ABSTRACT
Objective? To?compare?the?efficacy?and?safety?of?conservative?and?conventional?oxygen?therapy?in?critically?ill?patients.? Methods? Relevant?literature?and?randomized?controlled?trials?(RCTs)?about?the?effect?of?conservative?oxygen?therapy?and?conventional?oxygen?therapy?on?the?prognosis?of?intensive?care?unit?(ICU)?critically?ill?patients?was?searched?from?CNKI,?VIP,?Wanfang?Data,?Chinese?Clinical?Trial?Registry,?PubMed,?Embase,?the?Cochrane?Library,?and?ClinicalTrials.gov?by?using?the?keywords?"critically?ill?patients,?conservative?oxygen?therapy,?liberal?oxygen?therapy,?conventional?oxygen?therapy,?mortality"?until?October?30th?in?2018.?The?main?outcome?indicators?were?short-term?mortality?(28-day?mortality?or?ICU?mortality);?secondary?indicators?were?90-day?mortality,?duration?of?mechanical?ventilation,?the?length?of?ICU?stay,?total?hospitalization?time,?new?infection?rate?in?ICU?and?incidence?of?new?organ?dysfunction?in?ICU.?In?the?conservative?oxygen?therapy?group,?the?aim?of?pulse?oxygen?saturation?(SpO2)?was?0.90-0.92?or?the?arterial?partial?oxygen?pressure?(PaO2)?was?70-100?mmHg?(1?mmHg?=?0.133?kPa),?while?in?conventional?oxygen?therapy?group?SpO2?>?0.96?or?PaO2?>?150?mmHg.?Literature?search,?quality?evaluation?and?data?extraction?was?conducted?independently?by?the?two?authors.?The?quality?of?these?study?was?evaluated?using?Cochrane?risk?deviation?assessment?tool,?and?the?relevant?data?were?analyzed?using?RevMan?5.3?software.? Results? Four?studies?were?included?in?the?analysis,?these?studies?were?assessed?as?moderate?to?high?quality?studies.?A?total?of?1?076?patients?were?enrolled,?with?539?in??the?conservative?oxygen?therapy?group?and?537?in?the?conventional?oxygen?therapy?group.?Compared?with?conventional? oxygen?therapy?group,?short-term?mortality?[odds?ratio?(OR)?=?0.66,?95%?confidence?interval?(95%CI)?=?0.50-0.87,?P?=?0.003]?and?the?incidence?of?new?organ?dysfunction?in?ICU?(OR?=?0.64,?95%CI?=?0.41-0.99,?P?=?0.04)?were?significantly?decreased?in?conservative?oxygen?therapy?group,?duration?of?mechanical?ventilation?was?significantly?prolonged?[standardized?mean?difference?(SMD)?=?17.17,?95%CI?=?7.14-27.21, P?=?0.000?8].?But?there?was?no?significantly?difference?in?90-day?mortality?(OR?=?0.83,?95%CI?=?0.59-1.17,?P?=?0.28),?new?infection?rate?in?ICU?(OR?=?0.90,??95%CI?=?0.66-1.21,?P?=?0.47),?the?length?of?ICU?stay?(SMD?=?-0.22,?95%CI?=?-1.02-0.59,?P?=?0.60)?and?total?hospitalization?time?(SMD?=?1.44,?95%CI?=?-1.43-4.31,?P?=?0.32)?between?the?two?groups.? Conclusion? Compared?with?conventional?oxygen?therapy,?conservative?oxygen?therapy?can?reduce?short-term?mortality?and?the?incidence?of?organ?dysfunction?in?critically?ill?patients,?but?cannot?decrease?the?length?of?ICU?stay?and?total?hospitalization?time.
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Objective To understand the situations of departments of intensive care units (ICUs) of different level hospitals in Guizhou Province, and to provide directions and evidences for improving quality control in critical care medicine.Methods A county-level hospital and a provincial-level hospital's comprehensive ICU in Guizhou Province were selected to record and analyze and compare the structural indicators, patient admission and transfer, disease distribution, ventilator associated pneumonia (VAP), intravascular catheter related blood stream infection (CRBSI) and catheter-associated urinary tract infection (CAUTI) of the two hospitals' comprehensive ICU in 2017.Results The ICU of the People's Hospital of Suiyang County (county hospital) was found in 2012, and the ICU of the Affiliated Hospital of Guizhou Medical University (provincial hospital) was found in 1994. Until 2017, there were 10 and 46 beds, 6 (all of them hold bachelor's degree) and 18 physicians (6 of them hold PhD, 5 of them hold master's degree, 7 of them hold bachelor's degree), 17 (4 of them hold bachelor's degree, 13 of them hold college degree or graduated from secondary school) and 69 nurses (2 of them hold master's degree, 53 of them hold bachelor's degree, 14 of them hold college degree or graduated from secondary school) in the two ICUs respectively, there were significant differences in the education background of the physicians and nurses between the two ICUs (bothP < 0.01). During 2017, 471 cases were admitted to the ICU of the county hospital while 1633 cases were admitted to the ICU of the provincial hospital. Compared with the ICU of the provincial hospital, the ratio of the patients with acute physiology and chronic health evaluationⅡ(APACHE Ⅱ) ≥ 15 at admission was lower (74.8％ vs. 85.1％,P < 0.01), the ratio of direct admission was higher (30.8％ vs. 17.4％,P < 0.01), the ratio of the patients admitted to the ICU more than once was lower (0.8％ vs. 5.0％,P < 0.01), the ratio of the patients whose the length of ICU stay less than 24 hours was higher (51.6％ vs. 13.7％,P < 0.01), the ratio of the patients whose the length of ICU stay more than 28 days was lower (1.1％ vs. 2.9％, P < 0.05), the ratio of the patients discharged against-advice (25.5％ vs. 20.5％,P < 0.05) was higher, the ratio of the patients transferred to other hospitals was higher (5.1％ vs. 0.3％,P < 0.05), and the ICU mortality was lower (4.0％ vs. 13.9％,P < 0.01) in the ICU of the county hospital. The top three kinds of diseases treated in the ICU of the county hospital were brain injury (27.4％), trauma (19.1％) and toxication (6.8％); while in the ICU of the provincial hospital were brain injury (18.6％), sepsis (16.2％) and severe acute pancreatitis (4.8％). In addition, the incidences of VAP, CRBSI and CAUTI in the ICU of the county hospital were 10.0/1000 ventilator days, 1.4/1000 catheter days, 0.5/1000 catheter days; while in the ICU of the provincial hospital were 5.8/1000 ventilator days, 2.0/1000 catheter days, 3.7/1000 catheter days, respectively.Conclusions There are short of physicians and nurses in the ICU of the provincial and county hospitals in Guizhou Province, and the educational level of the medical staff in the ICU of the county hospital is relatively low. Moreover, there were significant differences in the admissions and treatments and the outcomes of the critically ill patients between the two ICUs. The characteristics of the ICUs of county hospitals should be fully considered when the quality control of critical care medicine and continuing medical education are done.
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OBJECTIVE To explore the effect of Lianhuaqingwen capsules ( LHQW ) on junction protein expression in mouse lung tissue of lipopolysaccharide (LPS)-induced acute lung injury ( ALl). METHODS 120 male mice were randomly divided into six groups: normal control, model, model+dexa-methasone 5 mg.kg-1 , model +LHQW 2, 4 and 8 g.kg-1 groups. Dexamethasone and LHQW were administered orally, once daily, for 7 d. 24 h after the last administration, LPS solution was instilled into the tracheas of mice except the normal control group to prepare the mouse model of ALl. 24 h after the establishment of the ALl model, the mice were sacrificed and the pathological changes in the mouse lung tissue were observed by optical microscopy and ultrastructure of alveolar epithelium was observed by transmission electron microscopy. The cell percentage of positive expression of tumor necrosis factor-α(TNF-α) in the peripheral blood T lymphocytes was detected by flow cytometry. The expressions of con-nexin 43 ( Cx43), occludin and zonula occludens protein-1 ( ZO-1) in lung tissues were detected by immunohistochemistry. RESULTS Under the light microscope, the mouse lung of model group showed a large amount of inflammatory cell infiltration and alveolar wall thickening. Compared with model group, inflammatory cell infiltration was reduced in model+dexamethasone, model+LHQW 2,4 and 8 mg.kg-1 groups. Under the electron microscope, the mouse alveolar epithelial cells of model group showed injury. Compared with model group, the damage was reduced in model+dexamethasone, and model+LHQW 2, 4 and 8 mg.kg-1 groups. The cell percentage of TNF-α positive expression in peripheral blood T lympho-cytes in normal control, model, model+dexamethasone, model+LHQW 2,4 and 8 mg.kg-1 groups was (3.6±0.9)%, (6.4±0.8)%, (2.8±0.7)%, (4.7±1.6)%, (4.0±1.5)% and (3.6±1.2)%, respectively. The percentage in model group was obviously higher than that in normal control group( P<0.01), but was lower in the four drug treatment groups than in model group(P<0.05, P<0.01). The expression of Cx43, occludin and ZO-1 in lung tissue of model group was lower than that of normal control group(P<0.01), but higher in model+dexamethasone, model + LHQW 4 and 8 mg.kg-1 groups than in model group(P<0.05). CONCLUSION LHQW may alleviate ALl induced by LPS and play a protective role by inhibiting inflammatory cell infiltration and improving protein connection expression in alveolar epithelial cells and pulmonary vascular endothelial cells.
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Aim To investigate the effect of Jinlida on cholesterol-related genes in skeletal muscle in fat-in-duced insulin resistance ApoE-/ - mice. Methods Ten male C57 BL/6 J mice were selected as normal group ( NF );50 male ApoE-/ - mice with a high-fat feeding after 16 weeks ( HF) were divided into model group, rosiglitazone ( LGLT ) , Jinlida low dose group ( JLDL, 0. 95 g · kg-1 · d-1 ) , Jinlida medium dose group ( JLDM, 1. 9 g·kg-1 ·d-1 ) , Jinlida high dose group (JLDH, 3. 8 g·kg-1·d-1), which were per-formed intragastric administration for 8 weeks. Oil red O staining of mouse skeletal muscle was used for fat ac-cumulation. Insulin receptor ( INSR) , insulin receptor body substrate-1 ( IRS-1 ) , low-density lipoprotein re-ceptor ( LDLR ) , cholesterol sensor ( SCAP ) mRNA and protein expression in mouse skeletal muscle were measured by quantitative reverse transcription PCR ( RT-PCR ) and Western blot. Results Compared with NF group, fasting blood glucose ( FBG) , choles-terol ( TC ) , triglyceride ( TG ) and low density lipo-protein cholesterol ( LDL-C ) of HF mice were signifi-cantly elevated, while high-density lipoprotein ( HDL-C ) significantly decreased ( P < 0. 05 ) . Compared with HF group, Jinlida group could reduce to varying degrees FBG, TC, TG and LDL-C in mice, and in-crease HDL-C ( P <0. 05 ) . Jinlida could downgrade fasting serum insulin ( FINS ) level, and improve the insulin sensitive index ( ISI ) ( P < 0. 05 ) . Jinlida could obviously improve skeletal muscle fat accumula-tion of mice. Compared with NF group, skeletal mus-cle INSR, IRS-1, LDLR mRNA and protein levels of HF group were significantly decreased ( P <0. 05 ) , while SCAP mRNA and protein level increased signifi-cantly (P<0. 05). Compared with HF group, Jinlida could increase to varying degrees INSR, IRS-1, LDLR mRNA and protein levels ( P < 0. 05 ) , and lower SCAP mRNA and protein levels ( P<0. 05 ) . Conclu-sion Jinlida can alleviate fat-induced insulin resist-ance in ApoE-/ - mice through regulation of cholester-ol-related gene expression.
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Objective To investigate the FH/Wjd rat model of alcoholic liver disease.Methods Thirty-six 16-18 week old SPF grade FH/Wjd rats (male:female=1:1) were used in this study.The rats were divided into two groups randomly by body weight:water intake group and alcohol intake group.The rats took water or alcohol freely.16 weeks lat-er, ALT, AST, TBIL, TG, CHO in the serum and TG, GSH in the liver homogenate were detected.The expression of PPARαprotein in the liver tissue was detected by Western blot.The apoptosis rate of liver cells was assessed by flow cy-tometry.The pathological changes of liver tissue were examined using HE staining.Results Compared with the water in-take group, the serum TBIL and TG were significantly increased in rats of both sexes of the alcohol intake group, moreover, ALT and CHO of the female rats in the alcohol intake group were significantly decreased.TG in the liver homogenate in-creased obviously, while GSH in the liver homogenate showed a decreasing tendency.Hepatocyte apoptosis in rats of both sexes in the alcohol intake group showed an increasing tendency.The PPARαprotein expression was up-regulated obvious-ly, and the main pathological change in the liver tissue was microvesicular fatty degeneration.Conclusion Spontaneous long-term alcohol intake can induce liver injuries in FH/Wjd rats.