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Hypothermia can have adverse effects on various systems of trauma patients, and significantly increase the mortality. All of the current rewarming equipments are contact rewarming equipment, which have the shortcomings of single function and poor effect. The medical staff of the First People's Hospital of Chenzhou designed a multi-functional infrared heating medical rewarming equipment, and obtained the National Utility Model Patent of China (ZL 2018 2 1705172.9). By integrating the infrared heating lamp tube and the air heating device and controlling them independently, the equipment can not only treat the wound by infrared alone, but also keep the wound warm by using the air heating function at low room temperature. In addition, it can also warm the patients with hypothermia separately. The device's dual functions of promoting wound healing and rewarming by infrared therapy and wind-heating are accurate. It is easy to operate with good controllability, and contributes to individualized precision treatment, which is worthy of transformation and promotion.
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Objective To explore the value of a new community-acquired pneumonia severity index(CPSI) in predicting the severity and mortality of patients with community-acquired pneumonia(CAP).Methods A retrospective analysis was conducted.Patients with CAP in critical care medicine of the First People's Hospital of Chenzhou were enrolled in this study.According to whether the patients died within 28 days,patients were divided into the survival group and the death group.The difference of sex,age,vital signs,blood test,the lowest Glasgow coma score (GCS) and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,sepsis related organ failure assessment (SOFA)score,CURB-65 (confusion,uremia,respiratory rate,BP,age 65 years) score,pneumonia severity index (PSI) score and community-acquired pneumonia severity index (CPSI) score were compared between the two groups.Logistic regression analysis was performed for the scoring systems with statistical significance in univariate analysis.The receiver operating characteristic (ROC) was drawn to analyze the prognostic value of each scoring system.Results Totally 283 patients were enrolled in this study (184 survivals and 99 deaths,mortality rate 35％).Univariate analysis showed that age,mechanical ventilation (MV) ratio,the fastest heart beat rate (HR),the lowest systolic blood pressure (SBP),the lowest mean blood pressure (MAP),pressure adjusted shock index (PASI),inspired oxygen concentration (FiO2),arterial oxygen partial pressure (PaO2),and oxygenation index (PO2/FiO2),blood urea nitrogen concentration (BUN),serum creatinine concentration (Scr),urine output,length of ICU stay,the lowest GCS,and APACHE Ⅱ score were significantly different between the two groups (P＜0.05).Multivariate regression analysis showed that CPSI score and SOFA score were independent risk factors for patients with CAP.The ROC curve of CAP patients was predicted in each scoring system,and the area under the ROC curve of CPSI score (0.728),SOFA and age score (0.708),PSI score (0.701),APACHE Ⅱ score (0.690),CURB-65 score (0.687) and SOFA score (0.683) gradually decreased.The sensitivity and specificity of the area under curve prediction showed that CPSI score was superior to the other scores.Conclusions The CPSI score can evaluate the severity of CAP patients,efficiently predict the outcome of patients with CAP,and can be widely used in clinical practice.
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Objective To study the predicting value of four different scoring systems such as the acute physiology and chronichealth evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, quick SOFA (qSOFA) score and systemic inflammatory response syndrome (SIRS) score for the prognosis of septic patients. Methods A retrospective analysis were conducted. Septic patients in intensive care unit (ICU) of the First People's Hospital of Chenzhou form July 1st, 2012 to June 30th, 2016 were enrolled.Patients were divided into survival group and death group according to 28-day outcome. The difference of clinic data, the worst clinical index value within 24 hours, whether mechanical ventilation performed on first day, length of stay in ICU, APACHE Ⅱ score, SOFA score, qSOFA score and SIRS score were compared between the two groups. The significant different factors of sepsis outcome in univariate analysis were analyzed by multiple logistic regression, and the ability of four scoring systems was tested by receiver operating characteristic (ROC) curve.Results 311 patients were enrolled in this study (221 survivals, 90 deaths, 28-day mortality rate 28.9%). Univariate analysis showed age, mechanical ventilation ratio, urine output, length of stay in ICU and the fastest heart beat rate (HR), the lowest systolic blood pressure (SBP), the lowest mean arterial pressure (MAP), HCO3-, minimum arterial blood oxygen partial pressure (PaO2), minimum oxygenation index (PaO2/FiO2), the maximum fraction of inspired oxygen (FiO2), Na+, the highest concentration of blood urea nitrogen (BUN), the highest concentration of serum creatinine (SCr), minimum concentration of plasma albumin (Alb), Glasgow coma score (GCS) score, APACHE Ⅱ score, SOFA score, qSOFA score, within 24 hours after diagnosis were significantly different between two groups (allP < 0.05). Multiple logistic regression showed age [odds ratio (OR) = 1.388, 95% confidence interval (95%CI) = 1.074-1.794,P = 0.012], PaO2/FiO2 (OR = 0.459, 95%CI = 0.259-0.812,P = 0.007), concentration of plasma Alb (OR = 0.523, 95%CI = 0.303-0.903,P = 0.020), GCS score (OR = 0.541, 95%CI = 0.303-0.967,P = 0.038) and SOFA scores (OR = 3.189, 95%CI = 1.813-5.610,P = 0.000) were independent risk factors for sepsis outcome. ROC curve test showed the APACHE Ⅱ score, SOFA score and qSOFA score had the ability to predict the outcome in critical ill patients with sepsis, the SOFA score of the most powerful, the area under the ROC curve (AUC) was 0.700,when the cut-off value was 7.5 points, the sensitivity was 73.3% and specificity was 58.8%.Conclusions APACHE Ⅱ score, SOFA score and qSOFA score have the predictive properties for septic patients. SOFA score is an independent prognostic risk factor of sepsis, while qSOFA score can be widely used in clinical practice as the advantage of quick evaluating.
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Objective To investigate the effect of low molecular weight heparin (LMWH) on the expression of endothelial protein C receptor (EPCR) and protease activated receptor 1 (PAR1) in abdominal vascular endothelial cells (VECs) of septic rats. Methods VECs were cultured by tissue-sticking method, and the purity was determined with flow cytometry (FCM). VECs were randomly divided into three groups: control group, septic group (LPS 1 μg/ml) and LMWH group (LPS 1 μg/ml+LMWH 5 μg/ml). The VECs were collected at 1st, 3rd, 5th days after stimulated. The expression of EPCR and PAR1 were assessed by FCM. Results The expression of EPCR and PAR1 of septic group decreased significantly compared with control group at each time point (P＜0.05 or P＜0.01), and the expression decreased most obviously on day 5 (26.53±7.21 vs 39.26±2.62,q＝6.45,P＜0.01;53.21±15.10 vs 86.54±11.34,q＝6.94,P＜0.01). In LMWH group, the levels of EPCR and PAR1 expression were higher than setpic group at each time point (P＜0.05). Compared to control group, the expression of EPCR had a significantly decrease on day 1 (40.86±1.63 vs 45.41±2.82,q＝3.51,P＜0.05), which had no significantly different on day 3 and 5 (41.20±3.32 vs 42.83±2.66,P＞0.05;39.23±3.33 vs 39.26±2.62,P＞0.05), and the expression of PAR1 were not significantly decrease compared with control group at each time point (P＞0.05). Conclusions LMWH could improve the inhibition status and the expression of EPCR and PAR1 on VECs in septic rats.
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Objective To investigate the effect of Xuebijing injectiong on lipopolysaccharide(LPS)-induced apoptosis of CD4+CD25+regulatory T cells(Tregs)and immune function of effector T cells(Teff)in vitro.Method CD4+CD25+Tregs isolated from rat spleens were divided into the control group,anti-CD3/CD28 group,anti-CD3/CD28+LPS group,anti-CD3/CD28+Xuebijing injection group,and anti-CD3/CD28+LPS+Xuebijing injection group.The apoptosis rate and expression of forkhead/winged helix transcription factor p3 (Foxp3)and cytotoxic T-lymphocyte-associated antigen 4(CTLA-4)of CD4+CD25+Tregs were detected by flow cytometry(FCM),and the secretion of IL-10 of Tregs was measured by ELBA on day 3.CD4+CD25-T cells were co-cultured with CD4+CD25+Tregs(1:1)for 68 hours,proliferative activity of Teff was determined by MTT,and interleukin(IL)-2/sIL-2Rα levels were measured by ELISA.Results The apoptosis rate of CD4+CD25+Tregs in anti-CD3/CD28 group was 33.70± 3.06%,which was significantly higher than that in control group(12.84±0.84%).Also,apoptosis rate of CD4 CD25+Tregs in anti-CD3/CD28+LPS+Xuebijing injection group(45.13±2.70%)was much higher than that in anti-CD3/CD28+IPS group(29.41 ± 1.63%,P＜0.01).The expression of Foxp3 as well as CTLA-4,and the secretion of IL-10 were markedly decreased along with increases in the apoptosis rates.Compared with control group(54.48%),the mean inhibitory rate of Teff proliferative activity in response to Con A was significantly decreased in anti-CD3/CD28+Xuebijing injection group(31.26%,P＜0.05),and it was markedly decreased in anti-CD3/CD28+LPS+Xuebijing injection group comaped to anti-CD3/CD28+LPS group(P＜0.01).In addition,IL-2 levels in the supernatant of anti-CD3/CD28+Xuebijing injection group and anti-CD3/CD28+LPS+Xuebijing injection group were significantly higher than those of anti-CD3/CD28+IPS group(P＜0.01).Conclusions The inhibitory activity of CD4+CD25+Tregs on Teff appears to be upregulated by IPS stimulation in vitro,and Xuebijing injection could markedly enhance apoptosis of CD4+CD25+Tregs,thereby improving suppressive immune function of Teff.
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Objective To evaluate the correlation between the level of CD4+CD25+regulatory T cells in periphend blood and disease severity in patients with sepsis.Methods Thirty-six septic patients and 5healthy controls were enrolled.Septic patients were divided into sepsis group(n=10),severe sepsis group (n=15)and septic shock group(n=11).The lymphocyte was seperated from peripheral blood and marked by PE-CD4 and FTTC-CD25 monoclonal antibody,the level of CD4+CD25+ regulatory T cells was detected by flow cytometry,and the clinical data of APACHE Ⅱ scores of septic patients was considered in 24 hours.The correlation between level of CD4+CD25+ regulatory T cells in peripheral blood and APACHE Ⅱ scores in septic patients was analyzed.Results Compared with the healthy controls [(5.48±0.98)%],the level of CD4+ CD25+ regulatory T cells in sepsis group(10.31±2.32)%,severe sepsis group(14.27 43.33)%,septic shock group(15.32±3.98)% had a significant increase(P＜0.05 or＜0.01).The log value of regulatory T cells in each group correlated positively with the APACHE Ⅱ scores(r=0.829,P=0.032;r=0.868,P=0.021;r=0.913,P=0.009),and the total coefficient of correlation was 0.903(P=0.013).Conclusion The level of CD4+CD25+ regulatory T cells in peripheral blood in septic patients has an abnormal increase,and their levels are related with the severity of disease.