Association between high-sensitivity C-reactive protein and contrast-induced nephropathy after primary percutaneous coronary intervention / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the association between high-sensitivity C-reactive protein (hs-CRP) and contrast-induced nephropathy (CIN) in patients with ST-segment elevated myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) .</p><p><b>METHODS</b>A total of 220 STEMI patients undergoing primary PCI from Guangdong general hospital were recruited. Patients were divided into four groups according to the quartile of hs-CRP (Q1 group:hs-CRP < 6.26 mg/L,Q2 group:6.26-14.44 mg/L, Q3 group:14.45-33.08 mg/L, Q4 group:hs-CRP > 33.08 mg/L) . Baseline data, CIN incidence and other in-hospital outcomes were compared among groups. CIN was defined as an increase in serum creatinine of more than 5 mg/L from baseline within 48-72 hours after contrast media exposure. Receiver operator characteristics (ROC) curves and multivariate logistic regression were used to assessed the correlation between hs-CRP and CIN.</p><p><b>RESULTS</b>CIN occurred in 21 (9.8%) patients. CIN incidence of hs-CRP quartitles were 1.8%(1/55), 1.8% (1/55), 14.5% (8/55) and 20.0% (11/55) (P-trend < 0.01), respectively. In-hospital death (P-trend > 0.05) , required renal replace therapy (P-trend > 0.05) were similar among groups. ROC analysis revealed that the optimal cutoff value of hs-CRP to predict the onset of CIN was 16.85 mg/L (sensitivity: 81.0%, specificity: 61.8%, AUC: 0.748). Univariate logistic analysis showed that hs-CRP was strongly related with CIN incidence (OR = 6.88,95%CI:2.23-21.21, P < 0.01). Multivariate logistic regression analysis showed that after adjusting other traditional risk factors including female gender, anemia, ACEI/ARB use, IABP support, LVEF < 40%, age > 75 years, baseline eGFR and diabetes, hs-CRP > 16.85 mg/L was still a significant independent predictor of CIN in patients with STEMI undergoing primary PCI. Additionally, age > 75 years (OR = 7.27,95%CI:1.85-28.63, P < 0.01), eGFR (OR = 6.38,95% CI:1.48-27.41, P < 0.05) were also independent risk factors of CIN.</p><p><b>CONCLUSIONS</b>hs-CRP is positively correlated with CIN incidence. STEMI patients with higher hs-CRP level post PCI is at higher risk of developing CIN.</p>

The relationship between hyperuricemia and contrast-induced nephropathy in patients with chronic kidney disease undergoing percutaneous coronary intervention / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the relationship between hyperuricemia and contrast-induced nephropathy (CIN) in patients with chronic kidney disease (CKD) undergoing percutaneous coronary intervention (PCI).</p><p><b>METHODS</b>A total of 446 consecutive patients with CKD undergoing PCI in Guangdong general hospital were enrolled in this study. Patients were divided into hyperuricemic group (n = 205) and normouricemic group (n = 241).Hyperuricemia was defined as serum uric acid > 420 µmol/L for male, > 357 µmol/L for female. CIN was defined as ≥ 44.2 µmol/L or ≥ 25% increase from baseline Serum creatinine within 48-72 hours after contrast medium exposure, and that was not attributable to other causes.In hospital incidences of CIN and the major adverse cardiac events were compared between the two groups. The relationship between the incidence of CIN and hyperuricemia was evaluated by multivariate logistic regression analysis.</p><p><b>RESULTS</b>CIN occurred in 16.6% (74/446) of patients, and incidence of CIN was significantly higher in the hyperuricemic group than in the normouricemic group [23.9% (49/446) vs. 10.4% (25/446) , P = 0.000]. Patients who developed CIN had higher in hospital mortality [14.9% (11/74) vs. 1.3% (5/372), P = 0.000]. Need for renal replacement therapy, acute heart failure, intra-aortic balloon pump use and the hypotension after PCI were significantly higher in the hyperuricemic group compared with normouricemic group (P < 0.01 or P < 0.05) . Multivariate analysis indicates that hyperuricemia (OR = 1.9, 95%CI:1.1-3.5, P = 0.037), age > 75 years (OR = 3.2, 95%CI:1.8-5.7, P = 0.000) , emergent PCI (OR = 2.9, 95%CI:1.6-5.1, P = 0.000) and anemia (OR = 2.1, 95%CI:1.2-3.8, P = 0.012) were predictors of CIN in patients with CKD.</p><p><b>CONCLUSION</b>Hyperuricemia is the independent risk predictor of CIN in patients with CKD undergoing PCI.</p>

Effect of probiotics on respiratory tract pathogen colonization in neonates undergoing mechanical ventilation / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the effect of mouth-fed probiotics on pathogenic bacteria colonization of the oropharynx and lower respiratory tract in neonates undergoing mechanical ventilation.</p><p><b>METHODS</b>Randomized control method was employed to divide the neonates undergoing mechanical ventilation into probiotics (n=82) and control groups (n=83). The control group received routine treatment. The probiotics group was administered with oral probiotics in addition to routine treatment. The number of pathogenic bacteria colonized on the oropharynx and lower respiratory tract, and the number of the bacterial strain of ventilator-associated pneumonia (VAP) in the two groups were examined. The timing of the bacteria colonization and VAP occurrence were also examined.</p><p><b>RESULTS</b>The probiotics group presented a lower bacterial strain colonization rate of the oropharynx pathogenic bacteria than the control group (35% vs 51%; P<0.05). The colonization time of pathogenic bacteria of the oropharynx and lower respiratory tract, and the time of VAP occurrence lagged behind in the probiotics group compared with that the control group (P<0.05). No adverse reaction caused by probiotics was found.</p><p><b>CONCLUSIONS</b>Probiotics administration is effective in decreasing pathogenic bacteria colonization on the oropharynx, in postponing the pathogenic bacteria colonization on the oropharynx and lower respiratory tract and in delaying the occurrence of VAP in neonates undergoing mechanical ventilation.</p>