A postoperative in-hospital mortality risk model for elderly patients undergoing cardiac valvular surgery based on LASSO-logistic regression / 中国胸心血管外科临床杂志

@#Objective     To evaluate the risk factors for postoperative in-hospital mortality in elderly patients receiving cardiac valvular surgery, and develop a new prediction models using the least absolute shrinkage and selection operator (LASSO)-logistic regression. Methods     The patients≥65 years who underwent cardiac valvular surgery from 2016 to 2018 were collected from the Chinese Cardiac Surgery Registry (CCSR). The patients who received the surgery from January 2016 to June 2018 were allocated to a training set, and the patients who received the surgery from July to December 2018 were allocated to a testing set. The risk factors for postoperative mortality were analyzed and a LASSO-logistic regression prediction model was developed and compared with the EuroSCOREⅡ. Results     A total of 7 163 patients were collected in this study, including 3 939 males and 3 224 females, with a mean age of 69.8±4.5 years. There were 5 774 patients in the training set and 1 389 patients in the testing set. Overall, the in-hospital mortality was 4.0% (290/7 163). The final LASSO-logistic regression model included 7 risk factors: age, preoperative left ventricular ejection fraction, combined coronary artery bypass grafting, creatinine clearance rate, cardiopulmonary bypass time, New York Heart Association cardiac classification. LASSO-logistic regression had a satisfying discrimination and calibration in both training [area under the curve (AUC)=0.785, 0.627] and testing cohorts (AUC=0.739, 0.642), which was superior to EuroSCOREⅡ. Conclusion     The mortality rate for elderly patients undergoing cardiac valvular surgery is relatively high. LASSO-logistic regression model can predict the risk of in-hospital mortality in elderly patients receiving cardiac valvular surgery.

Early survival analysis of acute type A aortic dissection and intramural hematoma / 中国胸心血管外科临床杂志

@#Objective    To explore the early clinical outcomes of patients with acute type A aortic dissection and intramural hematoma. Methods    The clinical data of 61 patients with acute type A aortic dissection or intramural hematoma in our hospital from January 23, 2020 to March 10, 2020 were retrospectively analyzed, including 43 males and 18 females, aged 22-81 (52.1±13.0) years. The patient's time of visit, clinical characteristics and early survival were analyzed. Kaplan-Mier survival curve and log-rank test were used for the survival analysis. Results    There were 48 (78.7%) patients diagnosed with acute type A aortic dissection and 13 (21.3%) patients with intramural hematoma; 34 patients received operation and 11 were emergent. The 30-day mortality was 2.9% among the patients receiving operation. There were 48 patients alive and 13 patients dead during the study period. The cumulative survival rates for all the patients on postoperative 1 day, 3 days and 7 days were 93.4%, 86.4% and 77.5%, respectively. The cumulative survival rates for the patients with dissection on postoperative 1 day, 3 days and 7 days were 95.7%, 88.7% and 79.4%, respectively. The cumulative survival rates for the patients with hematoma on postoperative 1 day, 3 days and 7 days were 92.3%, 84.6% and 84.6%, respectively. The difference of survival rates between the two groups was not statistically significant (P>0.05). The cumulative survival rate of all the patients on postoperative 14 days was 74.5%. No statistically significant difference in survival rate on postoperative 14 days was found between patients with intramural hematoma and patients with aortic dissection (P>0.05). The proportions of the patients with unstable hemodynamics were found statistically significant between the survival patients and the dead patients (P<0.05). Conclusion    Patients with acute aortic dissection and intramural hematoma who survive to the hospital still have the risk of death under active drug therapy, and rupture of the dissection is the leading cause of death in these patients, especially for those with hemodynamic unstability.

Ulinastatin combined with thymosin α1 for treatment of severe sepsis: a histopathological observation in rats / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the therapeutic effect of ulinastatin combined with thymosin α1 in the treatment of severe sepsis in rats.</p><p><b>METHODS</b>Normal Wistar rats were subject to cecal ligation and puncture (CLP) to establish models of severe sepsis. The rats were then randomized into 4 groups for treatment with saline (control), ulinastatin, thymosin α1, or the combination of the latter two injected through the caudal vein or subcutaneously at 6, 24, 48 and 72 h after modeling. The mortality rate was recorded daily and the rats were executed at 24, 48, 72 and 96 h after CLP to harvest the heart, liver, spleen, lung, kidney and small intestines for pathological examination. The spleen of the rats were taken for detection of apoptosis of the spleen cells.</p><p><b>RESULTS</b>The mortality rate of the septic rats in the combined treatment group was decreased significantly (P=0.0325). The control group showed the most severe organ damage, which was moderate in single drug treatment group and the mildest in combined treatment group. Obvious spleen cell apoptosis was found in the control group, and was significantly ameliorated in the combined treatment group[(47.4∓10.9)% vs (39.3∓11.4)%, P=0.0000].</p><p><b>CONCLUSION</b>Combined treatment with ulinastatin and thymosin α1 can significantly improve the prognosis and ameliorate organ damage and spleen cell apoptosis in rats with sever sepsis.</p>

Value of interleukin-18 changes in early warning of organ dysfunction after trauma / 中华创伤杂志

Objective To detect the changes of interleukin-18 (IL-18) in plasma of trauma patients and evaluate their value in early warning of organ dysfunction. Methods A prospective study was carried out in 54 trauma patients admitted in from March 2001 to September 2002, which were divided into low injury severity score(ISS) group (Group L-ISS) and high ISS group (Group H-ISS). ELISA was applied to measure the level of IL-18 of blood samples that were collected on arrival, at days 4, 7 and 14 following admission. In the meantime, IL-18 level of plasma samples from patients with systemic inflammatory response syndrome (SIRS), sepsis and multiorgan dysfunction syndrome (MODS) was retrospectively analyzed so as to calculate the critical value of IL-18 in predicting organ dysfunction. Results After trauma, IL-18 concentration of plasma reached peak at days 4 and 7, and decreased gradually at day 14, which was significantly related to SIRS, sepsis and MODS, respectively. The IL-18 level was high relatively in plasma from patients with organ dysfunction. The higher IL-18 level in plasma within seven days after trauma indicated the severer organ dysfunction. Conclusion IL-18 is sensitive in early warning of organ dysfunction after trauma.

Current status of critical care medicine and its future / 解放军医学杂志

Objective To reviewing the developmental history and to make an overall inquiry of the status quo of critical care medicine(CCM)in China,in order to make suggestions regarding the future development of this subspecialty in this country,particularly in the army forces.Methods Relevant articles regarding this subspecialty were retrieved from the published literature,and important events as well as advances in this field were reviewed to illustrate the history of establishment of intensive care unit(ICU),important events in the development,and academic advances in this subspecialty in this country and especially in the army forces.Results The review illustrated that this subspecialty of medical science had made a big stride in the past thirty years,and it has become one of the major forces in the medical arena in this country.The change in stratification of patients as a whole,further fragmentation of medical discipline,experiences obtained from participation in the care of mass casualties in multiple disasters,concerted efforts made by specialists devoted to this field of medicine,as well as strong support from the administration had given tremendous impetus to an upsurge of this subspecialty. In this army forces,this subspecialty had advanced in pace with that in the whole country.The inauguration of Military Association of CCM had further pushed forward the science and arts of CCM in the armed forces.Nevertheless,there are still many important problems in this field to be investigated.Conclusions The administration should give more support and advices for development of this important medical subspecialty in the armed forces,in order to further raise the standard of the arts and science of this branch of medical science to face any challenge in the care of serious illnesses and injuries encountered both in peace time and in combats.It is also important to propagate the perception of CCM in the medical establishments of grassroots level.

The new resuscitation strategy for hemorrhagic shock / 解放军医学杂志

For uncontrolled hemorrhagic shock the traditional method and target of resuscitation may be harmful. The existing data supported a strategy of less aggressive interventions to those shock with uncontrolled hemorrhage until a decisive surgery begin. The choice of liquor for resuscitation remains in controversy. A combined application of crystalloid and colloid liquor seems to be reasonable and may be accepted by most physicians. It should be noted that the new resuscitation strategy may not be suitable to some kinds of trauma, such as traumatic brain injury, and its long-term effects on to the prognosis should be further evaluated.

THE EVOLUTION AND PROGRESS IN OUR UNDERSTANDING OF SYSTEMIC INFLAMMATORY RESPONSE SYNDROME AND MULTIPLE ORGAN DYSFUNCTION SYNDROME / 解放军医学杂志

Systemic inflammatory response syndrome (SIRS) and its lethal sequela multiple organ dysfunction syndrome (MODS) are common complications in critical illness, such as severe trauma, shock, infection and major operations. During the past three decades, the evolution in our understanding of SIRS and/or MODS could be divided into three stages. Particularly in recent years, advances in molecular and cellular biology have provided new insights in the pathogenesis of this complex condition. The earlier emphasis on the pro inflammatory mediators involved in propagation of inflammatory response, has gradually been replaced by a realization that SIRS/MODS are the result of an imbalance of pro and anti inflammatory mediators to create the final status of excessive inflammation or immunoparalysis'. Though prognosis remains poor, the knowledge that now exists about SIRS/MODS gives great hope for the future. Progress has been made in new treatment modalities and re evaluation of current available measures. Nevertheless, improved techniques to monitor immunological or other markers of inflammatory and host defense responses will be important in assessing the effects of future therapies on central mechanisms contributing to SIRS/MODS.