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Objective To demonstrate the effect of tumor necrosis factor-α induced protein 8 like-2 (TIPE2) expression in patients with acute respiratory distress syndrome (ARDS) and its mechanism. Methods A prospective observation was conducted. Thirty-nine patients with ARDS admitted to department of emergency of PLA General Hospital from July 2013 to July 2015 were enrolled, and 35 healthy persons served as control group. The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score within 24 hours after admission, blood gas analysis, procalcitonin (PCT), and C-reactive protein (CRP) were recorded. The mRNA expressions of TIPE2 in peripheral blood mononuclear cell (PBMC) and myxoma resistance protein 1 (MX1) in plasma were determined by real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR). The correlations were analyzed by Spearman rank correlation analysis. Results The mean of APACHE Ⅱ score in 39 patients with ARDS was 25±3, the mean of PCT was (1.85±0.41) μg/L, and the mean of CRP was (18.0±3.0) mg/L. The TIPE2 mRNA expression in PBMC of ARDS patients was significantly down-regulated as compared with that of healthy control group (2-ΔΔCt: 3.28±0.15 vs. 8.87±0.20, P 0.05). The MX1 mRNA expression was positively correlated with APACHE Ⅱ score (r = 0.893, P 0.05). Conclusion TIPE2 expression was decreased in ARDS patients, which negatively correlate with disease severity, and indicate TIPE2 might be involved in the pathogenic process of ARDS.
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Objective:To discuss what impact prone position ventilation (PPV) plays in treatment of acute respiratory distress syndrom (ARDS)originating from pulmonary disease(ARDSp) and extra-pulmonary disease(ARDSexp).Methods: Retrospective case-control cohorts study. Sixty patients with ARDS were included, were classified two groups which were originated from pulmonary disease(n=30) and extra-pulmonary disease(n=30), they were ventilated in PPV. And oxygenation of 0,2,4, and 6 hours in PPV, static compliance(Cst), airway resistance(Raw) of were evaluated. The Ultrasonic Cardiac Output Monitor was applied to monitor the cardiac function.Results:At 2 hours after ventilation in ARDSexp group, PaO2/FiO2 have been improved significantly. The longer duration of PPV seemed to be associated with continuous improvement and peaks at 4 hours. In ARDSexp group PaO2/FiO2 after ventilation at 3 hours exceeds the other groups. At 4 hours after ventilation, PaO2/FiO2 of both ARDSp and ARDSexp groups of PPV have been improved than that of supine position. After ventilation for 4 hours, the RAW of ARDSp decreases dramatically and considerably below the other groups.Conclusion: PPV was a safe and effective maneuver for improving oxygenation in patients with ARDSp and ARDSexp. Both ARDSp and ARDSexp clearly appear to benefit from PPV, particularly in ARDSexp group. PPV aslo influenced haemodynamics in patients rarely.
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Objective To predict the risk of 28-day mortality in septic patients in intensive care unit (ICU) with the combination of Weighted index of comorbidities (WIC) and sepsis-related organ failure assessment (SOFA) score.Methods The clinical data of adult severe sepsis/septic shock patients in Department of Emergency Medicine of Changzheng Hospital and Department of Critical Care Medicine of Jinan Military General Hospital from October 2011 to February 2013 were analyzed retrospectively.The etiological factor,past history,having severe sepsis or not were recorded.Age score,WIC score,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and SOFA score were calculated at or 24 hours after admission.The logistic regression was used and the receiver operating characteristic curve (ROC curve) was drawn to calculate the patients' outcome.Results In 310 enrolled patients,223 (71.9％) patients survived and 87 (28.1％) died.Univariate analysis showed that the P values of the age score,WIC score,APACHE Ⅱ score and SOFA score,chronic cardiac insufficiency,type 2 diabetes,cerebrovascular disease,tumor,multiple injury,pulmonary infection and having severe sepsis or not were all less than 0.2.The above 11 variables were put into the multivariate logistic regression equation 1,of which predicted probability was reserved.It revealed that 5 variables were independently associated with 28-day prognosis,of which influence power in descending order were SOFA score [odds ratio (OR) =1.308,95％ confidence interval (95％ CI):1.158-1.478,P=0.000],having severe sepsis or not (OR =0.206,95％ CI:0.100-0.424,P=0.000),APACHE Ⅱ score (OR =1.090,95％CI:1.021-1.164,P=0.010),WICscore (OR=1.441,95％CI:1.067-1.947,P=0.017),agescore (OR=1.228,95％CI:1.027-1.468,P=0).024),the Walswere 18.554,18.369,6.725,5.662,5.067,respectively.The 3 variables,age score,WIC score and SOFA score,were brought into the multivariate logistic regression equation 2,of which predicted probability was reserved too.It revealed that age score (OR=1.330,95％CI:1.145-1.546,P=0.000),WIC score (OR =1.496,95％ CI:1.145-1.546,P=0.000) and SOFA score (OR =1.429,95％ CI:1.303-1.567,P=0.000),were independently associated with the septic patients' 28-day prognosis.There was no significant difference in the area under receiver operating characteristic curve (AUC) between the SOFA score and APACHE Ⅱ score (0.784 vs.0.780,Z=0.014,P=0.989).However,compared with APACHE Ⅱ score,the AUC of equation 1 (0.888) and 2 (0.851) were much more (Z=4.333,P=0.000; Z=2.669,P=0.008).Conclusion The sensitivity of 28-day prognosis by WIC score was improved greatly with the combination of SOFA score and age score.
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Objective To investigate the effects of hemodynamic,prognostic effect and myocardial protection of Salvia injection on patients with acute organophosphorus pesticide poisoning. Methods 68 cases of patients with acute organophosphate were divided into observation group(n=34)and control group(n=34) from January 2012 to December 2013.The control group were given with atropine detoxification (dose:5-10mg), Tiopronin (0.2 g/d, 1 times/d) liver treatment, Pioneer will(2 g/second,1/d).The observed group received the foundation treatment and Salvia injection(30ml, 1/d), 7d course of treatment. The myocardial enzymes and hemodynamic parameters of two groups were observed before and after treatment. Results The survival rate and died rate of observation group were 94.12%(32 cases ), 5.88%(2 cases ). The survival rate and died rate of control group were 79.41%(27cases )and 20.59%(7cases). The survival rate and died rate of two groups were significant difference (χ2=5.123, P<0.05). The myocardial enzymes (AST, CK, CK-MB, LDH, HBDH) of observation groupafter 2d each index[were(58.6±22.7)U/L, (412.6±156.9)U/L, (78.6± 35.2)U/L, (489.3 ± 112.3)U/L, (412.8 ± 259.6)U/L] and blood rheology (ESR, FIB, LBV, HBV)each index[were(14.36±4.19) mm/h before , (259.3±23.14)g/L, (7.17±1.12)mPa?s, (4.12±0.81)mPa?s]were lower than in the same group therapy [myocardial enzymes indexes were (131.3±32.5)U/L, (1324.5± 345.2)U/L, (187.5 ± 72.2)U/L, (914.5 ± 312.2)U/L, (812.3 ± 312.2)U/L; hemorheology indexes were (23.29±3.49)mm/h, (389.57±34.24) g/L, (10.4±1.3)mPa?s, (6.3±1.2)mPa?s]. 5 d after treatment control group myocardial enzymes(AST, CK, CK-MB, LDH, HBDH)each index[were(85.3±22.8)U/L, (486.3± 78.9)U/L, (67.8±11.2)U/L, (542.3±78.6)U/L, (225.9±112.4)U/L]and hemorheology indexes[were(17.7± 4.6)mm/h, (289.4±32.5)g/L, (8.9±1.2)mPa?s, (5.6±1.3)mPa?s] was significantly lower than in the same group before treatment[myocardial enzymes indexes were(128.3±29.3)U/L, (1298.6±329.4)U/L, (182.6± 70.6)U/L, (902.3±286.3)U/L, (803.6±293.6)U/L;hemorheology indexes were (23.9±3.5)mm/h, (382.6± 32.5)g/L, (10.3±1.1)mPa?s, (6.2±1.1)mPa?s, P<0.05]. Conclusion Salvia injection can effectively improve the hemodynamic indicators of acute organophosphorus pesticide poisoning patients , reduce myocardial damage, promote patient prognosis.
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<p><b>BACKGROUND</b>Comorbidity is one of the most important determinants of short-term and long-term outcomes in septic patients. Charlson's weighted index of comorbidities (WIC) and the chronic health score (CHS), which is a component of the acute physiology and chronic health evaluation (APACHE) II, are two frequently-used measures of comorbidity. In this study, we assess the performance of WIC and CHS in predicting the hospital mortality of intensive care unit (ICU) patients with sepsis.</p><p><b>METHODS</b>A total of 338 adult patients with sepsis were admitted to a multisystem ICU between October 2010 and August 2012. Clinical data were collected, including age, gender, underlying diseases, key predisposing causes, severity-of-sepsis, and hospital mortality. The APACHE II, CHS, acute physiology score (APS), sequential organ failure assessment (SOFA) and WIC scores were assessed within the first 24 hours of admission. Univariate and multiple Logistic regression analyses were used to compare the performance of WIC and CHS. The area under the receiver operating characteristic curve (AUC) was used to predict hospital mortality over classes of risk.</p><p><b>RESULTS</b>Of all the enrolled patients, 224 patients survived and 114 patients died. The surviving patients had significantly lower WIC, CHS, APACHE II, and SOFA scores than the non-surviving patients (P < 0.05). Combining WIC or CHS with other administrative data showed that the hospital mortality was significantly associated with age, severe sepsis, key predisposing causes such as pneumonia, a history of underlying diseases such as hypertension and congestive cardiac failure, and WIC, CHS and APS scores (P < 0.05). The AUC for the hospital mortality were 0.564 (95% confidence interval (CI) 0.496-0.631) of CHS, 0.663 (95% CI 0.599-0.727) of WIC, 0.770 (95% CI 0.718-0.822) of APACHE II, 0.856 (95% CI 0.815-0.897) of the CHS combined with other administrative data, and 0.857 (95% CI 0.817-0.897) of the WIC combined with other administrative data. The diagnostic value of WIC was better than that of CHS (P = 0.0015).</p><p><b>CONCLUSIONS</b>The WIC and CHS scores might be independent determinants for hospital mortality among ICU patients with sepsis. WIC might be an even better predictor of the mortality of septic patients with comorbidities than CHS.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , APACHE , Comorbidity , Organ Dysfunction Scores , Sepsis , Mortality , Pathology , Severity of Illness IndexABSTRACT
Objective To estimate the validity of Charlson' s weighted index of comorbidities (WIC) used to predicting 28-day mortality among ICU pneumonia patients with underlying diseases.Methods Aretrospective analysis of 160 adult patients with pneumonia admitted to a multi-discipline ICU of Shanghai Changzheng hospital between October 2010 and February 2012 was carried out.Clinical data were collected including age,gender,community acquired pneumonia (CAP) or hospital acquired pneumonia (HAP),underlying diseases,severity-of-sepsis,and 28-day mortality.WIC scores,acute physiology and chronic health evaluation (APACHE) Ⅱ,and sepsis related organ failure assessment (SOFA) were assessed within the first 24 hours after admission.Logistic regression analyses were used to evaluate the predictors for outcome.The receiver operating characteristic curve (ROC) was used to compare the performance of these scores between different methods.Results Of 160 enrolled patients,76 (48.8％) were CAP,82 (51.2％) HAP,and 106 (66.3％) male,54 (33.7％) female,and 99 (61.9％) patients survived and 61 (38.1％) died.The average age was (62.4 ± 17.3) years old.Compared with survivors,WIC,APACHE Ⅱ and SOFA scores were significantly higher in death group (P ＜ 0.05).The multivariate logistic regression revealed that risk of death depends predominantly on age (OR =1.049,95％ CI:1.011-1.088,P =0.011),WIC (OR =1.725,95％ CI:1.194-2.492,P =0.004),APACHE Ⅱ score (OR =1.175,95％CI:1.058-1.305,P =0.003),SOFA score (OR =1.277,95％ CI:1.048-1.556,P =0.015),presence of ARDS (OR =0.081,95％ CI:0.008-0.829,P =0.034),and complicated with severe sepsis (OR =0.149,95％ CI:0.232-0.622,P =0.004).The area under the receiver operating characteristics curve in predicting mortality was 0.639 (0.547-0.730) for the WIC,0.782 (0.709-0.856) for APACHE Ⅱ score,0.79 (0.714-0.866) for SOFA score and 0.842 (0.777-0.907) for the merger of three.Conclusions In pneumonia patients of ICU,WIC is a useful approach to predicting 28-day mortality,and the risk of death significantly depends on co-morbidities.
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We routinely used the high-power photon therapeutic device to treat drug eruption of epidermolysis bullosa in 1 case and there achieved good results.Through analysis,we believe that the device can be used to treat different types of complicated skin diseases.
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Objective: To investigate the postoperative change of concentration of CD_(41) in peripheral platelet following intra-operative polygeline administration. Method: Sixty-eight patients were randomly divided into studied and control groups. The patients in studied group were infused with 1 000ml polygeline whereas 1 000ml ringer's solution in control group. The concentration of CD_(41) in peripheral platelet was measured with immunocytometry before surgery, one hour, one day, two and five days after surgery. Result: There was no statistical difference in CD_(41) level between the two groups before surgery, CD_(41)values one hour and one day after surgery were obviously decreased in studied group compared with these in control group (P