Common problems and considerations in challenge tests of different animal models of SARS-CoV-2 vaccine / 中国生物制品学杂志

@#Animal challenge test is an effective means to study the efficacy of severe acute respiratory symptom coronavirus 2(SARS-CoV-2)vaccine. The appropriate animal models and reasonable experimental design play an important role in obtaining efficacy and safety information,as well as supporting clinical trials. At present,common non-clinical animal models include transgenic mice,non-human primates,hamsters,ferrets and so on. This paper reviews the common animal models used in non-clinical trials and the problems encountered in their application.

Re-evaluation of the diagnostic value and optimal cutoff point of captopril challenge test in diagnosis of primary aldosteronism / 中华内科杂志

Objective:The aim of the present study was to re-evaluate the diagnostic value and optimal cutoff point of captopril challenge test (CCT) in diagnosis of primary aldosteronism (PA).Methods:This is a retrospective study. All patients with a high risk for PA underwent screening test, and then proceeded to CCT and fludrocortisone suppression test (FST) on different days. The FST was used as a reference standard for PA. The plasma renin concentration (PRC) and plasma aldosterone concentration (PAC) were measured with an automated chemiluminescence immunoassay. Random number method was performed in the patients with unilateral primary aldosteronism (UPA), in order to make the proportion of the analyzed UPA in PA was 35%. Receiver operating characteristic (ROC) analyses were performed to compare diagnostic accuracy.Results:A total of 543 patients with 400 PA patients and 143 essential hypertension (EH) patients were enrolled. The diagnostic value of post-CCT PAC was significantly higher than that of the post-CCT plasma aldosterone-renin ratio (ARR), and that of the PAC suppression percentage, respectively. The area under the ROC curve (AUC ROC) was 0.86 (0.83, 0.89) for PAC, 0.78 (0.74, 0.82) for ARR, and 0.62 (0.56, 0.67) for the PAC suppression percentage (all P<0.01), respectively. The optimal cutoff point of post-CCT PAC for PA was 110 ng/L, in which the sensitivity and specificity were 73.25% and 79.02%, respectively. The diagnostic efficiency of post-CCT PAC was not improved either in combination with PAC suppression percentage or in combination with post-CCT ARR. Conclusions:CCT is a useful test for the confirmation of PA. PAC level of 110 ng/L at 2 h after 50 mg of captopril is recommended as an optimal cutoff point for the diagnosis of PA.

The immune mechanism and potential biomarkers of non-IgE-mediated food allergy / 中华实用儿科临床杂志

The immune mechanism of non-IgE-mediated food allergy is quite complex.Due to the lack of specific laboratory indicators and limited diagnosis and treatment methods, non-IgE-mediated food allergy is usually misdiagnosed.Therefore, it is urgent to clarify the pathogenesis of the disease and search for specific biomarkers and novel therapeutic targets.This review aims to summarize current research results on the immune mechanism of non-IgE-mediated food allergy from two aspects, including the specific immunity and innate immunity, and to explore the potential diagnostic markers.The results may provide novel ideas for effective therapeutic strategies of non-IgE-mediated food allergy.

Retrospective analysis of 120 cases with allergic reactions during oral food challenge test / 中华实用儿科临床杂志

Objective:To discuss the safety of oral food challenge test(OFC).Methods:Clinical data of 120 cases with allergic reactions during OFC in Department of Pediatrics, Peking University Third Hospital from October 2015 to October 2019 were retrospectively analyzed.The relationship between sex, type of allergic foods, type of allergic reactions, involved organ system, serum specific IgE and severe allergic reaction were analyzed.Results:Allergic reactions occurred in 120 cases.There were 95 males and 25 females.The age ranged from 2 months to 10 years.All involved allergens included milk protein(47.5%, 57/120 cases), egg white(22.5%, 27/120 cases), wheat(19.2%, 23/120 cases), peanut(6.7%, 8/120 cases), nut(1.7%, 2/120 cases), and others(2.5%, 3/120 cases). The type of allergic reaction: 107 cases (90.8%) of hypersensitivity reaction occurred, with 24 cases (21.7%) of severe hypersensitivity reaction, and 13 cases (9.2%) of delayed hypersensitivity reaction.The involved systems include skin and mucous membrane, respiratory system, cardiovascular system, digestive system and nervous system.The correlation coefficient between serum specific IgE and severe allergic reaction was 0.315.Conclusions:Children with indications of OFC in the admission hospital have a high risk of OFC allergic reaction.Nearly 90% of them are immediate hypersensiti-vities, even anaphylaxis.Anaphylaxis that is caused by OFC and may lead to life risk or even death should be avoided.

Problems and challenges of oral food challenge test / 中华实用儿科临床杂志

Oral food challenge test (OFC) is necessary for the diagnosis of food allergies, however, this clinical diagnosis method has not been popularized yet in China.Although OFC is very important, the knowledge of it is very insufficient and even biased, which is the root cause of non-standard diagnosis of food allergy and over-dependence on allergen testing.Therefore, the necessity, safety, experiment design and results interpretation of OFC would be elucidated in this paper in order to improve the understanding of OFC.

Allergy Testing – An Overview

Childhood allergies pose huge economic burden and adverse effects on quality of life. Serum IgE has been considered a surrogate allergymarker for decades. Availability of several over-the-counter allergy tests add to confusion of partially trained caregivers. The presentreview focuses on current status of allergy testing in Indian scenario. Various in-vitro and in-vivo diagnostic modalities are available forallergy detection. Skin prick tests are useful for aero-allergies whereas oral challenge tests are best for identifying suspected foodallergies. An allergy test should be individualized based on clinical features, diagnostic efficacy, and cost-benefit analysis.

Fetomaternal Outcome in Gestational Diabetes Mellitus at a Tertiary Care Hospital

Introduction: Gestational diabetes mellitus (GDM) is a common medical problem that results from an increased severityof insulin resistance as well as impairment of the compensatory increase in insulin secretion. GDM has profound effects onfetomaternal outcome.Aims and Objectives: This study aims to evaluate the impact of GDM on pregnancy and fetal outcome.Materials and Methods: The present study was a prospective observational study. The screening was done by glucosechallenge test and 3 h, 100 g glucose tolerance test. The study population was divided into two groups, cases and controls. Allthe patients were followed up for maternal complications, fetal complications, mode of delivery, and neonatal complications.Results: A total of 350 randomly selected pregnant females who met the inclusion criteria were subjected to oral glucosechallenge test. Of 350 women, 22 women were found to have GDM and were compared with non-GDM patients. GDM patientshad significantly higher percentage of pregnancy-induced hypertension (13.6% vs. 2.6%, P = 0.031), polyhydramnios (22.7%vs. 4.3%, P = 0.004), urinary tract infection (40.9% vs. 14.5%, P = 0.003), and excess weight gain (36.4% vs. 6.3%, P = 0.001).GDM patients had higher cesarean deliveries in 13 (59.1%) and assisted vaginal deliveries in 2 (9.1%) as compared to non-GDM(110 [36.3%] and 6 [2%], P = 0.006, respectively). Among the fetal outcome, GDM patients had higher macrosomia (31.8%vs. 8.3% in non-GDM group [P = 0.003]), neonatal convulsions (18.2% vs. 2.3% in non-GDM group [P = 0.003]), respiratorydistress (22.7% vs. 3.3% [P = 0.002]), and neonatal intensive care unit admission (72.7% vs. 12.9% [P = 0.001]).Conclusion: GDM is associated with both maternal and fetal complications, most notably macrosomia leading to increasedcesarean section rate and instrumental deliveries.

Screening for gestational diabetes mellitus by two step method and the pregnancy outcome: a study in Indian women

Background: In recent times, gestational diabetes is becoming more common Worldwide and complications are seen in fetal development, growth, labour and delivery due to maternal hyperglycemia. Gestational Diabetes Mellitus(GDM) is associated with adverse maternal and fetal outcomes. Among South Asian Population, Indian Women are at high risk of developing carbohydrate intolerance during pregnancy. Hence this study is undertaken to screen for gestational diabetes mellitus by two step method in Indian Women.Methods: This study was done in 153 nondiabetic pregnant women of gestational age 24-28 weeks, excluding diabetes mellitus diagnosed prior to pregnancy. Two step method was followed in the present study and GDM was diagnosed and the pregnancy outcomes were noted.Results: In our study the prevalence of GDM is 8.1% by two step method. Most of the women diagnosed with GDM were of age 26-30 yrs (41.66%). Among the women who were diagnosed as GDM, (58.33%) cases required Insulin along with diet control. In our study 33.33% had vaginal delivery, 8.33% had Emergency LSCS and 58.33% had Elective LSCS.Conclusion: Indian Women have high prevalence of GDM, hence universal screening is essential to diagnose GDM, which will improve the pregnancy outcome.

A comparative and correlative study of serum homocysteine level in gestational diabetes mellitus and normal pregnancy

Background: An alarming increase in Gestational diabetes mellitus (GDM) cases worldwide elevates concern regarding the consequences including fetal macrosomia, preeclampsia and many more. Plasma homocysteine levels which has direct impact on to endothelial function of blood vessels. The relationship of homocysteine and GDM is yet to be clarified.Methods: This single centre prospective observational study was conducted in Department of Obstetrics and Gynaecology of Thanjavur medical college hospital among 50 pregnant primi and multi gravida patients with normal pregnancy and gestational diabetes mellitus to assess the association and comparison of serum homocysteine levels in both groups.Results: The mean value of homocysteine in control group was 3.8 ± 0.95 and in gestational diabetes patients was 16.30±6.09. On comparison, found that there was hyperhomocysteinemia among GDM patients with normal pregnancy and results were statistically significant (T= -9.024 Df=48.000 <0.05).Conclusions: In this comparative and correlative study, we found that patients with gestational diabetes mellitus have higher serum homocysteine levels in comparison with normal pregnant women. Hyperhomocysteinemia is found to be an independent risk factor for gestational diabetes mellitus patients. Further investigations are needed to follow up for these patients in the postpartum period and later in their life.

First trimester uric acid level: a reliable marker for gestational diabetes mellitus

Background: The prevalence of diabetes mellitus (DM) is increasing worldwide and more in developing countries like India. The diabetic epidemic experienced in India can be due to strong genetic factors coupled with increasing urbanization, sedentary lifestyle, changes in the dietary patterns and increasing obesity. Indians are at an 11-fold increased risk of developing gestational glucose intolerance and hence universal screening is essential. Uric acid is a known marker of oxidative stress. Hyperuricemia in early pregnancy may be an indicator of the existing metabolic disturbance which can hinder the maternal physiological adaptations generally seen in pregnancy thus making the pregnant women more vulnerable to the development of gestational diabetes mellitus. The objective of this study was to investigate the association between elevated uric acid levels in the first trimester of pregnancy with gestational diabetes.Methods: This prospective observational study was conducted in Chinmaya mission hospital, Bangalore from June 2016 to March 2017 (10 months). Three hundred and twelve (312) pregnant women of gestational age less than 12 weeks who attended the OBG outpatient department within this time of period for regular antenatal check-up were enrolled in the study. Along with the other antenatal investigations serum uric acid levels were estimated before 12 weeks and also between 24-28 weeks. At 24-28 weeks screening for GDM was done by OGCT using 75 gms of glucose (IADPISG criteria). Other parameters like age, parity, BMI, family history of diabetes was noted and compared.Results: In our study, among the 312 pregnant women, 88 (28%) developed GDM. Of these 74 Women (84%) with GDM had uric acid levels above 3.5 mg/dl and 14 women (15.9%) with GDM had uric acid levels below 3.5 mg/dl. Women with higher BMI showed high uric acid levels.Conclusions: Elevated serum uric acid in the first trimester has a significant correlation with development of GDM. In present study; the cut-off level of maternal serum uric acid of 3.5 mg/dl in the first trimester appears to have a good sensitivity and specificity in identifying those patients who are most likely to develop GDM later in pregnancy.

Screening for Gestational Diabetes Mellitus by Measuring Glycated Hemoglobin Can Reduce the Use of the Glucose Challenge Test

BACKGROUND: Physiological changes during pregnancy, such as dilutional anemia and a reduced half-life of red blood cells, have prevented the use of glycated Hb (HbA1c) as a biomarker for gestational diabetes mellitus (GDM). Nevertheless, increasing evidence supports the use of HbA1c in GDM diagnostic strategies.We studied HbA1c as a biomarker of GDM and its possible use as a screening test to avoid the use of the glucose challenge test (GCT). METHODS: This case-control study involved 607 pregnant women between the 24th and 28th week of gestation. HbA1c level was determined, and GDM was diagnosed according to the National Diabetes Data Group criteria. The area under the ROC curve (AUC) was determined; two low and two high cut-off points were established to rule out GDM and classify high-risk pregnant women, respectively. For each cut-off, sensitivity (S), specificity (SP), and total number and percentage of GCTs avoided were determined. RESULTS: The AUC for HbA1c diagnostic performance was 0.68 (95% confidence interval 0.57–0.79). Using 4.6% HbA1c (27 mmol/mol) as the lower cut-off (S=100%), 14% of participants could avoid the GCT. Using 5.5% HbA1c (36 mmol/mol) as the upper cut-off (SP =94.5%), 6% of participants would be considered at high risk. CONCLUSIONS: HbA1c can be used as a screening test prior to the GCT, thereby reducing the need for the GCT among pregnant women at a low risk of GDM.

Value of percutaneous oxygen partial pressure monitoring in evaluating the prognosis of patients with acute heart failure / 中华危重病急救医学

Objective To explore the value of percutaneous oxygen partial pressure monitoring in prognosis evaluation of patients with acute heart failure (AHF). Methods A total of 91 patients with AHF due to various reasons admitted to the emergency department of the First Affiliated Hospital of China Medical University from July 2017 to June 2018 were enrolled. Dynamic monitoring data of arterial blood gas, percutaneous oxygen partial pressure monitoring and noninvasive cardiac output monitoring (NICOM) of all of the patients at the time of diagnosis (before treatment) and 6 hours after treatment were recorded, including arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), blood lactic acid (Lac), percutaneous oxygen partial pressure (TcPO2), percutaneous carbon dioxide partial pressure (TcPCO2), cardiac output (CO) and stroke volume (SV). The 10-minute oxygen challenge test value (OCT), oxygen and carbon dioxide offsets were calculated. The patients were divided into survival group and non-survival group according to 28-day survival situation, and the differences in above parameters were compared between the two groups. The receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of percutaneous partial oxygen pressure monitoring for the prognosis of patients with AHF. Results All the 91 patients were enrolled in the analysis, among whom 26 died on 28 days and 65 survived, with a mortality of 28.6%. Before treatment, 10-minute OCT in the non-survival group was significantly lower than that in the survival group [mmHg (1 mmHg = 0.133 kPa):41.0±3.9 vs. 45.6±3.2, P < 0.01], and the carbon dioxide offset was significantly higher than that in the survival group [(0.51±0.11)% vs. (0.37±0.11)%, P < 0.01]. However, there was no statistically significant difference in PaO2, PaCO2, TcPO2, TcPCO2, oxygen offset, CO, SV or Lac between the two groups. After 6 hours of treatment, TcPCO2, oxygen offset and carbon dioxide offset in the non-survival group were significantly higher than those in the survival group [TcPCO2 (mmHg): 36.0±2.8 vs. 33.2±2.8, oxygen offset: (0.25±0.05)% vs. (0.22±0.06)%, carbon dioxide offset: (0.29±0.12)% vs. (0.16±0.13)%, all P < 0.05], TcPO2, 10-minute OCT, CO and SV were significantly lower than those in the survival group [TcPCO2 (mmHg): 36.0±2.8 vs. 33.2±2.8, 10-minute OCT (mmHg): 49.1±4.5 vs. 53.6±5.5, CO (L/min):4.9±0.5 vs. 5.3±0.5, SV (mL): 57.8±3.5 vs. 64.4±4.8, all P < 0.01]. However, there was no statistically significant difference in PaO2, PaCO2 or Lac between the two groups. ROC curve analysis showed that the area under the ROC curve (AUC) of 10-minute OCT onset predicting the 28-day death of patients with AHF was 0.802; when the optimal cut-off value was 43.5 mmHg, the sensitivity and specificity was 77.3% and 68.0%, respectively. The AUC of carbon dioxide offset was 0.812; when the optimal cut-off value was 0.46%, the sensitivity and specificity was 86.4% and 68.0%, respectively. Conclusions Percutaneous oxygen partial pressure monitoring can be used as a reliable indicator for prognosis evaluation of patients with AHF. Increased carbon dioxide offset and decreased 10-minute OCT suggest poor prognosis, and the prognosis of patients with AHF should be evaluated by dynamic monitoring.

Bronchodilator challenge test using the tidal rapid thoracoabdominal compression technique among infants aged 6-24 months with recurrent wheezing

BACKGROUND@#A definite diagnosis of asthma during infancy is difficult. Asthma Predictive Index (API) is used to predict asthma at school age, but does not determine who among these actually have asthma.@*OBJECTIVES@#This study aims to determine the bronchodilator response of infants with recurrent wheezing compared with normal control.@*METHODOLOGY@#This cross sectional study included asymptomatic subjects aged 6-24 months with history of recurrent wheezing and age/sex matched controls. After sedation with chloral hydrate (Odan) at 50-75 mg/kg, a bronchodilator challenge test was performed with single dose 400 mcg salbutamol (Ventolin) MDI inhalation delivered via a spacer (Philips Respironic OptiChamber Diamond). Baseline and 15 minutes after salbutamol inhalation Maximum Flow at Functional Residual Capacity (V‘maxFRC) were determined using MasterScreen Paed/BabyBody Option Squeeze version 8.0. ANOVA and Pearson chi-square were used for the statistical analysis of data.@*RESULTS@#Sixty-nine infants (23 previous wheezers and positive API, 23 previous wheezers with negative API and 23 controls) were included. There was a significant difference in the post bronchodilator challenge test V‘maxFRC between wheezers with positive API and controls (p= 0.047). There was no significant difference in other parameter among groups.@*CONCLUSION AND RECOMMENDATION@#Absolute values of V‘maxFRC post bronchodilator challenge using the Tidal Rapid Thoracoabdominal compression technique may be used to identify current asthma among asymptomatic infants with recurrent wheezing. Further studies with patient follow-up are recommended to assess response to treatment.

Clinical significance of 10 min oxygen challenge test for acute kidney injury in patients with septic shock after fluid resuscitation / 中国综合临床

Objective To evaluate the significance of oxygen stress test in 10 minutes after fluid resuscitation in the incidence and prognosis of acute kidney injury (AKI) in septic shock patients.Methods From January 2014 to December 2017,fifty-eight patients with septic shock were enrolled.The 10 min oxygen challenge test was conducted using transcutaneous oximetry just before (T0) and 6 h (T1) after initiation of fluid resuscitation,and 10 min oxygen challenge test data(10 min OCT) at TO and T1 were then calculated,respectively.The enrolled patients were divided into L group (10 min OCT＜66 mmHg,32 cases) and H group (10 min OCT ≥66 mmHg,26 cases)according to the 10 min OCT value at T1.The hemodynamic variables and oxygen metabolism indexes,dose of vasoactive agents,10 min OCT at T0 and T1 were recorded,incidence and severity of septic shock-associated AKI,frequency of continuous renal replacement therapy,ICU mortality and 28 d mortality were compared between two groups,the risk factors associated with prognosis were analyzed using COX regression model.Results The hemodynamic variables and oxygen metabolism indexes and dose of vasoactive agents were comparable between two groups at TO and T1 (P ＜ 0.05).The incidence of septic shock-associated AKI (78.1％ (25/32) vs.50.0％ (13/26),x2 =6.365),proportion of phase 3 AKI (53.1％ (17/32) vs.26.9％ (7/26),x2 =8.016) and frequency of continuous renal replacement therapy (46.9％ (15/32) vs.23.1％ (6/26),x2 =5.764) was higher in L group than those in H group(P＜0.05),and similarly were the ICU mortality (23.1％ (6/26)vs.53.1％ (17/32),x2 =7.134,P ＜ 0.05) and 28 d mortality (30.8％ (8/26) vs.62.5％ (20/32),x2 =6.067,P ＜0.05).Therefore,the 6 h 10 min OCT≥66 mmHg was a protective factor to improve the ICU mortality(RR =0.013,95％CI:0.021-0.396,P＜0.05) and 28 d mortality(RR=0.018,95％CI:0.009-0.280,P＜0.05) in patients with septic shock-associated AKI.Conclusion 10 min OCT imposes substantial imquence on the incidence,severity and prognosis of patients with septic shock-associated AKI,oxygen challenge test could improve the treatment of septic shock-associated AKI.

The prognostic value of transcutaneous oximetry for patients with septic shock / 中华急诊医学杂志

Objective To evaluate the prognostic value of transcutaneous oximetry in patients with septic shock.Methods Fifty-three patients with septic shock were enrolled prospectively from January 2013 to December 2015.Transcutaneous oximetry were used to determine the results of 10 min oxygen challenge tests (OCT) carried out at beginning(0 h) and at 6 h after fluid resuscitation respectively.The 10-min OCT value (10 min OCT) and oxygen challenge index(OCI) were calculated.The APACHE Ⅱ and SOFA score,hemodynamic variables,oxygen metabolism indexes,dose of vasoactive agents,10 min OCT,and OCI at 0 h and at 6 h were recorded.Patients were assigned into survival group and death group according to the 28 d survival.The differences in demographics and clinical data were compared between groups.The role of 10 min OCT and OCI in predicting death was evaluated by receiver operating characteristic curves(ROC).The Kaplan-Meier surviving curve was created and the survival of the patients was analyzed by the Log-rank test.Risk factors associated with the prognosis were analyzed using the multiple logistic regression analysis.Results There were 29 patients in the survival group and 24 patients in the death group.Compared with death group,10 min OCT[(77.55±18.48)mmHg vs.(51.30±21.60)mmHg] and OCI [(0.78±0.13) vs.(0.59±0.15)] at 6 h in survival group were significantly higher(P＜0.05),while APACHE Ⅱ [(12.48±5.69) vs.(17.25±8.79)] and SOFA [(5.79±1.72) vs.(10.10±2.52)] in survival group were significantly lower than those in death group(P＜0.01).The area under the ROC curve of 10 min OCT at 6 h and OCI at 6 h for predicting 28 d death were 0.86±0.05(95％CI:0.76-0.87,P＜0.01) and 0.79±0.08(95％CI:0.64-0.95,P＜0.01),respectively.The optimal cutoff point for 10 min OCT at 6 h was 72.00 mmHg with the sensitivity of 76.84％ and specificity of 85.03％.The optimal cutoff point for OCI at 6 h was 0.76 with the sensitivity of 76.84％ and specificity of 77.47％.Kaplan-Meier survival analysis showed that 28 d survival rate in high level of 10 min OCT at 6 h and high level of OCI at 6 h were significantly higher than that in low level of 10 min OCT at 6 h(70.86％ vs.31.82％,x2=7.96,P＜0.01)and low level of OCI at 6 h (75.00％ vs.32.00％,x2=9.86,P＜0.01).Multivariate logistic regression analysis showed that both 10 min OCT at 6 h (OR=0.92,95％CI:0.88-0.96,P＜0.05) and OCI at 6 h (OR=0.01,95％CI:0.001-0.023,P＜0.05) were independent risk factors associated with 28 d mortality of patients with septic shock.Conclusions The 10 min OCT and OCI were reliable predictors for the prognosis of patients with septic shock.

The clinical significance of microcirculation and oxygen metabolism evaluation in acute kidney injury assessment in patients with septic shock after resuscitation / 中华内科杂志

Objective To evaluate the value of microcirculation and oxygen metabolism evaluation (MicrOME)in acute kidney injury(AKI) evaluation in patients with septic shock after resuscitation. Methods Consecutive patients with septic shock after resuscitation and mechanical ventilation were enrolled from October 2016 to February 2017 in ICU at Peking Union Medical College Hospital.Patients were divided into 3 groups based on 10 min transcutaneous oxygen challenge test transcutaneous partial pressure of oxygen(PtcO2)and venoarterial pressure of carbon dioxide difference(Pv-aCO2)/arteriovenous O2 content difference(Ca-vO2)by blood gas analysis, i.e. group A [ΔPtcO2>66 mmHg(1 mmHg=0.133 kPa) and Pv-aCO2/Ca-vO2≤1.23], group B (ΔPtcO2≤66 mmHg), group C (ΔPtcO2>66 mmHg and Pv-aCO2/Ca-vO2>1.23). Heart rate,mean arterial pressure,central venous pressure,noradrenaline dose,lactate,Pv-aCO2,Ca-vO2, lactate clearance, central venous oxygen saturation(ScvO2) and liquid equilibrium were assessed after resuscitation.AKI staging based on Kidney Disease Global Improving Outcomes (KDIGO) clinical practice guideline was analyzed. The predictive value of lactate,ScvO2,Pv-aCO2/Ca-vO2 to progression of AKI after resuscitation was determined using receiver operating characteristic(ROC)curve analysis.Results A total of 49 septic shock patients were enrolled including 30 males and 19 females with mean age of (61.10±17.10) years old.There were 19 patients in group A,21 patients in group B, and 9 patients in group C. Acute physiology and chronic health evaluation Ⅱ score was 20.92±7.19 and sequential organ failure assessment score 12.02±3.28. There were 4 patients with AKI and 1 progressed in group A,11 patients with AKI and 2 progressed in group B, 6 patients with AKI and 4 progressed in group C. The cutoff value of Pv-aCO2/Ca-vO2 was equal or more than 2.20 for predicting progression of AKI,resulting in a sensitivity of 85.7％ and a specificity of 73.8％.Conclusion MicrOME is a significant parameter to predict the progression of AKI in patients with septic shock after resuscitation. Pv-aCO2/Ca-vO2 is also a good predictive factor.

Diagnosis, treatment and progress of primary aldosteronism in China / 中华内分泌代谢杂志

Primary aldosteronism is an important cause of secondary hypertension with the prevalence of 10%-20%in hypertensive patients. Compared with essential hypertension, primary aldosteronism patients have more cardiovascular and cerebrovascular complications. In this article, we will make a discussion on the development and current situation of primary aldosteronism by means of its prevalence, case detection, case confirmation, subtype classification, treatment and basic research.

Characteristics of Tremor in Multiple System Atrophy Parkinsonism Type / 中国康复理论与实践

@#Objective To compare the characteristics of the tremor of multiple system atrophy Parkinsonism type (MSA-P) with Parkinson's disease (PD), and improvement after acute levodopa challenge test. Methods From Match to September 2017, 70 patients with PD and 23 patients with probable MSA-P were included. All the patients were required of rest or postural tremor in at least one extremity or head, and accepted acute levodopa challenge test and analysis for dominant tremor frequency, amplitude and rhythm under resting state, posturing and holding 1000 g state, respectively.Results The score of Unified Parkinson Diease Rating Scale Part III was higher in MSA-P patients than in PD patients (t=-2.098, P<0.05), with less improvement after acute levodopa challenge test (Z=-9.446, P<0.01), while the tremor score and improvement were not significantly different between two groups (P>0.05). There were more frequence with non-alternating or synchronic tremor rhythm (χ2=8.756, P<0.01) and small irregular tremor in rest tremor (χ2=4.788, P<0.05) in MSA-P patients than in PD patients, as well as the high frequency tremor (>6 Hz) in postural tremor (χ2=11.312, P<0.01). The frequency of rest tremor was higher in MSA-P patients than in PD patients (t=-2.119, P<0.05), as well as the frequency of postural tremor with 1000 g (t=-2.274, P<0.05). Both PD and MSA-P patients showed, the lower frequency the postural tremor was, the higher the tremor scores were. There were 25% PD patients with head tremor, while none in MSA-P patients. Tremor score improved more than 30% after acute levodopa challenge test in 22.7% MSA-P patients, but none improved in UPDRS score. The frequence of tremor score improvement was more in female MSA-P patients than in males (P<0.05).Conclusion The features of the tremor are similar in PD and MSA-P, with some differences that MSA-P tend to higher frequency in rest or postural tremor, more non-alternating or synchronic tremor rhythm in rest tremor, and fewer has tremor besides limbs. Some MSA-P patients improve after acute levodopa challenge test, and women may improve more than men.

Characteristics of Tremor in Young or Late Onset Parkinson's Disease / 中国康复理论与实践

Objective To compare the characteristics of tremor and improvement after acute levodopa challenge test in young onset Parkinson's disease(YOPD)and late onset Parkinson's disease(LOPD)with a cross-sectional study. Methods From Match to September,2017,70 Parkinson's disease inpatients with rest or postural tremor in at least one extremity were included,in which 23 patients were in YOPD group,and other 47 in LOPD group according to their ages of onset.They finished acute levodopa challenge test and were analyzed for dominant tremor frequen-cy,amplitude and rhythm under resting state,posturing and holding 1000 grams state,respectively. Results YOPD group was younger(t=-2.423,P<0.01)with lower Hoehn-Yahr stage(χ2=-4.604,P<0.05),and needed less equivalent dose of levodopa at early stage(first five years)(t=-2.119,P<0.05).There was a bigger ratio of patients with rest tremor in frequency of four to six Hz in YOPD group than in LOPD group(χ2=3.896,P<0.05). Rigidity and bradykinesia scores of LOPD group positively correlated with the course of disease (r=0.34, P<0.05),while it was not found in YOPD group. Conclusion Tremor expresses most in the classical way in YOPD patients,and tremor analysis could help to diagnose young adults. Both YOPD and LOPD patients get well in acute levodopa challenge test, while YOPD patients need less equivalent dose of levodopa at early stage.

Influence of transcutaneous oximetry on septic shock-associated acute kidney injury / 中华急诊医学杂志

Objective To explore the influence of transcutaneous oximetry on septic shock-associated acute kidney injury (AKI) in intensive care unit (ICU).Methods Forty-nine patients with septic shock admitted in the ICU of Wuxi People's Hospital Affiliated to Nanjing Medical University were enrolled from January 2013 to December 2015.The 10 min oxygen challenge test was conducted using transcutaneous oximetry just before (0 h) and 6 h after initiation of fluid resuscitation,and 10 min oxygen challenge test data (10 min OCT) at 0 h and 6 h were then calculated,respectively.The enrolled patients were divided into low 10 min OCT group (10 min OCT ＜ 66 mmHg,L group) or high 10 min OCT group (10 min OCT ≥66 mmHg,H group) according to the 10 min OCT value at 6 h.The hemodynamic variables [mean arterial pressure (MAP),central venous pressure (CVP)],oxygen metabolism indexes [central venous oxygen saturation (ScvO2),arterial lactate (Lac)],dose of vasoactive agents,10 min OCT at 0 h and 6 h were recorded.APACHE Ⅱ score,incidence and severity of septic shock-associated AKI,frequency of CRRT,ICU mortality and 28 d mortality were compared between groups using SPSS 22.0 software,risk factors associated with prognosis were analyzed using COX regression model.Results There were 27 cases in L group and 22 cases in H group.The MAP,CVP,ScvO2,lactate level and dose of vasoactive agents were comparable between groups at 0 h or 6 h (P ＞ 0.05),while 10 min OCT at 6 h was higher in H group than that inLgroup [(77.6±18.5) mmHgvs.(51.3 ±21.6) mmHg,P＜0.05].The incidence of septic shock-associated AKI (77.8％ vs.50.0％,P ＜ 0.05),proportion of phase 3 AKI (44.4％vs.22.7％,P ＜0.05) and frequency of CRRT (48.1％ vs.22.7％,P ＜0.05) was higher in L group than those in H group,and similarly were the ICU mortality (51.8％ vs.22.7％,P ＜0.05) and 28 d mortality (63.0％ vs.31.8％,P ＜ 0.05).Therefore,the 6 h 10 min OCT ≥66 mmHg was a protective factor to improve the ICU mortality (RR =0.01,95％ CI:0.001-0.39,P ＜ 0.05) and 28 d mortality (RR =0.01,95％CI:0.001-0.27,P＜0.05) in patients with septic shock-associated AKI.Conclusions 10 min OCT imposes substantial influence on the incidence,severity and prognosis of patients with septic shockassociated AKI,oxygen challenge test could improve the treatment of septic shock-associated AKI.