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Objective:To investigate the efficacy and nephrotoxicity of high-dosepolymyxin B (PMB) in treatment of patients with multidrug-resistant Gram-negative bacteria (MDR-GNB) infections.Methods:Clinical data of 90 patients with MDR-GNB infections who admitted to the Affiliated Huaian First People′s Hospital from January 2018 to December 2020 were retrospectively analyzed. Thirty one patients receivedhigh-dose PMB(≥25 000 U·kg?1·d?1) for treatment (high-dose group) and 59 patients received standard-dose PMB(<25 000 U·kg?1·d?1) for treatment (control group). The curative effect and renal function of the two groups were compared. The factors related toacute kidney injury (AKI) were analyzed with logistic regression.Results:The daily PMB dose and treatment course in high-dose group were (29 800±4 500) U/kg and (9.16±4.15) d, while those of the control group were (17 300±3 500)U/kg and (7.32±3.87) d ( P<0.01). The effective rate of the high-dose group was higher than that of control group (83.9% vs. 61.0%, χ2=4.95, P<0.05).The creatinine levels in high-dose group were increased significantly from 69.40(47.00, 94.70)μmol/L before treatment to 116.20(59.20, 213.20)μmol/L after treatment ( Z=-2.99, P<0.01); while there were no significant changesin control group before and after treatment [55.00(37.00, 92.47)μmol/L vs. 50.10(34.00, 156.00)μmol/L, Z=-1.78, P=0.78]. The 30-day mortality rate in the high-dose group was 32.3% (10/31), that in the standard-dose group was 49.2% (29/59)(χ2=2.36, P=0.12). The AKI incidence rate in high-dose group was higher than that in standard-dose group [ 67.7% (21/31) vs. 45.8% (27/59), χ2=3.94, P=0.04]. There were 4 and 10 deaths due to AKI in the high-dose and standard-dose groups, respectively (χ2=0.25, P=0.61). Logistic regression analysis showed that daily high-dose PMB was independently associated with AKI( OR=2.662, 95% CI:1.082-6.549, P=0.03). Conclusion:Thehigh-dose PMB is effective in treatment of patients with multidrug-resistant Gram-negative bacteriainfections, but the incidence of AKI is also significantly increased. Therefore, when using daily high-dose PMB, the pros and cons must be weighed to avoid increasing the risk of AKI.
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Objective To explore the protective effects of cannabinoid analogues WIN55212-2 on paraquat poisoned mice. Methods Totally 35 healthy male C57BL/6 mice were randomly(random number) divided into four groups: PQ group (paraquat poisoned, n=10), WIN 1 mg group (PQ+WIN55212-21 mg n=10), WIN 2 mg group (PQ+WIN55212-22 mg, n=10), control group (n=5).The PQ poisoned animal models were established in the PQ group, WIN 1 mg group and WIN 2 mg group by intraperitoneally injection of paraquat with a concentration of 20 mg/kg. Intraperitoneal injection of WIN55212-2 (containing Tween 80 cosolvent) at the concentration of 1 mg/kg and 2 mg/kg was performed 1 h before PQ exposure in the two interfered groups. Equivalent volume of saline was given to the control group. WIN55212-2 was injected twice a week from the second week. In the acute phase (14 d), 5 mice were randomly sacrificed in the PQ group, WIN 1 mg group and WIN 2 mg group, and 3 mice were sacrificed in the control group to obtain blood sample, bronchoalveolar lavage fluid (BALF) and lung tissue. All the remaining mice were executed on day 28, and the tissue samples were collected as mentioned above. HE staining and Masson staining were performed to observe the changes of lung tissues after PQ poisoning. Changes of TNF-α, IL-6 and TGF-β in plasma and BALF were measured by ELISA. Results In the acute phase, the pathological sections of lung tissues in the PQ group, WIN 1 mg group and WIN 2 mg group showed diffuse inflammation, which was improved after the intervention of WIN5522-2, especially in the WIN 1 mg group. IL-6 levels of BALF in the PQ group, WIN 1 mg group, WIN 2 mg group and the control group were (1024.77±124.74)U/L, (620.48±99.76)U/L, (823.29±157.88) U/L, and (180.42±20.22)U/L, respectively. IL-6 levels in the WIN 1 mg group and the WIN 2 mg group were statistically lower than those in the PQ group (P=0.021, P=0.016). However, no difference was found between the two intervention groups(P=0.114). The similar condition was also found in TNF-α in BALF and plasma. In the chronic phase, mice in the PQ group, WIN 1 mg group and WIN 2 mg group showed fibrosis in tissue by HE and Masson staining, and the inflammatory condition was improved after the intervention of WIN5522-2, which was more obvious in the WIN 1 mg group. In BALF, TNF-α level was (321.64±50.54)U/L, (260.23±48.19)U/L, (278.89±29.40)U/L, (89.76 ± 10.87)U/L in the PQ group, WIN 1 mg group, WIN 2 mg group and the control group. Differences were found between the WIN 1 mg group and the control group and the WIN 2 mg group. Similar differences were also observed in plasma TNF-α, but not in TGF-β. Conclusions A small dose of WIN55212-2 can improve the general condition of PQ poisoning mice, and reduce the inflammatory and fibrosis-related cytokines levels in PQ poisoning mice.
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Objective To explore the clinical effect of traditional Chinese medicine on lipid metabolism dis-orders in hemodialysis patients.Methods 70 patients with hemodialysis received in the hospital from Novem-ber 2015 to April 2017 were enrolled in the study.They were randomly divided into control group and treat-ment group with 35 cases in each group.The control group was treated with simvastatin and and the treatment group was treated with self-made fat recipe combined with simvastatin.The levels of serum lipid ,serum in-flammatory cytokines ,renal function and liver function ,the total effective rate of treatment and the incidence of adverse reactions were compared between the two groups before and after treatment.Results There were no statistical significances in serum lipid indexes such as triglyceride (TG) ,total cholesterol (TC) ,high densi-ty lipoprotein cholesterol (HDL-C) ,low density lipoprotein cholesterol (LDL-C) ,C reactive protein (CRP) , interleukin 6 (IL-6) ,tumor necrosis factor α(TNF-α) and other serum inflammatory factors ,and renal func-tion indexes ,including urea nitrogen (BUN) ,creatinine (Scr) ,liver function indexes ,including alanine amin-otransferase (ALT) ,aspartate aminotransferase (AST) between two groups before treatment (P＞0.05) ;af-ter treatment ,the TG ,TC ,LDL-C ,CRP ,IL-6 ,TNF-α ,BUN ,Scr ,ALT and AST levels of the patients in the treatment group were significantly lower than those in the control group ;the HDL-C level of the patients in the treatment group was significantly higher than that in the control group ;the total effective rate of the treat-ment group was significantly higher than that in the control group ;the incidence of adverse reactions was sig-nificantly lower than that of the control group ,and the differences were statistically significant (P＞0.05). Conclusion The lipid-lowering effect of treatment of hemodialysis patients with traditional Chinese medicine lipid-lowering treatment is remarkable ,and worthy of promotion.
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Objective To investigate the effect of new breast feeding pastes on puerperae with crater nipple. Methods A total of 100 cases of puerperae with crater nipple were divided into the experimental group and the control group according to hospitalization order. On the basis of routine breastfeeding, the experimental group was given the new type of breast feeding pastes.The control group received the ordinary nipple pastes.The breastfeeding test was used to evaluate the rate of successful postnatal breast feeding,the continuous breast feeding,the maternal comfort and self-efficacy. Results The successful rate of breastfeeding in the experimental group was 88%(44/50),higher than that in the control group(70%,35/50),the difference was statistically significant (χ2= 4.882, P = 0.027). In the experimental group, the successful rates of breastfeeding upon admission,in the first month and the sixth month were 98%(49/50),90%(45/50),and 72% (36/50) respectively, while in the control group the rates were 76% (38/50), 42% (21/50) and 34% (17/50). There were significant differences between the two groups (χ2= 10.698, 25.668, 14.492, P < 0.05). The experimental group was assessed in terms of light discomfort,moderate discomfort, severe discomfort when feeding by 72%(36/50),22%(11/50),6%(3/50),and the control group were significantly different from them by 28%(14/50), 50% (25/50) and 22% (11/50) respectively. There were significant differences between the two groups (Z =-4.347, P<0.05). Conclusions The new type of breast feeding pastes can effectively improve successful breast feeding rate of mothers with crater nipple and enhance the maternal and children health, thus it is worthy of being popularized.
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Objective To investigate the value of guide-wire loop in interventional therapy of patients with Budd-Chiari syndrome with hepatic vein obstruction.Methods A retrospective study was conducted on 25 patients with Budd-Chiari syndrome (BCS) with hepatic vein obstruction treated from May 2011 to August 2014.The technique of guide-wire loop was used in these patients.The pressure of the hepatic vein was measured before and after treatment.The difference in the pressure was analyzed by the t test.Results All the patients were treated successfully using guide-wire loop angioplasty.No complications of bleeding,pericardial tamponade and liver capsule hemorrhage were observed.After treatment,the pressure of the hepatic vein reduced from (48.3± 8.0) cmH2O to (20.9 ± 3.8) cmH2O (t =26.82,P ＜ 0.05);The symptoms and physical signs of the patients were relieved or disappeared.BCS-related symptoms reappeared on follow-up in 4 patients,2 were treated by balloon dilation successfully.1 patient was treated with transjugular intrahepatic portosystemic shunt (TIPS) because of decompensated liver cirrhosis.1 patient with ankylosing spondylitis had treatment failure and the symptoms relapsed for the third time.Conclusion The technique of guide-wire loop in interventional therapy of patients with Budd-Chiari syndrome with hepatic vein obstruction is safe and effective,and it can improve the overall success rate of treatment.