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The gut microbiome shows changes under a plateau environment, while the disbalance of intestinal microbiota plays an important role in the pathogenesis of irritable bowel syndrome (IBS); however, the relationship between the two remains unexplored. In this work, we followed up a healthy cohort for up to a year before and after living in a plateau environment and performed 16S ribosomal RNA (rRNA) sequencing analysis of their fecal samples. Through evaluating the participants' clinical symptoms, combined with an IBS questionnaire, we screened the IBS sub-population in our cohort. The sequencing results showed that a high-altitude environment could lead to changes in the diversity and composition of gut flora. In addition, we found that the longer the time volunteers spent in the plateau environment, the more similar their gut microbiota composition and abundance became compared to those before entering the plateau, and IBS symptoms were significantly alleviated. Therefore, we speculated that the plateau may be a special environment that induces IBS. The taxonomic units g_Alistipes, g_Oscillospira, and s_Ruminococcus_torques, which had been proved to play important roles in IBS pathogenesis, were also abundant in the IBS cohort at high altitudes. Overall, the disbalance of gut microbiota induced by the plateau environment contributed to the high frequency of IBS and the psychosocial abnormalities associated with IBS. Our results prompt further research to elucidate the relevant mechanism.
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ObjectiveTo analyze the dynamic changes of the main chemical components and color characteristics of Polygoni Multiflori Radix（PMR） during the process of ancient classical nine-time repeating steaming and sun-drying， and to explore the correlation between the changes. MethodHigh performance liquid chromatography（HPLC） was used to determine the contents of gallic acid， stilbene glycoside， emodin-8-O-β-D-glucoside， physcion-8-O-β-D-glucoside， emodin and physcion in PMR during the process of nine-time repeating steaming and sun-drying， and electronic eye technology was used to objectively characterize the color of PMR during the process. Partial least squares（PLS） was used to analyze the correlation between the content of main components and the color characteristics. ResultDuring the nine-time repeating steaming and sun-drying process of PMR， the content of gallic acid gradually increased with the increase of steaming and sun-drying times， and the contents of other components showed fluctuating changes， with an overall decreasing trend in the contents of stilbene glycoside， emodin-8-O-β-D-glucoside and physcion-8-O-β-D-glucoside， and an overall increasing trend in the contents of emodin and physcion. The results of electronic eye analysis showed that the color of PMR became dark， red and blue in the process of nine-time repeating steaming and sun-drying. The results of hierarchical cluster analysis（HCA） and principal component analysis（PCA） of the contents of six main components and the colors showed that the samples steamed and sun-dried for one to four times could be grouped into one category， the other five categories of samples could be grouped into another category. Gallic acid and stilbene glycoside were significantly correlated with the color indexes of PMR during the process of nine-time repeating steaming and sun-drying. ConclusionThe general changes of material basis and color characteristics of PMR during the process of ancient classical nine-time repeating steaming and sun-drying have certain rules， and the establishment of the correlation model between color and index components can realize the judgment and quality evaluation of processing degree of PMR decoction pieces.
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Objective:To summarize and analyze the clinical and genetic characteristics of Chinese patients with adrenomyeloneuropathy (AMN).Methods:Clinical data were collected and analyzed retrospectively on AMN patients who were diagnosed by genetic testing in Shanghai Sixth People′s Hospital, Shanghai Jiao Tong University School of Medicine from May 2008 to August 2022. Clinical characteristics of AMN patients with different types of gene mutations were compared. Loe score was used to evaluate the severity of white matter demyelinating, and the serum levels of very long-chain fatty acids (VLCFA) in patients with or without white matter demyelinating were compared. The motor function of the AMN patients was assessed using the Expanded Disability Status Scale (EDSS), and the association between EDSS scores and the course of disease was analyzed.Results:A total of 23 male patients with onset age of (29.52±9.91) years were included in this study. The first symptom of all patients was abnormal lower extremities, of which 17 patients showed stiffness and weakness in their lower limbs (73.9%, 17/23), and 6 patients showed numbness and pain in both lower limbs (26.1%, 6/23). The occurrence of symptoms was not related to the type of gene mutation. White matter demyelination occurred in 33.3% (7/21) of patients over a disease duration of (7.67±4.46) years. There was no statistically significant difference in serum VLCFA level between the white-matter demyelination group and the non-demyelination group. The EDSS score was positively correlated with the disease duration ( r=0.57, P=0.006). Sixteen ABCD1 gene mutations were found in this study, among which c.5_19delinsTCTCCAGG (p.P2Lfs *12) was reported for the first time. Four probands belonging to different families carried the c.1415_1416del (p.Q472Rfs *83) variant. Conclusions:Lower limb movement disorders and sensory dysfunction are the prominent clinical manifestations in AMN patients, with deterioration of motor function associated with the course of disease. AMN may be converted to cerebral type and VLCFA concentration is not associated with the phenotypic changes. The c.1415_1416del (p.Q472Rfs *83) mutation is a hot spot mutation of the disease.
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ObjectiveTo analyze the flavor substances and change rules of Rhei Radix et Rhizoma during the process of nine-time repeating steaming and sun-drying. MethodThe flavor response values of Rhei Radix et Rhizoma samples were obtained by using PEN3 electronic nose system. The data were processed and analyzed by principal component analysis （PCA）， linear discriminant analysis （LDA） and Loadings analysis. ResultRhei Radix et Rhizoma processed with nine-time repeating steaming and sun-drying could be effectively distinguished into two categories as the sixth sample was the turning point. The samples steamed and dried for one to five times could be grouped into one category， the other four samples were obviously distinguished from them. The main flavor components reached the maximum response in the sample processed with six-time repeating steaming and sun-drying， and its response value of inorganic sulfur compounds was about 2.7 times that of the sample processed with one-time repeating steaming and sun-drying. In addition， compared with the raw products， the flavors of Rhei Radix et Rhizoma processed with nine-time repeating steaming and sun-drying and wine stewing changed significantly， and the response value of inorganic sulfur compounds in sample processed with nine-time repeating steaming and sun-drying was about 2.2 times that of raw products. From the perspective of flavor analysis， the response values of inorganic sulfur compounds and nitrogen-oxygen compounds in sample processed with nine-time repeating steaming and sun-drying were higher than those of wine-stewed products， and the two were not completely equivalent. ConclusionElectronic nose technology preliminarily clarifies the dynamic change rules of the flavor of Rhei Radix et Rhizoma during the process of nine-time repeating steaming and sun-drying from the flavor characteristics， and clarifies the difference between products processed with nine-time repeating steaming and sun-drying and wine-stewed products from the odor characteristics， which lays a foundation for revealing the processing principle of Rhei Radix et Rhizoma processed with nine-time repeating steaming and sun-drying.
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Objective:To investigate the effects and mechanism of gut metabolite sodium butyrate on the proliferation and apoptosis of steatosis HepG2 cells in vitro. Methods:The in vitro steatosis hepatocyte model was established with human liver cell line HepG2 and free fatty acid (FFA; the concentration ratio of oleic acid to palmitic acid was 2∶1). Normal control group, model group and intervention groups with different concentration (1, 2, 5, 10, 20 and 50 mmol/L) of sodium butyrate were set up. The inhibition of sodium butyrate on the proliferation of steatosis HepG2 cells was detected by cell counting kit (CCK-8). The proportion of apoptotic cells of normal control group, model group and sodium butyrate 5 mmol/L (sodium butyrate intervention) group was detected by flow cytometry. Normal control group, model group, intervention group with different concentration (1, 2, 5 and 10 mmol/L) of sodium butyrate, negative small interfering RNA (siRNA) control group, G protein-coupled receptor (GPR) 43-siRNA group, GPR109a-siRNA group, GPR43+ GPR109 a double knockout group were set up. The change of the levels of phosphorylated protein kinase B (p-AKT) and phosphorylated mammalian target of rapamycin (p-mTOR) before and after transfection were detected by Western blotting. One-way analysis of varivance, SNK- q test and logistic regression analysis were used for statistical analysis. Results:The results of CCK-8 test indicated that sodium butyrate inhibited the proliferation of steatosis HepG2 cells in a dose-dependent and time-dependent manner. The results of flow cytometry showed that the proportion of apoptotic cells of the sodium butyrate intervention group was higher than that of the model group and normal control group ((3.400±0.100)% vs. (1.800±0.400)% and(1.067±0.451)%), and the differences were statistically significant ( t=6.721 and 8.705, both P<0.01). There was no significant difference in the proportion of apoptotic cells between the model group and the normal control group ( P>0.05). Before transfection, the expressions of p-AKT and p-mTOR at protein level of the model group were both higher than those of the normal control group (2.300±0.058 vs. 1.000±0.012, 2.160±0.125 vs. 1.000±0.052), and the differences were statistically significant ( t=22.080 and 8.575, both P<0.05). The expressions of p-AKT and p-mTOR at protein level of sodium butyrate intervention groups at 1, 2, 5 and 10 mmol/L were all lower than those of the model group (1.530±0.085, 1.407±0.096, 1.032±0.035 and 1.036±0.099 vs. 2.300±0.058; 1.483±0.073, 1.297±0.048, 1.067±0.035 and 0.970±0.072 vs. 2.160±0.125), and the differences were statistically significant ( t=7.491, 7.997, 19.790, and 11.020; 4.683, 6.445, 8.424, and 8.245; all P<0.05). After transfection, the expressions of p-AKT and p-mTOR at protein level of GPR43-siRNA group, GPR109a-siRNA group and GPR43/ GPR109 a double knockout group were all higher than those of the negative siRNA control group and 5 mmol/L sodium butyrate group (1.474±0.045, 1.471±0.058 and 2.067±0.120 vs. 1.158±0.030 and 1.139±0.031; 1.850±0.082, 1.683±0.058 and 2.160±0.091 vs. 1.469±0.037 and 1.490±0.116), and the differences were statistically significant ( tp-AKT=5.807, 4.816, 7.322, 6.109, 5.080 and 7.463; tp-mTOR=4.235, 3.113, 7.044, 2.542, 1.497 and 4.562; all P<0.05). Conclusions:The effect of sodium butyrate on the proliferation and apoptosis of steatosis HepG2 cells is associated with the GPR43/GPR109a-pAKT-mTOR signaling pathway.
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Objective:To observe the effect of high-flow nasal cannula oxygen therapy (HFNC) in patients with chronic obstructive pulmonary disease (COPD) and mild hypercapnia, and to evaluate the early predictive ability of physiological parameters in these patients.Methods:A retrospective cohort study was conducted based on Medical Information Mart for Intensive Care-Ⅳ (MIMIC-Ⅳ) updated in September 2020 and the data of adult patients with COPD and mild hypercapnia [45 mmHg (1 mmHg = 0.133 kPa) < arterial partial pressure of carbon dioxide (PaCO 2)≤ 60 mmHg] from 2008 to 2019 were collected. These patients were assigned to the HFNC group or non-invasive ventilation (NIV) group according to whether they received HFNC or NIV. Baseline data such as gender, age, body mass index (BMI), simplified acute physiology scoreⅡ (SAPSⅡ), Charlson comorbidity index (CCI) and physiological parameters were collected. A propensity score matching was conducted according to the baseline data of the HFNC group patients. The 48-hour and 28-day intubation rates, 28-day mortality, length of intensive care unit (ICU) stay, the length of hospital stay, and the changes in physiological parameters within 48 hours after treatment were compared between the two groups. The receiver operating characteristic curve (ROC curve) was drawn and the ratio of heart rate over pulse oxygen saturation (HR/SpO 2) and ROX index [SpO 2 / (inhaled oxygen concentration, FiO 2×respiratory rate, RR)] were analyzed to predict the 24-hour and 48-hour intubation rates. Results:A total of 524 520 inpatient records were screened and 153 patients were included, while 37 patients in the HFNC group and 116 patients in NIV group. There were 31 patients in the HFNC group and 84 patients in the NIV group remained after propensity score matching according to the baseline data. There were no significant differences in the baseline data of gender, age, BMI, SAPSⅡ, CCI score, physiological parameters and prognosis data except the length of ICU stay. The length of ICU stay in HFNC group was significant longer than that of the NIV group [days: 4.6 (3.1, 10.0) vs. 3.1 (1.6, 5.8), P < 0.05]. HR and RR at 40- 48 hours were significantly lower than those at 0-8 hours after treatment only in the HFNC group [HR (bpm): 84.1±12.2 vs. 91.1±16.4, RR (times/min): 19.8±4.9 vs. 21.6±4.1, both P < 0.05]. Both in the HFNC group and NIV group the pH increased (7.42±0.08 vs. 7.36±0.05 and 7.41±0.06 vs. 7.36±0.05, both P < 0.05) and PaCO 2 decreased significantly [mmHg: 46.3 (39.5, 51.0) vs. 49.8 (45.5, 54.0) and 46.0 (40.5, 51.5) vs. 49.5 (45.5, 55.3), both P < 0.05]. The HR, PaO 2 were higher in the HFNC group than those in the HFNC group at 40-48 hours after treatment [HR (bpm): 91.1±15.4 vs. 84.1±12.2, PaO 2 (mmHg): 99.5 (86.0, 132.3) vs. 85.8 (76.5, 118.0), both P < 0.05], PaO 2/FiO 2 were lower in the HFNC group than that in the HFNC group at 40-48 hours after treatment [mmHg: 223.8 (216.5, 285.0) vs. 278.0 (212.3, 306.0), P < 0.05]. Both HR/SpO 2 and ROX index at 4 hours after treatment had predictive value for 24-hour and 48-hour intubation in the HFNC group. The areas under ROC curve (AUC) of HR/SpO 2 at 4 hours after treatment in the HFNC group were larger than those of ROX index for predicting 24-hour and 48-hour intubation (24-hour: 0.649 vs. 0.574, 48-hour: 0.692 vs. 0.581, both P < 0.01); the 95% confidence interval (95% CI) of 4 hours HR/SpO 2 and for ROX index predicting 24 hours and 48 hours intubation were 0.497-0.780, 0.567-0.799, 0.450-0.694 and 0.454-0.716, respectively. The high sensitivity of HR/SpO 2 and ROX index in predicting 24-hour and 48-hour intubation were 84.6%, 92.9%, 88.2% and 94.4%, respectively, and the low specificity were 52.3%, 23.7%, 54.7% and 29.6%, respectively. Conclusions:HFNC can be used in COPD patients with mild hypercapnia, but it cannot replace NIV. The accuracy of ROX index at 4 hours after HFNC treatment in predicting intubation in COPD patients with mild hypercapnia is poor.
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Objective:To explore the early predictors of high flow oxygen treatment failure for post-operation patients with hypoxemia.Methods:The post-operation adult patients with hypoxemia (100 mmHg<PaO 2/FiO 2≤300 mmHg) received high flow nasal cannula (HFNC) oxygen were retrospectively screened in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The patients were assigned to the treatment success or failure group according to whether receiving reintubation with 48 h after extubation. The risk factors of 48-h reintubation were screened and analyzed by extreme gradient boosting (XGBoost) algorithm. And the predictors were formulated according to the risk factors. The changes of predictors were collected from extubation to 48 h later. The predictors were compared at different time points after extubation between patients weaning successfully and failed with t test. The values at different time after extubation were also compared to the baseline data. The areas under the receiver operating characteristic (ROC) curve were calculated for 48-h reintubation prediction according to values at 4 h before and after extubation, which were compared with those of rapid shallow breathing index (RSBI) and ROX index. The RSBI was defined as the ratio of respiratory rate to tidal volume. The ROX index was defined as the ratio of SpO 2/FiO 2 to respiratory rate. Results:A total of 524 520 medical records were screened and 318 patients were included. There were 38 patients (11.95%) received reintubation within 48 h. According to the XGBoost model, the important features of 48-h reintubation were the duration before extubation, body mass index, simplified acute physiology scoring II, heart rate (HR), PaO 2, mean blood pressure, tidal volume, age, SpO 2 and respiratory rate. Thus HR/PaO 2 and HR/SpO 2 were formulated as predictors for 48-h reintubation according to the above features. The areas under the ROC of HR/PaO 2 and HR/SpO 2 were 0.640 and 0.617 for 48-h reintubation prediction according values at 4 h before extubation, which were larger than those of RSBI (0.537) and ROX index (0.539). According values at 4 h after extubation, the area under the ROC of HR/SpO 2 was 0.657, which was larger than that of ROX index (0.587). When the HR/SpO 2 reached 1.2 at 4 h after extubation, the specificity for 48-h reintubation was 92%. There was significant difference of HR/SpO 2 at 4 h after extubation between patients weaning successfully and failed (1.02 vs 0.92, P<0.05), and no significant difference of ROX index at the same time (8.14 vs 9.27, P>0.05). There were significant differences of HR/SpO 2 and ROX index at 8 to 12 h after extubation between the two groups (both P<0.05). Conclusions:HR/SpO 2 is more early and accurate in predicting HFNC failure than ROX index for post-operation patients with hypoxemia. However, both the predictors should be further evaluated.
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Platelets are non-nucleated blood effector cells, which plays an important role in coagulation, hemostasis, and thrombosis. However, platelets are extremely susceptible to activation by external stimuli, which in turn damages the platelet's natural biological activity and affects its biological function. Platelet biological activity has become a hotspot in the field of vascular diseases. In this study, ultrasound parameters (ultrasound intensity and duration time) were used to intervene in the biological activity of platelets. The response of platelets to ultrasound energy was explored from the aspects of platelet morphology, aggregation ability and particle release (the expression of P-selectin and the number of particles). The results showed that the ultrasound intensity of 0.25 W/cm
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Humans , Blood Platelets , Platelet Aggregation , Thrombosis , UltrasonographyABSTRACT
Objective To assess the prognostic accuracy of the quick Sequential Organ Failure Assessment (qSOFA) score for septic shock of adults with soft tissue infections.The clinical characteristics of these patients were analyzed to provide reference for their multidisciplinary treatment.Methods A retrospective study was conducted.The patients with soft tissue infections admitted to the General Surgery Department of Beijing Hospital and the Burn and Plastic Surgery Department of Fourth Medical Center of PLA General Hospital from January 2012 to December 2018 were enrolled and patients combined with other infections were excluded.Patients were divided into the septic shock group and the non-septic group according to whether septic shock occurred during hospitalization.The baseline data,non-operative management and prognosis were compared between the two groups with Fisher's exact test.The sensitivity,specificity,positive predictive value,negative predictive value and the area under the receiver operating characteristic curve (AUC) of the qSOFA for diagnosis of sepsis and septic shock were calculated.Patients were also divided into four groups according to the etiology of soft tissue infection.The pathogens,surgical treatment and morbidity of septic shock among the four groups were also compared.Results A total of 192 patients were enrolled,including 28 (14.6％) patients with septic shock.Compared with the non-septic shock group,there were more proportion of patients with qSOFA ≥ 2 (60.7％ vs 18.3％,P=0.001) within 24 h of diagnosis of infection,and higher morbidity of sepsis (82.1％ vs 32.9％,P＜0.01)within 48 h of diagnosis of infection in the septic shock group.At the cut-off value of qSOFA ≥ 2,the sensitivity,specificity,positive predictive value,negative predictive value and the AUC were 60.7％,81.7％,36.2％,92.4％ and 0.767 (95％CI:0.665-0.869,P＜0.01) respectively for diagnosis of septic shock.The morbidity of septic shock (36.4％) and 28-day mortality (13.6％) in patients with necrotizing fasciitis were higher than those in patients with other causes (both P＜0.05).The most common pathogens were methicillin-sensitive Staphylococcus (6.8％),methicillin-resistant Staphylococcus (6.2％),Enterobacter (5.7％) and Enterococcus (5.2％).Conclusions qSOFA ≥ 2 can be used as a rapid septic shock screening tool for adults with soft tissue infection.Early diagnosis of sepsis,thorough debridement and effective antibiotic treatment are essential for these patients.
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The original version of this article unfortunately contained some mistakes.
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OBJECTIVE： To provide reference for optimizing the treatment of children with infective endocarditis. METHODS： Clinical pharmacists provide whole process pharmaceutical care for a child with congenital heart disease and infective endocarditis admitted to our hospital in April 2017. According to the individual situation of child， when therapy efficacy was poor， medication suggestions were put forward by timely referring to the guide and literature as well as combined with pharmacists’ work experience. RESULTS： After treatment with vancomycin at normal dose of 38 mg/（kg·d）， the vancomycin blood concentration （1.3 μg/mL） was low， and the treatment effect was poor. Clinical pharmacist made two suggestions to adjust the dose of vancomycin. The first dose was 45 mg/（kg·d）， the second dose was 60 mg/（kg·d）； pediatrician adopt clinical pharmacist recommendations completely. After treatment， the child’s body temperature was normal； vancomycin blood trough concentration increased to 5.8-6.5 μg/mL， and the disease was controlled. CONCLUSIONS： During vancomycin treatment of infective endocarditis in children， clinical pharmacists should provide pharmaceutical care throughout the course and pay close attention to the blood trough concentration of vancomycin in order to ensure the rational use of drugs in children.
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To assess the diagnosis accuracy of the quick sequential organ failure assessment (qSOFA) score for adult sepsis patient with soft tissue infection, and to assess the prognostic accuracy of the qSOFA score for septic shock. Methods A retrospective study was conducted. The patients with soft tissue infection admitted to the general surgery department of Beijing Hospital and the burns and plastic surgery department of Fourth Medical Center of PLA General Hospital from January 2012 to December 2018 were enrolled. Patients were divided into the sepsis group and the non-sepsis group according to whether sepsis occurred within 48 hours after diagnosis of infection. The baseline data, prognosis, and qSOFA, the change of sequential organ failure assessment (ΔSOFA), systemic inflammatory response syndrome (SIRS) scores were compared between the two groups, and the receiver operating characteristic (ROC) curves were also drawn to assess the diagnosis accuracy of the qSOFA and SIRS scores for adult sepsis patients with soft tissue infection and to assess the prognostic accuracy of the qSOFA, ΔSOFA and SIRS scores for septic shock of these patients. Results 192 patients were included in the study. Sepsis occurred in 79 patients (41.1%) within 48 hours after diagnosis of infection. Septic shock occurred in 28 patients (14.6%) during 28-day hospitalization and 6 patients (3.1%) died. Compared with non-sepsis group, more proportion of necrotizing fasciitis, septic shock and patients received mechanical ventilation (21.5% vs. 4.4%, 31.6% vs. 2.7%, 16.5% vs. 4.4%, all P < 0.01), with higher mortality (7.6% vs. 0%, P = 0.003) in sepsis group. ROC curve analysis showed that when the cut-off value of qSOFA ≥ 2, the sensitivity, specificity, positive predictive value, negative predictive value and area under ROC curve (AUC) were 48.1%, 92.0%, 80.8%, 71.7% and 0.824 [95% confidence interval (95%CI) = 0.764-0.884, P < 0.01] respectively for diagnosis of sepsis caused by soft tissue infection. When the cut-off value of SIRS score ≥ 3, the sensitivity, specificity, positive predictive value, negative predictive value and AUC were 89.8%, 48.6%, 55.0%, 87.3% and 0.721 (95%CI = 0.677-0.765, P < 0.01) respectively for diagnosis of sepsis caused by soft tissue infection. All scores of qSOFA ≥ 2, ΔSOFA ≥ 2 and SIRS score ≥3 could be used to predict septic shock (all P < 0.01). The AUC of ΔSOFA, qSOFA and SIRS scores were 0.767 (95%CI = 0.665-0.869), 0.840 (95%CI = 0.757-0.923) and 0.716 (95%CI = 0.596-0.835) respectively. Conclusions qSOFA ≥ 2 can be used as a rapid sepsis screening tool for adult patients with soft tissue infection. It is suggested that qSOFA or SIRS scores can be used to predict septic shock of adult patients with soft tissue infection initially.
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Objective To prospectively investigate the effects of high-flow nasal oxygen on hypoxemic patients after surgery.Methods A total of 108 postoperation hypoxemic patients (150 mmHg ≤ PaO2/FiO2 ＜300 mmHg, PaCO2 ≤50 mmHg) in Beijing Hospital Surgical Intensive Critical Unit was in cluded and assigned randomly to two groups from June 2016 to April 2017.Fifty four patients (study group) who received high-flow nasal oxygen therapy were compared with 54 patients (control group) who received noninvasive ventilation therapy.The data of reintubation and mortality in 28 days after extubation were collected and analyzed.Results No significant differences were found for reintubation rate (11.1％ vs 13.0％,P =0.767) and mortality (5.6％ vs 7.4％, P =0.696) in 28 days after extubation between two groups.In subgroup analysis, no significant differences were found for different hypoxima level (250 mmHg ≤ PaO2/FiO2 ＜ 300 mmHg,200 mmHg ≤ PaO2/FiO2 ＜ 250 mmHg and 150 mmHg≤ PaO2/FiO2 ＜ 200 mmHg) between two groups, for reintubation rate (0 vs 3.7％,P =0.296;20％ vs 14.3％,P =0.684;30％ vs 30.8％,P =0.968, respectively) and mortality (0 vs 3.7％,P =0.296;6.7％ vs 7.1％,P =0.960;20％ vs 15.4％,P =0.772, respectively).Face skin breakdown were significantly more common in control group (1 1.1％ vs 0,P =0.012).Conclusions High-flow nasal oxygen therapy was not inferior to noninvasive ventilation for mild and moderate hypoxemic patients after surgery.High-flow nasal oxygen therapy is safe and effective for these patients.
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Objective To investigate effects of Levosimendan on hemodynamics in heart failure patients with low cardiac output. Methods A total of 27 heart failure patients with low cardiac output were recruited in the surgical intensive care unit (SICU)of Beijing Hospital from July 2009 to May 2016. All patients were treated with continuous intravenous infusion of Levosimendan 12.5 mg within 24 h at a rate of 0.1~0.2 μg· kg -1·min-1. Hemodynamic variables were monitored by pulse-indicated continuous cardiac output(PICCO)at baseline ,24 h ,4 d and 7 d after infusion. Results There were no significant differences in systolic blood pressure(SBP) ,diastolic blood pressure(DBP) ,heart rate(HR)and global end diastolic volume index (GEDI)as comparing baseline with 24 h ,4 d and 7 d after infusion of levosimendan. The significant differences were found in central venous pressure (CVP) ,systemic vessel resistance index (SVRI) , extravascular lung water index (EVLWI ) among baseline versus 24 h ,4 d and 7 d after infusion of levosimendan[(8.34± 2.87)mmHg vs.(6.35± 2.31),(6.81± 2.03),(5.92± 2.23)mmHgforCVP ,(2 682.0 ± 388.9)dyn·s-1·cm -5·m-2vs. (2 170.0 ± 410.9) ,(2 062.0 ± 340.6 ) ,(1 960.0 ± 380.2 )dyn ·s-1·cm-5·m-2for SVRI ,(8.90 ± 2.45)ml/kg vs. (6.60 ± 2.66) ,(5.92 ± 2.88) ,(5.46 ± 2.52) ml/kg for EVLWI ,P=0.001 ,0.003 or＜0.01 ,respectively].As compared with hemodynamic variables at baseline ,brain natriuretic peptide levels were decreased ,and cardiac index ,cardiac function index and stroke volume index were increased at 24 h ,4 d and 7 d after infusion of Levosimendan (P＜0.01 ,0.05 or 0.01 , respectively ). Conclusions A single-dose intravenous infusion of Levosimendan can increase cardiac output and decrease systemic vascular resistance in heart failure patients with low cardiac output ,which maintain quite a long time.
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OBJECTIVE:To systematically review the related evidence-based guidelines of purulent meningitis in children,and to provide evidence-based reference for clinical treatment. METHODS:Retrieved from PubMed,EMBase,CBM,Wanfang Data-base,CJFD and VIP,NGC,GIN,TRIP and websites of domestic and international medical associations and industry bodies,the treatment guidelines about purulent meningitis in children were collected. Evidence-based evaluation was performed after data extrac-tion and quality evaluation. RESULTS:Finally 3 guidelines were enrolled in total,with development time ranging from 2004 to 2012,from USA,Britain and Australia,respectively. All of the recommendations were level B,scope and purpose and clarityshowed the higher scores in AGREEⅡ,more than 70%,and applicability showed generally low scores. Penicillin and cefotaxi-me were recommended in purulent meningitis of neonates,and vancomycin combined with cefotaxime or ceftriaxone were recom-mended for infants and children(it was combined with vancomycin when Streptococcus pneumoniae infection was suspected). The dose and duration of each guideline were certain different,and the period of treatment should be longer in neonates. In addition, the glucocorticoid was recommended in all guidelines. CONCLUSIONS:The recommendations of medicines for the treatment of pu-rulent meningitis are basically unanimous,with no regional difference,but there are some differences about dose and the course of treatment. In addition,the classification criteria of the levels of evidence and recommendation are still suboptimal,which needs fur-ther improvement. And guidelines on purulent meningitis should be improved inrigourandapplicabilityin future.
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Objective To systematically review articles about therapeutic drug monitoring of vancomycin in Chinese adults, so as to provide a reference of vancomycin trough concentrations for clinical evidence-based medicine.Methods Literature concerning vancomycin therapeutic drug monitoring were electronically retrieved in, CBM, Wanfang data, CNKI and Vip.Furthermore, the articles written in English by Chinese author in PubMed, EMbase were included.All the data were searched from inception of the database or network to Aug.2014.Two reviews independently screened literature according to the inclusion and exclusion criteria, and assessed the quality of literature using the Combieg and NOS.Analyzing the types of studies, the number of therapeutic monitoring of vancomycin, trough serum concentration, clinical outcome and renal function.Results A total of 35 studies including 32 cross-sectional studies and 3 cohort studies were included, all studies were observational studies.3099 patients with 5206 blood concentrations monitoring results were eligible for final analyses in all 32 cross-sectional studies.The rates of trough serum concentration in 5-15 mg/L was 53.6%.Compared with the trough concentrations between 5 and 15 mg/L, clinical cure rate was no significant difference in the trough concentrations of over 15μg/mL.However, the incidence rate was significantly reduced in renal toxicity in 5-15 mg/L trough serum concentration.Conclusions For adults, trough serum concentration of vancomycin should adopt the 5-15 mg/L in China.However, considering lack of high-level evidence, so it needs to be studied further.
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Objective To investigate the clinical efficiency of serum cystatin C as a marker of renal function to predict serum trough concentrations of vancomycin. Methods Data on trough concentrations of vancomycin(Cmea ),serum creatinine (Scr)concentrations,cystatin C( Cys C) concentrations were collected from 81 hospitalized patients who received vancomycin therapy. Predicted vancomycin trough concentrations(Cpre )were calculated based on Scr or Cys C concentrations associating with Bayesian forecasting method through NONMEM software. Finally,the correlations and distinctions between Cpre and Cmea were comparatively analyzed. Results There were both correlation between Cpre and Cmea in relation to Scr or Cys C(r = 0. 678,P<0. 01;r=0. 727,P<0. 01). Besides,the errors of mean predictive error(ME),mean absolute error(MAE)and root-mean-square error(RMSE)for Scr was - 5. 79,6. 86,9. 86 μg · mL-1 , respectively, where as the errors for Cys C was - 0. 82,5. 42, 7. 74 μg·mL-1 ,respectively. Conclusion Cystatin C is a good marker of renal function available for predicting serum vancomycin concentrations.
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Objective To evaluate the effect of mouse nerve growth factor on fracture healing.Methods Cochrane library, Pubmed, EMbase, CNKI,VIP,Wanfang Data and CBM were searched for the randomized controlled trials(RCTs)of mouse nerve growth factor on fracture healing from the date of establishment of the databases to May 2014.Three independent rese archers evaluated the included studies using GRADE,according to recommend classification method of GRADE system by three researchers,crtical evaluated and data extracted of the quality of the included studies,which conform to the quality standard of RCT was analyzed by Meta analysis.The extracted data were analyzed by RevMan 5.0 and GRAED proiler.Results A total 5 trials were discovered and all of these were in Chinese.Compared with conventional treatment was improved a lot[MD =-8.74,95%CI( -9.79,-7.68),P<0.0001].However, adverse drug reaction in patients with mouse nerve growth factor were increased[OR =14.66,95%CI(1.89, 113.99),P=0.01].The both outcomes were low quality in the GRADE system.Conclusion Mouse nerve growth factor can improve fracture healing and the side effects will also increase.
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Objective To investigate the expression of matrixmetalloprotein -9(MMP-9)and E-cad-herin in triple negative breast cancer ( TNBC) and its relationship with the clinicopathologic features of TNBC .To analyze the function of MMP -9 and E-cadherin in TNBC .Methods Immunohistochemical method was used to detect the expression of MMP -9 and E-cadherin in 127 cases of TNBC.Results The MMP-9 positive rate was 53.54%and E-cadherin positive grade was 32.28%in TNBC.Expression of MMP-9 was correlated with tumor size(P=0.007),histological grade(P=0.006),TNM stage(P=0.003),lymph node metastasis(P=0.000)and lymph duct invasive(P=0.000).Expression of E-cadherin was correlated with lymph node metasta-sis(P=0.016)and lymph duct invasive(P=0.015).However,they were not correlated with other factors .Con-clusion The expression of MMP -9 and E -cadherin was correlated with invasion and metastasis in TNBC , which could be an important research topic in the future studies .
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Population pharmacokinetics of vancomycin (VAN) in the Chinese patients was described by using nonlinear mixed-effects modeling (NONMEM). 619 VAN serum concentrations data from 260 patients including 177 males and 83 females were collected separately from two centers. A one-compartment model was used to describe this sparse data. No significant difference was observed between two center datasets by introducing SID covariate. The final model was as CL= (θ (base0+ θ(max) x(1 -e(-θ(Age)(Age/72) and V = θ x θ (Age)(Age/72). The creatinine clearance (CL(Cr)) and Age were identified as the most significant covariate in the final model. Typical values of clearance (CL) and volume of distribution (V) in the final model were 2.91 L x h(-1) and 54.76 L, respectively. Internal model validation by Bootstrap and NPDE were performed to evaluate the robustness and prediction of the final model. The median and 95% confidence intervals for the final model parameters were based on 1000 Bootstraps. External model evaluation was conducted using an independent dataset that consisted of 34 patients to predict model performance. Pharmacodynamic assessment for VAN by AUC (0-24 h) to MIC ratios of over 400 was considered to be the best to predict treatment outcomes for patients. AUC (0-24 h) was calculated by clearance based on the above population model. The results indicate that the conventional dosing regimen probably being suboptimal concentrations in aged patients. The approach via population pharmacokinetic of VAN combined with the relationship of MIC, Age, CL(Cr) and AUC(0-24 h)/MIC can predict the rational dose for attaining efficacy.