Research progress of PD-1 and PD-L1 in the immune of sepsis / 国际生物医学工程杂志

Sepsis is currently the leading cause of death in the intensive care unit, and its survivors also experience long-term immunosuppression and high rates of recurrent infections. At present, the clinical treatment of sepsis is still based on antibiotics, intravenous rehydration, and vasopressors, and there is no targeted drug treatment. However, as the rate of antibiotic resistance continues to increase, immunotherapy is highly anticipated as a new treatment. Patients with sepsis are often accompanied by acute leukocyte immune dysfunction and immunosuppression, which may be an important risk factor for the increasing morbidity and mortality of patients. Targeted inhibition of specific cell surface inhibitory immune checkpoint receptors and ligands, such as programmed death receptor-1 (PD-1), programmed death-ligand 1 (PD-L1), and other targets, can improve the host’s resistance to infection. In this paper, the research progress of PD-1 and PD-L1 in the immune response to sepsis was summarized to provide a theoretical basis for their further application in the treatment of sepsis in the future.

Effect of estrogen on expression of cysteine-rich secretory protein CRISPLD2 in myocardium of mice with sepsis / 中华危重病急救医学

Objective@#To investigate the effect of estrogen on expression of the cysteine-rich secretory protein containing LCCL domain 2 (CRISPLD2) in myocardium of lipopolysaccharide (LPS)-induced mice model of sepsis.@*Methods@#Totally 12 female and 12 male Balb/c mice of specific pathogen-free (SPF) level with 7 weeks were served as objectives. The female and male mice were randomly divided into model groups and control groups, respectively, with 6 mice in each group. The model of sepsis was reproduced by intraperitoneal injection of 10% LPS (5 mg/kg), and the mice in control groups were injected with the same volume of normal saline. The general condition of mice during experiment was observed at 24 hours after injection. All the mice were sacrificed and the heart was harvested after collecting the whole blood. The concentration of estrogen in serum was determined by double antibody sandwich enzyme linked immunosorbent assay (ELISA). The myocardial tissue homogenate was prepared at the same time, and the total protein was extracted. The expression level of CRISPLD2 was determined by Western Blot. Pearson correlation analysis was used to analyze the bivariate correlation.@*Results@#All of the experimental mice survived at 24 hours after injection. The mice in the model groups showed disorder and gray signs of body hair, with diarrhea and decreased appetite. No significant abnormality was observed in the control groups. There was no significant difference in the body weight or concentration of estrogen in serum between model and control group of both female and male mice [body weight (g): 24.6±1.8 vs. 24.5±1.3 in male mice, 18.0±0.8 vs. 17.5±1.1 in female mice; estrogen (ng/L): 11.93±2.59 vs. 12.17±3.87 in male mice, 28.20±5.75 vs. 29.82±6.10 in female mice, all P > 0.05]. There was no statistical difference in the expression of CRISPLD2 in myocardium between male control mice and female control mice (gray value: 1.02±0.19 vs. 1.00±0.11, P > 0.05). No significant difference in the expression of CRISPLD2 in myocardium was found between female sepsis mice and female control mice (gray value: 1.05±0.13 vs. 1.00±0.11, P > 0.05). The expression of CRISPLD2 in myocardium of male sepsis mice was significantly lower than that of male control mice (gray value: 0.29±0.08 vs. 1.02±0.19, P < 0.01), and it was significantly lower than that of female sepsis mice (P < 0.01). It was shown by correlation analysis that the expression level of CRISPLD2 in myocardium of sepsis mice was significantly correlated with serum estrogen concentration [R2 = 0.736, 95% confidence interval (95%CI) = 0.560-0.960, P < 0.001].@*Conclusions@#In female mice with sepsis, the expression of CRISPLD2 is comparable to that of female healthy mice. It is suggested that estrogen can maintain the expression of CRISPLD2 in LPS-induced septic mice at the normal level.

Pathogenesis of sepsis-induced myocardial dysfunction / 中华危重病急救医学

Sepsis is a common disease in intensive care units (ICU), and the resulted multi-organ dysfunction syndrome (MODS) is the main cause of death in patients with severe sepsis. The cardiovascular system is one of the most important target organ for sepsis. The severity of cardiac dysfunction is closely related to the clinical prognosis of patients with sepsis. Studies have reported that various cytokines are expressed during sepsis. They have influence on myocardial contractile function, mitochondrial function and self-regulation. Where after, it will induce cardiomyocyte apoptosis, which can lead to myocardial dysfunction. In this article, the pathogenesis of sepsis-induced myocardial dysfunction (SIMD) were reviewed to further clarify the pathogenesis of SIMD, and provide theoretical basis for subsequent research.

Effect of estrogen on expression of cysteine-rich secretory protein CRISPLD2 in myocardium of mice with sepsis / 中华危重病急救医学

OBJECTIVE@#To investigate the effect of estrogen on expression of the cysteine-rich secretory protein containing LCCL domain 2 (CRISPLD2) in myocardium of lipopolysaccharide (LPS)-induced mice model of sepsis.@*METHODS@#Totally 12 female and 12 male Balb/c mice of specific pathogen-free (SPF) level with 7 weeks were served as objectives. The female and male mice were randomly divided into model groups and control groups, respectively, with 6 mice in each group. The model of sepsis was reproduced by intraperitoneal injection of 10% LPS (5 mg/kg), and the mice in control groups were injected with the same volume of normal saline. The general condition of mice during experiment was observed at 24 hours after injection. All the mice were sacrificed and the heart was harvested after collecting the whole blood. The concentration of estrogen in serum was determined by double antibody sandwich enzyme linked immunosorbent assay (ELISA). The myocardial tissue homogenate was prepared at the same time, and the total protein was extracted. The expression level of CRISPLD2 was determined by Western Blot. Pearson correlation analysis was used to analyze the bivariate correlation.@*RESULTS@#All of the experimental mice survived at 24 hours after injection. The mice in the model groups showed disorder and gray signs of body hair, with diarrhea and decreased appetite. No significant abnormality was observed in the control groups. There was no significant difference in the body weight or concentration of estrogen in serum between model and control group of both female and male mice [body weight (g): 24.6±1.8 vs. 24.5±1.3 in male mice, 18.0±0.8 vs. 17.5±1.1 in female mice; estrogen (ng/L): 11.93±2.59 vs. 12.17±3.87 in male mice, 28.20±5.75 vs. 29.82±6.10 in female mice, all P > 0.05]. There was no statistical difference in the expression of CRISPLD2 in myocardium between male control mice and female control mice (gray value: 1.02±0.19 vs. 1.00±0.11, P > 0.05). No significant difference in the expression of CRISPLD2 in myocardium was found between female sepsis mice and female control mice (gray value: 1.05±0.13 vs. 1.00±0.11, P > 0.05). The expression of CRISPLD2 in myocardium of male sepsis mice was significantly lower than that of male control mice (gray value: 0.29±0.08 vs. 1.02±0.19, P < 0.01), and it was significantly lower than that of female sepsis mice (P < 0.01). It was shown by correlation analysis that the expression level of CRISPLD2 in myocardium of sepsis mice was significantly correlated with serum estrogen concentration [R2 = 0.736, 95% confidence interval (95%CI) = 0.560-0.960, P < 0.001].@*CONCLUSIONS@#In female mice with sepsis, the expression of CRISPLD2 is comparable to that of female healthy mice. It is suggested that estrogen can maintain the expression of CRISPLD2 in LPS-induced septic mice at the normal level.

A case of large pulmonary embolism in trunk and branches with main manifestation of syncope, vomiting and shock / 中华危重病急救医学

Pulmonary embolism (PE) refers to the endogenous or exogenous emboli blocking pulmonary trunk or branches, causing clinical and pathophysiological syndrome of pulmonary circulation disorder, the incidence rate is high. Sometimes PE patients were lack of specific symptoms and signs, or without any symptoms, which often result in misdiagnosis, un-timely diagnosis, and the delay of treatment. A PE case with syncope, vomiting and shock, which was proved to be pulmonary artery trunk and branch wide embolism later, was presented so as to improve the understanding of the disease.

Formulation of combined predictive indicators using logistic regression model in predicting sepsis and prognosis / 中华危重病急救医学

Objective To explore the method and performance of using multiple indices to diagnose sepsis and to predict the prognosis of severe ill patients.Methods Critically ill patients at first admission to intensive care unit (ICU) of Changzheng Hospital, Second Military Medical University, from January 2014 to September 2015 were enrolled if the following conditions were satisfied: ① patients were 18-75 years old;② the length of ICU stay was more than 24 hours; ③ All records of the patients were available. Data of the patients was collected by searching the electronic medical record system. Logistic regression model was formulated to create the new combined predictive indicator and the receiver operating characteristic (ROC) curve for the new predictive indicator was built. The area under the ROC curve (AUC) for both the new indicator and original ones were compared. The optimal cut-off point was obtained where the Youden index reached the maximum value. Diagnostic parameters such as sensitivity, specificity and predictive accuracy were also calculated for comparison. Finally, individual values were substituted into the equation to test the performance in predicting clinical outcomes.Results A total of 362 patients (218 males and 144 females) were enrolled in our study and 66 patients died. The average age was (48.3±19.3) years old. ① For the predictive model only containing categorical covariants [including procalcitonin (PCT), lipopolysaccharide (LPS), infection, white blood cells count (WBC) and fever], increased PCT, increased WBC and fever were demonstrated to be independent risk factors for sepsis in the logistic equation. The AUC for the new combined predictive indicator was higher than that of any other indictor, including PCT, LPS, infection, WBC and fever (0.930 vs. 0.661, 0.503, 0.570, 0.837, 0.800). The optimal cut-off value for the new combined predictive indicator was 0.518. Using the new indicator to diagnose sepsis, the sensitivity, specificity and diagnostic accuracy rate were 78.00%, 93.36% and 87.47%, respectively. One patient was randomly selected, and the clinical data was substituted into the probability equation for prediction. The calculated value was 0.015, which was less than the cut-off value (0.518), indicating that the prognosis was non-sepsis at an accuracy of 87.47%. ② For the predictive model only containing continuous covariants, the logistic model which combined acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and sequential organ failure assessment (SOFA) score to predict in-hospital death events, both APACHE Ⅱ score and SOFA score were independent risk factors for death. The AUC for the new predictive indicator was higher than that of APACHE Ⅱ score and SOFA score (0.834 vs. 0.812, 0.813). The optimal cut-off value for the new combined predictive indicator in predicting in-hospital death events was 0.236, and the corresponding sensitivity, specificity and diagnostic accuracy for the combined predictive indicator were 73.12%, 76.51% and 75.70%, respectively. One patient was randomly selected, and the APACHE Ⅱscore and SOFA score was substituted into the probability equation for prediction. The calculated value was 0.570, which was higher than the cut-off value (0.236), indicating that the death prognosis at an accuracy of 75.70%.Conclusion The combined predictive indicator, which is formulated by logistic regression models, is superior toany single indicator in predicting sepsis or in-hospital death events.

Epidemiology of traumatic cervical spinal cord injury in ICU / 中华急诊医学杂志

Objective To investigate the epidemiological characteristics of traumatic cervical spinal cord injury (TCSCI) in ICU.Method The data of patients with TCSCI admitted from October 2010 to March 2016 in the intensive care unit were retrospectively studied.The general epidemiological data included:gender,age,marital status,occupation,cause of injury,injury severity,injured segment (ASIA grade),and complications were collected.Results There were 109 patients identified to have TCSCI with mean age of 53.72 ± 14.86 years (25.69％ patients in the range of 60-69 years old).The male to female ratio was 9:1,and the most were married.The majority of individuals were retired (30.27％),and the main causes of injury were traffic accidents and tumble.The C5 segment of the spine was the most vulnerable to be injured,and then the C4 segment was the nest in turn.There were up to 30.28％ patients suffered from multiple injuries,and 26.61％ patients also had a craniocerebral injury.Bedsore and respiratory system complications were the two leading complications,and 83 patients suffered from at least one system dysfunction with respiratory dysfunction accounted for 98.79％ and circulatory dysfunction accounted for 65.06％.Fifty-one patients presented more than two system dysfunctions (46.79％).Twenty patients (18.35％) died.Conclusion Patients with TCSCI in ICU presented specially characteristic features.Traffic accidents were the main cause of TCSCI,and fall accidents were one of the main causes in the elderly.The mortality of TCSCI was high,especially in males.The complication rate was relatively high and the most common complications were water and electrolyte disturbance and respiratory dysfunction.Multiple organ dysfunction incidences might be associated with the ASIA grades.

The protective effect of PI3K/AKt/GSK3β signaling pathway on brain during resuscitation with neck cooling / 中华急诊医学杂志

Objective To study the changes of PI3K/Akt/GSK3β signaling pathway during resuscitation with neck cooling in order to explore the relationship between the protective effect of neck cooling and the phosphorylation of PI3K/Akt and GSK3β.Methods Thirty rabbits were randomly(random number) divided into five groups, and models of cadiac arrest were induced by ventricular fibrillation(VF, the positive electrode in the right ventricle and negative pole on the apex of heart) for 4 min.In sham group,a electrode was placed into right ventricle without electric current conducted, and CA was not induced.The rabbits were sacrificed and specimens were taken at 24 hours after modeling.In normothermia treat group(NT group),resuscitation was carried out to restoration of spontaneous circulation(ROSC),and the rabbits were sacrificed and specimens were taken at 24 hours after modeling.In intra-arrest therapeutic hypothermia group (IATH group), rapid neck cooling was initiated at the same time with CPR,and the target brain temperature was set at 34 ℃ maintained for 4 hours after ROSC.Rabbits were sacrificed and specimens were taken at 24 hours after modeling.In recovery period cooling + LY294002 group(PATH+LY294002 group), LY294002 was injected intra-ventricularly at 20 minutes before resuscitation.Rapid neck cooling was started at the same time with CPR,and the target brain temperature was set at 34 ℃ maintained for 4 hours after ROSC.The rabbits were sacrificed and specimens were taken at 24 hours after modeling.In post-arrest therapeutic hypothermia group (PATH group), rapid neck cooling was begun after CPR for 1 hour,and the target brain temperature was set at 34 ℃ maintained for 4 hours after ROSC.The rabbits were sacrificed and specimens were taken at 24 hours after modeling.Animals were sacrificed by using overdose anesthetic drug.Western blot was used to detect the level of Akt p-Akt GSK-3β p-GSK-3β (ser9) protein, and TUNEL was used to observe apoptosis of tissues in each group.Multiple comparisons were performed with one-way analysis of variance (ANOVA).Results Compared with Sham group, Akt (Thr-308) phosphorylation (P-AKT) and P-GSK-3β levels in the brain neuron cytoplasm in 24 hours after CPR resuscitation in NT group was significantly reduced, and showed a gradual reduction trend (P<0.05);the P-AKT and P-GSK-3β levels in the brain neuron cytoplasm in 24 hours after CPR resuscitation in IATH group were significantly enhanced compared with NT group (P<0.05);the levels of these two kinds of protein at one hour after resuscitation in PATH group were significantly enhanced compared with NT group (P<0.05), but lower in IATH group.Intra-ventricularly injection of LY294002 made the effect of hypothermia lost, indicating that LY294002 inhibited the phosphorylation of Akt.Apoptosis cells were significantly reduced in IATH group and normothermia theatment group compared with PATH group and LY294002 group(P<0.05).Conclusions Neck cooling can reduce apoptosis in rabbit brain cells after recovery, and the protective effect on brain is best in intra-arrest therapeutic hypothermia group.LY294002 specifically block the PI3K/Akt pathway, and the protective effect of cooling on the brain can be abolished,indicating hypothermia protects the neurological function via activation of PI3K/Akt pathway.Neck cooling protects the neurological function by activating PI3K/Akt/GSK-3β, promoting the Akt activation, and increasing the expression of P-GSK3β.Specific Akt inhibitor LY294002 inhibits Akt phosphorylation of brain tissue recovery and further inhibit the phosphorylation of GSK-3β, thus abolishing protective effect of cooling on neurological function.

A study on effect of vaporized perfluorocarbon combined with exogenous surfactant inhalation on rabbit models of acute lung injury / 中国中西医结合急救杂志

Objective To observe the effects of vaporized perfluorocarbon (PFC) combined with exogenous pulmonary surfactant (PS) inhalation on rabbit models of acute lung injury (ALI).Methods Thirty-two New Zealand rabbits were randomly divided into four groups: ALI group, combination treatment group, PFC group, and PS group (each groupn = 8 rabbits). The rabbit model of ALI was induced by the whole lung normal saline lavage. After modeling, in the combined group, 3 mL/kg vaporized perfluorooctyl bromide/dipalmitoylphosphatidylcholine (PFOB/DPPC) emulsion was inhaled, the rabbits in PFC and PS groups were treated with vaporized PFOB emulsion and vaporized DPPC emulsion 3 mL/kg inhalation respectively, and in the ALI group was given the same amount of vaporized normal saline inhalation. In each group, before modeling for 30 minutes (basic value), after modeling for 1 hour and after treatment at 0 minute, 30 minutes, 2 hours, 4 hours, the respiratory rate (RR), oxygenation index (OI), dynamic lung compliance (Cdyn) were observed, and the lung coefficient (LI) and lung permeability index (LPI) were calculated; the levels of serum tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) were measured by double antibody sandwich enzyme-linked immunosorbent assay (ELISA); the lung tissue was collected and the lung pathological changes were observed under macroscopic and microscopic observation.Results Aftermodeling, the levels of OI, Cdyn were quickly lowered, RR became significantly elevated, and there were obvious edema, hemorrhage and exudation in lung tissue of ALI group. The levels of OI were significantly increased in combined group and PFC group compared with the level in ALI group after treatment at 0 minute initially [mmHg (1 mmHg = 0.133 kPa): 231.0±16.7, 221.4±19.0 vs. 189.5±21.0, both P < 0.05], while the level of OI in PS group was increased significantly until 4 hours after treatment, being higher than that in ALI group (mmHg: 297.0±20.7 vs. 243.3±36.7,P < 0.05); RR was decreased significantly in combined treatment group at 30 minutes after treatment compared with that in ALI group (bpm: 151.1±13.3 vs. 178.5±32.0,P < 0.05), while the RR in PFC group and PS group were not increased significantly until 4 hours after treatment being higher than that in ALI group (bpm: 129.3±14.3, 133.1±13.9 vs. 157.5±32.5, bothP < 0.05). Compared to ALI group, the three treatment groups resulted in significant improvement in Cdyn right at 0 minute (mL/cmH2O: 1.64±0.10, 1.45±0.10, 1.43±0.09 vs. 0.57±0.05, allP < 0.05), their LPI, LI and inflammatory cytokines were significantly decreased [LPI (×10-5): 4.21±0.42, 4.76±0.55, 4.87±0.49 vs. 5.56±0.52, LI: 8.04±0.58, 8.90±0.88, 9.22±0.71 vs. 10.85±0.73, TNF-α (ng/L): 50.05±4.91, 56.18±5.54, 63.60±5.96 vs. 73.60±5.27, IL-1β (ng/L): 34.27±4.55, 40.29±5.03, 48.13±6.38 vs. 54.71±4.26, allP<0.05], and pulmonary edema, congestion and inflammatory cell infiltration were obviously ameliorated (pathological scores: 3.74±0.58, 4.50±0.75, 5.29±0.72 vs. 6.13±0.72, P < 0.05). Cdyn levels were increased significantly in combined treatment group at 0 minute, 30 minutes, 4 hours after treatment compared with thosein PFC and PS group, but there were no significant differences between PFC and PS group. Levels of LI, LPI, inflammatory factors and pathological scores were decreased significantly in combined treatment group compared with those in PFC and PS group, the degrees of improvement of inflammatory factors and pathological scores in PFC group were more obvious than those in PS group (allP < 0.05).Conclusions PFOB combined with DPPC inhalation can provide greater oxygen delivery, reduce the pro-inflammatory cytokines, supplement PS and influence its distribution on the surface of lung, which might lead to a marked and sustained improvement in oxygenation, pulmonary function and amelioration of lung edema and inflammatory reaction in saline lavage induced lung injury of rabbits.

The physiological responses of healthy youth to doing chest compression as a feedback of the quality and intervention effects of CPR after their rapid ascent to high altitude / 中华急诊医学杂志

Objective To investigate the physiological responses of healthy youth to doing chest compression as a feedback of quality of CPR after their rapid ascent to high altitude and to evaluate the feedback in the intervention effects of CPR.Methods Prospective,single sample,before-after comparison method was used in this study.Fifteen young adults from plains natives were enrolled as trial subjects in this study.All of them received basic life support training course in advance.In Chongqing (259 m above sea level),subjects performed empiric chest compressions on the model body for 4 minutes followed by feedback compressions for 4 minutes after at least 30 minutes rest.Compression depth,rate and other compression quality parameters were measured and recorded at each turn of compressions with an AED PLUS device.Subjects performed empiric compressions based on their knowledge and experiences,and practiced feedback compressions according to the audiovisual guidance of AED PLUS device.Blood pressure,heart rate and SpO2 were taken before and after each turn of compressions.One week after arrival to Lhasa (3658 m above sea level) by flight,all subjects were asked to do the same procedure as did in Chongqing to see their physiological response to.Paired t tests or Wilcoxon matched pair rank test were used for comparisons of measurements before and after trials.Results Systolic pressures,diastolic pressures,heart rates at baseline in Lhasa were significant different from those in Chongqing,including systolic pressure (125.9 ±9.5) mmHg vs.(112.7 ±13.4) mmHg,diastolic pressure (75.3 ±7.7) mmHg vs.(64.2 ±7.3) mmHg,heart rate (86.3 ± 13.0) beat/min vs.(72.7 ± 11.6) beat/min,SpO2 (90.4 ± 1.7)％ vs.(97.8 ±0.9)％,all P ＜ 0.01.In Lhasa,empiric compressions only caused an increase in heart rate (91.1 ± 14.9) beat/min vs.(86.3 ± 13.0) beat/min,P ＜ 0.01.However,feedback compressions resulted in a significant decrease in SpO2 [(88.3 ± 3.4) ％ vs.(90.6 ± 1.9) ％,P ＜ 0.01] as well as change of systolic pressure [(130.9 ± 11.7) mmHg vs.(120.1 ± 11.9) mmHg,P ＜0.05] and heart rate [(87.9 ± 17.5) beat/min vs.(80.9 ± 11.7) beat/min,P ＜0.05].In Lhasa,the compression quality during feedback compressions was closer to guideline recommendation than that during empiric compressions.The median (interquartile range) of composite qualification rate was 43.6％ (55.9％) vs.0.6％ (5.3％) during feedback compressions and empiric compressions respectively,P ＜ 0.01.Conclusions Compression quality decreased significantly among youth after rapid ascent to high altitude.Feedback techniques for CPR could effectively guide the rescuer to improve their CPR quality,but it may be at the expense of more physical consumption.

Advances in rabbit models of cardiac arrest-cardiopulmonary resuscitation / 中华危重病急救医学

The successful establishment of animal models of cardiac arrest-cardiopulmonary resuscitation (CA-CPR) undoubtedly provided an important basis for exploring the method of cardiopulmonary resuscitation (CPR) and advanced cardiovascular life support (ACLS). However, pathophysiology varied with the etiology of cardiac arrest (CA). Therefore, preparation of similar animal models according to etiology was the basis for pathophysiological changes research. Compared with other animals, the rabbits had both the advantages of large and small animals, so they became common research object for the CA-CPR model. This paper reviewed the common methods of animal models of CA-CPR in rabbits. In this review, the methods, criteria, advantages, disadvantages and precautions of each model were analyzed, which would provide useful reference for CPR researchers.

CD4 + CD25 + T regulatory cells in predicting the prognoses of patients with sepsis / 中华急诊医学杂志

Objective We aimed to evaluate the role of CD4 + CD25 + T regulatory cells in predicting the prognoses of patients with sepsis.Methods Patients with sepsis in Shanghai Changzheng Hospital from December 2013 to April 2014 were identified and grouped into survival group (SG,n =19) and death group (DG,n =9) in accordance with their clinical outcomes.CD4 + CD25 +T regulatory cell ratio,C-replication protein,bilirubin,procalcitonin,and coagulation function were tested on the 1st day and 7th day,and APACHE Ⅱ and SOFA were analyzed to assess the predictability of this group of cells.Results Twentyeight patients were identified,with a mean age of (60.36 ± 15.30) years,a mean APACHE Ⅱ score of (16.68±7.00),and a mean SOFA score of (7.18 ±3.78).Twelve (42.9％) of the individuals were accompanied with severe multiple trauma,and 10 (35.7％) were in septic shock,and 9 (32.2％) died of severe sepsis.The first day CD4 + CD25 + T regulatory cell ratios on the first day were 2.10％ (0.80,3.10)％ (SG) vs.1.80％ (1.15,3.65)％ (DG) (Z=-0.148,P=0.883),andonday7 were 0.90％ (0.30,2.80)％ (SG) vs.5.70％ (2.60,8.30)％ (DG) (Z=-2.905,P=0.004) presented significant predictability.Conclusions Dynamic monitoring of CD4 + CD25 + T regulatory cells could predict the prognoses of patients with sepsis and should be generalized in clinical emergency practice.

Correlation of red cell distribution width with prognosis in patients with severe traumatic brain injury / 中华创伤杂志

Objective To investigate the correlation between red cell distribution width RDW) and prognosis in patients with severe traumatic brain injury.Methods A total of 264 consecutive patients with severe traumatic brain injury admitted from May 2012 to November 2014 were enrolled.The patients were divided into low-RDW group (RDW ＜ 15％,n =198) and high-RDW group (RDW ≥ 15％,n =66) based on their RDW levels.Between-group differences were evaluated on general conditions,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ),inflammatory markers [high sensitivity C-reactive proteins(hs-CRP) and arterial lactate],liver/renal dysfunction,and 28-day mortality.Spearman correlation analysis of RDW with mortality was conducted.Independent factors of 28-day mortality were identified using multivariate Logistic regression.Kaplan-Meier 28-day survival curve was analyzed and survival probability of the two groups was compared using Log-Rank test.Results The 28-day mortality was significantly enhanced in high-RDW group compared to that in lowRDW group (43.9％ vs 26.8％,P ＜ 0.01).RDW ≥ 15％ related positively to APACHE Ⅱ and mortality(r =0.172 and 0.253 respectively,P ＜ 0.01),but negatively to Glagow coma score (GCS) (r =-0.169,P ＜0.01).RDW≥ 15％ was the independent risk factor for predicting the 28-day mortality (OR =2.144,95％ CI 1.202-3.826,P ＜0.01).After adjusted gender,age,and other relative factors,RDW≥15％ was still strongly correlated with the 28-day mortality(OR =2.244,95％ CI 1.076-4.678,P ＜ 0.05).Significantly lower 28-day survival rate was found in high-RDW group than in low-RDW group (P ＜ 0.01).Conclusions RDW level rises beyond the normal range on admission in patients with severe traumatic brain injury,which is closely correlated with the 28-day poor outcome.RDW≥ 15％ has significant predictive value in the prognosis.

Comparison of Charlson's weighted index of comorbidities with the chronic health score for the prediction of mortality in septic patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Comorbidity is one of the most important determinants of short-term and long-term outcomes in septic patients. Charlson's weighted index of comorbidities (WIC) and the chronic health score (CHS), which is a component of the acute physiology and chronic health evaluation (APACHE) II, are two frequently-used measures of comorbidity. In this study, we assess the performance of WIC and CHS in predicting the hospital mortality of intensive care unit (ICU) patients with sepsis.</p><p><b>METHODS</b>A total of 338 adult patients with sepsis were admitted to a multisystem ICU between October 2010 and August 2012. Clinical data were collected, including age, gender, underlying diseases, key predisposing causes, severity-of-sepsis, and hospital mortality. The APACHE II, CHS, acute physiology score (APS), sequential organ failure assessment (SOFA) and WIC scores were assessed within the first 24 hours of admission. Univariate and multiple Logistic regression analyses were used to compare the performance of WIC and CHS. The area under the receiver operating characteristic curve (AUC) was used to predict hospital mortality over classes of risk.</p><p><b>RESULTS</b>Of all the enrolled patients, 224 patients survived and 114 patients died. The surviving patients had significantly lower WIC, CHS, APACHE II, and SOFA scores than the non-surviving patients (P < 0.05). Combining WIC or CHS with other administrative data showed that the hospital mortality was significantly associated with age, severe sepsis, key predisposing causes such as pneumonia, a history of underlying diseases such as hypertension and congestive cardiac failure, and WIC, CHS and APS scores (P < 0.05). The AUC for the hospital mortality were 0.564 (95% confidence interval (CI) 0.496-0.631) of CHS, 0.663 (95% CI 0.599-0.727) of WIC, 0.770 (95% CI 0.718-0.822) of APACHE II, 0.856 (95% CI 0.815-0.897) of the CHS combined with other administrative data, and 0.857 (95% CI 0.817-0.897) of the WIC combined with other administrative data. The diagnostic value of WIC was better than that of CHS (P = 0.0015).</p><p><b>CONCLUSIONS</b>The WIC and CHS scores might be independent determinants for hospital mortality among ICU patients with sepsis. WIC might be an even better predictor of the mortality of septic patients with comorbidities than CHS.</p>

Combination of Weighted index of comorbidities and sepsis-related organ failure assessment score in death risk evaluation of septic patients / 中华危重病急救医学

Objective To predict the risk of 28-day mortality in septic patients in intensive care unit (ICU) with the combination of Weighted index of comorbidities (WIC) and sepsis-related organ failure assessment (SOFA) score.Methods The clinical data of adult severe sepsis/septic shock patients in Department of Emergency Medicine of Changzheng Hospital and Department of Critical Care Medicine of Jinan Military General Hospital from October 2011 to February 2013 were analyzed retrospectively.The etiological factor,past history,having severe sepsis or not were recorded.Age score,WIC score,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and SOFA score were calculated at or 24 hours after admission.The logistic regression was used and the receiver operating characteristic curve (ROC curve) was drawn to calculate the patients' outcome.Results In 310 enrolled patients,223 (71.9％) patients survived and 87 (28.1％) died.Univariate analysis showed that the P values of the age score,WIC score,APACHE Ⅱ score and SOFA score,chronic cardiac insufficiency,type 2 diabetes,cerebrovascular disease,tumor,multiple injury,pulmonary infection and having severe sepsis or not were all less than 0.2.The above 11 variables were put into the multivariate logistic regression equation 1,of which predicted probability was reserved.It revealed that 5 variables were independently associated with 28-day prognosis,of which influence power in descending order were SOFA score [odds ratio (OR) =1.308,95％ confidence interval (95％ CI):1.158-1.478,P=0.000],having severe sepsis or not (OR =0.206,95％ CI:0.100-0.424,P=0.000),APACHE Ⅱ score (OR =1.090,95％CI:1.021-1.164,P=0.010),WICscore (OR=1.441,95％CI:1.067-1.947,P=0.017),agescore (OR=1.228,95％CI:1.027-1.468,P=0).024),the Walswere 18.554,18.369,6.725,5.662,5.067,respectively.The 3 variables,age score,WIC score and SOFA score,were brought into the multivariate logistic regression equation 2,of which predicted probability was reserved too.It revealed that age score (OR=1.330,95％CI:1.145-1.546,P=0.000),WIC score (OR =1.496,95％ CI:1.145-1.546,P=0.000) and SOFA score (OR =1.429,95％ CI:1.303-1.567,P=0.000),were independently associated with the septic patients' 28-day prognosis.There was no significant difference in the area under receiver operating characteristic curve (AUC) between the SOFA score and APACHE Ⅱ score (0.784 vs.0.780,Z=0.014,P=0.989).However,compared with APACHE Ⅱ score,the AUC of equation 1 (0.888) and 2 (0.851) were much more (Z=4.333,P=0.000; Z=2.669,P=0.008).Conclusion The sensitivity of 28-day prognosis by WIC score was improved greatly with the combination of SOFA score and age score.

Weighted index of comorbidities evaluates the impact of underlying diseases on hospital mortality of pneumonia patients / 中华急诊医学杂志

Objective To estimate the validity of Charlson' s weighted index of comorbidities (WIC) used to predicting 28-day mortality among ICU pneumonia patients with underlying diseases.Methods Aretrospective analysis of 160 adult patients with pneumonia admitted to a multi-discipline ICU of Shanghai Changzheng hospital between October 2010 and February 2012 was carried out.Clinical data were collected including age,gender,community acquired pneumonia (CAP) or hospital acquired pneumonia (HAP),underlying diseases,severity-of-sepsis,and 28-day mortality.WIC scores,acute physiology and chronic health evaluation (APACHE) Ⅱ,and sepsis related organ failure assessment (SOFA) were assessed within the first 24 hours after admission.Logistic regression analyses were used to evaluate the predictors for outcome.The receiver operating characteristic curve (ROC) was used to compare the performance of these scores between different methods.Results Of 160 enrolled patients,76 (48.8％) were CAP,82 (51.2％) HAP,and 106 (66.3％) male,54 (33.7％) female,and 99 (61.9％) patients survived and 61 (38.1％) died.The average age was (62.4 ± 17.3) years old.Compared with survivors,WIC,APACHE Ⅱ and SOFA scores were significantly higher in death group (P ＜ 0.05).The multivariate logistic regression revealed that risk of death depends predominantly on age (OR =1.049,95％ CI:1.011-1.088,P =0.011),WIC (OR =1.725,95％ CI:1.194-2.492,P =0.004),APACHE Ⅱ score (OR =1.175,95％CI:1.058-1.305,P =0.003),SOFA score (OR =1.277,95％ CI:1.048-1.556,P =0.015),presence of ARDS (OR =0.081,95％ CI:0.008-0.829,P =0.034),and complicated with severe sepsis (OR =0.149,95％ CI:0.232-0.622,P =0.004).The area under the receiver operating characteristics curve in predicting mortality was 0.639 (0.547-0.730) for the WIC,0.782 (0.709-0.856) for APACHE Ⅱ score,0.79 (0.714-0.866) for SOFA score and 0.842 (0.777-0.907) for the merger of three.Conclusions In pneumonia patients of ICU,WIC is a useful approach to predicting 28-day mortality,and the risk of death significantly depends on co-morbidities.

Eearly diagnostic value of urinary NGAL in acute kidney injury in critically ill patients / 中华急诊医学杂志

Objective To estimate the predictive value of neutrophil gelatinase-associated lipocalin in urine (uNGAL) for detection of acute kidney injury (AKI) in the intensive care unit (ICU) critically ill patients.Methods A total of 110 patients from the ICU of three general hospitals were enrolled in the study.The patients were adults more than 18 years of age.After admitted to ICU,the patients were continuously observed for 72 hours.According to the RIFLE criteria for diagnosis of AKI,the patients were classified as AKI group (33 cases) or non-AKI (77 cases).According to the sepsis diagnostic criteria,the patients were classified as sepsis (79 cases) or non-sepsis (31 cases).Exclusion criteria of patients were chronic renal insufficiency,malignant tumor,death after admitted to ICU 24 hours.Serum creatinine and uNGAL of the patients were analyzed daily.The difference of uNGAL between sepsis and non-sepsis patients,AKI and non-AKI patients,sepsis non-AKI and sepsis AKI patients was compared.Moreover,the difference of serum creatinine and uNGAL between AKI and non-AKI patients into ICU 24 h was compared,and the sensitivity and specificity of uNGAL and serum creatinine for diagnosis of AKI in the ICU patients were evaluated using ROC curve.Results The uNGAL levels were all significantly different between sepsis and non-septis patients,AKI and non-AKI patients,sepsis concomitant AKI and sepsis without AKI patients.The uNGAL levels were significantly different between AKI and non-AKI patients in ICU for the first 24 h,while the difference of serum creatinine were not significant.The area under receiver operating characteristic (ROC) curve of uNGAL and serum creatinine of patients in ICU for the first 24 h were 0.828 (95％ CI:O.742-0.914) and 0.583 (95％ CI:0.471-0.695),respectively.The cutoff value of uNGAL was 170 ng/ml,and the sensitivity and specificity were 0.778 and 0.784,respectively.The sensitivity was superior to serum creatinine.Conclusions uNGAL was superior to serum creatinine in the diagnosis of AKI,and could be used as a marker of the early diagnosis of AKI.

Diagnostic value of serum tissue inhibitor of metalloproteinase in severe sepsis patients with disseminated intravascular coagulation / 中华急诊医学杂志

Objective To examine the levels of serum tissue inhibitor of metalloproteinase in severe sepsis patients with disseminated intra-vascular coagulation (DIC) and evaluate its diagnostic value in severe sepsis with DIC.Methods Sixty patients were divided into 3 groups,namely severe sepsis group (SS group,n =28),severe sepsis with DIC group (SSD group,n =12) and normal group (n =20).Clinical data including APACHE Ⅱ score and DIC score of these patients were collected.Serum levels of TIMP-1 and TIMP-2 of these patients were measured by using ELISA.Results The patients of SS group had higher levels of TIMP-1 (723.74 ± 96.27) and lower levels of TIMP-2 (68.08 ± 14.87) than healthy control subjects (TIMP-1:574.24 ± 79.99,TIMP-2:89.99 ± 18.45) (P ＜ 0.05).The patients of SSD group had higher levels of TIMP-1 (907.56 ± 200.20) and lower levels of TIMP-2 (44.84 ± 22.13) than patients of SS group (P ＜ 0.05).An association was found between TIMP-1 and fibrinogen (FIB) (r =-0.392,P ＜ 0.05),TIMP-1 and D-dimer (r =0.407,P ＜ 0.05),TIMP-2 and PLT (r =0.484,P ＜0.01),TIMP-2 and PCT (r=-0.523,P＜0.01),TIMP-2 and DIC score (r=-0.579,P＜0.01).The areas under the curves (AUC) for TIMP-1/TIMP-2 was 0.896 (95％ CI:0.843 ～ 0.950 (P ＜ 0.05).Conclusions Serum levels of TIMP-1 in patients with severe sepsis complicated with DIC increased and TIMP-2 decreased,suggesting they were valuable in diagnosis of severe sepsis complicated with DIC.

Risk factors and drug resistance of enterobacter cloacae infection in ICU / 中国基层医药

Objective To study the antimicrobial susceptiblity,clinical and bacteriological characteristics of enterobacter cloacae infection in ICU. Methods 83 cases of ICU infected with enterobacter cloacae were analyzed retrospectively. Results The elderly, hypoproteinemia,invasive operation,long-term hospitalization and the abuse of broad-spectrum antibiotics were the risk factors of infection with enterobacter cloacae. Besides highly sensitive to imipenem, the bacterium was resistant to most antibiotics, many of whose drug resistance ratio is over 50%. Conclusion The patients in ICU should be avoided the long-term abuse of broad-spectrum antibiotics and invasive operation.Bacterial culture and antibiotic susceptibility test should be carried out promptly. They could reduce the incidence of enterobacter cloacae infection.

Role of the permeability transition pore in cytochrome C release from mitochondria in rats brain after resuscitation from cardiac arrest / 中华急诊医学杂志

Objective To analyse the relationship between cytochrome C release and the opening degree of the permeability transition pore (PTP) during in post cardiopulmonary resuscitation(CPR) rats. Method Adult male Sprague Dawley (SD)rats were randomly (random number ) divided into a surgical sham group (no CA/CPR) ( n = 8) and CA/CPR group ( n = 48). Animals in CA/CPR group was induced by asphyxiation and icecold 0.5 mmol/L KCI and killed by decapitation and processed for isolation of brain cortex mitochondria at 3 h,6 h,12 h,24 h,48 h,72 h after restoration of spontaneous circulation (ROSC). MPTP opening degree was based on the absorbance changes of the mitochondrial suspension at 540 nm. Western blot analysed the release of CytC from mitochondrial to cytoplast. Results Neural cells MPTP always remained opening post ROSC. The opening degree of MPTP was not reaching the peak instantly. While its' change depended on time: remaining low level within 6 h post ROSC,then rapidly opening, till 12 h reaching the largest degree,and at 24 h post ROSC slightly shrunken. All these suggested that mitochondria started to shink. While at 48 h the opening degree largen again, shrunken once more at 72 h,but not reaching the normal level ( P ＜ 0.05 or P ＜ 0.01). Cytochrome C could not be detected in the cytosol in the earlier phases of the sham-operated brain samples but appeared in the mitochondria.The amount of cytochrome C released was proportional after restoration of spontaneous circulation 3 h and 24 h,failed to detect the enzyme in the mitochondria fraction. Conclusions We draw the conclusion MPTP plays a key role in neurocyte apoptosis after CA/CPR, which leads to mitochondria release CytC.