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Flagella are the main motility structure of Clostridioides difficile that affects the adhesion, colonization, and virulence of C. difficile in the human gastrointestinal tract. The FliL protein is a single transmembrane protein bound to the flagellar matrix. This study aimed to investigate the effect of the FliL encoding gene flagellar basal body-associated FliL family protein (fliL) on the phenotype of C. difficile. The fliL gene deletion mutant (ΔfliL) and its corresponding complementary strains (: : fliL) were constructed using allele-coupled exchange (ACE) and the standard molecular clone method. The differences in physiological properties such as growth profile, antibiotic sensitivity, pH resistance, motility, and spore production ability between the mutant and wild-type strains (CD630) were investigated. The ΔfliL mutant and the : : fliL complementary strain were successfully constructed. After comparing the phenotypes of strains CD630, ΔfliL, and : : fliL, the results showed that the growth rate and maximum biomass of ΔfliL mutant decreased than that of CD630. The ΔfliL mutant showed increased sensitivity to amoxicillin, ampicillin, and norfloxacin. Its sensitivity to kanamycin and tetracycline antibiotics decreased, and the antibiotic sensitivity partially returned to the level of CD630 strain in the : : fliL strain. Moreover, the motility was significantly reduced in the ΔfliL mutant. Interestingly, the motility of the : : fliL strain significantly increased even when compared to that of the CD630 strain. Furthermore, the pH tolerance of the ΔfliL mutant significantly increased or decreased at pH 5 or 9, respectively. Finally, the sporulation ability of ΔfliL mutant reduced considerably compared to the CD630 strain and recovered in the : : fliL strain. We conclude that the deletion of the fliL gene significantly reduced the swimming motility of C. difficile, suggesting that the fliL gene is essential for the motility of C. difficile. The fliL gene deletion significantly reduced spore production, cell growth rate, tolerance to different antibiotics, acidity, and alkalinity environments of C. difficile. These physiological characteristics are closely related to the survival advantage in the host intestine, which is correlated with its pathogenicity. Thus, we suggested that the function of the fliL gene is closely related to its motility, colonization, environmental tolerance, and spore production ability, which consequently affects the pathogenicity of C. difficile.
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Humans , Clostridioides/metabolism , Clostridioides difficile/metabolism , Bacterial Proteins/metabolism , Virulence , Anti-Bacterial Agents/metabolismABSTRACT
Objective:To investigate the effect of NEMO binding domain peptide (NBDP) on lung inflammation and apoptosis in mice with acute respiratory distress syndrome (ARDS) and its mechanism.Methods:Thirty-six male BALB/c mice were divided into normal saline (NS) control group, ARDS model group, NBDP negative control group and 6, 12 and 18 μg NBDP pretreatment group by random number table method, with 6 mice in each group. ARDS mouse model was reproduced by aerosol inhalation lipopolysaccharide (LPS) 50 μL. An equivalent among of NS was inhaled in NS control group. The mice in NBDP negative control group were inhaled the materials similar to the non-functional NBDP 30 minutes before the aerosol inhalation LPS; 6, 12 and 18 μg of NBDP 50 μL were respectively inhaled in NBDP pretreatment groups. After inhalation of LPS for 6 hours, mice were sacrificed to get lung tissue and observe the degree of pathological injury and edema. Western blotting was used to detect the phosphorylation of nuclear factor-κB (NF-κB) pathway related proteins [NF-κB inhibitor (IκB) kinaseα/β(IKKα/β), IκBα and NF-κB p65; p-IKKα/β, p-IκBα, p-p65] and the expression of caspase-3 in lung tissue. The bronchoalveolar lavage fluid (BALF) was collected and the levels of inflammatory markers such as myeloperoxidase (MPO), interleukins (IL-1β, IL-8), and tumor necrosis factor-α (TNF-α) were detected by enzyme linked immunosorbent assay (ELISA).Results:ARDS model group had severe edema and hemorrhage, alveolar structure destruction, pulmonary hemorrhage and hyaline membrane formation etc. under light microscope, consistent with the pathological characteristics of ARDS lung tissue, suggesting that the ARDS model was successfully reproduced. ELISA showed that MPO, IL-1β, IL-8 and TNF-α levels of BALF in ARDS model group were obviously higher than those in NS control group. There were no significant differences in the above inflammatory indicators between NBDP negative control group and ARDS model group. The levels of MPO, IL-1β, IL-8 and TNF-α in NBDP pretreatment groups were significantly lower than those in ARDS model group in a dose-dependent manner, especially in 18 μg NBDP, the differences were statistically significant as compared with ARDS model group [MPO (ng/L): 393.32±19.35 vs. 985.87±101.50, IL-1β (ng/L): 43.05±5.11 vs. 97.68±10.88, IL-8 (ng/L): 84.64±2.32 vs. 204.00±17.37, TNF-α (ng/L): 229.13±17.03 vs. 546.73±62.72, all P < 0.05]. Western blotting showed that p-IKKα/β, p-IκBα, p-p65 and caspase-3 protein expressions in ARDS model group were significantly higher than those in NS control group. There was no significant difference in above NF-κB pathway and apoptosis-related protein expression between the NBDP negative control group and ARDS model group. The p-IKKα/β, p-IκBα, p-p65 and caspase-3 protein expression in NBDP pretreatment groups were significantly lower than those in ARDS model group in a dose-dependent manner, especially in 18 μg NBDP, the differences were statistically significant as compared with ARDS model group [p-IKKα/β protein (p-IKKα/β/β-actin): 0.15±0.02 vs. 0.42±0.04, p-IκBα protein (p-IκBα/β-actin): 0.10±0.01 vs. 0.93±0.30, p-p65 protein (p-p65/β-actin): 0.22±0.05 vs. 1.37±0.21, all P < 0.05]. Conclusion:NBDP can inhibit inflammatory response and apoptosis in ARDS lung tissue in a dose-dependent manner, and its mechanism is associated with interference NF-κB signaling pathway transduction.
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Objective:To determine the effect of andrographolide (AD) on the expression of procoagulant and fibrinolytic inhibitory factors in rat type Ⅱ alveolar epithelial cells (AECⅡ) stimulated by lipopolysaccharide (LPS).Methods:The AECⅡ cells RLE-6TN in the logarithmic growth phase were divided into 5 groups: the normal control (NC) group, the LPS group, and the 6.25, 12.5, and 25 mg/L AD groups (AD 6.25 group, AD 12.5 group, AD 25 group). The NC group was cultured with RPMI 1640 conventional medium. In the LPS group, 5 mg/L LPS was added to the RPMI 1640 conventional medium for stimulation. Cells in the AD groups were treated with 6.25, 12.5, and 25 mg/L AD in advance for 1 hour and then given LPS to stimulate the culture. The cells and cell culture supernatant were collected 24 hours after LPS stimulation. The protein and mRNA expressions of tissue factor (TF), tissue factor pathway inhibitor (TFPI), and plasminogen activator inhibition-1 (PAI-1) in cells were detected by Western blotting and real-time fluorescent quantitative polymerase chain reaction (RT-qPCR). The levels of procollagen Ⅲ peptide (PⅢP), thrombin-antithrombin complex (TAT), antithrombin Ⅲ (AT-Ⅲ) and activated protein C (APC) in the cell supernatant were detected by enzyme linked immunosorbent assay (ELISA).Results:Compared with the NC group, the protein and mRNA expressions of TF and PAI-1 in the LPS group were significantly increased, and the protein and mRNA expressions of TFPI were significantly reduced. At the same time, the levels of PⅢP and TAT in the cell supernatant were significantly increased, the levels of AT-Ⅲ, APC were significantly reduced. Compared with the LPS group, the protein and mRNA expressions of TF and PAI-1 in AD 6.25 group, AD 12.5 group, AD 25 group were significantly reduced [TF/GAPDH: 0.86±0.08, 0.45±0.04, 0.44±0.04 vs. 1.32±0.10, TF mRNA (2 -ΔΔCt): 2.59±0.25, 2.27±0.05, 1.95±0.04 vs. 4.60±0.26, PAI-1/GAPDH: 2.11±0.07, 1.45±0.04, 0.86±0.09 vs. 2.56±0.09, PAI-1 mRNA (2 -ΔΔCt): 3.50±0.22, 2.23±0.29, 1.84±0.09 vs. 6.60±0.27, all P < 0.05], while the protein and mRNA expressions of TFPI were significantly increased [TFPI/GAPDH: 0.78±0.05, 0.81±0.03, 0.84±0.07 vs. 0.36±0.02, TFPI mRNA (2 -ΔΔCt): 0.46±0.09, 0.69±0.07, 0.91±0.08 vs. 0.44±0.06, all P < 0.05]. Also the levels of PⅢP and TAT in the cell supernatant were significantly reduced, and the levels of AT-Ⅲ and APC were significantly increased [PⅢP (μg/L): 13.59±0.23, 12.66±0.23, 10.59±0.30 vs. 15.82±0.29, TAT (ng/L): 211.57±6.41, 205.69±4.04, 200.56±9.85 vs. 288.67±9.84, AT-Ⅲ (μg/L): 102.95±3.86, 123.92±2.63, 128.67±1.67 vs. 92.93±3.36, APC (μg/L): 1 188.95±14.99, 1 366.12±39.93, 1 451.15±29.69 vs. 1 145.55±21.07, all P < 0.05]. With the increase of the dose of AD, the above-mentioned promotion and inhibition effects became more obvious. In the AD 25 group, TF, PAI-1 protein and mRNA expressions decreased, TFPI mRNA expression increased, PⅢP level in the supernatant decreased and AT-Ⅲ, APC levels increased compared with AD 6.25 group, the difference was statistically significant, and the decrease of PAI-1 protein expression and PⅢP level in the supernatant were also statistically significant compared with AD 12.5 group. Conclusions:Andrographolide in the dose range of 6.25-25 mg/L can dose-dependently inhibit the expression and secretion of procoagulant and fibrinolytic inhibitor-related factors in AECⅡ cells RLE-6TN stimulated by LPS, and promote the secretion of anticoagulant factors. 25 mg/L has the most obvious effect.
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Objective:To observe the effects of berberine on procoagulant and fibrinolytic inhibitory factors produced by rat type Ⅱ alveolar epithelial cell (AECⅡ) induced by lipopolysaccharide (LPS).Methods:AECⅡ cells (RLE-6TN cells) were cultured in vitro, and the cells in logarithmic growth phase were collected. The cytotoxicity text of berberine was detected by cell counting kit-8 (CCK-8) to determine the drug concentration range according to inhibition concentration of half cells (IC 50). The RLE-6TN cells were divided into five groups, the cells in blank control group were cultured in DMEM; the cells in LPS group were stimulated with 5 mg/L LPS; and the cells in berberine pretreatment groups were pretreated with 20, 50 and 80 μmol/L berberine for 1 hour, and then were co-cultured with 5 mg/L LPS. The cells were collected after LPS induced for 24 hours. The protein and mRNA expression levels of tissue factor (TF), tissue factor pathway inhibitor (TFPI) and plasminogen activator inhibitor-1 (PAI-1) in the cells were detected by Western blotting and real-time fluorescence quantification reverse transcription-polymerase chain reaction (RT-qPCR). The levels of activated protein C (APC), precollagen Ⅲ peptide (PⅢP), thrombin-antithrombin complex (TAT) and antithrombin Ⅲ (ATⅢ) in the cell supernatant were measured by enzyme linked immunosorbent assay (ELISA). Results:According to the inhibition rate curve, the IC 50 of berberine on RLE-6TN cells was 81.16 μmol/L. Therefore, 20, 50 and 80 μmol/L were selected as the intervention concentration of berberine. Compared with the blank control group, the expression and secretion of procoagulant and fibrinolytic inhibitory factors were abnormal in RLE-6TN cells after LPS induced for 24 hours. The protein and mRNA expression levels of TF and PAI-1 in the LPS group were significantly increased, but the protein and mRNA expression levels of TFPI were significantly decreased. Meanwhile, the levels of APC and ATⅢ in the cell supernatant were significantly decreased, while the levels of PⅢP and TAT were significantly increased. After pretreatment with berberine, the abnormal expression and secretion of procoagulant and fibrinolytic inhibitory factors induced by LPS were corrected in a dose-dependent manner, especially in 80 μmol/L. Compared with the LPS group, the protein and mRNA expression levels of TF and PAI-1 in the berberine 80 μmol/L group were significantly decreased [TF protein (TF/GAPDH): 0.45±0.02 vs. 0.55±0.03, TF mRNA (2 -ΔΔCt): 0.39±0.08 vs. 1.48±0.11, PAI-1 protein (PAI-1/GAPDH): 0.37±0.02 vs. 0.64±0.04, PAI-1 mRNA (2 -ΔΔCt): 1.14±0.29 vs. 4.18±0.44, all P < 0.01] and those of TFPI were significantly increased [TFPI protein (TFPI/GAPDH): 0.53±0.02 vs. 0.45±0.02, TFPI mRNA (2 -ΔΔCt): 0.94±0.08 vs. 0.40±0.05, both P < 0.01]. Meanwhile, the levels of APC and ATⅢ in the cell supernatant were significantly increased [APC (μg/L): 1 358.5±26.0 vs. 994.2±23.1, ATⅢ (μg/L): 118.0±7.4 vs. 84.4±2.7, both P < 0.01], while those of PⅢP and TAT were significantly decreased [PⅢP (μg/L): 11.2±0.4 vs. 18.6±0.9, TAT (ng/L): 222.1±2.8 vs. 287.6±7.0, both P < 0.01]. Conclusions:Berberine could inhibit the LPS-induced expressions of procoagulant and fibrinolytic inhibitory factors in rat AECⅡ cells and promote the expressions of anticoagulant factors in a dose-dependent manner. Berberine may be a new therapeutic target for alveolar hypercoagulability and fibrinolysis inhibition in acute respiratory distress syndrome (ARDS).
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Carbon dioxide (CO 2) ejection syndrome is common after artificial pneumoperitoneum, and it often attracts the attention of anesthesiologists because of its rapid changes in vital signs. CO 2 ejection syndrome is not uncommon in critically ill patients, and may occur after mechanical ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). There are few relevant reports about CO 2 ejection syndrome, and a considerable number of clinicians have little understanding of the pathological changes. A case of AECOPD patient with CO 2 ejection syndrome after endotracheal intubation was admitted to the intensive care unit (ICU) of the Affiliated Hospital of Guizhou Medical University. After treatment, such as fluid expansion, vasoactive drugs and ventilator assistance, the patient's condition improved and was transferred out of the ICU. It is expected to provide some references by summarizing the diagnosis and treatment of this case and reviewing relevant literature reports.
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Objective:To discuss the feasibility of offering specialized courses of critical care medicine in undergraduate clinical medicine education, so as to alleviate the shortage of critical care medicine staffs and lay a foundation for improving the success rate for the treatment of critical cases.Methods:The undergraduates majoring in clinical medicine from 2008 to 2011 in Guizhou Medical University (the former Guiyang Medical College) were enrolled. After they had been enrolled in the undergraduate education for 3 years and were ready for Grade four, which meant basic medicine teaching had been completed and clinical medicine teaching was about to start, they were introduced and preached to each discipline, including critical care medicine. The undergraduates were free to choose professional direction of clinical training in Grade four. Students majoring in clinical medicine from 2012 to 2014 were free to choose their major direction when they entered the school.Results:From September 2011 to July 2019, the university had cultivated 246 undergraduates majoring in clinical critical care medicine from 2008 to 2014, and the critical care medicine professional team of affiliated hospital had undertaken 540 teaching hours. By July 2019, all students had graduated on time, with an employment rate of 100%. Forty students took postgraduate programs in our school and other schools, accounting for 16.3%.Conclusions:Professional education of critical care medicine in the undergraduate course of clinical medicine can mobilize students' interest in learning and subjective initiative, which is conducive to career selection. During the clinical training, the students can identify and timely cure critical care cases in the early stage, and partly alleviate the current shortage of critical care medical staffs.
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Objective:To know the critical care resources of the different class-hospitals in Guizhou Province, China, and to provide the direction and evidence for quality improvement and discipline construction of critical care medicine in Guizhou Province.Methods:The resource status of the departments of intensive care unit (ICU) in Guizhou Province was obtained through form filling and/or field investigation. The forms were filled and submitted from May 2017 to February 2018, and the field investigation (some of the hospitals) was carried out in March 2018. The data of hospitals in Guizhou Province in 2018, was obtained from the official website of Health Committee of Guizhou Province, which was released online on November 28th, 2019. The obtained data were summarized and analyzed according to different aspects such asthe status of ICU construction, main equipment configuration and technology implementation.Results:There were 39 third-class hospitals and 77 second-class hospitals included in this study, which accounted for 76.5% (39/51) of third-class public hospitals and 50.0% (77/154) of second-class public hospitals respectively. Among them, there were 86.8% (33/38) of third-class general hospitals and 50.4% (69/137) of second-class general hospitals respectively. In terms of ICU construction, compared with the ICUs of second-class hospitals, the ICUs of third-class hospitals were established earlier [years: 2011 (2008, 2012) vs. 2013 (2011, 2015), P < 0.01], had more ICU beds, doctors and nurses [15 (11, 20) vs. 8 (6, 10), 9 (8, 11) vs. 6 (5, 7), 25 (20, 41) vs. 15 (12, 19), respectively, all P < 0.01]. However, there were no significant differences regarding the doctor-bed ratio and the nurse-bed ratio in ICUs between second-class hospitals and third-class hospitals. In terms of main equipment configuration, compared with the ICUs of second-class hospitals, the ICUs of third-class hospitals had more ventilators, higher ratio of ventilators to beds, more infusion pumps, higher ratio of infusion pumps to beds, more monitor, gastrointestinal nutrition pumps and single rooms, and higher proportion of ICUs equipped with negative pressure rooms [ventilators: 14 (10, 18) vs. 6 (4, 8), ratio of ventilators to beds: 1.0 (0.7, 1.1) vs. 0.8 (0.6, 1.0), infusion pumps: 10 (6, 20) vs. 5 (3, 8), ratio of infusion pumps to beds: 0.8 (0.0, 1.0) vs. 0.0 (0.0, 0.4), monitor: 18 (13, 24) vs. 9 (6, 12), gastrointestinal nutrition pumps: 2 (1, 5) vs. 1 (0, 3), single rooms: 2 (1, 3) vs. 1 (0, 3), proportion of ICUs equipped with negative pressure rooms: 53.8% (21/39) vs. 31.5% (23/73), respectively, all P < 0.05]. Furthermore, there were higher proportions of ICUs equipped with portable ventilator, pulse indicator continuous cardiac output monitoring (PiCCO), intra-aortic balloon pump (IABP), extra-corporeal membrane oxygenation (ECMO), B ultrasound machine, bronchoscope, pressure of end-tidal carbondioxide (P ETCO 2) monitoring, bispectral index (BIS) monitoring, bedside gastroscopy, the apparatus used for the prevention of deep vein thrombosis of lower extremity in third-class hospitals than in second-class hospitals [portable ventilator: 86.7% (26/30) vs. 59.6% (28/47), 43.3% (13/30) vs. 1.5% (1/66), 14.3% (4/28) vs. 0% (0/65), 10.7% (3/28) vs. 0% (0/65), 62.5% (20/32) vs. 37.3% (25/67), 97.1% (33/34) vs. 63.6% (42/66), 60.6% (20/33) vs. 28.4% (19/67), 17.2% (5/29) vs. 0% (0/65), 27.6% (8/29) vs. 1.5% (1/65), 77.4% (24/31) vs. 52.3% (34/65), respectively, all P < 0.05]. In terms of skills development, there were more ICUs carried out intracranial pressure monitoring, abdominal pressure monitoring, ultrasound diagnosis, bronchoscope examination and treatment and blood purification in third-class hospitals than in second-class hospitals [31.6% (12/38) vs. 14.7% (11/75), 75.7% (28/37) vs. 38.6% (27/70), 61.5% (24/39) vs. 24.3% (18/74), 89.7% (35/39) vs. 45.9% (34/74), 92.3% (36/39) vs. 48.6% (36/74), respectively, all P < 0.05]. Conclusions:The data were mainly derived from public general hospitals in Guizhou Province. Compared with the ICUs of second-class hospitals, the ICUs of third-class hospitals were founded earlier and larger, had better hardware configuration and could carry out more skills. However, the human resource situations were similar between second-class hospitals and third-class hospitals. Both second-class hospitals and third-class hospitals have a need to improve the allocation of manpower and equipment and expand various skills in ICUs, while it is more urgent for second-class hospitals.
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Objective:To explore the effect of small dose of low molecular weight heparin on the prognosis of elderly patients with severe pneumonia using systematic evaluation method.Methods:Databases including Wanfang data, VIP, CNKI, SinoMed, PubMed, Embase and Cochrane Library were searched for randomized controlled trial (RCT) studies about the comparison of conventional therapy and low molecular weight heparin on prognosis of elderly patients with severe pneumonia from the time of database establishment to August 2019. The patients in conventional treatment group were treated by improving ventilation, anti-infection, eliminating phlegm, relieving asthma and maintaining homeostasis while those in low molecular weight heparin group were subcutaneously injected with low molecular weight heparin of 4 000 U, once a day for 7 days. The patients' main outcomes included the oxygenation index (PaO 2/FiO 2) after 7 days of treatment, duration of mechanical ventilation, mortality in hospital, and secondary outcomes included acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score and coagulation function after 7 days of treatment, the length of intensive care unit (ICU) stay, and incidence of bleeding. Data extraction and quality evaluation were conducted. The Meta-analysis of included studies that met the quality standards was performed using RevMan 5.3 software. Funnel diagram analysis was used to analyze the parameters with no less than 10 studies enrolled. Results:A total of 14 RCT studies were enrolled involving 1 173 elderly patients with severe pneumonia, among whom 590 received low molecular weight heparin while the other 583 received conventional therapy. All the included studies were well designed and of high quality. The results of Meta-analysis showed that compared with conventional therapy, small dose of low molecular weight heparin significantly elevated PaO 2/FiO 2 after 7 days of treatment [mean difference ( MD) = 19.25, 95% confidence interval (95% CI) was 16.88 to 21.61, P < 0.000 01], shortened the duration of mechanical ventilation ( MD = -48.88, 95% CI was -67.42 to -30.33, P < 0.000 01), and decreased mortality in hospital [odds ratio ( OR) = 0.40, 95% CI was 0.22 to 0.73, P = 0.003] and APACHEⅡ score after 7 days of treatment ( MD = -3.38, 95% CI was -3.94 to -2.83, P < 0.000 01), and shortened the length of ICU stay ( MD = -4.51, 95% CI was -5.75 to -3.27, P < 0.000 01). There was no significant difference in the changes of coagulation parameters after 7 days of treatment or the incidence of bleeding between low molecular weight heparin group and conventional therapy group [7-day thrombin time (TT): MD = 0.57, 95% CI was -0.15 to 1.28, P = 0.12; 7-day prothrombin time (PT): MD = 0.32, 95% CI was -0.35 to 0.98, P = 0.35; 7-day fibrinogen (FIB): MD = -0.17, 95% CI was -0.45 to 0.10, P = 0.22; incidence of bleeding: OR = 0.86, 95% CI was 0.36 to 2.07, P = 0.74]. The funnel diagram showed that there was publication bias of included 10 studies about APACHEⅡ score after 7 days of treatment. Conclusion:Small dose of low molecular weight heparin can improve the prognosis of elderly patients with severe pneumonia and it has no obvious side-effect on coagulation function.
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To construct TeI3c/4c-based and temperature-inducible gene inactivation system (Thermotargetron) and to apply it to gene inactivation of mesophilic bacteria. The subunit of flagellum (fliC) and C4 dicarboxylate orotate:H⁺ symporter (dctA) genes were chosen as targets in the genome of Escherichia coli HMS174 (DE3) strain. According to recognition roles of TeI3c/4c intron, the fliC489a, fliC828s, fliC1038s and dctA2a sites were chosen as target sites. Gene-targeting plasmids were constructed based on pHK-TT1A by using overlap PCR method and transformed into HMS174 cells. An aliquot mid-log phase cultures of the transformants were shocked at 48 °C and plated on LB plate (containing chloramphenicol). Afterwards, gene mutants were screened by using colony PCR and DNA sequencing. After the mutants were obtained, the phenotypes of ΔfliC and ΔdctA gene mutants were characterized by using agar puncture and carbon metabolism experiments. Colony PCR and sequencing results show that TeI3c/4c intron was inserted in the designed sites of fliC and dctA genes. The gene-targeting efficiency of Thermotargetron system was 100%. Phenotype verification experiments of the mutants demonstrated that the cell motility of all ΔfliC mutants was damaged and the malate assimilation ability of ΔdctA mutant was deprived comparing to wild-type HMS174 strain. In our study, a temperature-inducible and high-efficiency gene inactivation system was established for mesophilic bacteria. This system could achieve high efficiency and precise gene inactivation by modulation of the incubation duration of the transformants at 48 °C.
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Objective@#To explore the therapeutic effect of Xuebijing on patients with acute paraquat poisoning (APP) by using systematic evaluation method.@*Methods@#PubMed, Cochrane Library, Embase, Wanfang database, China National Knowledge Infrastructure (CNKI), VIP database (VIP) and China Biology Medicine (CBM) were searched using the computers to find the literatures published about the Xuebijing injection for the treatment of APP. Randomized controlled trials (RCT) were retrieved from the establishment of the database to August 2019. Patients in experimental group were treated with Xuebijing injection combined with conventional treatment, while the patients in control group were only given conventional treatment. The patients' outcome included the 14-day mortality, arterial oxygen saturation (SaO2) and incidence of pulmonary fibrosis. In addition, the 6-month survival rate, alanine aminotransferase (ALT), serum creatinine (SCr), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), malondialdehyde (MDA) and superoxide dismutase (SOD) between the two groups were compared. The literature data were extracted by two researchers independently, and the quality of the literatures was evaluated according to the Cochrane 5.1 handbook. The Meta-analysis was performed by using RevMan 5.3 software. The results stability of Meta-analysis was tested by sensitivity analysis. The publication bias was analyzed through drawing of funnel diagram.@*Results@#Twenty-seven RCT studies in total were enrolled, of which 26 were in Chinese and 1 was in English. A total of 1 429 patients were enrolled, among whom 726 were in experimental group and another 703 were in control group. Meta-analysis showed that compared with the control group, the 14-day mortality [relative risk (RR) = 0.62, 95% confidence interval (95%CI) was 0.54 to 0.72, P < 0.000 01] and incidence of pulmonary fibrosis (RR = 0.67, 95%CI was 0.53 to 0.85, P = 0.000 9) of patients in the experimental group were significantly lowered, while SaO2 at 7 days and 14 days were significantly increased [7 days: mean difference (MD) = 16.86, 95%CI was 9.89 to 23.83, P < 0.000 01; 14 days: MD = 16.51, 95%CI was 10.22 to 22.80, P < 0.000 01]. Compared with the control group, the survival rate within 6 months (RR = 1.55, 95%CI was 1.41 to 1.71, P < 0.000 01) and SOD (MD = 13.88, 95%CI was 7.43 to 20.33, P < 0.000 1) of patients in the experimental group were significantly increased, ALT at 14 days (MD = -78.35, 95%CI was -127.35 to -29.34, P = 0.000 5), SCr at 7 days and 14 days (7 days: MD = -135.13, 95%CI was -219.09 to -51.17, P = 0.002; 14 days: MD = -206.05, 95%CI = -290.13 to -121.96, P < 0.000 01), CRP (MD = -11.55, 95%CI was -17.77 to -5.33, P = 0.000 3), TNF-α (MD = -9.27, 95%CI was -15.48 to -3.96, P = 0.000 9) and MDA (MD = -1.27, 95%CI was -1.57 to -0.96, P < 0.000 01) were significantly lowered. The overall effect value of the parameters with high heterogeneity was not significantly changed after furtherMeta-analysis excluding any one of the studies, suggesting that the result was relatively stable. Funnel chart analysis was used to analyze the parameters from more than 10 articles enrolled, and it showed that there was publication bias.@*Conclusion@#Xuebijing injection can reduce the mortality of patients with APP, which may because that it can improve liver and kidney function, reduce inflammation and oxidative stress damage, inhibit pulmonary fibrosis and increase oxygenation level.
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To explore the therapeutic effect of Xuebijing on patients with acute paraquat poisoning (APP) by using systematic evaluation method. Methods PubMed, Cochrane Library, Embase, Wanfang database, China National Knowledge Infrastructure (CNKI), VIP database (VIP) and China Biology Medicine (CBM) were searched using the computers to find the literatures published about the Xuebijing injection for the treatment of APP. Randomized controlled trials (RCT) were retrieved from the establishment of the database to August 2019. Patients in experimental group were treated with Xuebijing injection combined with conventional treatment, while the patients in control group were only given conventional treatment. The patients' outcome included the 14-day mortality, arterial oxygen saturation (SaO2) and incidence of pulmonary fibrosis. In addition, the 6-month survival rate, alanine aminotransferase (ALT), serum creatinine (SCr), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), malondialdehyde (MDA) and superoxide dismutase (SOD) between the two groups were compared. The literature data were extracted by two researchers independently, and the quality of the literatures was evaluated according to the Cochrane 5.1 handbook. The Meta-analysis was performed by using RevMan 5.3 software. The results stability of Meta-analysis was tested by sensitivity analysis. The publication bias was analyzed through drawing of funnel diagram. Results Twenty-seven RCT studies in total were enrolled, of which 26 were in Chinese and 1 was in English. A total of 1 429 patients were enrolled, among whom 726 were in experimental group and another 703 were in control group. Meta-analysis showed that compared with the control group, the 14-day mortality [relative risk (RR) = 0.62, 95% confidence interval (95%CI) was 0.54 to 0.72, P < 0.000 01] and incidence of pulmonary fibrosis (RR = 0.67, 95%CI was 0.53 to 0.85, P = 0.000 9) of patients in the experimental group were significantly lowered, while SaO2 at 7 days and 14 days were significantly increased [7 days:mean difference (MD) = 16.86, 95%CI was 9.89 to 23.83, P < 0.000 01; 14 days: MD = 16.51, 95%CI was 10.22 to 22.80, P < 0.000 01]. Compared with the control group, the survival rate within 6 months (RR = 1.55, 95%CI was 1.41 to 1.71, P < 0.000 01) and SOD (MD = 13.88, 95%CI was 7.43 to 20.33, P < 0.000 1) of patients in the experimental group were significantly increased, ALT at 14 days (MD = -78.35, 95%CI was -127.35 to -29.34, P = 0.000 5), SCr at 7 days and 14 days (7 days: MD = -135.13, 95%CI was -219.09 to -51.17, P = 0.002; 14 days: MD = -206.05, 95%CI = -290.13 to -121.96, P < 0.000 01), CRP (MD = -11.55, 95%CI was -17.77 to -5.33, P = 0.000 3), TNF-α (MD = -9.27, 95%CI was -15.48 to -3.96, P = 0.000 9) and MDA (MD = -1.27, 95%CI was -1.57 to -0.96, P < 0.000 01) were significantly lowered. The overall effect value of the parameters with high heterogeneity was not significantly changed after further Meta-analysis excluding any one of the studies, suggesting that the result was relatively stable. Funnel chart analysis was used to analyze the parameters from more than 10 articles enrolled, and it showed that there was publication bias. Conclusion Xuebijing injection can reduce the mortality of patients with APP, which may because that it can improve liver and kidney function, reduce inflammation and oxidative stress damage, inhibit pulmonary fibrosis and increase oxygenation level.
ABSTRACT
Objective To explore the risk factors affecting prognosis of critically ill patients following cardiac surgery, furthermore, to assess severity and keep alarm earlier. Methods A retrospective study was conducted. The clinical data of critically ill patients following cardiac surgery admitted to intensive care unit (ICU) of the Affiliated Hospital of Guizhou Medical University from January 1st 2014 to December 31st 2018 were enrolled. The clinical characteristics, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and the worst laboratory examination within 24 hours after ICU admission, and the duration of mechanical ventilation, length of ICU stay, using continuous renal replacement therapy (CRRT), accepting vasoactive agents such as norepinephrine, dopamine or dobutamine and blood products such as red blood cells, plasma or platelets were recorded. The patients were divided into survival group and dead group based on discharge prognosis, and the difference in clinical data between the two groups was compared. Binary multivariate Logistic regression analysis was used to screen the risk factors affecting the prognosis of critically ill patients following cardiac surgery, and the receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of these risk factors. Results In total, 97 patients after cardiac operation were admitted to ICU during the five years. Thirty-two patients were excluded owing to age less than 16 years old, no more than 24 hours of the length of ICU stay, without the outcomes of myocardium enzymes or myocardium markers within the first 24 hours or admitted only for pacemaker. Finally, 65 patients met the criteria, with 40 survived and 25 died. Compared with survival group, APACHEⅡ scores, the level of serum uric acid, serum creatinine (SCr), cardiac troponin T (cTnT), brain natriuretic peptide (BNP), procalcitonin (PCT) and the rate of patients accepting CRRT, vasoactive agents and blood products in dead group were significantly increased with significant differences; however, there was no statistically difference in gender, age, body weight index (BMI), distribution of types of cardiac surgery, ratio of patients suffered from hypertension and diabetes, mean arterial pressure (MAP), white blood cell (WBC), coagulation, length of ICU stay, or duration of mechanical ventilation between the two groups. Binary multivariate Logistic regression analysis showed that APACHEⅡ scores [odds ratio (OR) = 1.123, 95% confidence interval (95%CI) = 1.004-1.257, P = 0.043] and cTnT (OR = 1.496, 95%CI = 1.038-2.158, P = 0.031) were the independent risk factors for prognosis of critical ill patients following cardiac surgery. ROC curve analysis showed that APACHEⅡ score and cTnT had predictive value for prognosis of critical ill patients following cardiac surgery, the best was exerted when APACHEⅡ score combined with cTnT, the area under the ROC curve (AUC) was 0.839, the joint prediction probability was 0.42, the sensitivity was 80.0%, and the specificity was 64.0%. Conclusion APACHEⅡscore and cTnT may be one of independent risk factors for prognosis of critical ill patients following cardiac surgery, and there will be far more greater predictive value when APACHEⅡ score combined with cTnT.
ABSTRACT
Objective? To?systematically?analyze?the?effect?of?haemoperfusion?(HP)?combined?with?continuous?veno-veno?haemofiltration?(CVVH)?in?the?treatment?of?the?patients?with?paraquat?poisoning?(PQP).? Methods? Words?of?paraquat,?poisoning,?continuous?venous?hemofiltration,?hemoperfusion,?hemodiafiltration?in?Chinese?and?paraquat,?poisoning,?intoxication,?haemofiltration,?continuous?venovenous?haemofiltration,?haemoperfusion?in?English?were?chosen?as?keywords,?the?Chinese?and?English?literatures?about?acute?PQP?treated?with?HP?combined?with?CVVH?published?in?Wanfang?database,?CNKI,?CBM,?VIP?database,?PubMed,?Embase,?Cochrane?Library?were?searched?by?computer,?and?the?retrieval?time?was?from?the?establishment?of?the?database?to?July?2018.?The?experimental?group?was?treated?with?HP?combined?with?CVVH,?while?the?control?group?was?treated?with?HP?alone.?Besides,?the?outcome?indicators?included?mortality,?survival?time?of?dead?patients?(the?patient's?time?from?exposure?to?poison?to?death),?serum?creatinine?(SCr),?alanine?aminotransferase?(ALT),?arterial?partial?pressure?of?oxygen?(PaO2),?and?incidence?of?circulatory?and?respiratory?failure.?The?literature?data?were?extracted?by?two?researchers?independently,?the?quality?of?the?literature?was?evaluated? according?to?the?modified?Jadad?score?table?or?Newcastle-Ottawa?scale?(NOS),?and?the?Meta-analysis?was?carried?out?by?RevMan?5.3?software;?and?the?stability?of?the?results?of?Meta-analysis?was?tested?by?sensitivity?analysis.?Further,?the?publication?bias?was?analyzed?through?drawing?a?funnel?diagram.? Results? Finally,?20?articles?were?included,?with?18?in??Chinese?and?2?in?English.?Among?them,?6?were?randomized?controlled?trial?(RCT)?and?14?were?case-control?studies.?Furthermore,?a?total?of?2?870?patients?were?involved,?with?1?558?in?the?control?group?and?1?312?in?the?experimental?group.?Meta-analysis?showed?that?the?mortality?rate?of?patients?in?the?experimental?group?was?significantly?lower?than?that?in?the?control?group?[odds?ratio?(OR)?=?0.55,?95%?confidence?interval?(95%CI)?=?0.42?to?0.73,?P <?0.000?1],?the?patients'?time?from?toxin?exposure?to?death?was?significantly?longer?than?that?in?the?control?group?[standard?mean?difference?(SMD)?=?2.16,?95%CI?=?1.46?to?2.86,?P?<?0.000?01).?In?the?course?of?treatment,?the?peak?value?of?SCr?in?the?experimental?group?was?significantly?lower?than?that?in?the?control?group?(SMD?=?-0.53,?95%CI?=?-0.65?to?-0.42,?P?<?0.000?01),?and?the?peak?value?of?ALT?was?also?decreased?(SMD =?-0.72,?95%CI?=?-0.99?to?-0.44,?P?<?0.000?01).?Besides,?there?was?no?significant?difference?in?PaO2?between?the?two?groups?on?the?3rd?day?of?treatment?(SMD =?0.15,?95%CI?=?-0.19-0.49,??P?=?0.40),?but?on?the?7th?day,?PaO2?in?the?experimental?group?was?significantly?higher?than?that?in?the?control?group?(SMD?=??0.23,?95%CI =?0.29?to?0.98,?P?=?0.000?3).?Furthermore,?the?incidence?of?circulatory?failure?in?the?experimental?group?was?significantly?lower?than?that?in?the?control?group?(OR =?0.26,?95%CI?=?0.19?to?0.37,?P?<?0.000?01),?but?the?incidence?of?respiratory?failure?was?significantly?higher?than?that?in?the?control?group?(OR =?4.14,?95%CI?=?3.00?to?5.72,?P?<?0.000?01).?The?influence?of?heterogeneity?on?statistical?results?was?excluded?in?the?sensitivity?analysis,?and?funnel?plot?diagram?was?applied?to?indicate?the?publication?bias?of?mortality?and?survival?time?of?the?dead?patients.? Conclusion? Combined?with?HP?alone,?HP?combined?with?CVVH?could?better?improve?liver?and?kidney?function?and?oxygenation?state?of?PQP?patients,??reduce?the?incidence?of?early?circulatory?failure,?prolong?the?survival?time?and?reduce?the?death?rate?of?PQP?patients.
ABSTRACT
Objective To investigate the current state of sedation,analgesia and blood glucose management in intensive care units (ICUs) of county hospitals in Guizhou Province of China,and to provide the evidences for improving quality control in critical care medicine.Methods In March 2018,3-4 ICUs of hospitals in every prefecture (one hospital per county) in Guizhou Province were visited to do the field survey.The patients' nursing records within 24 hours after ICU admission were reviewed,and the information such as gender,age,major diagnosis at the ICU admission,the time of admission,were collected.Moreover,the conditions about sedation and analgesia drug use and monitoring,blood pressure,blood glucose as well as and the usage of insulin and ventilator were recorded.Because not all the needed information of every ICU or patient was obtained,only the numbers of the ICUs and patients whose required information had been obtained were analyzed.Results Twenty-eight county hospitals in nine prefectures of Guizhou Province and 152 ICU patients were surveyed.There was a median of 5 (4,7) patients stayed in every ICU on the day of survey.A total of 152 patients were enrolled,with 102 male (67.1％) and 50 female (32.9％);the median age was 65.0 (51.5,74.8) years old;the major diagnosis at ICU admission was mainly cerebral diseases which accounted for 50.0％ (76/152),and the second place was digestive system diseases which accounted for 13.8％ (21/152);53.8％ (78/145) of patients were admitted to ICUs during 08:00-18:00.The percentages of ICUs which had patients received sedation and analgesia were 92.6％ (25/27) and 88.9％ (24/27) respectively,while only 44.4％ (12/27) and 18.5％ (5/27) of them were evaluated the depth of sedation and the level of pain respectively.There was 49.0％ (71/145) of patients received sedation,and 33.8％ (24/71) of them was evaluated by sedation scores;49.7％ (72/145) of patients received analgesia,and 13.9％ (10/72) of them were evaluated by pain scores.The proportions of invasive mechanical ventilation in the patients with sedation or analgesia were both higher than those in the patients without sedation or analgesia [sedation compared with non-sedation:85.9％ (61/71) vs.21.6％ (16/74),analgesia compared with non-analgesia:87.5％ (63/72)vs.19.2％ (14/73),both P ＜ 0.01].The incidence of hypotension was similar between the sedated patients and the non-sedated patients [55.9％ (38/68) vs.40.3％ (29/72),P ＞ 0.05],while the incidence of hypotension was higher in the patients with analgesia as compared with that in the patients without analgesia with significant difference [56.9％ (41/72) vs.38.2％ (26/68),P ＜ 0.05].Within 24 hours after ICU admission,there were 40.7％ (59/145) and 5.5％ (8/145)of patients had hyperglycemia (random blood glucose level ≥ 11.1 mmol/L) or hypoglycemia (random blood glucose level ＜≤ 3.9 mmol/L) respectively.No insulin was used to control the blood glucose level in the patients who had hypoglycemia or did not have hyperglycemia.However,only 23.7％ (14/59) of patients with hyperglycemia were treated with insulin,the initiation of insulin therapy was triggered when median blood glucose level was 19.8 (16.8,24.5) mmol/L.Conclusions The evaluation of analgesia and sedation in the ICUs of county hospitals in Guizhou Province was seriously inadequate and needed to be strengthened urgently.Moreover,the strategy of blood glucose management was also needed to be improved.
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Objective To compare the influence of sevoflurane inhalation sedation and propofol intravenous sedation on duration of endotracheal intubation as well as the length of intensive care unit (ICU) stay and total length of hospital stay in postoperative critical patients.Methods Six databases including CNKI,Wanfang data,PubMed,Embase,Cochrane Library and Web of Science were searched for randomized controlled trials (RCTs) about the influence of sevoflurane inhalation sedation or propofol intravenous sedation on the sedation time,the duration of endotracheal intubation,the length of ICU stay,the total length of hospital stay and the adverse effects rate in postoperative critical patients from the time of database establishment to July 2018.At the same time,the reference materials of included literature were retrieved manually.All literatures were screened by three independent reviewers,and the data extraction and quality evaluation of the included studies were conducted.Meta-analysis was used for RCT that met the quality standards.Results A total of 7 RCT studies were enrolled involving 537 patients who were all transferred into ICU after surgery with trachea cannula.Among the patients,272 received sevoflurane sedation while the other 265 received propofol sedation.All the included studies were well designed and of high quality.The results of Meta-analysis showed that compared with propofol sedation,sevoflurane sedation could significantly shorten the duration of endotracheal intubation [standardized mean difference (SMD) =-0.60,95％ confidence interval (95％CI) =-0.88 to-0.31,P ＜ 0.000 1]and the total length of hospital stay (SMD =-0.36,95％CI =-0.61 to-0.12,P =0.003),and lower the cardiac troponin T (cTnT) within 12-24 hours after ICU admission (SMD =-0.61,95％CI =-0.85 to-0.36,P ＜ 0.000 01).There was no significant difference in the sedation time (SMD =-0.07,95％CI =-0.29 to 0.15,P =0.52),the length of ICU stay (SMD =-0.19,95％CI =-0.39 to 0.01,P =0.06),the incidence of nausea and vomiting [odds ratio (OR) =1.19,95％CI =0.61 to 2.32,P =0.61] or incidence of delirium (OR =0.80,95％CI =0.34 to 1.90,P =0.62) between sevoflurane group and propofol group.Conclusions Sevoflurane inhalation sedation may lead to shorter duration of endotracheal intubation and total length of hospital stay,and had better protection for myocardium as compared with propofol intravenous sedation.The above conclusions needed further study to confirm,due to the lack of literature enrolled in this Meta-analysis.
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Objective To study the difference of clinical outcome between late preterm twins (LPT) and late preterm singletons (LPS),and the influence of assisted reproduction technology (ART) or natural conception on the clinical outcomes of LPT.Method The data of late preterm infants born in the Beijing Obstetrics and Gynecology Hospital between January 2016 and January 2018 were retrospectively collected.Infants were assigned to LPT group or LPS group according to twins or singleton status.The differences of the demographic data,morbidity,oxygen therapy rate,respiratory support rate,mortality,hospitalization rate and hospitalization time between LPT and LPS were compared.In order to analyze the effects of different ways of conception on LPT,LPT was further divided into assisted reproduction technology (ART) subgroup and natural pregnancy subgroup.Result A total of 1 824 late preterm infants were included in the study,including 582 cases of LPT and 1 242 cases of LPS.The birth weight and body length of LPT were lower than those ofLPS [(2572±395)gvs.(2614±413)g,P＜0.05;(46.5±1.1)cm vs.(47.5 ± 1.0)cm,P ＜0.01],while the cesarean delivery rate of LPT was higher than that of LPS [90.7％ (528/582) vs.39.9％ (496/1 242),P ＜ 0.01].The incidence of respiratory distress syndrome (RDS) in LPT was higher than that of LPS [5.2％ (30/582) vs.3.6％ (45/1 242),P ＜ 0.05],and the length of hospitalization of LPT was also longer than that of LPS[(8.9 ±3.1)d vs.(7.2 ±2.9)d,P ＜0.01],the differences were statistically significant.There were no significant differences between groups in neonatal pneumonia,apnea,hypoglycemia,sepsis,neonatal necrotizing enterocolitis (NEC),grade Ⅲ ～ Ⅳ intracranial hemorrhage,severe asphyxia,bronchopulmonary dysplasia (BPD),oxygen therapy rate,respiratory support rate and mortality rate.There was also no significant difference between ART subgroup and natural pregnancy subgroup in gestational age,gender,cesarean section rate,birth weight,and birth length (P ＞ 0.05).There was no significant difference in RDS,pneumonia,apnea,hypoglycemia,sepsis,NEC,Ⅲ ～ Ⅳ intracranial hemorrhage,severe asphyxia,BPD,oxygen uptake rate,respiratory support rate,mortality rate and hospitalization time between the two subgroups (P ＞ 0.05).Conclusion The birth weight and birth length of LPT are lower than those of LPS,and the incidence of RDS is higher.The hospitalization time of LPT is also longer than that of LPS.It is necessary to strengthen the high-risk management of twin pregnant women and post-natal management of LPT.
ABSTRACT
Objective To evaluate the relationship between hypophosphatemia and prognosis in critically ill patients. Methods Some hypophosphatemia-associated prospective or retrospective clinical cohort studies were searched through CNKI, Wanfang Data, PubMed, Embase, Cochrane library, and Google Scholar English database respectively, with the guidance of these key words such as hypophosphatemia, intensive care, prognosis and fatality rate. The articles were concerned about the correlation between hypophosphatemia and the prognosis of patients in intensive care unit (ICU). The literatures collected were restricted from the creation of data base to April 2017. The mean value of < 0.8 mmol/L in serum phosphorus concentrations of the patients within the first 2 days of ICU admission would be treated as the diagnostic criteria of hypophosphatemia. Literature qualities were assessed by Newcastle-Ottawa scale (NOS). Meta-analysis was carried out by RevMan 5.3, and the sensitivity analysis was performed to test the stability of the meta-analysis. The existence of bias was analyzed by using the funnel graph analysis. Results Ten articles were ultimately included in the analysis, including 9 in Chinese and 1 in English, all of which were high qualities. 1 555 patients were involved in these clinical studies, of whom 606 patients had hypophosphatemia and other 949 were normal phosphatemia. Meta analysis results showed that patients with hypophosphatemia had higher acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score as compared with that of normal phosphatemia group [standardized mean difference (SMD) = 0.64, 95% confidence interval (95%CI) = 0.24-1.04, P = 0.002]. Subgroup analysis showed that APACHE Ⅱ score increased in mild, moderate and severe hyperphosphatemia subgroups, and there were significant differences between any two subgroups (all P < 0.01). Longer duration of mechanical ventilation (SMD = 0.50, 95%CI =0.23-0.78, P = 0.000 3) and the length of ICU stay (SMD = 0.36, 95%CI = 0.06-0.67, P = 0.02), and even higher ICU mortality [odds ratio (OR) = 2.99, 95%CI = 2.09-4.27, P < 0.000 01] were seen in patients with hypophosphatemia as compared with normal phosphatemia patients. However, serum creatinine (SCr) levels (SMD = -0.19, 95%CI =-2.76-2.39, P = 0.89) and serum albumin (Alb) level (SMD = -0.63, 95%CI = -1.54-0.27, P = 0.17) were all similar between hypophosphatemic group and normal phosphatemia group. Sensitivity analysis excluded the effect of heterogeneity on statistical results. The funnel graphics were basically symmetrical, which indicated that the included literatures were distributed well, and the publication bias was small. Conclusions Occurrence of hypophosphatemia in ICU patients is associated with severity of illness, prolonged duration of MV and length of ICU stay, and higher mortalities. Levels of serum phosphorus may have certain clinical values for assessing prognosis of ICU patients.
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Objective To understand the situations of departments of intensive care units (ICUs) of different level hospitals in Guizhou Province, and to provide directions and evidences for improving quality control in critical care medicine.Methods A county-level hospital and a provincial-level hospital's comprehensive ICU in Guizhou Province were selected to record and analyze and compare the structural indicators, patient admission and transfer, disease distribution, ventilator associated pneumonia (VAP), intravascular catheter related blood stream infection (CRBSI) and catheter-associated urinary tract infection (CAUTI) of the two hospitals' comprehensive ICU in 2017.Results The ICU of the People's Hospital of Suiyang County (county hospital) was found in 2012, and the ICU of the Affiliated Hospital of Guizhou Medical University (provincial hospital) was found in 1994. Until 2017, there were 10 and 46 beds, 6 (all of them hold bachelor's degree) and 18 physicians (6 of them hold PhD, 5 of them hold master's degree, 7 of them hold bachelor's degree), 17 (4 of them hold bachelor's degree, 13 of them hold college degree or graduated from secondary school) and 69 nurses (2 of them hold master's degree, 53 of them hold bachelor's degree, 14 of them hold college degree or graduated from secondary school) in the two ICUs respectively, there were significant differences in the education background of the physicians and nurses between the two ICUs (bothP < 0.01). During 2017, 471 cases were admitted to the ICU of the county hospital while 1633 cases were admitted to the ICU of the provincial hospital. Compared with the ICU of the provincial hospital, the ratio of the patients with acute physiology and chronic health evaluationⅡ(APACHE Ⅱ) ≥ 15 at admission was lower (74.8％ vs. 85.1％,P < 0.01), the ratio of direct admission was higher (30.8％ vs. 17.4％,P < 0.01), the ratio of the patients admitted to the ICU more than once was lower (0.8％ vs. 5.0％,P < 0.01), the ratio of the patients whose the length of ICU stay less than 24 hours was higher (51.6％ vs. 13.7％,P < 0.01), the ratio of the patients whose the length of ICU stay more than 28 days was lower (1.1％ vs. 2.9％, P < 0.05), the ratio of the patients discharged against-advice (25.5％ vs. 20.5％,P < 0.05) was higher, the ratio of the patients transferred to other hospitals was higher (5.1％ vs. 0.3％,P < 0.05), and the ICU mortality was lower (4.0％ vs. 13.9％,P < 0.01) in the ICU of the county hospital. The top three kinds of diseases treated in the ICU of the county hospital were brain injury (27.4％), trauma (19.1％) and toxication (6.8％); while in the ICU of the provincial hospital were brain injury (18.6％), sepsis (16.2％) and severe acute pancreatitis (4.8％). In addition, the incidences of VAP, CRBSI and CAUTI in the ICU of the county hospital were 10.0/1000 ventilator days, 1.4/1000 catheter days, 0.5/1000 catheter days; while in the ICU of the provincial hospital were 5.8/1000 ventilator days, 2.0/1000 catheter days, 3.7/1000 catheter days, respectively.Conclusions There are short of physicians and nurses in the ICU of the provincial and county hospitals in Guizhou Province, and the educational level of the medical staff in the ICU of the county hospital is relatively low. Moreover, there were significant differences in the admissions and treatments and the outcomes of the critically ill patients between the two ICUs. The characteristics of the ICUs of county hospitals should be fully considered when the quality control of critical care medicine and continuing medical education are done.
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Objective To compare the lung protection roles of intraperitoneal pre-injection with penehyclidine for two kinds of rat models with pulmonary and extrapulmonary acute respiratory distress syndrome (ARDSp and ARDSexp). Methods Forty healthy adult Sprague-Dawley (SD) rats were randomly divided into five groups (each n = 8): the rats in sham group received only tracheotomy; the ARDS rat models were reproduced by intratracheal inhalation of 0.1 mol/L hydrochloric acid (HCl) 2 mL/kg to simulate ARDSexp (HCl group) and 0.15 mL/kg oleic acid (OA) intravenous injection to simulate ARDSp (OA group) after tracheotomy; and the rats in two intervention groups were intraperitoneal injected with penehyclidine 0.5 mg/kg. All rats were received mechanical ventilation immediately after model reproduction. Carotid arterial blood was collected 4 hours after model reproduction for determining the arterial partial pressure of oxygen (PaO2), and oxygenation index (PaO2/FiO2) was calculated. Carotid venous blood and lung tissues were harvested, and the levels of myeloperoxidase (MPO), interleukin-8 (IL-8) and nuclear factor-κB (NF-κB) in serum and lung tissue were determined by enzyme linked immunosorbent assay (ELISA). Pulmonary pathology was observed under optical microscope, and pathological score of Smith was calculated. Results Under optical microscope, a large number of inflammatory cells infiltration in lung tissue, obvious alveolar collapse, fibrous exudation in alveolar and alveolar hyaline were found in HCl group. In OA group, however, microvascular congestion and interstitial pulmonary edema were the main pathological changes, with alveolar structure being kept relatively intact. Compared with sham group, pathological score of Smith in HCl and OA groups were increased, oxygenation was lowered, and inflammatory factors levels in serum and lung tissue were increased with levels in lung tissue being higher than those in serum, without significant difference between the two models. When pretreated with penehyclidine, however, pathological injury induced by HCl or OA was alleviated, and pathological score of Smith was also decreased as compared with that of corresponding model groups (5.48±1.76 vs. 9.69±2.02, 3.97±2.14 vs. 8.71±2.18, both P < 0.05), PaO2/FiO2was raised significantly [mmHg (1 mmHg = 0.133 kPa): 323±55 vs. 211±27, 307±56 vs. 207±31, both P < 0.05], the inflammatory factors levels in serum and lung tissue were obviously decreased [MPO (μg/L): 11.91±1.55 vs. 14.82±1.25, 12.75±1.16 vs. 16.97±2.06 in serum, 25.80±3.36 vs. 35.18±4.01, 24.23±1.24 vs. 33.94±1.43 in lung tissue; IL-8 (ng/L): 358±30 vs. 459±25, 377±38 vs. 427±34 in serum, 736±53 vs. 866±51, 701±53 vs. 809±39 in lung tissue; NF-κB (ng/L):483±68 vs. 632±73, 514±83 vs. 685±78 in serum, 984±75 vs. 1 217±123, 944±90 vs. 1 163±105 in lung tissue;all P < 0.05]. But all parameters above were similar between the two pretreatment groups (all P > 0.05). Conclusions Inflammatory cell infiltration and alveolar collapse mainly happened in HCl induced ARDSp, while pulmonary interstitial edema and hemorrhage was mostly seen in ARDSexp rats induced by OA intravenous injection. There was no significant difference in oxygenation and inflammatory response between the two models of rats. Pre-intraperitoneal injection of penehyclidine equally improved oxygenation state, inhibited lung inflammation response, and reduced lung injury in the two kinds of ARDS, but there was no difference in protective role between two models pretreated with penehyclidine.
ABSTRACT
The lung is a major target organ in acute paraquat (PQ) poisoning, but early PQ-induced severe liver failure is also an important life-threatening situation that can't be neglected. At present, toxin elimination through blood purification is a routine effective therapy recommended at the initial stage of PQ poisoning. However, the mode, therapeutic course and efficacy of blood purification for treatment of liver failure induced by PQ intoxication are still further to be explored. Theoretically, PQ is a substance with small molecule soluble in water, so hemofiltration (HF) is more suitable to be applied for treatment of PQ poisoning, but since PQ itself elimination rate (170 mL/min) from the kidney is far greater than the extracorporeal elimination rate of HF, it is suggested that HF be used only in cases with kidney functional injury caused by PQ poisoning. After PQ intoxication, a great amount of inflammatory mediators are produced; under this circumstance, if continuous veno-venous hemo-filtration (CVVH) is applied, its convection and dispersion features can remove the inflammatory mediators and toxin. Using hemoperfusion (HP) combined with CVVH not only can reduce the concentration of PQ but also can decrease plasma cytokine levels and ameliorate the organ damages. Thus, in cases with hepatic and renal functional damage, the application of combination of HP and CVVH is more effective for the treatment. Bilirubin adsorption can not only reduce bilirubin, but also can decrease PQ concentration, and it is also a means to treat PQ poisoning. In this article, the experience of using CVVH combined with HP, plasma separation and bilirubin adsorption for treatment of 1 case with liver failure induced by PQ poisoning was reported.