Progress and Prospect in Intensive Care and Treatment of Patients with Solid Tumors / 肿瘤防治研究

The incidence of cancer has remained high in recent years, and anti-tumor treatment methods are emerging. Cancer treatment has undergone significant changes, and the survival rate of patients with cancer has significantly improved. Various types of new anti-tumor treatments may not only treat and control tumor growth but also place patients in critical situations that require treatment by intensive care medical personnel. Patients with cancer are in critical condition mainly due to three reasons: severe cases caused by cancer diseases themselves, complications during the perioperative period, and accompanying diseases and hospital acquired diseases. In the new situation, we should consider patient characteristics, such as abnormal metabolism, abnormal coagulation system, and abnormal immune mechanism, to save them from serious illness. We need to comprehensively evaluate patients with cancer, emphasize the role of the Intensive Care Unit (ICU) treatment platform, and promote the treatment concept of planned transfer to ICU, to improve the success rate and efficiency of treatment. After transferring the patient out of the ICU, the planned follow-up anti-tumor treatment can still be continued as the endpoint of ICU treatment for critically ill patients with cancer. In the future, efforts will be devoted to establishing a discipline and talent echelon with distinctive characteristics of oncology critical care medicine and treating "the critical illness of cancer and the cancer of critical illness".

The option of critical patients with cancer for ICU / 中华肿瘤杂志

With the improvement of diagnosis and treatment, tumor has become a chronic disease, and an increasing number of older patients will live with tumors. This change has led to an increase in demand for intensive care unit (ICU) and a challenge to the traditional ICU treatment concept. The option of ICU consists of two parts. The first is the option for admission. Since classic predictors of mortality are no longer relevant, we suggest broadening the criteria for ICU admission. Patients during the first course of cancer therapies should be treated with a full-code status similar to that of other patients without malignancy. Patients whose clinical response to therapy was not available or undetermined should be allowed an ICU trial that consists of unlimited invasive support, including anti-cancer therapies such as ambulatory chemotherapy. Do everything that can be done to save the patients who might benefit from ICU treatment. The second is the option of therapeutic end point. An interdisciplinary meeting, including an ethics consultation, should be held after 3-6 days′ICU trial to make end-of-life decisions with relatives of patients if the SOFA score shows clinical deterioration with no available therapeutic options. The treatment goals should shift from curative or supportive therapies to end-of-life care. we could integrate hospice and palliative care with intensive care more effectively and efficiently. That would be the future of oncological ICUs.

Analysis of COL1A1 gene mutation in an ethnic Han Chinese family from Henan affected with osteogenesis imperfecta / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To identify potential mutation of COL1A1 gene in an ethnic Han Chinese family from Henan affected with osteogenesis imperfecta (OI).</p><p><b>METHODS</b>Peripheral blood samples were collected from all 11 members of the family and 50 healthy adults for the extraction of genomic DNA. All exons and introns of the COL1A1 gene were amplified by polymerase chain reaction and subjected to direct sequencing. Mutations found in the proband were analyzed through comparison with other members of the family, 50 healthy individuals and sequence from the GenBank.</p><p><b>RESULTS</b>Fifteen sequence variants were discovered, which included 1 missense mutation, 1 synonymous mutation and 13 intronic mutations. All of the 4 patients from the family were detected as having carried a novel heterozygous missense mutation (c.4193T>G, p.I1398S) in exon 50 of the COL1A1 gene. The father of the proband has carried the same mutation but had a normal phenotype. The same mutation was not found in other healthy members of the family.</p><p><b>CONCLUSION</b>The OI type of this family may have been autosomal dominant with incomplete penetrance or autosomal recessive associated with COL1A1 gene mutations.</p>

The value of differential time to positivity of blood cultures in diagnosis of catheter-related bloodstream ;infection in patients with solid tumors in intensive care unit / 中华危重病急救医学

Objective To determine the value of differential time to positivity ( DTTP ) of blood culture for the diagnosis of catheter-related bloodstream infection ( CRBSI ) in patients with solid tumors in intensive care unit ( ICU ). Methods A retrospective study was conducted. 615 pairs of peripheral vein blood cultures and instantaneous catheter tip blood culture of 615 patients admitted to ICU of Tianjin Medical University Cancer Institute and Hospital were collected from August 2011 to March 2014. The DTTP method and ( or ) semi quantitative culture of catheter tip were compared. CRBSI was diagnosed when both cultures were positive for the same microorganism and DTTP ≥2 hours ( 120 minutes ). The result of this procedure was compared with that of organism obtained using the semi quantitative culture of blood at catheter tip with≥15 cfu. Based on the clinical diagnosis, the reliability of two kinds of laboratory examination was compared for the diagnosis of CRBSI by plotting receiver operator characteristic curve ( ROC curve ). Results The result of 615 cases suspected of having CRBSI were analyzed during the study period. Of these, 440 episodes were excluded because cultures were negative for blood obtained through peripheral vein and central vein. Eight episodes were excluded because only peripheral vein blood culture was positive and 57 episodes were excluded because of only central vein blood culture was positive, 68 pairs of blood cultures were excluded due to the presence of multiple catheters and repeated blood withdrawals. Two cases of polymicrobial cultures were excluded from the final analysis due to the difficulty in determining the time of positive result for each individual microorganism. Ten cases in 42 cases of suspected cases of CRBSI were excluded from analysis because catheter was not removed, therefore culture from catheter tip could not be obtained. Using the DTTP method, 14 out of 17 CRBSI cases were diagnosed with DTTP≥120 minutes, while 3 cases were missed;the semi quantitative catheter tip culture was positive in 13 cases, and in 4 cases it was neglected. In 2 cases of CRBSI it was missed by both methods. The area under the ROC curve ( AUC ) of DTTP, catheter tip culture and the combination method was 0.912, 0.882 and 0.941 for diagnosis of CRBSI, respectively. Validity values for the diagnosis of CRBSI for DTTP were:sensitivity 82.35%, specificity 92.31%, positive predictive value 93.33%and negative predictive value 80.00%, and they were higher than those of the catheter tip culture method only ( 76.47%, 84.62%, 86.67% and 73.33%). The specificity and positive predictive CRBSI combination of the two methods in the diagnosis value were up to 100%, the sensitivity ( 88.24%) and negative predictive value ( 86.67%) was also increased, but no significant differences were found with DTTP method (χ2=0.00, P=1.00;χ2=0.00, P=0.98;χ2=0.00, P=0.98;χ2=0.00, P=0.98 ). Conclusions DTTP can be a valid method recommended for CRBSI diagnosis in critically ill patients with acceptable sensitivity, good specificity as well as positive predictive value. DTTP combined with other clinical symptoms can not only avoid unnecessary catheter withdrawal, but it also can help obtain the optimal treatment time and strategy.

A case study of cancer-associated VTE:diagnosis and treatment strategies / 中国肿瘤临床

Symptomatic venous thromboembolism (VTE) has a six-to seven-fold risk of occurring in cancer patients compared with non-cancer patients. VTE is the second most common cause of death among patients with cancer, and cancer-associated VTE is be-coming increasingly prevalent. Therefore, early diagnosis and treatment of cancer-associated VTE is particularly important. This study presents a pancreatic cancer-associated deep vein thrombosis (DVT) patient who engaged in a multidisciplinary comprehensive discus-sion in the Interventional Therapy Department, Tianjin Medical University Cancer Hospital to enhance concern, interdisciplinary com-munication, and cooperation in terms of cancer-associated VTE diagnosis and treatment strategies.

Study on the hospital acquired pneumonia prevention in intensive cancer patient using the bundle strategy of diagnosis and treatment / 国际外科学杂志

Objective To investigate the effect of bundle strategy of diagnosis and treatment on preventing hospital acquired pneumonia in intensive cancer patients.Methods Two hundred and sixty-five patients as control group were treated by regular preventive measures,and 292 cases as intervention group were treated by bundle strategy including the control application of antibiotics,hand hygiene,oral care,isolation of multi-drug resistant,elevation of bedside,management of respiratory tract and appropriate sedation and analgesia et al.Compare the hospital acquired pneumonia incidence,attribution mortality,duration of mechanical ventilation,stay-time in ICU,hospital acquired pneumonia antibiotics defined daily doses system and positive rate of multi-drug resistant infection between two groups.Results With the bundle treatment,the decreases of the hospital acquired pneumonia Incidence,duration of mechanical ventilation,stay-time in ICU and hospital acquired pneumonia Antibiotics daily doses system were significant(P＜ 0.01),and the positive rate of hospital acquired pneumonia attribution mortality and MDR infection were no statistical significance (P ＞ 0.05).Conclusion The bundle strategy of diagnosis and treatment could reduce the hospital acquired pneumonia incidence and the length-time in hospital.

Effect of Fish-oil fatty emulsion on immunity of postoperative patients with malignancy tumors / 肠外与肠内营养

Objective: To study the effect of fish-oil fatty emulsion on immunity of post-operation patients with malignancy tumors.Methods: Forty-three post-operation patients with malignancy tumors were randomly divided into control group and study group and both groups were provided with parenteral nutrition treatment [104.6 kJ(25 kcal/kg)].Fish-oil fatty emulsion was given to the study group.The level of serum albumin,immunity function,jaundice index,aminotransferase,blood lipid and morbidity rate of infectious complications of the two groups were compared.Results: After five days of post-operation treatment,in the study group,the immunity function was significantly improved and morbidity rate of infectious complications declined.The levels of serum albumin,the blood lipid,jaundice index,and aminotransferase had no significant difference between the two groups.Conclution:Fish-oil fatty emulsion is beneficial to the immunity function and can emilsion decrease infectious complications of post-operation patients with malignancy tumors.

Nitric oxide signaling in oxytocin-mediated cardiomyogenesis.

Oxytocin (OT), a hormone recently identified in the heart, induces embryonic and cardiac somatic stem cells to differentiate into cardiomyocytes (CM), possibly through nitric oxide (NO). We verified this hypothesis using P19 cells and P19 Clone 6 derivatives expressing a green fluorescent protein (GFP) reporter linked to cardiac myosin light chain-2v promoter. OT treatment of these cells induced beating cell colonies that were fully inhibited by N,G-nitro-L-arginine-methyl-ester (L-NAME), an inhibitor of NO synthases (NOS), partially reduced by 1400W, an inhibitor of inducible NOS, and ODQ, an inhibitor of NO-sensitive guanylyl cyclases. The NO generator S-nitroso-N-acetylpenicillamine (SNAP) reversed the L-NAME inhibition of cell beating and GFP expression. In OT-induced cells, L-NAME significantly decreased transcripts of the cardiac markers Nkx2.5, MEF2c, alpha-myosin heavy chain, and less, GATA4, endothelial NOS, and atrial natriuretic peptide, as well as the skeletal myocyte (SM) marker myogenin. Image analysis of OT-induced P19Cl6-GFP cells revealed ventricular CM coexpressing sarcomeric alpha-actinin and GFP, with some cells exclusively expressing alpha-actinin, most likely of the SM phenotype. The OT-mediated production of CM, but not SM, was diminished by L-NAME. In P19 cells, exogenously added OT stimulated the expression of its own transcript, which was reduced in the presence of L-NAME. Surprisingly, L-NAME alone decreased the expression of anti-stage specific embryonic antigen-1 marker of the undifferentiated state and induced some beating colonies as well as GFP in P19Cl6-GFP cells. Collectively, our data suggest that the pleiotropic action of NO is involved in the initiation of CM differentiation of P19 cells and maintenance of their undifferentiated state.

Treatment of septic thrombocytopenia with immunoglobulin / 中华急诊医学杂志

Objective To investigate the effects of intravenous immunoglobulin(IVIG)on thrombocytopenia associated with sepsis.Methods Fifty-two septic thrombocytopenia patients were randomly derided into IVIG group and control group,with 26 patients in each group.IVIG with dose of 400 mg/(kg?d)for 5 days was intravenously administered together with conventional treatment in IVIG group.Before and after IVIG treatment,platelet(PLT)counts,TNF-?,IL-6 and APACHEⅢscore were determined.Results In treatment group platelet counts were increased after IVIG treatment at 3 and 7 days in the IVIG group(P＜0.05);The bleeding rate and APACHEⅡwere significantly lower than control group,TNF-?level was lower at 3 days after treatment than cortrol group,and IL-6 level was lower at 1,3,and 7 days ( P＜0.05).Conclusion The use of IVIG to treat septic thrombocytopenia leads to a rapid and great increase in platelet count and significantly reduce the incidence of bleeding episode and TNFa,IL-6 level and APACHEⅢscore.