Correlation between malnutrition and delirium in elderly patients with severe pneumonia undergoing invasive mechanical ventilation / 中华危重病急救医学

OBJECTIVE@#To investigate the relationship between malnutrition and delirium and its effect on prognosis in elderly patients with severe pneumonia undergoing invasive mechanical ventilation.@*METHODS@#A prospective observational study was conducted. Patients with severe pneumonia aged ≥ 60 years old who underwent invasive mechanical ventilation admitted to department of critical care medicine of the Second People's Hospital of Lianyungang from January 2021 to December 2022 were enrolled. The confusion assessment method (CAM) was used to evaluate the delirium of the patients in intensive care unit (ICU). The score of CAM ≥ 1 was defined as delirium. Mini nutritional assessment short-form (MNA-SF) was used to assess the nutritional status of patients, and MNA-SF score ≤ 7 was defined as malnutrition. Patients were divided into delirium group and non-delirium group according to whether delirium occurred. The differences in clinical indicators, length of ICU stay, duration of mechanical ventilation and wake-up time after drug withdrawal were compared between the two groups. After 28 days of short-term follow-up, the patients were divided into death group and survival group, and the differences in the incidence of delirium and malnutrition between the two groups were compared. Binary multivariate Logistic regression analysis was used to screen the risk factors for delirium in elderly patients with severe pneumonia undergoing invasive mechanical ventilation. Kaplan-Meier survival curve was used to analyze the effect of delirium on prognosis.@*RESULTS@#A total of 132 elderly patients with severe pneumonia undergoing invasive mechanical ventilation were enrolled, of whom 98 survived and 34 died within 28 days, with a mortality of 25.76%. The incidence of malnutrition and delirium in the death group was significantly higher than that in the survival group (61.76% vs. 37.76%, 64.71% vs. 26.53%, both P < 0.05), and the MNA-SF score was significantly lower than that in the survival group (6.32±1.80 vs. 8.72±2.23, P < 0.01). Procalcitonin (PCT), interleukin-6 (IL-6) and blood lactic acid (Lac) in the death group were significantly higher than those in the survival group [PCT (μg/L): 4.47 (2.69, 10.39) vs. 2.77 (1.28, 5.94), IL-6 (ng/L): 204.08 (126.12, 509.85) vs. 120.46 (60.67, 290.99), Lac (mmol/L): 5.14 (2.75, 8.60) vs. 3.13 (2.16, 4.30), all P < 0.05], and the wake-up time after drug withdrawal was significantly longer than that in the survival group (minutes: 33.94±8.51 vs. 28.92±7.03, P < 0.01). Among 132 elderly patients with severe pneumonia undergoing invasive mechanical ventilation, 48 patients had delirium during ICU stay, and 84 patients did not have delirium. The incidence of delirium was 36.36%. The 28-day mortality in the delirium group was significantly higher than that in the non-delirium group (45.83% vs. 14.29%, P < 0.01), and the MNA-SF score was significantly lower than that in the non-delirium group (6.46±1.77 vs. 9.05±2.15, P < 0.01), the length of ICU stay, duration of mechanical ventilation, and wake-up time after drug withdrawal were also significantly longer than those in the non-delirium group [length of ICU stay (days): 13.40±9.59 vs. 10.06±7.81, duration of mechanical ventilation (hours): 197.06±89.80 vs. 138.81±82.30, wake-up time after drug withdrawal (minutes): 35.85±7.01 vs. 26.99±6.12, all P < 0.05]. Binary multivariate Logistic regression analysis showed that malnutrition [odds ratio (OR) = 7.527, 95% confidence interval (95%CI) was 2.585-21.917], Lac (OR = 5.345, 95%CI was 1.733-16.483), wake-up time after drug withdrawal (OR = 6.653, 95%CI was 2.021-21.904) were independent risk factors for delirium during ICU stay in elderly patients with severe pneumonia undergoing invasive mechanical ventilation (all P < 0.01). Kaplan-Meier survival analysis showed that the 28-day cumulative survival rate of patients in the delirium group was significantly lower than that in the non-delirium group (54.17% vs. 85.71%), and the difference was statistically significant (Log-Rank test: χ2 = 16.780, P < 0.001).@*CONCLUSIONS@#The risk factors for delirium in elderly patients with severe pneumonia undergoing invasive mechanical ventilation during ICU stay include malnutrition, Lac, and wake-up time after drug withdrawal. The occurrence of delirium is closely related to poor prognosis.

Pathological components of thrombi retrieved with endovascular mechanical thrombectomy in patients with acute ischemic stroke / 国际脑血管病杂志

Endovascular mechanical thrombectomy (EMT) has become the main treatment of acute ischemic stroke, but the pathological study of thrombi retrieved with EMT is still very limited. This article reviews the routine staining, special components, expression of immune factors, electron microscopic morphology, imaging features of the pathological components of thrombi retrieved with EMT, and their correlation with the etiological differentiation and outcomes of stroke.

Effects of enteral nutrition beginning at different time on aspiration rate and immune function in patients with severe traumatic brain injury / 中国康复理论与实践

@#Objective To investigate the effect of enteral nutritional support beginning at different time on aspiration events and immune function in the early post-traumatic (within 14 days) period in patients with severe traumatic brain injury.Methods From June, 2018, to February, 2021, 75 patients with acute traumatic brain injury admitted in the Department of Neurosurgery of the Second People's Hospital of Lianyungang were randomly divided into early feeding group (24 to 48 hours, n=35) and delayed feeding group (48 to 120 hours, n=40). The 14-day reflux rate, aspiration rate, incidence of aspiration pneumonia, immune indexes and complications were compared between two groups.Results There was no significant difference in the reflux rate, aspiration rate and the incidence of aspiration pneumonia between the two groups (P > 0.05). The levels of IgG, IgA, and complements C3 and C4 were significantly higher in the early feeding group than in the delayed feeding group (|t| > 1.720, P<0.001). The incidence of non-aspiratory lung infections was significantly lower in the early feeding group than in the delayed feeding group (χ2=4.728, P<0.05).Conclusion Initiating enteral nutrition within 24 to 48 hours after injury may preserve immune function and reduce the incidence of non-aspiratory lung infections in patients with severe traumatic brain injury.

Current status and outlook of studies on the involvement of brain natriuretic peptide levels in the pathogenesis of cardioembolic stroke / 中华神经科杂志

Cardiac stroke is a stroke that occurs when a heart mural thrombus falls off and embolizes in the cerebral arterial system caused by various causes of heart disease, accounting for about 30% of all ischemic strokes. At present, in order to find evidence that emboli may originate from the heart, a large number of auxiliary examinations are needed. Good blood biomarkers are essential for the rapid identification of ischemic stroke in the emergency department. However, there is no breakthrough in this area. Brain natriuretic peptide is secreted in ventricular muscle and hypothalamus. It may be an important bridge between brain and heart diseases. However, the application of brain natriuretic peptide in the diagnosis and treatment of cardiogenic stroke is still very limited. This article reviews the current research status of brain natriuretic peptide levels and cardiogenic stroke and proposes further research trends and prospects.

Effects of combination therapy of calcium dobesilate dispersible and monosialotetrahex-osylganlioside sodium on serum inflammatory cytokines IL-6 and MCP-1 in elderly patients with painful diabetic peripheral neuropathy / 中国基层医药

Objective To observe the efficacy of combination therapy of calcium dobesilate dispersible and monosialotetrahexosylganlioside sodium on interleukin-6 (IL-6) and monocyte chemotactic protein-1 (MCP-1) in elderly patients with painful diabetic peripheral neuropathy.Methods From January 2012 to May 2017,in the Second People's Hospital of Lianyungang 70 patients of painful diabetic peripheral neuropathy,aged ≥60 years,were analyzed in this study.They were randomly divided into observation group (35 cases) and control group (35 cases).The observation group was treated with 40mg monosialotetrahexosylganlioside sodium dissolved in 250mL physiological saline,intravenous infusion per day,and oral calcium dobesilate dispersible 0.5g twice a day for two weeks.The control group was treated with methylcobalamin injection 0.5mg per day for two weeks.The clinical treatment effects and levels of IL-6 and MCP-1 were observed and compared between the two groups.Results After two weeks of treatment,the MDNS and MNSI scores of the observation group [(13.09 ± 5.38)points,(2.53 ± 1.19)points] were significantly lower than those of the control group [(18.31 ± 6.13) points,(4.19 ± 1.05) points,t =2.036,2.365,all P ＜ 0.05] and those before treatment [(21.26 ± 4.28) points,(5.40 ± 0.89) points,t =3.251,3.698,all P ＜ 0.05].The VAS-PI scores in the observation group [(6.24 ± 1.25) points,(4.13 ± 1.69) points] were significantly lower than those in the control group[(7.26 ± 1.28) points,(6.34 ± 2.65) points] at the first and second week (t =3.265,5.395,all P ＜ 0.05).The serum levels of inflammatory cytokines IL-6 and MCP-1 in the observation group [(15.16 ±0.88) ng/L,(157.19 ± 11.22) ng,/L] were significantly lower than those in the control group[(17.87 ± 1.19) ng/L,(198.21 ± 12.07)ng/L,t =2.152,1.365,all P ＜0.05]and those before treatment[(20.26 ± 1.05) ng/L,(260.44 ± 13.63) ng,/L,t =1.235,0.965,all P ＜ 0.05].Conclusion Combination of calcium dobesilate and mono-sialotetrahexosyl ganglioside may alleviate the sensory and pain sensations in patients with painful diabetic peripheral neuropathy,possibly by reducing the level of inflammatory cytokines IL-6 and MCP-1.

Relationship between plasma tau protein , p-tau protein and cognitive function in elderly patients with global brain atrophy / 中国神经精神疾病杂志

Objective To investigate the relationship between plasma tau protein, phosphorylated tau protein (p-tau) protein and cognitive function in subjects with generalized brain atrophy. Methods A total of 100 subjects with moderate and severe brain atrophy were divided into two groups according to cognitive function: normal group (n=50 cases) and dementia group (n=50 cases). And their gender, age, educational level, etc. are recorded. The tau protein and p-tau protein content in plasma were measured by double antibody sandwich enzyme-linked immunosorbent assay (ELISA). The differences between plasm tau and p-tau protein expression and their relationship with cognitive function were analyzed. Results Plasma tau protein and p-tau protein levels were significantly higher (P<0.05) in the dementia group [(210.92±43.79)pg/mL、(81.15±16.85)pg/mL] than in the normal group[(210.92±43.79)pg/mL、(81.15±16.85)pg/mL]. Plasma tau protein and p-tau protein levels were negatively correlated with the MMSE score (P<0.05) and had no significant correlation with the degree of brain atrophy (P>0.05). Conclusion Cognitive impairment may be associated with elevated tau protein levels in patients with extensive brain atrophy.

Anti-diabetic activities of catalpol in db/db mice

The objective was to investigate the hypoglycemic action of catalpol in spontaneous diabetes db/db mice. 40 db/db mice were randomly divided into fi ve groups: model control gourp; db/db plus catalpol 40, 80, 120 mg/kg body wt. groups and db/db plus metformin 250 mg/kg group. Age-matched db/m mice were selected as normal control group. The mice were administered with corresponding drugs or solvent by gavage for 4 weeks. The oral glucose tolerance test was carried out at the end of 3rd week. After 4 weeks of treatment, the concentrations of fasting blood glucose (FBG), glycated serum protein (GSP), insulin (INS), triglyceride (TG), total cholesterol (TC) and adiponection (APN) in serum were detected. The protein expressions of phosphorylation-AMPKalpha1/2 in liver, phosphorylation-AMPKalpha1/2 and glucose transporter-4 (GLUT-4) in skeletal muscle and adipose tissues were detected by western blot. Real time RT-PCR was used to detect the mRNA expressions of acetyl-CoA carboxylase (ACC) and Hydroxymethyl glutaric acid acyl CoA reductase (HMGCR) in liver. Our results showed that catalpol could significantly improve the insulin resistance, decrease the serum concentrations of INS, GSP, TG, and TC. The concentrations of APN in serum, the protein expression of phosphorylation-AMPKalpha1/2 in liver, phosphorylation-AMPKalpha1/2 and GLUT-4 in peripheral tissue were increased. Catalpol could also down regulate the mRNA expressions of ACC and HMGCR in liver. In conclusion, catalpol ameliorates diabetes in db/db mice. It has benefi t eff ects against lipid/glucose metabolism disorder and insulin resistance. The mechanism may be related to up-regulating the expression of phosphorylation-AMPKalpha1/2.

Effects of different doses rosuvastatin on carotid vulnerable plaques and cerebral ischemic events in patients with transient ischemic attack: a prospective randomized controlled trial / 国际脑血管病杂志

Objective To investigate the effects of different doses rosuvastatin on carotid vulnerable plaques and cerebral ischemic events in patients with transient ischemic attack (TIA).Methods The TIA patients with carotid vulnerable plaques were enrolled retrospectively.They were randomly divided into either a rosuvastatin conventional dose group or a high-dose group.On the basis of conventional treatment,the former was also given rosuvastatin 10 mg/d,and on the basis of conventional treatment,the latter also took rosuvastatin 20 mg/d.The patients were followed up for 6 months.Blood lipid was detected before and after treatment.The carotid intima-media thickness (IMT),atherosclerotic plaque area,and Crouse plaque score were detected with cervical vascular ultrasound.The incidences of cerebral ischemic events were compared within six months after treatment.Results A total of 71 patients were enrolled.There were 35 patients in the conventional-dose group and 36 patients in the high-dose group.Two and one patients were lost to follow up respectively in both the conventional-dose group and the high-dose group.There were no significant differences in baseline total cholesterol (TC) (5.65 ± 1.05 mmol/L vs.5.46 ±0.87 mmol/L;t =0.812,P =0.419),triacylglycerol (TG) (2.85 ± 0.74 mmol/L vs.2.95 ± 0.86 mmol/L;t =0.513,P =0.609),low-density lipoprotein cholesterol (LDL-C) (4.11 ± 0.47 mmol/L vs.4.08 ± 0.33 mmol/L;t =0.304,P =0.761),and high-density lipoprotein cholesterol (HDL-C) (1.27 ± 0.22 mmol/Lvs.1.23 ± 0.20 mmol/L;t =1.339,P =0.185) between the high-dose group and the conventional dose group.After treatment,TC (3.06±0.77 mmol/L vs.4.98 ±0.78 mmol/L;t=10.214,P＜0.001),TG (2.15±0.56 mmol/L vs.2.52 ± 0.68 mmol/L;t =2.492,P =0.015),and LDL-C (2.18 ± 0.59 mmol/L vs.3.86 ± 0.42 mmol/L;t =13.526,P＜0.001) in the high-dose group were significantly lower than those in the latter,while HDL-C (1.43 ±0.20 mmol/L vs.1.33 ± 0.21 mmol/L;t =2.010,P =0.048) was significantly higher than the conventional dose group.There were no significant differences in baseline IMT (1.59 ± 0.26 mm vs.1.58 ± 0.28 mm;t =0.152,P =0.879),plaque area (0.87 ± 0.29 mm2 vs.0.85 ± 0.34 mm2;t =0.261,P =0.749),and Crouse score (4.26 ± 0.31 mm vs.4.18 ± 0.25 mm;t =1.171,P =0.245) between the high-dose group and the conventional dose group;after treatment,IMT (1.26 ± 0.25 mm vs.1.44 ±0.27 mm;t =2.852,P=0.005),plaque area (0.50±0.25 mm2 vs.0.70±0.25 mm2;t=3.298,P=0.001),and Crouse score (2.30 ±0.26 mm vs.4.03 ±0.24 mm;t =28.509,P ＜0.001) in the high-dose group were significantly decreased compared with the conventional dose group.The incidence of cerebral ischemic events in the high-dose group was significantly lower than that in the conventional dose group (11.76％ vs.29.41％;x2 =3.202,P =0.001).Conclusions Rosuvastatin has significant lipid-lowering effect.It can eliminate or stabilize carotid vulnerable plaque and reduce ischemic stroke events.The effect of rosuvastatin 20 mg/d is superior to that of rosuvastatin 10 mg/d.