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Article in Chinese | WPRIM | ID: wpr-910602


Objective:To study the efficacy and safety of early abdominal puncture drainage (APD) in severe acute pancreatitis (SAP).Methods:A retrospective study was conducted on 189 patients with SAP who were managed at the Department of Intensive Medicine of the Second Affiliated Hospital of Anhui Medical University from January 2013 to May 2020. According to whether ultrasound-guided APD was performed within one week after admission to ICU, these patients were divided into 2 groups: patients treated with APD (the APD group) and patients treated without APD (the non-APD group). Clinical data, including the acute physiological and chronic health status (APACHE) Ⅱ score, modified Marshall score, sequential organ failure evaluation (SOFA) score, and prognostic indicators including the retroperitoneal percutaneous drainage (PCD) rate and length of hospital stay, were compared between the two groups before and 1 week after surgery.Results:Of the 189 SAP patients in this study, there were 110 males and 79 females, aged (52.5±17.4) years old. On admission to ICU, the blood amylase, C-reactive protein, procalcalonin, interleukin-6, APACHE II score, modified Marshall score and SOFA score in the APD group were significantly higher than those in the non-APD group. After 1 week of treatment, most clinical indicators in the 2 groups were significantly improved, and there were no significant differences between these indicators (all P>0.05). There were no significant differences in the abdominal infection, retroperitoneal PCD and mortality rates between the APD group and the non-APD group ( P>0.05). The length of hospital stay [29 (18, 45) vs 21 (15, 32) d] and ICU stay [5 (3, 11) vs. 7 (5, 17) d] in the APD group were significantly higher than those in the non-APD group ( P<0.05). Conclusion:For patients with SAP with peritoneal effusion, early APD effectively improved the condition and prognosis without increasing the peritoneal infection and mortality rates.

Article in Chinese | WPRIM | ID: wpr-863828


Objective:To analyze the clinical characteristics of patients with novel coronavirus pneumonia (COVID-19) and the factors influencing mild cases developing into severe cases, so as to provide a basis for clinical screening, prevention and treatment of potential severe cases.Methods:Retrospective analysis was performed on the clinical characteristics of 168 cases who were admitted to two tertiary general hospitals in Anhui province and diagnosed with COVID-19 from January 20 to March 4, 2020. According to the classification criteria in the COVID-19 diagnosis and treatment program (trial version 6) issued by the National Health Commission, the mild and common cases were classified as the mild group ( n=137), and the severe and critical cases were classified as the severe group ( n=31). The general data, epidemiological history, clinical manifestations, laboratory examination and imaging indexes of the two groups were compared. Univariate analysis was performed. Then multivariate Logistic regression analysis was conducted on the factors with statistically significant differences in univariate analysis to obtain independent influencing factors of the occurrence of severe COVID-19. Results:Among the 168 COVID-19 patients, 95 were male and 73 were female, with an average age of 42.6±15.8 years old. The mean age of the mild group was younger than that of the severe group (40.5±15.5 vs 51.6 ±14.1, P<0.01). The proportion of patients combined with hypertension (29.0% vs 10.9%), diabetes (25.8% vs 2.2%, P=0.005) and two or more underlying diseases (29.0% vs 4.4%, P=0.006) in the severe group were significantly higher than those in the mild group. In the severe group, the proportion of patients receiving initial treatment in Medical institutions below secondary hospitals was significantly higher than that in the mild group ( P<0.01), and the time between symptom onset and diagnosis was longer [(8.00±3.27) d vs (6.49±3.90) d, P=0.048]. There was no significant difference in the initial symptoms between the mild group and the severe group. However, the body temperature was higher in the severe group [(38.80±0.67)℃ vs (37.9±0.60)℃, P<0.01]. At the time of admission, the lymphocyte percentage of the severe group was significantly lower than that of the mild group [(18.20±9.13)% vs (24.43±10.43)%, P<0.01], while C-reactive protein, interleukin-6 (IL-6), D-dimer, LDH, aspartate and aminotransferase were significantly higher than that of the mild group ( P<0.01). CT imaging showed that 11 (8%) patients in the mild group had lesions confined to a single lobe of the lung, while all patients in the severe group had multi-lobe lesions ( P<0.01). All the 168 COVID-19 patients in this study were cured, and the length of hospital stay in the severe group was significantly longer than that in the mild group [(24.71±7.72) d vs (20.28±7.67) d, P=0.021]. According to multivariate binary Logistic regression analysis, age ( P=0.042), diabetes ( P=0.021), body temperature at admission ( P=0.001), and IL-6 measured at admission ( P=0.008) were independent factors affecting COVID-19 to severe progress. Conclusions:Strengthening the professional knowledge training of primary hospitals is helpful for early diagnosis of COVID-19. Patients with older age, combined with diabetes, high initial fever and significantly increased IL-6 level are more possibly to develop into severe disease. Early identification and prevention should be carried out.

Acta Universitatis Medicinalis Anhui ; (6): 480-483,490, 2018.
Article in Chinese | WPRIM | ID: wpr-691435


Objective To study the effects of tigecycline on immune function in patients with complicated intra-abdominal infections (cIAI). Methods A total of 24 cIAI patients received treatment of tigecycline, and then the effects of tigecycline on level of peripheral blood monouclear cells (PBMC) proliferation, concentration of inflammatory cytokines, and expression of CD3, CD4 and CD8 were investigated. Results The total effective rates of tigecycline were 70. 8%. Tigecycline treatment significantly reduced proliferative level of PBMC, decreased the levels of interleukin-1β (IL-1β), IL-6 and IL-8 in supernatants of PBMC cultures as well as serum. Moreover, tigecycline therapy significantly up-regulated the percentage of CD3 + and CD4 +, increased the ratio of CD4+ / CD8 +, and down-regulated percentage of CD8 + in peripheral blood. Conclusion Tigecycline could regulate immune function in cIAI patients.

Article in Chinese | WPRIM | ID: wpr-511050


OBJECTIVE To investigate the immunogenicities of Poria cocos polysaccharides, PCP-Ⅰand PCP-Ⅱ, as a vaccine adjuvant. METHODS ①Keyhole limpet hemocyanin (KLH) was linked to PCP-Ⅰor PCP-Ⅱrespectively to prepare immuno-antigen KLH-PCP-Ⅰor KLH-PCP-Ⅱ. Bovine serum albumin (BSA) was also linked to PCP-Ⅰor PCP-Ⅱrespectively to prepare screening-antigen. Rabbits were immunized with KLH-PCP-Ⅰor KLH-PCP-Ⅱplus Freund adjuvant by intradermal injection twice, and serum specific antibody titers were determined by ELISA. ②BALB/c mice were immunized with PCP-Ⅰ or PCP-Ⅱ alone intramuscularly twice, and serum polysaccharide antibody titers were determined by ELISA.③BALB/c mice were co-immunized intramuscularly or subcutaneously with PCP-Ⅰor PCP-Ⅱplus hepatitis B surface antigen (HBsAg) or porcine reproductive and respiratory syndrome virus inactivated vaccine (PRRSV) twice, and serum polysaccharide-antibody titers were determined by ELISA. RESULTS ①Serum anti-KLH and anti-polysaccharides (PCP-Ⅰor PCP-Ⅱ) antibodies were pro?duced after rabbits were immunized with KLH-PCP-Ⅰor KLH-PCP-Ⅱplus Freund adjuvant twice.②Serum anti-PCP-Ⅰor anti-PCP-Ⅱantibodies were not found after mice were immunized with PCP-Ⅰand PCP-Ⅱalone twice.③After mice were immunized with HBsAg or PRRSV plus PCP-Ⅰor PCP-Ⅱtwice, serum anti-PCP-Ⅰor anti-PCP-Ⅱantibodies were not found. CONCLUSION PCP-Ⅰand PCP-Ⅱshow weak immunogenicity, which may be quite safe as a vaccine adjuvant.

Article in Chinese | WPRIM | ID: wpr-666709


Objective To compare the accuracy of ultrasound,pulse indicator continuous cardiac output monitoring (PiCCO) and traditional methods in predicting fluid responsiveness in septic patients.Methods Forty-six septic patients of both sexes,aged 18-72 yr,requiring mechanical ventilation treatment in the intensive care unit,were enrolled in the study.Venous blood samples were collected for determination of plasma B-type natriuretic peptide (BNP) concentrations by chemiluminescence assay,and central venous pressure (CVP) was recorded.Stroke volume variation (SVVTTE),distensibility index of inferior vena cava (dIVC) and velocity time integral changes of aortic blood flow (△VTI) were measured by ultrasound method.SVVPiCCO and global end-diastolic volume index (GEDVI) were measured by PiCCO method.The patients were divided into negative fluid responsiveness group and positive fluid responsiveness group according to the fluid responsiveness after volume expansion.The receiver operating characteristic curves of the parameters mentioned above in predicting fluid responsiveness were drawn.A consistency check for dIVC,△VTI and SVVPiCCO thresholds was conducted by using Kappa statistics.The agreement between SVVTTEand SVVPiCCO was analyzed by the Bland-Altman analysis.Results There were 24 patients in positive fluid responsiveness group and 22 patients in negative fluid responsiveness group.Compared with negative fluid responsiveness group,the plasma BNP concentration,CVP and GEDVI were significantly decreased,and SVVPiCCO,SVVTTE,dIVC and △VTI were increased before volume expansion in positive fluid responsiveness group (P<0.05).The area under the curve (95% confidence interval),sensitivity and specificity of the plasma BNP concentration were 0.894 (0.807-0.981),81.8% and 79.2%,respectively,of CVP 0.859 (0.752-0.965),81.8% and 79.2%,respectively,of GEDVI 0.772 (0.628-0.915),72.7% and 75.0%,respectively,of SVVPiCCO 0.965 (0.922-1.008),95.8% and 81.8%,respectively,of SVVTTE 0.940 (0.874--1.006),91.7% and 86.4%,respectively,of dIVC 0.964 (0.920-1.008),83.3% and 95.5%,respectively,and of △VTI 0.958 (0.909-1.008),87.5% and 90.9%,respectively.The Kappa value for dIVC threshold and SVVPiCCO threshold was 0.826,and for △VTI threshold and SVVPiCCO threshold was 0.743 (P<0.01).The mean deviation of SVVTTE and SVVPiCCO was 0.209,95% confidence interval (-2.967-3.385)%,and the limit of agreement (-2.46-2.62)% (P< 0.05).Conclusion Ultrasound and PiCCO methods can accurately predict fluid responsiveness,have a good agreement and are superior to the traditional method in septic patients.

Article in Chinese | WPRIM | ID: wpr-664295


Objective To explore the value of predicting fluid responsiveness using velocity time index variation (△VTI) and stroke volume variation (△SV) before and after passive leg raising (PLR)monitored by bedside temporary test equipment (TTE).Methods A cohort of 42 patients supported with mechanical ventilation in our hospital admitted from October 2014 to October 2015 were prospectively selected.The hemodynamic variables including heart rate (HR),mean arterial pressure (MAP),central venous pressure (CVP),VTI,SV and other parameters were monitored before and after after undergoing PLR.Fluid resuscitation volume expansion test was carried out after stroke volume index (SVI) monitored by pulse indicator continuous cardiac output monitoring (PICCO).Patients were divided into fluid responsiveness positive group and fluid responsiveness negative group according to presence or absence of SVI ≥ 15% after fluid resuscitation volume expansion.Results Of 42 patients,22 belonged to fluid responsiveness positive group,20 got into fluid responsiveness negative group.There were no significant differences in basic clinical data between two groups.Before and after PLR,there were no distinct changes in HR and CVP (P > 0.05),while MAP,VTI and SV increased significantly (P < 0.05) after PLR in fluid responsiveness positive group.Contrarily,there were no noticeable changes in MAP and SV after PLR (P > 0.05),but HR,CVP and VTI increased significantly (P < 0.05) in fluid responsiveness negative group.The degrees of △VTI and △SV in fluid responsiveness positive group were much higher than those in fluid responsiveness negative group (P <0.05).According to SVI ≥ 15% monitored by PICCO after fluid resuscitation volume expansion test as a standard,the area under the ROC (AUC) of △VTI between prePLR and post-PLR was 0.75 (95% CI:O.593-0.907,P < 0.01),the sensitivity and specificity were 63.6% and 95% respectively using △VTI 15.6% as threshold value.The AUC of △SV was 0.844 (95%CI:O.716-0.972,P <0.01),the sensitivity and specificity were 81.8% and 85.0% respectively using △SV 10.5% as threshold value.Conclusion △VTI and △SV monitored by TTE before and after PLR could be employed for predicting fluid responsiveness of critical patients under the status of spontaneous respiration.Their value for prediction of critical patients could be further improved by combined employment of these two indexes of variation.