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Objective:To explore the risk factors of hypomagnesemia in elderly patients with sepsis and the influence of hypomagnesemia on the prognosis of elderly patients with sepsis.Methods:In this retrospective study, 249 elderly patients with sepsis or septic shock were recruited between January 2018 and January 2021 from the Department of Geriatrics and the Department of Emergency Medicine, General Hospital of Tianjin Medical University, and relevant clinical data were collected.The Logistic regression analysis model was used to identify the relationship between risk factors and hypomagnesemia in patients with sepsis.The prognosis criteria such as hospitalization time in intensive care unit(ICU), 28-day mortality rate, mechanical ventilation time, double infection rate, shock reversal time, etc., were compared between the hypomagnesemia group and the normal magnesium group.Results:Among the 249 elderly patients with sepsis, 187 had normal blood magnesium, 43 had low blood magnesium and 19 had high blood magnesium, accounting for 75.10%, 17.27% and 7.63%, respectively.Compared with the normal blood magnesium group, elderly sepsis patients with hypomagnesemia had a longer hospitalization time in ICU[(16.21±3.68)d vs.(13.86±3.58)d, t=-4.845, P=0.036], and a significantly prolonged mechanical ventilation time[11(3, 18)d vs.3(1, 6)d, Z=-1.782, P=0.033]. There was no significant difference in mortality and double infection rate between the two groups(both P>0.05). The sequential organ failure assessment(SOFA)score of elderly sepsis patients in the low magnesium group was significantly higher than that in the normal magnesium group[(5.69±1.28)scores vs.(3.09±0.68)scores, t=-0.322, P=0.008], but there was no significant difference in acute physiology and chronic health evaluation(APACHE) Ⅱ score between the two groups( P>0.05). Multivariate Logistic regression analysis showed that high SOFA score( OR=1.111, 95% CI: 1.025-1.758, P=0.001)was an independent risk factor for hypomagnesemia. Conclusions:A high SOFA score is an independent risk factor for hypomagnesemia in elderly sepsis patients, and the clinical prognosis of elderly sepsis patients with hypomagnesemia is poor.
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Objective:Taking emergency department (ED) as a starting point, to analyze the epidemiological characteristics and mortality risk factors of sepsis, and to provide evidences for ED to carry out the strategy of "three early and two lower" for sepsis.Methods:Based on the ED and inpatient medical record management information platform of Tianjin Medical University Gernal Hospital, adult ED patients with sepsis from January 1, 2017 to December 31, 2020 were included according to the third international consensus definitions for sepsis and septic shock in 2016 and the consensus of Chinese experts on early prevention and blocking of sepsis in 2020. The epidemiological characteristics of patients were retrospectively analyzed. Chi-square test was used to compare the difference of age, sex, hospitalization times, length of stay, hospitalization cost and infection location between dead patients and survival patients, and a stepwise logistic regression model was used to analyze the influencing factors of mortality in hospitalized patients with ED sepsis.Results:A total of 7 494 patients with sepsis in ED were included in this study, and the annual and monthly component ratios varied from 3.8‰ to 6.1‰ and 2.0‰ to 9.0‰, respectively. The main characteristics of patients with sepsis in ED were as follows: 40-69 years old (46.0%), male (59.0%), mostly diagnosed with sepsis (96.8%), mainly treated with urban health insurance (59.6%), and ED diagnosis and treatment fees of 2 000-8 000 Yuan (51.1%). The mortality of hospitalized patients with ED sepsis was 24.4% and that of hospitalized patients with septic shock was 28.8%. The main characteristics of hospitalized patients with ED sepsis were as follows: most of them were male (56.2%) patients over 70 years old (56.0%), most of them were diagnosed with sepsis (94.0%) and hospitalized for the first time (76.0%), the median hospitalization time was 15 d, most of them were hospitalized under urban health insurance (65.2%), and the median hospitalization fees was 47 000 Yuan. The risk factors of death were influenced by age and length of stay. Patients aged 70 years or older had a higher risk of death than those aged from 18 to 39 years, and patients with a length of stay of more than 7 d had a lower risk of death than those with a length of stay of shorter than 7 d. The primary infection focus were mainly respiratory and urinary systems, while the death rate of patients with hematological and abdominal infections was relatively high, and the difference was statistically significant ( P<0.01). Respiratory and abdominal infections were risk factors for death in patients with ED sepsis. Conclusions:The composition ratio of sepsis in ED patients is not regular in time, so vigilance of sepsis in elderly men and patients with respiratory system, blood system, urinary system and abdominal infections should be constantly raised. Patients with sepsis who are older, hospitalized more frequently, hospitalized for a shorter time, and infected in the respiratory system or abdomen have a higher risk of death.
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Objective:To investigate the effect of interleukin (IL)-37 on the immune function of regulatory T cells (Treg) in sepsis.Methods:TTregs were isolated and purified from the spleen of C57BL/6J mice and cultured in vitro. The cells were divided into the control group, lipopolysaccharide (LPS) group, IL-37 group, LPS+IL-37 group, LPS+3-Methyladenine (3-MA) group, LPS+3-MA+IL-37 group, LPS+Rapamaycin group, and LPS+Rapamaycin+IL-37 group. Culture supernatants and cells were collected, respectively, after cell culture for 24, 48, and 72 h. The secretion of IL-10 and TGF-β by Tregs was detected by ELISA, expressions of forkhead wing-link transcription factor (Foxp3) and cytotoxic T lymphocytes antigen 4 (CTLA-4) were measured by flow cytometry. Formation and number of autophagosomes were observed by transmission electron microscope. Western blot was used to determine expressions of autophagy associated proteins, including LC3I/II and Beclin1. Cecal ligation and puncture (CLP) was used to construct septic mice model, and the differences in survival rates between the groups were recorded and compared.Results:IL-37 was given to Tregs at 24, 48, and 72 h after LPS stimulation. The function of Treg was significantly enhanced after 72 h of synergistically stimulation by both LPS and IL-37. After stimulation with LPS and IL-37, the formation of autophagosomes in Tregs was obviously increased under observation of transmission electron microscopy. Pretreatment with autophagy agonist Rapamycin and autophagy inhibitor 3-MA was applied for altering the activity of cell autophagy. It was noticed that immune function of Treg was significantly decreased in the 3-MA group compared with the control group, while it was enhanced in the Rapamycin group. Secretion of TGF-β in the 3-MA group presented with significant reduction, which showed a marked increase in the Rapamycin group. However, no significant differences were found in IL-10 levels among various groups. Administration of IL-37 improved the survival rates of septic mice, which was much more efficient by treatment prior to the onset of sepsis.Conclusions:IL-37 appears to be capable of augmenting immune function of Tregs in an autophagy-dependent pathway, which might contribute to maintaining homeostasis of immune response in the setting of sepsis, and further improves the survival and prognosis of septic mice.
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Objective@#To explore the success rate and safety of axillary venipuncture catheterization with ultrasound localization and homologous surface localization (Magney).@*Method@#A total of 80 patients were enrolled in the EICU from January 2017 to September 2018. They were randomly assigned to the Magney method (n=35) and the ultrasound-guided method (n=45). The number of successful punctures, success rate and complications were recorded.@*Results@#Compared with ultrasound-guided method, the one-time success rate (25.7% vs 68.9%, P<0.01), puncture greater than 2 times (34.3% vs 11.1%, P=0.012), and total success rate (82.9% vs 100%, P=0.004) in Magney method were significantly different. Both of the two puncture methods were mis-invasive, and the difference was not statistically significant. In Magney method 2 patients occurred hematoma and 1 patient brachial plexus injury, but no infection occurred within 48 h. While no such occurrence was found in ultrasound-guided method.@*Conclusion@#Ultrasound-guided method axillary venipuncture is a safe and effective method of central venous catheterization, which has higher success rate and safety than Magney method.
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Objective To explore the success rate and safety of axillary venipuncture catheterization with ultrasound localization and homologous surface localization(Magney).Method A total of 80 patients were enrolled in the EICU from January 2017 to September 2018.They were randomly assigned to the Magney method(n=35)and the ultrasound-guided method(n=45).The number of successful punctures,success rate and complications were recorded.Results Compared with ultrasound-guided method,the one-time success rate(25.7％vs 68.9％,P＜0.01),puncture greater than 2 times(34.3％vs 11.1％,P=0.012),and total success rate(82.9％vs 100％,P=0.004)in Magney method were significantly different.Both of the two puncture methods were mis-invasive,and the difference was not statistically significant.In Magney method 2 patients occurred hematoma and 1 patient brachial plexus injury,but no infection occurred within 48 h.While no such occurrence was found in ultrasound-guided method.Conclusion Ultrasound-guided method axillary venipuncture is a safe and effective method of central venous catheterization,which has higher success rate and safety than Magney method.
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Objective To explore the timeliness value of cardiopulmonary resuscitation quality index (CQI) in patients' prognostic evaluation during cardiopulmonary resuscitation (CPR).Methods A prospective descriptive study was conducted.According to whether they got return of spontaneously circulation (ROSC) or not,45 patients receiving CPR were divided into the ROSC group and non-ROSC group.The changes of CQI and partial pressure of end-tidal carbon dioxide (PETCO2) during CPR were collected,and were analyzed to valuate the prognosis of patients.Results The initial,end,and average PETCO2 were statistically different between the ROSC group and the non-ROSC group [7.0(3.6,14.6) vs 7.0(3.6,14.6) mmHg;29.5(19.8,35.9) vs 4.0(2.3,10.2)mmHg;and 22.2(11.8,36.3) vs 4.0(2.5,9.0) mmHg,respectively;P＜0.05],and the end CQI was statistically different between the two groups (59.6±8.9 vs 34.8±5.2,P＜0.05).The CQI differences between the two groups initiated at 11 min after CPR,and stopped at 29 min after CPR.The optimal cut-offpoint of terminal CQI and PETCO2 for prognostic was 33.2 and 16.1 mmHg respectively,and there was a statistically difference in the area under the curve between them (P＜0.05).Conclusions During CPR,both CQI and PETCO2 can be used to evaluate the prognosis,and CQI is more capable of predicting in the late stage of CPR.
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ObjectiveTo assess the efficacy and safety of Xuebijing injection for the treatment of severe acute pancreatitis (SAP).Methods An extensive search of related literatures from the Cochrane Library, EMBASE, China Biology Medicine (CBM), CNKI, VIP and Wanfang data up to March 2014 was performed. Randomized controlled trials (RCTs) regarding Xuebijing injection for the treatment of SAP were collected regardless of languages. Jadad scale was taken for quality evaluation of the included studies by two researchers. The patients in control group were given conventional treatment, and those of the Xuebijing group were given Xuebijing injection on the top of conventional treatment. The Cochrane Collaboration RevMan 5.2 software was used for data analysis regarding the effect of Xuebijing injection on the mortality, incidence of complication, effective rate, the length of stay in hospital, and the safety of the drug in patients with SAP.Results A total of 15 published reports meeting the inclusion criteria were enrolled. The methodological quality of the trials was low. Meta analysis showed that the mortality in Xuebijing group was significantly lower [odds ratio (OR) = 0.37, 95% confidence interval (95%CI) =0.17 - 0.77,P = 0.008], and the incidence of complication was also significantly decreased (OR = 0.26, 95%CI =0.14 - 0.45,P< 0.000 01) as compared with those of control group. The effective rate in Xuebijing group was significantly higher than that of the control group [relative risk (RR) = 0.85, 95%CI = 0.80-0.91,P< 0.000 01]. The length of stay in hospital in Xuebijing group was significantly shorter than that of the control group [mean difference (MD) = -5.28, 95%CI = -6.69 to -3.86,P< 0.000 01]. Adverse reactions of Xuebijing injection were reported in 2 studies. The adverse reaction in one study was headache and nausea, which were relieved by adjusting the speed of intravenous infusion, and mild rash was reported in another case, and it disappeared after the withdrawal of Xuebijing. Conclusions The currently available evidence shows that Xuebijing injection may have some therapeutic effect on SAP. Because of the low methodological quality of the included trials, multi-center and high-quality RCTs with large sample sizes are needed to provide stronger evidence.
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BACKGROUND: Previous studies suggest that vascular endothelial growth factor 121 may be an optimal target gene for thetreatment of acute myocardial infarction.OBJECTIVE: To investigate effect of direct myocardial injection of adenovirus recombinant human vascular endothelial growthfactor 121 gene (Ad-hVEGF121) on myocardial infracted rat heart structure, function and angiogenesis.METHODS: Totally 78 male SD rats were randomly divided into the sham-surgery (n=18), acute myocardial infarction (n=24),Ad-VEGF121 (n=19) and normal saline (n=17) groups. Among them, left anterior descending coronary arteries of the latter threegroups were ligated to prepare acute myocardial infarction models and rats were randomly selected to receive Ad-hVEGF12 ornormal saline via three points in the cardiac muscle at the 10-15 minutes after ligation. The chest was exposed without ligation inthe sham-surgery group.RESULTS AND CONCLUSION: At 2 weeks after injection, cardiac ultrasound showed that, compared with the sham-surgerygroup, the number of new capillaries, body weight and left ventricular mass / body weight of the acute myocardial infarction,Ad-hVEGF121 and normal saline groups were obviously increased (P < 0.05 or P < 0.01), especially those received transfectedrAd-hVEGF12, had higher density of blood capillaries than those of the normal saline and acute myocardial infarction groups.However, there were no obviously differences between each group in infarct size, cardiac structure or functions. The directmyocardial injection of Ad-VEGF121 can significantly promote the formation of new blood vessels within the myocardium.
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Objective To investigate the expression changes of hepatic gelsolin (GSN) and the potential effect of traditional Chinese medicine Xuebijing injection in septic rats. Methods A total of 104 male Wistar rats were randomly divided into four groups, ie, normal control group (n = 8), sham operation group (n = 32), cecal ligation and puncture group (CLP group, n = 32) and Xuebijing treatment group (n = 32). The sepsis animal models in the last two groups were developed by CLP. In Xuebijing treatment group, animals were treated intravenously with Xuebijing injection (4 ml/kg) at 2, 12, 24,36, 48 and 60 hours after operation, respectively. Animals were sacrificed respectively at 6, 12, 24, and 72 hours after operation to harvest blood and hepatic tissue samples. Markers of liver function, contents of GSN and Gc globulin and expression of GSN mRNA in the liver tissues were detected. Results Compared with normal control group and sham operation group, hepatic GSN content was decreased significantly at various intervals in CLP group (P ＜ 0. 05), which reached the lowest value of (1.42 ±0.50) ng/mg at 12 hours. Meanwhile, expression of GSN mRNA in the liver was markedly enhanced at six hours after CLP and remained a high value until 72 hours, compared with the sham operation group (1.203±0.053 vs 1.030 ±0.084, P ＜0.05). Similarly, the hepatic Gc globulin contents was increased in the CLP group compared with the normal control group and sham operation group (P ＜ 0.05).After treatment with Xuebijing injection, the hepatic GSN contents at 6-72 hours was increased gradually while serum ALT and AST levels at 6, 12 and 24 hours were reduced significantly in comparison to the CLP group (P ＜ 0.05). Nevertheless, treatment with Xuebijing injection showed no marked effect on hepatic GSN mRNA expression and Gc globulin release (P ＞ 0.05). Conclusions Hepatic GSN contents are persistently reduced in the development of sepsis and treatment with Xuebijing injection can markedly attenuate acute liver injury through increasing GSN contents in severe sepsis.