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OBJECTIVE@#To investigate the effect of scutellarin (SCU) on proliferation, cell cycle and apoptosis of acute myeloid leukemia (AML) cells and its related molecular mechanism.@*METHODS@#Human AML HL-60 cells were cultured in vitro. The cells were treated with SCU at the concentration of 0, 2, 4, 8, 16, 32, 64 μmol/L, and the inhibition rate of cell proliferation was detected by CCK-8 method. Then HL-60 cells were treated with SCU at the concentration of 4, 8, 16 μmol/L, and the negative control group (NC group) was set. The cell cycle distribution and apoptosis were detected by flow cytometry, and the expression of cell cycle, apoptosis and JAK2/STAT3 pathway related proteins were detected by Western blot.@*RESULTS@#SCU significantly inhibited the proliferation of HL-60 cells in a concentration- and time-dependent manner(r =0.958,r =0.971). Compared with NC group, the proportion of cells in G0/G1 phase and apoptosis rate of HL-60 cells in 4, 8, 16 μmol/L SCU group were significantly increased, and the proportion of cells in S phase was significantly decreased (P <0.05). The relative protein expression levels of p21, p53, caspase-3 and Bax were significantly increased, while the relative protein expression levels of CDK2, cyclin E and Bcl-2 were significantly decreased (P <0.05). The ratio of p-JAK2/JAK2 and p-STAT3/STAT3 were significantly decreased (P <0.05). The changes of above-mentioned indexes were concentration dependent.@*CONCLUSION@#SCU can inhibit the proliferation of AML cells, induce cell cycle arrest and apoptosis, and its mechanism may be related to the regulation of JAK2/STAT3 signaling pathway.
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Humans , Apoptosis , Signal Transduction , Leukemia, Myeloid, Acute , HL-60 Cells , Cell Proliferation , Cell Line, TumorABSTRACT
ObjectiveAutonomic dysfunction is a common and serious complication in patients with early chronic kidney disease （CKD）. Sweat gland dysfunction is an initial sign of autonomic dysfunction. Electrochemical skin conductance （ESC） measurement by reverse iontophoresis and chronoamperometry to assess sweat gland function may detect patients with mild renal insufficiency in healthy population for early intervention and treatment to delay further deterioration of renal function. MethodsAn EZSCAN score （0~100） was calculated using a proprietary algorithm based on the chronoamperometry analysis. A total of 6 661 subjects who received physical examination from the physical examination center of the Second Affiliated Hospital of Zhejiang University School of Medicine from January to October 2020 were enrolled， including 2 075 （31.15%） subjects with reduced renal function （eGFR < 90 mL·min-1·1.73 m-2） as the case group and 4 586 （68.85%） subjects with normal renal function （90 mL·min-1·1.73 m-2≤ eGFR ≤120 mL·min-1·1.73 m-2） as the control group. Lasso regression was used to screen covariates， and the relationship between the risk score and eGFR was analyzed by loess curve and logistic regression. ResultsAfter multivariate adjustment， the risk score was correlated with the risk of eGFR decline. Compared with the group with the lowest risk value （Q1<24）， the OR（95%CI ）of Q2 （25-27）， Q3 （28-47）， and Q4 （48-75） were 1.85 （1.55， 2.21）， 2.53 （2.13， 3.00）， 2.49 （2.13， 2.93）， respectively. The maximum area under the ROC curve is 0.75（0.74，0.76）， the sensitivity is 73.98%， the specificity is 63%， the positive predictive value is 47.49%， the negative predictive value is 84.25%， and the Youden index is 0.369 72， the optimal cutoff value is 25. ConclusionsEZSCAN could be a useful screening tool to identify healthy individuals at increased risk of renal function decline， and the one with an EZSCAN score of more than 25% should undergo diagnostic laboratory testing.
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Objective:To study the predictive value of central venous-arterial CO 2 difference (Pv-aCO 2)/arterial-central venous O 2 difference (Ca-vO 2) ratio for progressive organ dysfunction in patients with septic shock after resuscitation. Methods:Septic shock patients receiving resuscitation in ICU were retrospectively enrolled from July 2018 to June 2019 at the First Affiliated Hospital Anhui Medical University. Hemodynamic and laboratory data were collected. Single and multivariate logistic regression model was constructed to explore the independent risk factors of progressive organ dysfunction. The predictive value of hemodynamic parameters to progression of organ dysfunction was determined using receiver operating characteristic (ROC)curve analysis.Results:A total of 99 patients were enrolled with 25 patients (25.25%) progressing to organ dysfunction. The norepinephrine dose [0.61 (0.27,1.42) μg·kg -1·min -1 vs. 0.91 (0.47,2.87) μg·kg -1·min -1], blood lactic acid [2.93 (1.77,5.88) mmol/L vs. 6.15 (2.56,8.59) mmol/L], Pv-aCO 2 [5.00 (3.98,7.85) mmHg(1 mmHg=0.133 kPa) vs. 7.00 (5.00,8.35) mmHg] and Pv-aCO 2/Ca-vO 2 [1.36(1.17,1.69) vs. 2.23 (1.83,2.78)] in patients with progressive organ dysfunction were significantly higher than those in patients without( P<0.05). Multivariate logistic regression analysis suggested that Pv-aCO 2/Ca-vO 2 ( OR=20.48,95 %CI 5.25-79.93, P<0.001) was independent risk factors for predicting organ dysfunction. The cutoff value of Pv-aCO 2/Ca-vO 2 was equal or more than 1.77 with a sensitivity of 80.00% and a specificity of 79.73%. Compared with those with Pv-aCO 2/Ca-vO 2<1.77, patients with Pv-aCO 2/Ca-vO 2≥1.77 had a greater probability of progressive organ dysfunction (47.37% vs. 8.20%, P<0.001). Conclusion:The progression of organ dysfunction in septic patients after resuscitation is associated with poor prognosis. Pv-aCO 2/Ca-vO 2 is a good indicator to evaluate oxygen metabolism and predict the progression of organ dysfunction.
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Objective:To establish a comet test method for detection of genotoxicity of three reference chemicals in rat liver cells. Methods:6-10 week old Sprague Dawley rats were randomly divided into 4 groups， with normal saline （0.9% NaCl solution） as negative control group. Animals in three test groups were treated， respectively， with ethyl methanesulfonate （EMS） 200 mg/kg， N-methyl-N-nitrosourea （MNU） 50 mg/kg， and D-mannitol 2 000 mg/kg. There were 10 animals in each group， 5 males and 5 females. The animals received two times （21 h interval） of test compounds through intragastric administration， and their clinical symptoms and body weight changes were recorded during the experiment. The rats were sacrificed 3 h after the last exposure. The liver was weighed， then used to prepare single-cell suspensions for the alkaline comet test which determines the average tail DNA content percentage （DNA%） of hepatocytes and other comet indicators. Results:（1） D-mannitol， EMS and MNU did not show significant toxicity in the whole animal. （2） The mean values of tail DNA content percentage （DNA%） of rat hepatocytes in EMS ［（60.07±24.69）%］ and MNU ［（41.66±22.35）%］ groups were higher than that in the negative control group ［（2.32±1.39）%］ and the difference was statistically significant （P<0.05）. The difference between D-mannitol group ［（3.06±3.30）%］ and the negative control group was not significant （P>0.05）. Conclusion:This laboratory has established a comet test method using hepatocytes from treated rats. Among three testing chemicals， EMS and MNU have displayed genotoxicity by this assay， but no genotoxicity was observed in D-mannitol treated animals.
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Protein kinases are intimately involved in the pathogenesis of many diseases such as cancer, inflammation, and autoimmune and neurological diseases. Therefore, kinases have been widely studied as drug targets over the past three decades. As of April, 2020, the FDA had approved 59 small molecule kinase inhibitors (SMKIs) in the emerging field of targeted drug therapy. This paper focuses on the biochemistry and pharmacology of these 59 SMKIs and 121 SMKIs for which structures can be retrieved and that are now in phase Ⅱ and Ⅲ clinical trials. In addition, this paper also conducts a simple analysis of several popular targets and their inhibitors.
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Objective To analyze the application of intraoperative neurophysiological monitoring combined with neuronavigation multi-modal fusion technology in the brainstem glioma resection. Methods One hundred twenty patients with brainstem glioma were divided into observation group and control group. The control group was treated by traditional operation, while the observation group was treated by intraoperative nerve electrophysiological monitoring combined with neuronavigation multimodal fusion technology. The general condition, clinical efficacy, KPS score, complications and survival rate of the two groups were compared. Results The effect was significantly better in the observation group(76.66%)than in control group(53.33%)( x2=11.962,P=0.001).KPS scores were significantly higher in the observation group (27.91 ±1.98) than in the control group (12.11 ±2.13)(t=32.669, P<0.001). Conclusions Intraoperative nerve electrophysiological monitoring plus neuronavigation multimodality fusion technology can improve clinical efficacy and quality of life in patients with brainstem glioma.
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Objective Antibody drugs are one of the hot topics in biomedical research.This study aims to develop egg yolk antibodies (IgYs) against human isomaltase and determine their biological activities.Methods The purified recombinant isomaltase protein was used as an antigen to immunize egg-laying hens in combination with complete Freund adjuvant (CFA).Anti-isomahase IgYs were extracted by water dilution-sodium sulfate extraction assay and further analyzed for their purity,specificity,titer and stability by SDS-PAGE,Western blot and ELISA respectively,and their inhibitory effect on human alpha-glycosidase enzymes was evaluated by the PNPG method.Results Anti-isomaltase IgYs were obtained,with a titer of 1 ∶ 12800,capable of specifically binding human isomaltase,and with a good thermal stability,acid/alkali stability and pepsin resistance.Conclusion Anti-human isomaltase IgYs were successfully prepared,which may provide an experimental ground for further investigation of oral antihyperglycemic agents for type Ⅱ diabetes mellitus.
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Objective To study the effect of WeChat follow-ups on the self-management ability and satisfaction of demand of the patients with home peritoneal dialysis. Methods We established a WeChat platform to implement the follow-ups to the patients with home peritoneal dialysis in our hospital. Sixty patients with regular peritoneal dialysis were enrolled. On the basis of the routine follow-ups at outpatient visits,telephone and family visits,the WeChat follow-ups were carried out.The comparison was carried out on the self-management ability and satisfaction of demand before the implementation and six months after the implementation. Results The total score and the scores on each dimension of the patients'self-management ability after the implementation were all significantly higher than those before the implementation (P<0.01).The patients'satisfaction of demand after the implementation was superior to the one before the implementation (P<0.01). Conclusion WeChat follow-ups improve the patients' ability in self-management and satisfaction of the patients'demand.
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Objective To evaluate the clinical performance of checklist for early recognition and treatment of acute illness (CERTAIN) on patients in the intensive care unit (ICU). Methods A prospective observational study was performed. 100 patients (age > 18 years old, the length of ICU stay > 72 hours) admitted to ICU of the Second People's Hospital of Lu'an from January to July in 2018 were enrolled. By convenience sampling methods, 50 patients admitted to the hospital from January to April in 2018 were selected as the control group. Standard ward inspection was given to the control group by three senior-level and intermediate-level doctors blinded from the research plan; at the end of March 2018, these three doctors were trained with the CERTAIN checklist and certified by the Mayo Clinic distance learning training. Fifty patients enrolled from March to July 2018 received medical rounds using CERTAIN (observation group). The CERTAIN checklist contained 20 items that cover the range of daily critical ward rounds, which need clinicians to quantify each item. The data included the length of ICU stay, central venous catheter (CVC) indwelling time, catheter indwelling time, duration of mechanical ventilation, drug use rate, ICU mortality, and incidence of adverse events were collected and compared between the two groups. The independent factors affecting ICU death were analyzed by log-rank univariate analysis and Cox regression multivariate analysis. Results Compared with control group, the length of ICU stay (days: 8.68±4.84 vs. 13.64±9.37), catheter indwelling time (days: 8.16±5.29 vs. 13.32±9.31), duration of mechanical ventilation (days: 3.46±4.14 vs. 6.62±9.57) in observation group were significantly decreased, insulin use rate (34.0% vs. 56.0%) and ICU mortality (2.0% vs. 14.0%) were significantly decreased, with statistically significant differences (all P < 0.05). Besides, the use of CERTAIN can significantly improve the efficiency of the ward inspection. The ward inspection time was shortened from (8.00±0.45) minutes to (5.00±0.33) minutes by using the CERTAIN checklist (t = 9.312, P < 0.01). Survival analysis showed that CERTAIN application could reduce ICU mortality (χ2= 3.898, P = 0.048), but the use of CERTAIN was not an independent factor for reducing ICU mortality [odds ratios (OR) = 1.001, P = 0.922]. Conclusions CERTAIN application has a significant effect on critical patients. It is suggested to spread in ICU of China.
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BACKGROUND:Distal radius C fractures belong to multiple fractures in the joint. Its treatment should recover various angles and joint surface continuity outside the joint. The recovery of palmar tilt angle, radial inclination angle and radial height is also very important for treating distal radius. OBJECTIVE:To study the changes in palmar tilt angle, radial inclination angle and radial height after type C fractures of the distal radius repaired with Acu-Loc(R)2 VDR bone plate system. METHODS:From May 2015 to March 2016, 11 cases of type C distal radial fractures were treated with Acu-Loc(R)2 VDR bone plate system. Preoperatively, the palmar tilt angle was-31° to-4° (-12.45° on average), and the radial inclination angle was 6° to 18° (11.18° on average), and the radial height was 1.92 mm to 8.68 mm (5.28 mm on average). X-ray films were observed at postoperative 4, 8 and 12 weeks and half a year in all patients. Palmar tilt angle, radial inclination angle and radial height were measured and observed using anteroposterior and lateral X-ray films during final follow-up. Wrist function was assessed with Gartland-Werley score. RESULTS AND CONCLUSION:(1) 11 patients were followed and the postoperative follow-up ranged from 7 months to 15 months. X-ray films showed that the union of fractures was achieved in 6-8 weeks (6.5 weeks on average). No infection or internal fixation failure occurred. The articular facets were smooth in 10 patients and a little poor was found in 1 case (<2 mm). (2) After operation, the palmar tilt angle was 8° to 15° (11.55° on average) (P<0.05);the radial inclination angle was 22° to 27° (23.18° on average) (P<0.05);the radial height was 8.01 mm to 13 mm (11.03 mm on average) (P<0.05). (3) The results were excellent in 8 cases, good in 2 cases, and poor in 1 cases according to Gartland-Werley wrist function assessment;the excellent and good rate was 91%. (4) Acu-Loc(R)2 VDR bone plate fixation can provide reliable fixation and effective support for type C distal radius fractures, which can recover the palmar tilt angle, the radial inclination angle and the radial height, so the Acu-Loc(R)2 VDR bone plate is an ideal method to treat type C fractures of the distal radius.
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Objective To study the nursing intervention of acupuncture plus rehabilitation training on patients with hemiplegia after stroke. Methods 60 patients with hemiplegia after stroke from February 2016 to January 2017 were randomly divided into the control group and the experimental group, each with 30 cases. The control group was given routine treatment and nursing measures, the patients in the experimental group were received acupuncture treatment plus rehabilitation training, and given specific nursing intervention measures, the psychological state of patients with attention, eliminating the patient anxiety and anxiety and other negative emotions, explaining to patients patiently, rehabilitation training guide patients. Clinical indicators of two groups of patients were compared and analyzed. Results After treatment, the total score of quality of life of patients in the experimental group was (75.2±11.2) points, the control group quality of life in patients was (64.2±9.3) points, the effective rate of the experimental group (90.00%) was significantly higher than (70.00%) in the control group with statistical difference (P<0.05). Conclusion Acupuncture plus rehabilitation training combined with nursing intervention in clinical application of hemiplegia patients after stroke, could significantly improve the quality of life and life ability of patients with high safety and clinical significance.
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Objective To study the nursing intervention of acupuncture plus rehabilitation training on patients with hemiplegia after stroke. Methods 60 patients with hemiplegia after stroke from February 2016 to January 2017 were randomly divided into the control group and the experimental group, each with 30 cases. The control group was given routine treatment and nursing measures, the patients in the experimental group were received acupuncture treatment plus rehabilitation training, and given specific nursing intervention measures, the psychological state of patients with attention, eliminating the patient anxiety and anxiety and other negative emotions, explaining to patients patiently, rehabilitation training guide patients. Clinical indicators of two groups of patients were compared and analyzed. Results After treatment, the total score of quality of life of patients in the experimental group was (75.2±11.2) points, the control group quality of life in patients was (64.2±9.3) points, the effective rate of the experimental group (90.00%) was significantly higher than (70.00%) in the control group with statistical difference (P<0.05). Conclusion Acupuncture plus rehabilitation training combined with nursing intervention in clinical application of hemiplegia patients after stroke, could significantly improve the quality of life and life ability of patients with high safety and clinical significance.
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<p><b>BACKGROUND</b>Patients on hemodialysis have a high-mortality risk. This study analyzed factors associated with death in patients on maintenance hemodialysis (MHD). While some studies used baseline data of MHD patients, this study used the most recent data obtained from patients just prior to either a primary endpoint or the end of the study period to find the characteristics of patients preceding death.</p><p><b>METHODS</b>Participants were selected from 16 blood purification centers in China from January 2012 to December 2014. Patients' data were collected retrospectively. Based on survival status, the participants were divided into two groups: survival group and the death group. Logistic regression analysis was performed to determine factors associated with all-cause mortality.</p><p><b>RESULTS</b>In total, 4104 patients (57.58% male, median age 59 years) were included. Compared with the survival group, the death group had more men and more patients with diabetic nephropathy (DN) and hypertensive nephropathy. The patients preceding death also had lower levels of diastolic blood pressure, hemoglobin, serum albumin, serum calcium, serum phosphate, Kt/V, and higher age. Multivariate analysis revealed that male sex (odd ratio [OR]: 1.437, 95% confidence interval [CI]: 1.094-1.886), age (OR: 1.046, 95% CI: 1.036-1.057), and presence of DN (OR: 1.837, 95% CI: 1.322-2.552) were the risk factors associated with mortality. High serum calcium (OR: 0.585, 95% CI: 0.346-0.989), hemoglobin (OR: 0.974, 95% CI: 0.967-0.981), albumin (OR: 0.939, 95% CI: 0.915-0.963) levels, and dialysis with noncuffed catheter (OR: 0.165, 95% CI: 0.070-0.386) were protective factors based on a multivariate analysis.</p><p><b>CONCLUSIONS</b>Hemodialysis patients preceding death had lower hemoglobin, albumin, and serum calcium levels. Multivariate analysis showed that male sex, age, DN, low hemoglobin, low albumin, and low serum calcium were associated with death in hemodialysis patients.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , China , Multivariate Analysis , Renal Dialysis , Mortality , Retrospective Studies , Risk FactorsABSTRACT
Objective:To prepare the egg yolk immunoglobulin Y ( IgY) against human Sucrase and study its stability,in vitro activity. Methods:Hy-line laying hens were immunized with human Sucrase protein,IgY was isolated and purified from egg yolks of im-munized hens using water dilution and salting out method. Indirect ELISA was used to evaluate the titer and stability of IgY. The purity and specificity of IgY were analysed by SDS-PAGE and Western blot respectively. The inhibitory effects of IgY on α-glucosidase was studied by PNPG method. Results:Indirect ELISA results showed IgY could be detected on the tenth day after the first immunization, and the peak titer of IgY was 1:12 800 after the 40th day of immunization. SDS-PAGE showed that the heavy chain and light chain of IgY were 65 kD and 25 kD respectively, and the IgY against human Sucrase could specifically recognize the protein of human Sucrase. The IgY maintained primary titer when it was kept between 29-69℃ for 15 min,and pH 4-7,37℃,4 h. The titer of IgY was maintained 50% after digestion by pepsin and trypsin respectively for 2 hours. IgY had a higher resistence to pepsin than trypsin after longer digestion time. IgY showed an inhibitory effect on α-glucosidase in concentration dependent manner. The half inhibitory concentration (IC50) was 0. 540 mg/ml. Conclusion:The IgY against human Sucrase has been successfully obtained,which established foundations for its study of Type 2 diabetes mellitus rat models in vivo.
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BACKGROUND:Intertrochanteric fracture is one of the most common fractures in older adults. The surgical treatment methods include artificial joint replacement (total hip and femoral head replacement) and internal fixation (proximal femoral nail anti-rotation and dynamic hip screw), but there is no clear evidence to evaluate the effect of them. OBJECTIVE: To compare the effect difference of arthroplasty and internal fixation in the treatment of intertrochanteric fracture in the elderly people. METHODS:We retrieved randomized controled studies on artificial joint replacement (total hip and femoral head replacement) and internal fixation (proximal femoral nail anti-rotation and dynamic hip screw) in the treatment of intertrochanteric fracture from 1990 to 2015. Meta-analysis was used to compare operation time, intraoperative bleeding volume, one-year postoperative Harris hip scores, and one-year postoperative complication between the arthroplasty and internal fixation. RESULTS AND CONCLUSION:(1) Twenty-one studies were included. (2) Intraoperative bleeding volume and one-year postoperative Harris hip scores were higher in the arthroplasty group than in the internal fixation group. (3) Operation time was similar between the arthroplasty and internal fixation groups. (4) Complication rate was lower in the arthroplasty group than in the internal fixation group. Incidence of complications was closed between the arthroplasty and internal fixation groups. (5) Results suggested that the effect of arthroplasty was better than internal fixation for treating intertrochanteric fracture in the elderly. However, prospective large-sample long-term randomized controled trials are needed for verification.
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Aim ToexploretheeffectsofnewdrugT-006 on improving learning and memory abilities in scopolamine-induced dementia mice and its possible mechanism.Methods 72maleKunmingmicewere randomly divided into six groups:normal control group,model group,donepezil treatment group,T -006 treatment group with different doses(1,3 and 10 mg·kg-1 ).All mice were treated by intragastric ad-ministration for 14 consecutive days. Learning and memory abilities were tested by a five-day Morris water maze trial from the 1 1 th day.the first 4 days of the five-day Morris water maze,the navigation test was performed,the last day of Morris water maze is the spatial probe test.During the navigation test, mice were intraperitoneally given 2 mg · kg-1 scopolamine 20 minutes before entering the water,while normal control group mice administrated with sterile saline in-stead.Mice were not given T-006 nor scopolamine in spatial probe test.After Morris water maze,all mice were sacrificed for hippocampus and cortex.The activi-ties of AchE and SOD and the levels of GSH and MDA in hippocampus and cortex were measured after tissue harvesting.Results Comparedwithmodelgroup,T-006 could obviously improve learning and memory abil-ities in scopolamine-induced mice, significantly in-crease the levels of SOD and GSH and decrease the levelsofMDAandAchE.Conclusion T-006can significantly improve cognitive abilities in scopolamine-induced dementia mice,and its relevant mechanism may be closely related to its antioxidative effect and the ability to decrease AchE level.
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<p><b>BACKGROUND</b>The aim of this study was to evaluate the efficacy of ultrasonic features in predicting the malignancy of thyroid nodules in a group of Chinese patients.</p><p><b>METHODS</b>In all, 762 patients with thyroid nodules (424 malignant and 338 benign) underwent ultrasound (US) check and surgery between March 2011 and July 2014 at Peking University First Hospital were identified. Univariate and receiver operating characteristic (ROC) analyses were performed to calculate the sensitivity, specificity, negative and positive predictive values of each US feature, and the accuracy of their combinations for prediction of malignancy.</p><p><b>RESULTS</b>Patients with malignant nodules were younger and without obvious risk history than those in the benign group (P < 0.001, P = 0.93). No individual US sign was fully predictive of a malignant lesion. The Youden indexes of irregular margins and hypoechogenicity were the first and second highest in all US features, which were 51.9% and 45.2%, respectively. The sensitivity of solid components (89.7%) and hypoechogenicity (89.2%) and the specificity of taller-than-wide shape (98.5%) and microcalcifications (90.6%) were the first and second highest in all US features. Intranodular flow on a color Doppler examination was a weak predictor of malignancy. Under ROC analysis excepting intranodular flow, the 95% confidence interval (CI) of areas under the curves of hypoechogenicity and irregular margins with any one of the US features were overlapped that of five-feature combinations (95% CI: 0.850-0.901).</p><p><b>CONCLUSIONS</b>We should be alert with taller-than-wide shape and microcalcifications. Intranodular flow was a weak predictor of malignancy. According to Youden indexes and ROC analysis, irregular margins and hypoechogenicity combined with solid component or taller-than-wide shapes or microcalcifications have a high predicative value for malignant thyroid nodules in Chinese patients.</p>
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Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Asian People , ROC Curve , Retrospective Studies , Sensitivity and Specificity , Thyroid Neoplasms , Diagnosis , Thyroid Nodule , Diagnosis , Ultrasonography , MethodsABSTRACT
ObjectiveTo evaluate the influence of different hemoperfusion (HP) intensity on 7-day and 28-day mortality for patients with paraquat (PQ) poisoning, and examine the factors that may affect the decision of the clinicians to prescribe a high intensity HP.Methods A retrospective cohort study was conducted. The patients admitted to the department of critical care medicine of Anhui Provincial Hospital Affiliated to Anhui Medical University with the diagnosis of PQ poisoning from August 2012 to August 2014, fulfilling the following criteria were enrolled in the study: older than 18 years, interval from ingestion PQ to hospital admission shorter than 12 hours, and receiving HP treatment within 24 hours, and expecting surviving time exceeding 24 hours after admission, and data of the patients available for at least 28 days after admission. Depending on the intensity of HP, patients were assigned to either lower intensity HP group (LHP, defined as receiving HP for less than 4 hours, 2 columns) or higher intensity HP group (HHP, defined as receiving HP longer than 6 hours, 3 columns). Patients' data were retrieved from hospital's electronic database after hospital admission, and the results at 7th day and 28th day were recorded. Multiple logistic regression model was used to determine factors with which the clinician decided to choose the intensity of HP for the patients, and Cox regression model was used to evaluate 7-day and 28-day mortality.Results Data of 60 patients was finally available for this study. LHP group consisted of 28 patients, with a 7-day mortality of 53.6%(15 patients) and 28-day mortality of 64.3% (28 patients); 32 patients were assigned to HHP group with 7-day mortality of 43.8% (14 patients) and 28-day mortality of 62.5% (20 patients). Twenty-eight patients constituted as the HHP group, with higher PQ concentration in plasma, higher incidence of respiratory alkalosis and acute kidney injury (AKI), and higher level of lactate (Lac) compared with LHP group. However, a lower 7-day mortality was observed in the HHP group. Multiple logistic regression model indicated that at admission, interval from ingestion PQ to hospital admission longer than 4 hours [odds ratio (OR) = 1.461, 95% confidence interval (95%CI) = 1.132-1.435,P 10×109/L (OR = 1.222, 95%CI = 1.032-1.275, P = 0.018), Lac> 2.0 mmol/L (OR = 2.392, 95%CI = 2.090-2.734,P 50 years old (HR = 1.282, 95%CI = 1.050-1.530,P = 0.043), PQ concentration increased by 1 mg/L (HR = 2.521, 95%CI = 2.371-3.825,P = 0.012), AKI on admission (HR = 3.850, 95%CI = 2.071-5.391,P10×109/L (HR = 1.932, 95%CI = 1.782-2.171,P = 0.006), Lac> 2.0 mmol/L (HR = 2.981, 95%CI =2.210-3.792,P = 0.002), and PaCO2< 35 mmHg (HR = 1.772, 95%CI = 1.483-2.516,P = 0.008; 1 mmHg =0.133 kPa) were independent risk factors for 28-day mortality.Conclusions Though HHP was helpful in lowering mortality rate in patients with PQ poisoning within 7 days, it did not influence on 28-day mortality. Clinicians' decisions on HP intensity need further investigation, and more perfect clinical evaluation system is required for reasonable use of expensive medical resources such as HP.
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Objective To investigate efficacy in Alpmstadil and Shenkang on regulating renal function and lipids in patients with chronic renal failure (CRF).Methods Ninety-eight cases of CRF patients were collected for the study,and 1:1 randomized,double-blind experiment grouping principles were used in the current study.All cases were divided into study group and the control group (49 cases of each group).The two group were given the high quality low protein,low fat low salt diet,inftion control,diuretic swelling,correct acidosis,buck,correction of electrolyte imbalance and other conventional treatment.The patients in study group on the basis of conventional therapy were given 20 g Alprostadil injection + 100 ml saline,intravenous infusion of 1times/d,and 100 ml Shenkang injection +300 ml 5％ glucose the solution,intravenous infusion of 1 times/d.While patients of control grrup on the basis of conventional therapy plus 200 mg Ligustrazine + 250 ml 5％Glucose Injection,intravenous infusion of 1times/d.Two groups were treated for 14 d.Before and after treatment,renal function,lipid metabolism,adverse drug reactions were observed and determined.Results There was no significant difference in term of renal function between two groups before treatment(P ＞ 0.05).After treatment,the levels of serum creatinine,blood urea nitrogen,24 h-Urine protein and creatinine clearance(Ccr) in study group were (313.7 ±66.2) mmol/L,(15.3 ±2.9) mmol/L,(1.24 ±0.45) g/24 h and (35.7 ±5.4) mmol/L respectively,significant different from those in control group ((358.4 ± 53.9) mmol/L,(18.4 ± 3.0) mmol/L,(1.57 ±0.39) g/24 h and (28.4 ±4.3) mmol/L;t =3.754,7.864,5.873,4.312,P ＜0.05).There was no significant difference in term of blood fat between two groups before treatment (P ＞ 0.05).In study group,the levels of glycerin trilaurate,cholesterol total,high density hpoprotein cholesterol,low density lipoprotein cholesterol were significantly different than those in the control group ((2.12 ± 1.26) mmol/L vs.(2.32 ± 1.34) mmol/L,(4.91 ± 1.43) mmol/vs.(5.35 ± 1.31) mmol/L,(1.39 ± 0.43) mmol/L vs.(1.23±0.37) mmol/L,(2.39 ± 0.68) mmol/L vs.(2.73 ± 0.88) mmol/L; t =3.876,4.661,5.387,8.543 ; P ＜ 0.05) after treatment.There were no adverse drug reactions in both groups.Conclusion Combined usage of alprostadil and shenkang injection could significantly improve the patient's renal function,lipid metabolism disorders and shows no significant adverse reactions,suggesting that it is worthy of clinical application and promotion.