Clinical characteristics and influencing factors for mortality of patients with intra-abdominal candidiasis: a multicenter retrospective study / 中华消化外科杂志

Objective:To investigate the clinical characteristics and influencing factors of mortality in patients with intra-abdominal candidiasis (IAC).Methods:The retrospective case-control study was conducted. The clinicopathological data of 203 IAC patients who were admitted to 7 medical centers from June 2018 to June 2020 were collected, including 54 cases in Sir Run Run Shaw Hospital of Zhejiang University School of Medicine, 31 cases in Fujian Medical University Union Hospital, 25 cases in Beijing Hospital, 25 cases in the First Affiliated Hospital of Xi'an Jiaotong University, 24 cases in China-Japan Friendship Hospital, 22 cases in General Hospital of Eastern Theater Command of Chinese PLA and 22 cases in Chongqing University Cancer Hospital. There were 130 males and 73 females, aged (64±15)years. Observation indicators: (1) candida infection and treatment of IAC patients; (2) analysis of influencing factors for mortality of IAC patients. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Univariate and multivariate analyses were performed by Logistic regression model. Results:(1) Candida infection and treatment of IAC patients: 134 cases of candida albicans were cultured in the initial abdominal drainage fluid or intraoperative abdominal specimens of 203 patients, and 49 cases were treated with fluconazole. Of 69 cases infected with non candida albicans, 13 cases were treated with fluconazole. The resistance rate of candida albicans to fluconazole was 5.91%(12/203). Of 203 patients, there were 68 cases with infections shock, 53 cases with renal failure, 84 cases with respiratory failure and 63 cases with multiple organ failure, respectively. There were 148 of 203 patients admitted to intensive care unit for 9 days(range, 3-20 days), and the total hospital stay was 28 days(range, 17-50 days). Of 203 patients, 86 cases were cured and discharged, 50 cases were improved and transferred to local hospitals, 32 cases gave up treatment and discharged automatically, 19 cases died, 16 cases had no follow-up data. The mortality was 25.12%(51/203). (2) Analysis of influencing factors for mortality of IAC patients. Results of univariate analysis showed that acute physiology and chronic health evaluation score, sequential organ failure assessment score, the Cr, bilirubin, albumin, procalcitonin, and PLT on the first day of candida positive culture, of the lowest value in a week and the highest in a week, heart disease, diabetes, infections shock, renal failure, respiratory failure, multiple organ failure, anti-fungal therapy were the related factors for mortality of IAC patients ( t=-2.322, Z=-2.550, -2.262, -4.361, t=2.085, Z=-3.734, -5.226, -2.394, -5.542, t=3.462, Z=-4.957, -5.632, 3.670, -5.805, t=3.966, Z=-3.734, -5.727, χ2=4.071, 4.638, 27.353, 18.818, 13.199, 26.251, 13.388, P<0.05). Multivariate analysis showed that the bilirubin, procalcitonin on the first day of candida positive culture and infections shock were independent risk factors for mortality of IAC patients ( odds ratio=1.021, 1.022, 6.864, 95% confidence interval as 1.010-1.033, 1.001-1.044, 1.858-25.353, P<0.05). Conclusions:The common fungus of IAC was candida albicans, and fluconazole can be used as the initial empirical treatment. The prognosis of patients with abdominal candidiasis is poor. Bilirubin, procalcitonin on the first day of candida positive culture and infections shock are indepen-dent risk factors for mortality of IAC patients.

Clinical characteristics of elderly patients with coronavirus disease 2019 / 中华老年医学杂志

Objective:To investigate the clinical characteristics of elderly patients with coronavirus disease 2019(COVID-19), in order to provide scientific evidence for the diagnosis and treatment of COVID-19 in elderly patients.Methods:Clinical data of 102 patients with COVID-19 admitted to the B11 East Ward of the Zhongfaxincheng campus and the E1-3 ward of the Guanggu Campus of Tongji Hospital affiliated to Huazhong University of Science and Technology in Wuhan from 1 February 2020 to 28 February 2020 were retrospectively collected and analyzed.Patients were categorized into 2 groups: the elderly group(≥60 years old)and the young and middle-aged group(<60 years old). Differences in epidemiological features, demographics, clinical symptoms, laboratory results and imaging findings between the two groups were retrospectively analyzed.Results:Among 102 patients with COVID-19, 58 were in the elderly group(≥60 years old), with a median age of 67.0(63.8, 71.0)years old, and 44 in the young and middle-aged group(<60 years old), with a median age of 47.5(38.0, 51.8)years old.There was no significant difference in gender ratio between the two groups( χ2=0.033, P=0.855). Of 102 patients, 42.0%(21/50)had close contact with an infected person, 14.0%(7/50)were from infection clusters, and 18.0%(9/50)had suspected hospital-acquired infections.Fever and cough remained the most common symptoms, but gastrointestinal symptoms such as nausea, poor appetite, diarrhea and muscle cramps were also warning signs.Fatigue and cough were the most common presenting symptoms in elderly male patients.Bilateral patchy infiltrates(57.9%, 22/38)and ground-glass opacities(42.1%, 16/38)were the main imaging features and 42.1%(16/38)patients had multiple areas of the lungs involved.Over 50% patients had increased levels of blood glucose, D-dimer, fibrinogen, C-reactive protein, procalcitonin, multiple cytokines and neutrophil-to-lymphocyte ratio, as well as decreased levels of albumin, hemoglobin, hematocrit, lymphocytes and serum calcium.Compared with the young and middle-aged group, the elderly group had higher rates of abnormality in levels of D-dimer and serum calcium( χ2=7.067 and 4.166, P=0.008 and 0.041). Conclusions:Fever and cough are the most common symptoms in elderly patients with COVID-19.Elderly patients with COVID-19 have multiple abnormalities in clinical laboratory test results, which show a certain level of specificity compared with young and middle-aged patients.

Metabolic characteristics of critically ill patients and nutrition support strategy / 中华消化外科杂志

Nutrition support is an important part of comprehensive treatment strategy for critically ill patients. After long-term scientific research and practice, great progress has been made in theoretical cognition and clinical application. The authors summarize the metabolic charac-teristics and nutritional support strategies of critically ill patients based on their pathophysiological changes, in order to provide rational and theoretical basis for reasonable and effective nutrition support strategy in critically ill patients.

Nutritional therapy for severe acute pancreatitis: assessment, route and timing / 中华临床营养杂志

Nutritional support is one of the core issues in the treatment of severe acute pancreatitis (SAP). Recently, with continued advances in this field, more and more evidences were found in the strategies, methods and routes of nutritional support for patients with SAP. Meanwhile, with deeper understanding of pathogenesis and metabolic characteristics of severe patients in acute phase, we may have a better understanding in the strategies of nutritional support from the pathogenesis and pathophysiology aspects. In this paper, we discuss the hotspots and challenges over recent year in the nutritional support of SAP. We aim to give a clear insight into current progress and help to individualize the nutritional program.

The efficacy and safety of recombinant activated factor Ⅶ on uncontrolled perioperative hemorrhage in elderly patients / 中华老年医学杂志

Objective:To investigate the efficacy and safety of recombinant activated factor Ⅶ(rFⅦa)on uncontrolled perioperative hemorrhage in elderly patients in surgical intensive care unit(SICU).Methods:Clinical data of 27 elderly patients with uncontrolled perioperative hemorrhage treated successfully with rFⅦa in surgery-ICU of our hospital from May 2004 to December 2018 were retrospectively analyzed.And the application method and experience were summarized.Results:Of the 27 patients, 16 cases were cured, 11 cases died, and the total fatality rate was 40.74%(11/27). The bleeding stopped in 23 cases, four cases died of uncontrolled peri-operative hemorrhage, and the hemorrhage-caused fatality rate was 14.81%(4/27). Seven patients died of primary diseases after the control of bleeding, with a fatality rate of 25.93%(7/27 ). The thrombin time(TT), prothrombin time(PT), activated partial thromboplastin time(APTT)and international normalized ratio(INR)were reduced and the prothrombin activity(AT)was increased after versus before the application of rFⅦa( Z=-2.197, -3.180, -2.271, -2.803 and 2.756, P=0.028, 0.001, 0.023, 0.005 and 0.006, respectively). Conclusions:rFⅦa has a better effect on uncontrolled peri-operative hemorrhage in elderly patients, when traditional treatments are ineffective.

Effects of Levosimendan on haemodynamics in heart failure patients with low cardiac output / 中华老年医学杂志

Objective To investigate effects of Levosimendan on hemodynamics in heart failure patients with low cardiac output. Methods A total of 27 heart failure patients with low cardiac output were recruited in the surgical intensive care unit (SICU)of Beijing Hospital from July 2009 to May 2016. All patients were treated with continuous intravenous infusion of Levosimendan 12.5 mg within 24 h at a rate of 0.1~0.2 μg· kg -1·min-1. Hemodynamic variables were monitored by pulse-indicated continuous cardiac output(PICCO)at baseline ,24 h ,4 d and 7 d after infusion. Results There were no significant differences in systolic blood pressure(SBP) ,diastolic blood pressure(DBP) ,heart rate(HR)and global end diastolic volume index (GEDI)as comparing baseline with 24 h ,4 d and 7 d after infusion of levosimendan. The significant differences were found in central venous pressure (CVP) ,systemic vessel resistance index (SVRI) , extravascular lung water index (EVLWI ) among baseline versus 24 h ,4 d and 7 d after infusion of levosimendan[(8.34± 2.87)mmHg vs.(6.35± 2.31),(6.81± 2.03),(5.92± 2.23)mmHgforCVP ,(2 682.0 ± 388.9)dyn·s-1·cm -5·m-2vs. (2 170.0 ± 410.9) ,(2 062.0 ± 340.6 ) ,(1 960.0 ± 380.2 )dyn ·s-1·cm-5·m-2for SVRI ,(8.90 ± 2.45)ml/kg vs. (6.60 ± 2.66) ,(5.92 ± 2.88) ,(5.46 ± 2.52) ml/kg for EVLWI ,P=0.001 ,0.003 or＜0.01 ,respectively].As compared with hemodynamic variables at baseline ,brain natriuretic peptide levels were decreased ,and cardiac index ,cardiac function index and stroke volume index were increased at 24 h ,4 d and 7 d after infusion of Levosimendan (P＜0.01 ,0.05 or 0.01 , respectively ). Conclusions A single-dose intravenous infusion of Levosimendan can increase cardiac output and decrease systemic vascular resistance in heart failure patients with low cardiac output ,which maintain quite a long time.

Enhancement of T-type Ca2+ channel currents in dorsal root ganglia neurons by nesfatin-1 and possible mechanisms / 中华老年医学杂志

Objective To investigate the effect of nesfatin-1 (NSF-1) on T-type Ca2+ channel currents in adult mouse dorsal root ganglion (DRG) neurons and possible signal transduction mechanisms involved.Methods We measured the expression of melanocortin 4 receptors(MC4-R)in mouse DRG by using western blotting analysis.The whole-cell patch clamp technique was used to record the effects of NSF 1 on T-type Ca2+ channel currents in small DRG neurons and several ligands were experimented to further clarify relevant signaling pathways.Results MC4-Rs were abundantly expressed in DRG neurons.NSF-1 enhanced T-type calcium channel currents in a dose-dependent manner in small DRG neurons in mice.NSF-1 mediated increment of T-type calcium channel currents was blocked by the MC4-R antagonist HS024,phosphokinase C antagonists GF109203X,and chelerythrine chloride,while the blockade of phospohokinase A PKI 6-22 elicited no such effects.Conclusions NSF-1 can enhance T type calcium channel currents in small DRG neurons through an MC4-R-dependent PKC signaling pathway.

Treatment of early phase severe acute pancreatitis in intensive care units: a retrospective multicenter study / 中华肝胆外科杂志

Objective To analyse the experience and treatment of early phase severe acute pancreatitis (SAP) in intensive care units (ICU).Methods A multicenter retrospective study was done on patients with SAP treated in three major teaching hospitals (Beijing Hospital,Peking University First Hospital and Peking University Shenzhen Hospital) in China from Jan.2001 to Dec.2011.Results There were 188 patients who were enrolled in the study,including 121 males and 67 females.The age ranged from 19 to 104 (51.0±18.2) years.The mean APACHE Ⅱ score was (22.2±4.6).84.0％ of patients survived,the mortality was 10.1％ in the early phase and 5.9％ in the late phase.The most common systemic complications were acute renal injury (46.3 ％),acute respiratory distress syndrome (35.6％),and septic shock (17.6％).The local complication rate was 47.3％,which included acute peripancreatic fluid collections (32.8％),acute necrotic collection and walled-off necrosis (48.4 ％) and pseudocyst (18.8 ％).The conservative treatments included intensive care,fluid resuscitation,mechanical ventilation,continuous renal replacement therapy,antibiotics,glucose control,inhibition of pancreatic enzyme activity and secretion,and nutritional support.Surgical intervention included endoscopic retrospective cholangio-pancreatography and endoscopic sphincterectomy,B ultrasound or CT guided puncture and drainage,and surgical drainage and debridement of necrosis.Conclusions The early phase of SAP was characterized by systemic inflammatory response syndrome and multiple organ dysfunction syndrome which accounted for the first peak in mortality.Intensive care therapy and multi disciplinary comprehensive combined strategy were very important for these patients with systemic and local complications.ICU treatment in the early phase was preferred for patients with SAP.

Precise liver resection by intraoperative interventional intravascular segmental vessel balloon catheter occlusion / 中华肝胆外科杂志

Objective To evaluate the feasibility of precise hepatic segmentectomy or subsegmentectomy using intraoperative image-guided interventional intravascular segmental vessel balloon catheter occlusion of the segmental hepatic artery and portal vein.Methods 6 patients with liver resection carried out from 2011.3-2011.8 were retrospectively analyzed.Results The mean operating time was (270.83±21.31) min,the median of blood loss was 800 ml,the median of intraoperative transfusion volume was 450 ml.The tumors were mainly located in segments Ⅴ,Ⅵ,Ⅶ,Ⅷ.The mean diameter of tumor was (5.67±1.03) cm.Postoperative liver function in the first postoperative day showed the mean alanine aminotranferase (ALT) was (570.00±157.76) U/L,the mean aspirate aminotrarsferase (AST) was (410.00 ±189.94) U/L,and the mean total bilirubin (TBIL) was (10.83± 1.60) mmol/L.Liver function recovered to normal within 7 days.There was intestinal leakage and wound dehiscence in one patient,pleural and effusion in two patients.Conclusion Imageguided interventional intravascular segmental vessel balloon catheter occlusion was a safe and efficacious maneuver.This technique allowed hepatic segmentectomy or subsegmentectomy to be carried out,decreased intraoperative bleeding,and protected the function of the liver remnant.

Influence of continous veno-venous hemofiltration therapy on PiCCO monitering data / 中华老年医学杂志

Objective To explore the influence of continuous veno-venous hemofiltration (CVVH) therapy on cardiac index (CD, global end-diastolic volume index (GEDI) and extravascular lung water index (ELWI) monitored by Pulse-indicated continuous cardiac output (PiCCO). Methods The 12 critically ill patients with acute renal failure were selected consecutively from department of intensive care unit (ICU) in Beijing Hospital. The patients who received CVVH therapy were monitored by PiCCO plus device. The hemodynamic measurements were performed during the process and interruption of CVVH. Pared t-test was used to analyze the values of CI, GEDI and ELWI. Results A total of 48 groups of data from 12 patients were analyzed. There were no significant differences in CI [(4.75±0.93) L ? min(-1) · m(-2)vs. (4.69±0.89) L · min(-1) · m(-2)], GEDI [(780.60±109.30) ml/m2 vs. (784.75± 106.20) ml/m2] and ELWI CC11.61±3.45) ml/kg vs. (11.54±3.56) ml/kg] between the interruption and process of CVVH, as obtained by the pared t-test (all P>0.05). Conclusions The CVVH therapy has no effect on the accuracy and reliability of PiCCO measurement of CI, GEDI and ELWI.

Radiofrequeney ablation in treating unresectable liver cancer / 中国综合临床

Objective To investigate the effect of radiofrequency ablation (RFA) in treating unresectable liver caneer. Methods 43 patients(78 lesions) who suffered from unresectable liver cancer were treated with cool-tip RFA from May 2006 to November,2008 in our hospital. 26 cases were treated with RFA in laparotomy besides with reseet of lesion in 6 eases and with alinjection in 5 cases,while 17 eases were treated only with percutaneous RFA. Results All patients were diagnosed by CT and B-ultrasound or MRI,among whom 18 cases were confirmed with primary hepatic carcinoma, 12 eases experienced recurrence following resect of primary hepatic carcinoma and 13 eases developed metastatic carcinoma;Every patient was followed up with AFP, abdominal B-ultrasound, CT scans or MRI from 1 to 28 months after treatment (mean 13.6 months). Before procedure, AFP increased in 20 eases which recovered within 3 months of treatment. 2 cases were suspected having residual on CT scan ,6 cases were found with new masses on liver on CT scan, 1 case complicated with gastrointestinal fistula and then died of systemie metas-tasis 3 months later,1 ease died of postoperative bleeding and 1 died of bleeding and infection after reseet + RFA treatment,and 3 cases died of multi-metastasis during following up who survived on average of 6 months. Conclu-sions B-ultrasound -guided cool-tip circulation RFA is an effective and safe method in treating unresectable liver cancer.

The effect of octreotide on growth inhibition of subcutaneous implanted tumor with human gallbladder carcinoma in nude mice / 中国普通外科杂志

Objective To investigate the effect of octreotide on inhibition of growth of subcutaneously implantedtumor with human gall bladder cancer cells in nude mice,and to explore the mechanisms.Methods We established subcutaneous implanted tumor model in nude mice by using human gallbladder carcinomacell line GBC-SD.A total of 18 male nude mice bearing xenografts of the cell line were randomly divided into therapy and control groups,with 9 in each group.Octreotide was administered intraperitoneally at a dose of 100 ?g/(kg?d) to the therapy group and isovolumic normal saline was administered to the controlgroup for 6 weeks.All mice were put to death,and the weight and volume of the tumors were assayed.Flow cytometry was used to examine apoptosis of tumor cells.Immunohistochemical staining was used to examin the expression of p53,bcl-2,and Ki-67.Results The weight of implanted tumors in nude mice in the therapy group[(0.99?0.54)g] was lower than that in control group [(1.58?0.51)g,P