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Objective:To explore the risk factors of intensive care unit acquired weakness (ICUAW) in patients with sepsis, and to evaluate the predictive value of each risk factor for ICUAW.Methods:A case control study was conducted, 60 septic patients admitted to the intensive care unit (ICU) of Henan Provincial People's Hospital from October 20, 2020 to February 20, 2021 were enrolled. The patients were divided into two groups: sepsis ICUAW group and sepsis non-ICUAW group. The data of gender, age, body mass index (BMI), acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, complications, mechanical ventilation, duration of ICUAW, length of stay in ICU, fasting blood glucose, blood lactic acid (Lac), procalcitonin (PCT), C-reactive protein (CRP), sequential organ failure assessment (SOFA) score, outcome, antimicrobial agent, glucocorticoid, sedatives and analgesics drugs and vasoactive drugs were collected. Risk factors were screened by univariate Logistic regression analysis, and odds ratio ( OR) was adjusted by multivariate binary logistic regression, P < 0.05 was considered as independent risk factors. Finally, the receiver operating characteristic curve (ROC curve) was drawn to analyze the predictive value of independent risk factors. Results:The APACHEⅡ score of the sepsis ICUAW group was significantly higher than that of the sepsis non-ICUAW group (23.05±8.17 vs. 15.33±4.89, P < 0.05), the total length of stay in the ICU was significantly longer than that of the sepsis non-ICUAW group (days: 15.1±9.2 vs. 8.5±3.4, P < 0.05), the improvement rate of patients was significantly lower than that of the sepsis non-ICUAW group [45.0% (9/20) vs. 95.0% (38/40), P < 0.05]. After univariate Logistic regression and multicollinearity test analysis, 7 factors including APACHEⅡ score, average SOFA score, blood lactic acid, proportion of mechanical ventilation, sedatives and analgesics drugs, type of antibiotics and type of vasoactive drugs were included in the binary Logistic regression model [ OR: 1.21, 2.05, 2.26, 0.21, 1.54, 2.07, 1.38, 95% confidence interval (95% CI): 1.09-1.35, 1.42-2.94, 1.12-4.57, 0.05-0.66, 1.03-2.29, 1.27-3.37, 0.96-2.00, all P < 0.05]. Hosmer-Lemchaw test P = 0.901, and the correct percentage of prediction was 85%, indicating good model fit. Multivariate binary Logistic regression analysis showed that APACHEⅡ score and average SOFA score were independent risk factors for the occurrence of ICUAW in septic patients (APACHEⅡscore: OR = 1.17, 95% CI was 1.004-1.376, P = 0.044; average SOFA score: OR = 1.86, 95% CI was 1.157-2.981, P = 0.01). ROC curve analysis showed that the mean value of APACHEⅡ score, average SOFA score and their combined detection had a certain predictive value for the occurrence of ICUAW in sepsis patients, areas under ROC curve (AUC) were 0.787, 0.881, 0.905, 95% CI was 0.646-0.928, 0.791-0.972, 0.828-0.982, all P < 0.05. When the cut-off value was 19.500, 6.225, 0.375, the sensitivity was 75%, 90%, 90%, and the specificity were 80%, 80%, 85%, respectively. Conclusion:APACHEⅡ score and average SOFA score can be used as independent risk factors for the occurrence of ICUAW in sepsis, and their combined predictive value is better than that of individual index.
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Objective@#To explore the usability of regional saturation of cerebral oxygenation (rScO2) combined with percentage of α variability (PAV) in predicting brain function prognosis in patients with traumatic brain injury (TBI).@*Methods@#A retrospective analysis was conducted. The clinical data of patients with TBI who were monitored rScO2 and bedside quantitative electroencephalogram (qEEG) admitted to intensive care unit (ICU) of Henan Provincial People's Hospital from August 2018 to July 2019 were collected. The rScO2, PAV, and Glasgow coma scale (GCS) score were recorded within 72 hours after the TBI. The primary prognostic indicator was the 3-month Glasgow outcome score (GOS) score. The differences between the two groups of poor prognosis of brain function (GOS score 1-3) and good prognosis (GOS score 4-5) were compared. Binary multivariate Logistic regression analysis was used to analyze the correlation between rScO2, PAV, GCS score and the prognosis of brain function in patients with TBI. In addition, receiver operating characteristic (ROC) curve was plotted to analyze the predicting value of rScO2 and PAV only or combination for prognosis of brain function.@*Results@#A total of 42 patients with TBI were enrolled in the study, with rScO2≥0.60 (grade Ⅰ) in 14 patients, 0.50≤rScO2 < 0.60 (grade Ⅱ) in 16 patients, and rScO2 < 0.50 (grade Ⅲ) in 12 patients. PAV 3-4 scores (grade Ⅰ) were detected in 16 patients, 2 scores (grade Ⅱ) in 17 patients, and 1 score (grade Ⅲ) in 9 patients. GCS score 9-14 (grade Ⅰ) were observed in 13 patients, 4-8 (grade Ⅱ) in 23 patients, and 3 (grade Ⅲ) in 6 patients; 18 patients had poor prognosis and 24 had good one. The rScO2, PAV and GCS scores of the poor-prognosis group were significantly higher than those in the good-prognosis group [rScO2 with grade Ⅲ: 55.6% (10/18) vs. 8.3% (2/24), PAV with grade Ⅲ: 38.9% (7/18) vs. 8.4% (2/24), GCS score with grade Ⅲ: 27.7% (5/18) vs. 4.1% (1/24)] with significant differences (all P < 0.05). There was no significant difference in other general data including gender, age, total length of hospital stay or acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score between the two groups. Binary multivariate Logistic regression analysis showed that rScO2 and PAV were independent risk factors for prognosis of brain in patients with TBI [rScO2: odds ratio (OR) = 4.656, 95% confidence interval (95%CI) was 1.071-20.233, P = 0.040; PAV: OR = 3.525, 95%CI was 1.044-11.906, P = 0.042]. ROC curve analysis showed that both of rScO2 and PAV had predictive value for the prognosis of brain function in patients with TBI (AUC was 0.796 and 0.780, respectively, both P < 0.01), and rScO2 combined with PAV had higher predictive value with the AUC of 0.851 (P < 0.01) than rScO2 or PAV alone, the sensitivity was 94.4% and the specificity was 62.5%.@*Conclusions@#rScO2 and PAV were associated with early brain function prognosis in patients with TBI. The combination of two monitoring indicators can reliably assess the prognosis of brain function in patients with TBI.
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To explore the usability of regional saturation of cerebral oxygenation (rScO2) combined with percentage of α variability (PAV) in predicting brain function prognosis in patients with traumatic brain injury (TBI). Methods A retrospective analysis was conducted. The clinical data of patients with TBI who were monitored rScO2 and bedside quantitative electroencephalogram (qEEG) admitted to intensive care unit (ICU) of Henan Provincial People's Hospital from August 2018 to July 2019 were collected. The rScO2, PAV, and Glasgow coma scale (GCS) score were recorded within 72 hours after the TBI. The primary prognostic indicator was the 3-month Glasgow outcome score (GOS) score. The differences between the two groups of poor prognosis of brain function (GOS score 1-3) and good prognosis (GOS score 4-5) were compared. Binary multivariate Logistic regression analysis was used to analyze the correlation between rScO2, PAV, GCS score and the prognosis of brain function in patients with TBI. In addition, receiver operating characteristic (ROC) curve was plotted to analyze the predicting value of rScO2 and PAV only or combination for prognosis of brain function. Results A total of 42 patients with TBI were enrolled in the study, with rScO2≥0.60 (grade Ⅰ) in 14 patients, 0.50≤rScO2 < 0.60 (grade Ⅱ) in 16 patients,and rScO2 < 0.50 (grade Ⅲ) in 12 patients. PAV 3-4 scores (grade Ⅰ) were detected in 16 patients, 2 scores (grade Ⅱ) in 17 patients, and 1 score (grade Ⅲ) in 9 patients. GCS score 9-14 (grade Ⅰ) were observed in 13 patients,4-8 (grade Ⅱ) in 23 patients, and 3 (grade Ⅲ) in 6 patients; 18 patients had poor prognosis and 24 had good one. The rScO2, PAV and GCS scores of the poor-prognosis group were significantly higher than those in the good-prognosis group [rScO2 with grade Ⅲ: 55.6% (10/18) vs. 8.3% (2/24), PAV with grade Ⅲ: 38.9% (7/18) vs. 8.4% (2/24), GCS score with grade Ⅲ: 27.7% (5/18) vs. 4.1% (1/24)] with significant differences (all P < 0.05). There was no significant difference in other general data including gender, age, total length of hospital stay or acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score between the two groups. Binary multivariate Logistic regression analysis showed that rScO2 and PAV were independent risk factors for prognosis of brain in patients with TBI [rScO2: odds ratio (OR) = 4.656, 95% confidence interval (95%CI) was 1.071-20.233, P = 0.040; PAV: OR = 3.525, 95%CI was 1.044-11.906, P = 0.042]. ROC curve analysis showed that both of rScO2 and PAV had predictive value for the prognosis of brain function in patients with TBI (AUC was 0.796 and 0.780, respectively, both P < 0.01), and rScO2 combined with PAV had higher predictive value with the AUC of 0.851 (P < 0.01) than rScO2 or PAV alone, the sensitivity was 94.4% and the specificity was 62.5%. Conclusions rScO2 and PAV were associated with early brain function prognosis in patients with TBI. The combination of two monitoring indicators can reliably assess the prognosis of brain function in patients with TBI.
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Objective To investigate the influence of simvastatin treatment on Toll-like receptor 4 (TLR4) in monocytes of peripheral blood in patients with sepsis and severe sepsis and its significance. Methods A prospective randomized controlled trial was conducted. 106 patients with sepsis and 92 patients with severe sepsis admitted to Department of Critical Care Medicine of Henan Provincial People's Hospital from August 2013 to June 2015 were enrolled. These two groups of patients were randomized into conventional treatment group and simvastatin group. All patients received treatment according to the 2012 International Sepsis Treatment Guidelines, including anti-infection drugs, nutritional support, and palliative treatment, and the patients with severe sepsis were given early goal-directed therapy (EGDT). The patients in simvastatin group received simvastatin 40 mg daily orally for at least 15 days. The peripheral blood was collected and the monocytes were isolated at 1, 5, 10, 15 days after intensive care unit (ICU) admission. TLR4 expression on the surface of TLR4/CD14+ double positive monocytes was determined by flow cytometry, and adverse reaction was observed during treatment. Results TLR4 expression on the surface of monocytes showed a tendency of decreasing with prolongation of simvastatin treatment in the simvastatin group in patients with sepsis (n = 59) or severe sepsis (n = 54). However, in patients with sepsis, TLR4 level was significantly decreased from 10 days in simvastatin group as compared with that of conventional therapy group (n = 47), and it was decreased up to 15 days [mean fluorescence intensity (MFI): 21 (19, 28) vs. 27 (25, 33) at 10 days, Z = 2.198, P = 0.021; 16 (15, 21) vs. 26 (23, 34) at 15 days, Z = 4.611, P = 0.002]. In patients with severe sepsis, there was no significant difference in TLR4 level at different time points between simvastatin group and conventional treatment group (n = 38) [MFI: 55 (52, 63) vs. 56 (48, 65) at 1 day, Z = 0.313, P = 0.692; 47 (42, 56) vs. 49 (41, 58) at 5 days, Z = 0.827, P = 0.533; 40 (35, 42) vs. 42 (37, 45) at 10 days, Z = 1.012, P = 0.301; 33 (30, 38) vs. 38 (35, 41) at 15 days, Z = 0.539, P = 0.571]. No adverse reaction related with simvastatin was found during treatment in patients with sepsis or severe sepsis. Conclusions Statins could significantly down-regulate the TLR4 expression on peripheral blood monocytes in septic patients, while it showed no significant influence on TLR4 expression in patients with severe sepsis. A different effect of statins on TLR4 expression and the downstream inflammation process in sepsis and severe sepsis patients might partially explain the discrepancy in previous reports about the therapeutic effect of statins therapy in sepsis and severe sepsis patients.
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Objective To investigate the abnormal expression of proto-oncogene YES-associated protein (YAP) in gastric cancer tissues in the elderly and its correlation with poor prognosis.Methods Clinical data of 80 elderly patients with gastric cancer treated in our hospital from March 2011 to October 2014 were statistically analyzed.Results The positive expression rate of YAP was significantly higher in gastric carcinoma than in adjacent tissues [71.3％ (57/80) vs.13.8％ (11/80),P＜0.05].The positive expression of YAP were significantly associated gastric tumor size,tumor stage,invasion depth and lymph node metastasis (all P＜0.05),but had no correlation with tumor differentiation (P＞0.05).The 5-year survival rate was significantly lower in patients with YAP-positive expression than in patients with YAP-negative expression (P ＜ 0.05),but the differences in 1-year,3-year survival rates were not significant between the two groups (all P＞0.05)The YAP expression,tumor stage,lymph node metastasis were significantly associated with the prognosis of gastric cancer in patients (all P＜0.05).Conclusions YAP-positive expression rate is significantly higher in gastric cancer tissues than in adjacent tissues in the elderly,which indicates poor prognosis of patients with gastric cancer.
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To investigate the characteristics of acute respiratory distress syndrome(ARDS)in the casualties of a great earthquake in Wenchuan China on May 12,2008.Records of the hospitalized patients in ICU injured in the earthquakes were examined retrospectively.Among the total of 153 critical patients injured in the earthquake,52(34.0%)had ARDS.Among these 52 patients with ARDS,24(46.2%)had multiple organ dysfunction syndrome(MODS).9(17.3%)patients with ARDS dead.Approximate 34.0% of the casualties of a great earthquake in ICU had ARDS,MODS is a common associated conditions in these patients,infection phy a great role in these patients.