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Objective:To evaluate the efficacy and safety of regional citrate and heparin anticoagulation in continuous renal replacement therapy (CRRT) in critically ill patients by Meta-analysis.Methods:Randomized controlled trials (RCT) comparing the efficacy and safety of regional citrate and heparin anticoagulation in English or Chinese were retrieved from Medline, Embase, Cochrane library, Web of Science, CNKI, Wanfang Database by electronic and manual search before December 2019. The primary outcomes were mortality and circuit life span, and the secondary outcomes were complications such as bleeding, heparin-induced thrombocytopenia (HIT), metabolic alkalosis, and hypocalcemia. Meta-analysis of the literature was conducted using the methods recommended by the Cochrane Collaboration's software RevMan 5.3 and funnel plot was used to analyze whether there was publication bias in each study.Results:Sixteen RCTs with 1 229 patients were included. Meta-analysis showed that there was no significant difference in mortality between the regional citrate and heparin anticoagulation in CRRT [relative risk ( RR) = 0.95, 95% confidence interval (95% CI) was 0.83-1.09, P = 0.47]. The circuit life span in the regional citrate group was 15.37 hours (95% CI was 10.09-20.65, P < 0.000 01) longer than that in the heparin group. Bleeding risk ( RR = 0.29, 95% CI was 0.19-0.44, P < 0.000 01) and HIT ( RR = 0.35, 95% CI was 0.16-0.74, P = 0.006) were lower in the regional citrate group than those in the heparin group, whereas the regional citrate anticoagulation could cause hypocalcemia ( RR = 4.67, 95% CI was 1.88-11.60, P = 0.000 9). There was no significant difference in the incidence of metabolic alkalosis between the two groups ( RR = 0.76, 95% CI was 0.42-1.37, P = 0.36). The funnel plot showed that there were no significant publication bias in the included studies. Conclusion:Regional citrate anticoagulation could significantly prolong circuit life span and decrease the risk of bleeding, and should be preferentially selected for the CRRT anticoagulation in critically ill patients.
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Objective To compare and study the two kinds of quality control methodologies related to intelligent quality management system ( iQM) and traditional quality control , and the quality control performance of iQM equivalent to traditional quality control were evaluated , ensuring the accuracy of the results of blood gas testing.Methods Beijing Chaoyang Hospital of Capital Medical University , Beijing Tiantan Hospital of Capital Medical University , Shanghai Longhua Hospital of Shanghai University of Chinese Medicine, and Sichuan Provincial People′s Hospital, these 4 medical institutions were selected to implement this study.During the period from June 2016 to December 2016, in the routine detection of total 3 712 specimen, the iQM and traditional quality control modes were used simultaneously to calculate the mean values of all blood gas parameters quality controls , SD, CV (%) and Sigma values, to evaluate the quality control performance and difference of the two quality control modes .Results During the process of testing blood gas samples from 3 712 specimen in 4 hospitals, iQM process control solution ( PCS) A, B, C ran 1 089, 7 678 and 154 quality control samples respectively , and 732 external quality control samples were run by traditional quality control mode .Considering the most sensitive parameters of blood gas testing pO 2, iQM PCS A, B, C′s Sigma value are higher than 8, however, the traditional quality control′s Sigma value are less than 6; For parameters pCO2, pO2and Na+, there exists significant difference between two quality control methods (P＝0.004 8,P＝0.000 1,P＝0.004 4,P＜0.01), other parameters pH, K+, Ca ++, Glu, Lac and Hct, there exists no significant difference between two quality control methods (P＝0.250 6, P＝0.062 3,P＝0.034 0,P＝0.346 9,P＝0.186 3,P＝0.823 1,P＞0.01).Totally 22 errors detected by iQM, includes 14 micro-clots and 8 interferences samples, which were not detected by traditional quality control .Conclusions The error in blood gas analysis mainly comes from the pre-analytical phase.iQM enhanced specimen inspection capabilities and make up for the inability of traditional quality control to monitor the quality of specimens , enabling full-scale, real-time, and dynamic monitoring of each specimen , powerful error detection capabilities , and automatic error correction capabilities . Besides, automatic documentation saves staff much time.The system can effectively ensure the accuracy of blood gas test results, meet the quality requirements of related laws and regulations and related industry standards , and also can meet the clinical intended use , providing new ideas for POCT quality management and improvement.
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Objective:To investigate the essential biochemical indices like 1α-hydroxylase and hypocalcaemia in the rats with severe acute pancreatitis and explore the correlation between them.Methods:A total of 120 SPF grade Wistar male rats which were in similar physiological status were selected and randomly divided into two groups: sham group (SO group) and severe acute pancreatitis group (SAP group). Then they were divided into 1 h, 3 h, 6 h, and 12 h subgroups according to the killing time. The severe acute pancreatitis model was established by retrograde injection of 5% sodium taurocholate. Serum calcium, serum creatinine, serum urea nitrogen and serum amylase were measured at different time. Serum 1, 25 dihydroxy vitamin D3 level was determined by enzyme linked immunosorbentassay. The expression of 1α-hydroxylase protein in the kidney tissue was determined with Western blotting and immunohistochemistry to observe its location. The pathologic features of the kidney tissue section was observed under light microscope and submicroscopic structure of the proximal convoluted tubule epithelial cell was observed under transmission electron microscope. Results:Compared with the SO group, rats in the SAP group showed continuous pathological injury as time went by. There was significant increase in serum creatinine, serum urea nitrogen and serum amylase in SAP group compared with the SO group 1, 3,6,12 hours after the operation (P<0.05). There was significant decrease in serum calcium and 1, 25 dihydroxy vitamin D3 3,6,12 hours after the operation (P<0.05). It also showed that the expression of the 1α-hydroxylase protein in kidney tissues was upregulated at 1 h, 3 h and decreased at 6 h,12 h compared with the SO group. The serum calcium, 1, 25 dihydroxy vitamin D3 and the expression of the 1α-hydroxylase protein in kidney tissues of the SAP group showed sustaining decrease. Western blotting showed positive correlation between the 1α-hydroxylase expression and serum calcium at 3 h, 6 h and 12 h (r=0.976,P<0.001;r=0.948,P<0.001; r=0.742, P=0.001) and also positive correlation between the 1α-hydroxylase expression and serum 1, 25 dihydroxy vitamin D3 at 1 h,3 h, 6 h and 12 h (r=0.935,P<0.001;r=0.952,P<0.001;r=0.917,P<0.001; r=0.874, P<0.001).Conclusions:At the early stage of the kidney injury, the expression of 1α-hydroxylase in the kidney tissue is reduced with the progress of the disease and the decrease in its activity has a correlation with the hypocalcaemia.