Early recovery status and outcomes after sepsis-associated acute kidney injury in critically ill patients / 中南大学学报(医学版)

Objective:Acute kidney injury (AKI) is one of the common complications in critically ill septic patients, which is associated with increased risks of death, cardiovascular events, and chronic renal dysfunction. The duration of AKI and the renal function recovery status after AKI onset can affect the patient prognosis. Nevertheless, it remains controversial whether early recovery status after AKI is closely related to the prognosis in patients with sepsis-associated AKI (SA-AKI). In addition, early prediction of renal function recovery after AKI is beneficial to individualized treatment decision-making and prevention of severe complications, thus improving the prognosis. At present, there is limited clinical information on how to identify SA-AKI patients at high risk of unrecovered renal function at an early stage. The study aims to investigate the association between early recovery status after SA-AKI, identify risk factors for unrecovered renal function, and to improve patients ' quality of life.Methods:We retrospectively analyzed clinical data of septic patients who were admitted to the intensive care unit (ICU) and developed AKI within the first 48 hours after ICU admission in the Second Xiangya Hospital and the Third Xiangya Hospital of Central South University from January 2015 to March 2017. Sepsis was defined based on the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). AKI was diagnosed and staged according to the 2012 Kidney Disease:Improving Global Outcomes (KDIGO) guideline. SA-AKI patients were assigned into 3 groups including a complete recovery group, a partial recovery group, and an unrecovered group based on recovery status at Day 7 after the diagnosis of AKI. Patients ' baseline characteristics were collected, including demographics, comorbidities, clinical and laboratory examination information at ICU admission, and treatment within the first 24 hours. The primary outcome of the study was the composite of death and chronic dialysis at 90 days, and secondary outcomes included length of stay in the ICU, length of stay in the hospital, and persistent renal dysfunction. Multivariate regression analysis was performed to evaluate the prognostic value of early recovery status after AKI and to determine the risk factors for unrecovered renal function after AKI. Sensitivity analysis was conducted in patients who still stayed in hospital on Day 7 after AKI diagnosis, patients without premorbid chronic kidney disease, and patients with AKI Stage 2 to 3.Results:A total of 553 SA-AKI patients were enrolled, of whom 251 (45.4％), 73 (13.2％), and 229 (41.4％) were categorized as the complete recovery group, the partial recovery group, and the unrecovered group, respectively. Compared with the complete or partial recovery group, the unrecovered group had a higher incidence of 90-day mortality (unrecovered vs partial recovery or complete recovery: 64.2％ vs 26.0％ or 22.7％; P<0.001) and 90-day composite outcome (unrecovered vs partial recovery or complete recovery:65.1％vs 27.4％or 22.7％;P<0.001). The unrecovered group also had a shorter length of stay in the hospital and a larger proportion of progression into persistent renal dysfunction than the other 2 groups. After adjustment for potential confounders, patients in the unrecovered group were at an increased risk of 90-day mortality (HR=3.50, 95％ CI 2.47 to 4.96, P<0.001) and 90-day composite outcome (OR=5.55, 95％CI 3.43 to 8.98, P<0.001) when compared with patients in the complete recovery group, but patients in the partial recovery group had no significant difference (P>0.05). Male sex, congestive heart failure, pneumonia, respiratory rate>20 beats per minute, anemia, hyperbilirubinemia, need for mechanical ventilation, and AKI Stage 3 were identified as independent risk factors for unrecovered renal function after AKI. The sensitivity analysis further supported that unrecovered renal function after AKI remained an independent predictor for 90-day mortality and composite outcome in the subgroups. Conclusion:The early recovery status after AKI is closely associated with poor prognosis in critically ill patients with SA-AKI. Unrecovered renal function within the first 7 days after AKI diagnosis is an independent predictor for 90-day mortality and composite outcome. Male sex, congestive heart failure, pneumonia, tachypnea, anemia, hyperbilirubinemia, respiratory failure, and severe AKI are risk factors for unrecovered renal function after AKI. Therefore, timely assessment for the renal function in the early phase after AKI diagnosis is essential for SA-AKI patients. Furthermore, patients with unrecovered renal function after AKI need additional management in the hospital, including rigorous monitoring, avoidance of nephrotoxin, and continuous assessment for the renal function, and after discharge, including more frequent follow-up, regular outpatient consultation, and prevention of long-term adverse events.

Protective effect of hydrogen sulfide on pressure ulcer rats with ischemia/reperfusion injury and its mecha-nisms / 中华实用儿科临床杂志

Objective To explore the protective effect and mechanism of exogenous hydrogen sulfide ( H2 S) on pressure ulcer rats with ischemia/reperfusion ( I/R) injury. Methods Forty SD rarts were randomly divided into 4 groups,namely normal control group,I/R model group,low-dose H2 S intervention group and high-dose H2 S interven-tion group. Each group had 10 animals. The low-and the high-dose H2 S intervention groups were injected intraperitone-ally 10 and 30μmol/kg of sodium hydrosulfide ( NaHS) for 1 week,respectively;however,the normal control group and I/R model group were treated with same volume 9 g/L saline. Then,the normal control group did not sustain any pres-sure,but other 3 groups were pressurized. After 3 circulations of ischemia/reperfusion,all rats were sacrificed,and path-ological changes in pressure ulcer rats were evaluated by HE staining. Serum H2 S contents were analyzed through meth-ylene spectrophotometric method. Serum levels of tumor necrosis factor-α(TNF-α),interleukin-6 (IL-6),intercellu-lar adhesion molecule -1 (ICAM-1),and myeloperoxidase (MPO) were detected by enzyme linked immunosorbent assay ( ELISA ) . The activities of malondialdehyde ( MDA ) , superoxide dismutase ( SOD ) , glutathione-peroxidase ( GSH-Px) and catalase ( CAT) in the homogenate of muscle were examined. Apoptotic index ( AI) was calculated by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling ( TUNEL) . The expressions of Bcl-2 and Bax in muscle tissue were evaluated by Western blot. Results In comparison with the normal control group,serum TNF-α, IL-6,ICAM-1 and MPO levels,MDA activity in the homogenate of muscles,AI and Bax expression level were in-creased (all P<0. 01),while serum H2S levels,the activities of SOD,GSH-Px and CAT as well as Bcl-2 expression levels were reduced in the I/R model group (all P<0. 01). Upon intervention therapy of low-or high-dose H2S,path-ological scores,serum TNF-α,IL-6,ICAM-1 and MPO levels,MDA activity in the homogenate of muscle,AI and Bax expression levels were gradually reduced while serum H2 S levels,the activities of SOD,GSH-Px and CAT and Bcl-2 expression levels were gradually enhanced when compared to those of the I/R model group (all P<0. 05,0. 01). Con-clusions Exogenous H2 S has better protection against pressure ulcer rats with I/R injury. The mechanism may be as-sociated with inhibition of inflammatory reaction and enhancement of antioxidative ability as well as reduction of apopto-sis.

Effects of sildenafil citrate on mice hearing / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>The purpose of this investigation was to study the effects of the Sildenafil citrate on mice hearing.</p><p><b>METHODS</b>Seven-week-old adult male Kunming mice were used. The mice were randomly divided into four groups with 10 mice in each group.Sildenafil groups were orally administered daily with sildenafil [0.1 mg/(kg·d), 1 mg/(kg·d), 10 mg/(kg·d)] and control group was orally administered with normal saline. Then mice were tested for auditory brainstem response (ABR) to observe the changes of ABR's thresholds at before administration and 1, 5, 10, 15, 20 day afterwards. The mice basilar membrane samples were studied by immunofluorescent labeling.High performance liquid chromatography was used for determination the concentration of sildenafil in endolymph of mice cochlea. Statistical analysis was performed using SPSS 13.0.</p><p><b>RESULTS</b>After 30 min following administration, the Sildenafil in endolymph of mice cochlear could be assayed by high performance liquid chromatography, and it was dose-related.Sildenafil increased the hearing thresholds with the time of administration. Hearing thresholds increased significantly in the sildenafil group at 20 d compared to the control group (P < 0.05). After administered high dose of Sildenafil, on the 20th day, the ABR thresholds average threshold was (60.0 ± 10.0) dBnHL, and the control group was (14.5 ± 6.0) dBnHL.Hair cells damages in the base ring of cochlea could be observed in experimental group in a concentration-dependent manner.</p><p><b>CONCLUSION</b>Sildenafil can pass through blood-labyrinth barrier to the inner ear, and doses of sildenafil administration can induce hearing impairment in mice.</p>

Effects of acetamidophenol on auditory in mice / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#The purpose of this investigation was to observe the effects of the Acetaminophen on auditory in mice.@*METHOD@#Regardless of male and female mice, healthy seven-year-old C57 mice were randomly divided into Acetaminophen low-dose group (150 mg/kg), Acetaminophen medium-dose group (300 mg/kg), Acetaminophen high-dose group(600 mg/kg) and control group. Then mice were tested for ABR to observe the changes of ABR's threshold in the zero, second, fourth and ninth day separately. The change of cochlea hair cells morphology was studied by immunofluorescent labeling. And HPLC detects the concentration of Acetaminophen in endolymph of mice cochlea.@*RESULT@#After 30 minutes following administration, the Acetaminophen in endolymph of mice cochlear can be assayed by high performance liquid chromatography (HPLC). Acetaminophen increased the hearing thresholds compared to the control group. Hearing thresholds increased significantly in the Acetaminophen at 9 d,compared to the control group (P < 0.05). After administered medium-dose and high-dose of Acetaminophen, on the 9th day with the time of giving medicine to all the groups strengthens, the ABR thresholds heightens. And the average threshold is (44.75 +/- 16.00) dB, (50.00 +/- 11.00) dB respectively. Hair cells damages could be observed in experimental group after operations.@*CONCLUSION@#Acetaminophen can pass through blood-labyrinth barrier to the inner ear. These data demonstrate that taking certain acetaminophen can induce hearing impairment in mice.

MR imaging findings in cesarean scar pregnancy / 中华放射学杂志

Objective To analyze MRI findings of cesarean scar pregnancy (CSP). Methods The MR findings in 18 patients who were diagnosed as CSP by surgery from March 2010 to November 2011 were retrospectively analyzed,and comparison was made between the MRI findings and surgical results.Results All Gestational sacs (18) were clearly detected by MRI.Among the 18 cases,gestational sac presented as cystic mass with smooth margin located within the scar of uterine wall at the lower anterior uterus in 16 cases.In 2 of the 16 cases,gestational sac was found within the myometrium,whereas in the remaining 14 cases,gestational sac was found partially within the myometrium with extension into the uterine cavity.The anteior wall of isthmus uteri became thinner.In the remaining 2 of the 18 cases,gestational sac presented as irregular,multilobolated mass,growing deep inot the myometrium as well as into the uterinecavity. On T2WI,the mass showed heterogeneous signal intensity. A small amount of hemorrhage within the mass and uterine cavity could be seen on T1 WI. An enhancing solid component with a heterogeneous mass could be seen. All gestational sacs in 18 cases were located at or adjacent to the previous cesarean scar.In the area of cesarean scar,the signal of the uterine wall was disconnected,with focal indentation or thinning and the previous cesarean scar exhibited hypointensity on both T1WI and T2WI.Conclusion CSP has its unique findings on MRI,these specific features can provide useful information in the management of CSP.

The effects of daylily on the behaviors and learning memory in the depressed rats / 中华行为医学与脑科学杂志

Objective To observe the effects of the extract from daylily on the learning and memory in depression model rats, and to explore its possible mechanism. Methods Rats were randomly divided into control group, model group ( CUMS), the positive group (CUMS + fluoxetine) , high, medium and low dose group (stress + daylily extract in different doses), 12 rats in each group. The depression model was established by combining separation and chronic unpredictable stress. Body mass, open-field-test and sugar consumption experiment were used to evaluate the changes of behaviors in rats. And morris water Maze test was used to evaluate the ability of learning and memory. Results There was no statistically distinction between the rats of each group on weight and the behavioral indicator before modeling. Compared with the control group, the vertical movement,horizontal movement of open box test in the model group were reduced (P＜0.05 ) ,and sugar consumption and preference degree decreased (P<0.05 ).The target quadrant time, platform resident time, effective area residence time and crossing platform times in the water maze test of the model group was less than those of the control group. The daylily effect was evaluated at 0, 7, 14, 21, 28, 35, 42 days respectively post treatment. There were significant differences in depression behaviors between model group and daylily group(P＜0.05). And each indicator in the water maze test of the daylily group (high, medium dose) was more than that of model group (P ＜ 0. 05). Control group, model group, positive group, high, medium and low dose group, vertical movement scores were (41.83 ± 17.63; 8.14 ±4.23; 12.73 ±7.21; 23.17 ± 18.75; 8.38 ±3.46; 13.50 ±5.44); horizontal movement scores were (69.92 ±34.04; 28.33 ±20.36; 62.25 ± 15.72; 69.42 ±35.17 ; 49.08 ±32.85; 48.08 ±21.19). Conclusion Daylily may be partially work on the depression of rats, with some antidepressant effect, meantime,daylily can improve the ability of learning and memorizing of the depressed rats.

Anti-tumor activity and mechanism with SSCE of Spatholobus suberctus / 中国中药杂志

<p><b>OBJECTIVE</b>To observe the effect of anti-tumor and mechanism of the extract of Spatholobus suberctus (SSCE) in vivo.</p><p><b>METHOD</b>The mouse model of Lewis lung carcinoma was used to investigate the effects of SSCE on tumor growth and metastasis. Furthermore, we explored the mechanism of anti-tumor by analyze the cell cycle and determine the apoptosis.</p><p><b>RESULT</b>The studies demonstrated that the tumor inhibitory rate of SSCE in low dose group was the highest (30.65%) on Lewis lung cancer. SSCE can resist metastasis, at the same time, it can induce cell cycle arrested in G1 phase, whereas, there was no significant difference in apoptotic rate each group.</p><p><b>CONCLUSION</b>We verified that SSCE exits anti-tumor effect and resist metastasis, furthermore, it can arrest function cell in G1 phase.</p>

Study on Antitumor Activity in Vivo and Effect on Hematopoiesis of Extract of Spatholobus suberctus Dunn / 中国中医药信息杂志

Objective To observe the effect of antitumor and hematopoiesis of the extract of Spatholobus suberctus Dunn (SSCE) in vivo. Methods The mouse model of Lewis lung carcinoma was used to investigate the effects of SSCE on tumor growth and hematopoiesis by detecting the counts of peripheral blood, the counts and classify of the cells in bone marrow. Result The tumor inhibitory rate of SSCE on Lewis lung cancer was 30.65%. SSCE can stimulate the proliferation of bone marrow cells and relieve the marrow depression induced by chemotherapy, at the same time, the physique of the mouse treated by SSCE was not effected. Conclusion SSCE exits antitumor effect, moreover, it can stimulate the bone marrow cells to proliferate and relieve the marrow depression produced by chemotherapy.