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To determine the physicians′compliance of hour-1 bundle for sepsis. A management system of hour-1 bundle for sepsis was established. The clinical data of 286 sepsis patients were collected, who were classified into 3 months before the bundle (control group), 9 months during process (observation group) and 3 months after bundle (study group). The compliance of hour-1 bundle implementation was compared in three groups. The results showed that with the application and implementation of the management system, the compliance of hour-1 bundle for sepsis in the control group, observation group and study group was 58.3%(28/48), 69.1%(105/152) and 88.4%(76/86) respectively (χ 2=7.053, P=0.029). The 28 day mortality in sepsis patients was 41.7%(20/48), 34.9%(53/152) and 23.3%(20/86) respectively (χ 2=5.576, P=0.062).The management system of hour-1 bundle for sepsis can effectively improve the physicians′ compliance.
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Objective To estimate dry weight (DW) and prevent dialysis-related hypotension and hypertension with the on-line monitoring of relative blood volume (RBV) and other judgments.Methods One hundred and eight maintenance hemodialysis patients were assigned to three groups according to their blood pressure:normal blood pressure group (A group,n=43),hypotension group (B group,n=35) and hypertension group (C group,n=35).The level of hemoglobin,serum albumin,dialysis adequacy were determined.Systolic blood pressure,diastolic blood pressure,mean arterial pressure,heart rate,ultrafiltration volume,relative blood volume changes and the corresponding clinical symptoms were monitored during hemodialysis in all patients.Each of the patients was continuously monitored of the indicators above for 10-12 times.At the observing period,the inferior vena cava diameter (IVCD),brain natriuretic peptide (BNP) and cardiothoracic ratio(CTR) were measured.Then according to the monitoring results,appropriate clinical interventions were given under on-line blood volume monitoring guidance.Results (1)The shape of RBV curve in group A showed doubleexponential curve early,then down to the final linear decling ended during hemodialysis.(2)The RBV curve in group B was stable in the former two hours,then rapidly linear declined.RBV changes were significantly higher in group B than group A (P ＜ 0.05),but when changes in RBV were plotted against ultrafiltration volume,there was no significant difference in the two groups.The level of RBV reduction at which symptomatic hypotension occurred showed considerable inter-individual variability (P ＜ 0.05,coefficient of variation=0.28).(3)The RBV curve in group C slowly linear declined.At the end of dialysis,RBV changes were significantly lower in group C than group A (P ＜ 0.05).(4)The IVCD values in three groups of patients before dialysis were greater than normal,significantly decreased after the dialysis (P ＜ 0.05),but that in group B and group C were still greater than that in group A (P ＜ 0.05).The BNP values were significantly greater in three groups before and after dialysis (P ＜ 0.05),but after dialysis,the values decreased significantly than that before dialysis (P ＜ 0.05).(5)After appropriate clinical intervention were given under on-line blood volume monitoring in hemodialysis,the patients of group B controlled weight gain,and even cut dry weight,the RBV change significantly decreased at the end of dialysis and significantly reduced the incidence of hypotension events (P ＜ 0.05); When the patients of group C cut dry weight,increased ultrafiltration,the RBV change increased,the mean arterial pressure decreased significantly than before (P＜ 0.05).Conclusions (1)Hemodialysis patients with symptomatic hypotension show larger RBV decline rate in the forth hour and lager total RBV changes,which provides important information for forecasting the symptomatic hypotension in hemodialysis.(2)IVCD and CTR have certain significance to the adjustment of dry weight,but the BNP has guiding significance to volume change.(3)On-line monitoring of RBV can effectively guide the adjustment of dry weight,reduction of symptomatic hypotension occruence,and controlling of refractory hypertension in hemodialysis.
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Objective To investigate the risk factors for cardiovascular complications in the elderly persons undergone with dialysis.Methods One hundred and eighteen patients undergone with hemodialysis(HD)or continuous ambulatory peritoneal dialysis(CAPD)at the Eastern Hospital, Tongji University, Shanghai during January 2002 to December 2006 were retrospectively analyzed.They were divided into four groups based oil their age and mode of dialysis, i.e., 44 patients in the elderly HD group(aged over 60years), 16 patients in the elderly CAPD group(aged over 60), 46 patients in medium-age HD group(aged under 60 years)and 12 patients in the medium-age CAPD group(aged under 60).Routine biochemical parameters were measured for all the patients and their difference was compared among the four groups.Logistic regression analysis was performed for the risk factors of cardiovascular complications.Results Pulse pressure(PP)was(66±21)mm Hg, serum level of triglycerides(TG)was(1.28±0.67)mmol/L, serum level of lipoprotein(a)[LP(a)]was(434±202)mg/L, C-reactive protein was(CRP)(21±15)mg/L, serum phosphorous(P3-)was(2.02±0.77)mmol/L, and product of serum calcium and phosphorous(Ca×P)was(4.3±1.6)mmol2/L2, respectively, in the elderly group with dialysis, all significantly higher than those in the medium-age group with dialysis(t=1.535, 1.016, 2.154, 2.252, 4.676, and 4.534, respectively, P＜0.05).Incidence of cardiovascular events was markedly lower in the CAPD group than that in the HD group(P＜0.05), either in the elderly or medium-aged patients.And, incidence of cardiovascular complications correlated positively with age, PP, LP(a), CRP and Ca×P of the patients with dialysis, but correlated reversely with serum level of albumin(all with P＜0.05).Conclusions There exist a few risk factors for cardiovascular complications in the elderly patients with dialysis, so proper mode of dialysis should be selected for those who need it and adequate intervention should be implemented for them to correct the risk factors.
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Objective To investigate the oxidative DNA damage in lymphocyte of MHD patients and the effect of dialysis membrane on it through comet assay.Methods From 2003-05 to 2004-10 we selected 20 CRF patients undergoing maintenance hemodialysis and divided the patients into HE and PS group randomly.And 7 volunteers were chosen as controls.The patients in each group had undergone hemodialysis for 12 weeks using HE or PS membrane respectively.Then we took venous blood sample and separated lymphocyte.The oxidative DNA damage was measured by comet assay.Results The comet tail length of control group,HE group and PS group was(0.286?0.194)?m,(0.970?0.120)?m and(0.656?0.187)?m respectively.Compared with control group,the comet tail length of MHD patients was significantly longer(P
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Objective To investigate the inhibition effect of plasma-mediated small interfering RNA (siRNA) on the expression of monocyte chemotacite protein-1 (MCP-1) gene in human renal tubular epithelial cells (HKC).Methods Three pairs of siRNAs directed human's MCP-1 mRNA 67,116,142 targets were designed and synthesized.Eukaryotic expression vector special for MCP-1,pRNAT-MCP-1-Ⅰ、pRNAT-MCP-1-Ⅱ、pRNAT-MCP-1-Ⅲ were constructed and transfected into HKC by lipofectamine.At 24 hour after transfection,the expression of MCP-1 in the levels of mRNA was detected by Real Time RT-PCR,and the expression of MCP-1 in the levels of protein was detected by Western blot.Results Transfection efficiency of siRNA expression vector was 60%;the expression of MCP-1 in the levels of mRNA and protein of three pairs of plasma-mediated siRNA group were markedly decreased compared with normal control group(P
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Objective To elucidate the effects of Ginkgo biloba extract on advanced glycation end products-induced TGF-?_1,CTGF mRNA expression and oxidative stress in cultured NRK-49F cells.Methods From Jan.to Jul.2005,NRK-49F cells were incubated with serum-free medium with or without 25 mmol/L glucose as control.Cells were incubated with medium containing AGEs-BSA with or without 25 mmol/L glucose for 24 h.Cells were pretreated with EGb(50,100mg?mL -1)for 24 h to evaluate effects of EGb.And then intracellular ROS generation was measured by flowcytometry,expression of TGF-?_1 and CTGF mRNA were performed by a semi-quantitative RT-PCR technique.Results Compared with control,AGEs significantly increased the expression of TGF-?_1 and CTGF mRNA and intercellular ROS generation in NRK-49F cells.Incubation with both AGEs and high glucose(25 mmol/L)can upregulate TGF-?_1 and CTGF mRNA expression and intercellular ROS generation,compared with AGEs and high glucose(25 mmol/L)respectively.Preincubation with EGb attenuated AGEs-induced TGF-?_1 and CTGF mRNA overexpression and intercellular ROS generation.Conclusion Attenuation of AGEs-induced TGF-?_1 and CTGF mRNA overexpression in renal fibroblasts through scavenging of free radical and inhibition of oxidative stress may be one of mechanisms underlying EGb in prevention and therapy of DN.
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The method of preparation of a Milk Substitute, formula 5410, and its nutritive value on rats have been reported in previous communications. Further tests of its nutritive effect were made by feeding a group of 100 infants including 4 premature and 10 undernourished. Another group of 43 infants fed with human breast milk or cow's milk were observed during the same period as controls. Among the infants of the two groups there were 6 pairs of twins; one of each pair was fed with the Milk Substitute and the other with human or cow's milk. Great majority of the infants were cared by their own mothers whose cooperation had been secured, while the rest of the infants (10%) were kept in our nursery.The Milk Substitute feeding was started with infants between half and six months of age, with an average age of three months. Observations were continued until they all reached one year old. Fish liver oil and ascorbic acid were supplied to infants of both the experimental and the control groups. Vegetable soup and fruit juice were given to the infants before five months of age. Then various kinds of other foods, including rice porridge, wheat flour nudols, bread, crackers, mashed meat and vegetable and egg yolk were individually supplemented furnishing not more than 1/3 of the total caloric intake, (at the age of one year), as the family income permitted.The appetite of the experimental infants was normal. There was no digestive disturbances and abnormal frequency and appearance of the stool. The average daily caloric intake was similar to those recorded in the literature.The body weight and height of the babies in the experimental group fell well within the normal range. The average initial body weight and height of the infants in the experimental group were somewhat lower than those of the control; however, the height reached .that of the control at the age of 7 months, and the weight at about 11 months. The red blood cell counts and the hemoglobin value of the blood were normal.Values of blood alkaline phosphatase activity higher than 15 Bodansky units were shown in 20 babies of the experimental group (27%) and 8 babies of the control group (23%) at the beginning of the observation; only 4 babies in the experimental group were found abnormal high blood alkaline phosphatase value at the end. At the beginning, 3 cases of rickets and 3 cases of suspected rickets were indicated by the radiograph of the wrist bones of the babies in the experimental group, and only one suspected ricket in the control group were observed; and they all became normal at the end of the experiment. Besides, there were no other signs of any nutritional deficiency among all the infants.