serum creatinine (sCr) increased (71.15％),74 cases of alanine aminotransferase (ALT) increased (71.15％),85 cases of aspartate transaminase (AST) increased (81.73％),96 cases of lactate dehydrogenase (LDH) increased (92.31％),and 31 cases of creatine kinase (CK) increased (29.81％).All of the 104 patients were cured,with no death.Conclusions Majority of the HFRS patients are young adults.The peak of the incidence of HFRS lies in Autumn.The proportion of the moderate type is the highest.Early diagnosis and treatment is the key to improve the prognosis of patients with HFRS.
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BACKGROUND: Studies have shown that chitooligosaccharides have antitumor effect. However, the influence of chitooligosaccharides on cyclin D1, bcl-2 and bcl-xl remains unclear.OBJECTIVE: To observe the JnhJbJtJon effect of chitooligosaccharides on the proliferation of Hela cells, and the influence on cyclin D1, bcl-xl and bcl-2 mRNA expression.METHODS: Hela cells were stimulated by different concentrations of chitooligosaccharides (0.1, 0.5, 1, 2, 5 g/L). The effects of chitooligosaccharides on Hela cells were detected by CCK8 kit. Using real-time PCR methods, the gene expression of cyclin D1, bcl-xl and bcl-2 mRNA were determined.RESULTS AND CONCLUSION: Chitooligosaccharides inhibited the proliferation of Hela cells. With the concentrations of chitoolJgosaccharides increased from 0.1 g/L to 2 g/L, the inhibition effects on the gene expressJon of cyclin D1, bcl-xl and bcl-2 were enhanced, peaked at 2 g/L, and decreased at high concentration (5 g/L). Antitumor activity of chitooligosaccharides may exert through two aspects: it inhibits cyclin D1 mRNA expression to suppress the proliferation of tumor cells; on the other hand, chitooligosaccharides inhibits the expression of bcl-xl and bci-2 to promote the apoptosis of tumor cells. Moreover, the effects of the former are stronger than the latter.
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Objective To study the effect of high volume hemofiltration(HVHF) in patients with multiple organ dysfunction syndrome (MODS). Methods Nineteen MODS patients were divided into two groups randomly, 10 patients receiving HVHF and 9 patients treated by routine continuous venovenous hemofiltration(CVVH).Artery blood was sampled before and 2、4、8 hours after HVHF and CVVH, concentrations of Scr, BUN, TNF?, IL 1?, IL 6 and blood gas were measured.Results In both HVHF group and CVVH group, the 4th hour Scr、BUN decreased significantly, renal function improved. In HVHF group compared with pre-treatment level the 4th hour concentrations of TNF?[(1 759?506)ng/L vs. (1 265?397)ng/L]、IL-1?[(964?185)ng/L vs. (511?124)ng/L]、IL-6[(1 332?415) ng/l vs. (726?243)ng/L] decreased singificantly. In CVVH group, the 4th hour concentrations of TNF?[(1 799?511) vs.(1 327?421) ng/L] decreased significantly (all P
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ObjectiveTo study the effect of recombinant human growth hormone (rhGH) on postoperative patients on mechanical ventilation.Methods Forty postoperative respiratory failure patients on mechanical ventilation were treated by rhGH 8?IU injection subcutaneously QD.ResultsThe time of mechanical ventilation of rhGH group was (30?12)?d, compared with that in 40 control patients (39?13)?d (t=2 538,P