Development of a prognostic model for long-term survival of young patients with bladder cancer: a retrospective analysis of the SEER Database.

OBJECTIVES: This study aims to present the clinical characteristics of young patients with bladder cancer (YBCa), evaluate related risk factors and construct a nomogram based on data acquired from the Surveillance, Epidemiology, and End Results (SEER) Database. DESIGN: Retrospective analysis of the SEER Database (2004-2015) for primary YBCa. SETTING AND PARTICIPANTS: Data for YBCa (defined as those aged 40 years or younger) were extracted from the SEER Database, which covers approximately 28% of the US population, using the SEER*Stat software (V.8.4.0.1). A total of 1233 YBCa were identified. Patients were randomly assigned to the training and validation sets. The database included clinicopathological features, demographic information and survival outcomes, such as age, gender, race, year of diagnosis, marital status at diagnosis, primary tumour site, histological type, tumour grade, tumour, node, metastases (TNM) staging, treatment regimen for the primary tumour, cause of death and survival time. A nomogram model was developed using univariate and multivariate analyses. The prediction model was validated using the consistency index (C-index), calibration curve and receiver operating characteristic curve. PRIMARY OUTCOME MEASURES: 3-year, 5-year and 10-year overall survival (OS). RESULTS: 1233 YBCa from 2004 to 2015 were randomly assigned to the training set (n=865) and validation set (n=368). Age, marital status, tumour grade, histological type and TNM staging were included in the nomogram. The C-index of the model was 0.876. The 3-year, 5-year and 10-year OS area under the curve values for the training and validation sets were 0.949, 0.923 and 0.856, and 0.919, 0.890 and 0.904, respectively. Calibration plots showed that the nomogram had a robust predictive accuracy. CONCLUSIONS: To our knowledge, this is the first study to establish a precise nomogram predicting the 3-year, 5-year and 10-year OS in YBCa based on multivariate analyses. Our nomogram may serve as a valuable reference for future diagnostics and individualised treatments for YBCa. However, external validation is warranted to assess the accuracy and generalisability of our prognostic model.

The Apelin/APJ System: A Potential Therapeutic Target for Sepsis.

Apelin is the native ligand for the G protein-coupled receptor APJ. Numerous studies have demonstrated that the Apelin/APJ system has positive inotropic, anti-inflammatory, and anti-apoptotic effects and regulates fluid homeostasis. The Apelin/APJ system has been demonstrated to play a protective role in sepsis and may serve as a promising therapeutic target for the treatment of sepsis. Better understanding of the mechanisms of the effects of the Apelin/APJ system will aid in the development of novel drugs for the treatment of sepsis. In this review, we provide a brief overview of the physiological role of the Apelin/APJ system and its role in sepsis.

CAV1 and KRT5 are potential targets for prostate cancer.

Prostate cancer is the most common malignant tumor of male urogenital system that occurs in prostate epithelium. However, relationship between CAV1 and KRT5 and prostate cancer remains unclear. The prostate cancer datasets GSE114740 and GSE200879 were downloaded from Gene Expression Omnibus generated by GPL11154 and GPL32170. De-batch processing was performed, differentially expressed genes (DEGs) were screened, and weighted gene co-expression network analysis. The construction and analysis of protein-protein interaction network, functional enrichment analysis, gene set enrichment analysis. Gene expression heat map was drawn and immune infiltration analysis was performed. Comparative toxicogenomics database analysis were performed to find the disease most related to core gene. In addition, the cell experiment was performed to verify the role of CAV1 and KRT5 by western blot. Divided into 4 groups: control, prostate cancer, prostate cancer-over expression, and prostate cancer- knock out. TargetScan screened miRNAs that regulated central DEGs; 770 DEGs were identified. According to Gene Ontology analysis, they were mainly concentrated in actin binding and G protein coupled receptor binding. In Kyoto Encyclopedia of Gene and Genome analysis, they were mainly concentrated in PI3K-Akt signal pathway, MAPK signal pathway, and ErbB signal pathway. The intersection of enrichment terms of differentially expressed genes and GOKEGG enrichment terms was mainly concentrated in ErbB signaling pathway and MAPK signaling pathway. Three important modules were generated. The protein-protein interaction network obtained 8 core genes (CAV1, BDNF, TGFB3, FGFR1, PRKCA, DLG4, SNAI2, KRT5). Heat map of gene expression showed that core genes (CAV1, TGFB3, FGFR1, SNAI2, KRT5) are highly expressed in prostate cancer tissues and low in normal tissues. Comparative toxicogenomics database analysis showed that core genes (CAV1, TGFB3, FGFR1, SNAI2, KRT5) were associated with prostate tumor, cancer, tumor metastasis, necrosis, and inflammation. CAV1 and KRT5 are up-regulated in prostate cancer. CAV1 and KRT5 are highly expressed in prostate cancer. The higher expression of CAV1 and KRT5, the worse prognosis.

Optimization of thermoelectric properties of carbon nanotube veils by defect engineering.

Carbon nanotubes (CNTs), with their combination of excellent electrical conductivity, Seebeck coefficient, mechanical robustness and environmental stability are highly desired as thermoelectric (TE) materials for a wide range of fields including Internet of Things, health monitoring and environmental remediation solutions. However, their high thermal conductivity (κ) is an obstacle to practical TE applications. Herein, we present a novel method to reduce the κ of CNT veils, by introducing defects, while preserving their Seebeck coefficient and electrical conductivity. Solid-state drawing of a CNT veil embedded within two polycarbonate films generates CNT veil fragments of reducing size with increasing draw ratio. A successive heat treatment, at above the polycarbonate glass-to-rubber transition temperature, spontaneously reconnects the CNT veils fragments electrically but not thermally. Stretching to a draw ratio of 1.5 and heat repairing at 170 °C leads to a dramatic 3.5-fold decrease in κ (from 46 to 13 W m-1 K-1), in contrast with a decrease in electrical conductivity of only 26% and an increase in Seebeck coefficient of 10%. To clarify the mechanism of reduction in thermal conductivity, a large-scale mesoscopic simulation of CNT veils under uniaxial stretching has also been used. This work shows that defect engineering can be a valuable strategy to optimize TE properties of CNT veils and, potentially, other thermoelectric materials.

Combinatorial Metabolic Engineering and Enzymatic Catalysis Enable Efficient Production of Colanic Acid.

Colanic acid can promote the lifespan of humans by regulating mitochondrial homeostasis, and it has widespread applications in the field of health. However, colanic acid is produced at a low temperature (20 °C) with low titer. Using Escherichia coli K-12 MG1655, we constructed the SRP-4 strain with high colanic acid production at 30 °C by enhancing the precursor supply and relieving the regulation of transcription for colanic acid synthesis genes by the RCS system. After media optimization, the colanic acid titer increased by 579.9-fold and reached 12.2 g/L. Subsequently, we successfully purified the colanic acid hydrolase and reduced the molecular weight of colanic acid (106.854 kDa), thereby eliminating the inhibition of high-molecular-weight colanic acid on strain growth. Finally, after adding the colanic acid hydrolase (4000 U/L), the colanic acid with low molecular weight reached 24.99 g/L in 3-L bioreactor, the highest titer reported so far. This high-producing strain of colanic acid will promote the application of low-molecular-weight colanic acid in the field of health.

Identifying the Phenotypes of Sepsis that will Benefit from Red Blood Cell Transfusion Using Unsupervised Cluster Analysis.

BACKGROUND: Sepsis is a heterogeneous syndrome. Previous studies have shown controversial results of the effects of red blood cell transfusion (RBC) on the clinical outcomes of septic patients. This study aimed to identify the phenotypes of sepsis that will benefit from RBC transfusion. METHODS: Clinical data were extracted from the Medical Information Mart for Intensive Care III database. The study population included adult (age ≥ 18 years) septic patients with moderate non-bleeding anemia (hemoglobin ≤ 10 g/dL) within 24 hours after admission to the intensive care unit (ICU) between 2001 and 2012. After data preprocessing, partitioning around medoids function was used for unsupervised cluster analysis. We used Kaplan-Meier survival analysis and multivariable Cox proportional hazard models to explore the relationship between RBC transfusion and mortality. RESULTS: In total, 6,821 septic patients with moderate non-bleeding anemia within 24 hours after ICU admission, and 3,874 patients (56.8%) received RBC transfusion during their stay in the ICU. Using unsupervised cluster analysis, we identified three phenotypes of septic patients with moderate non-bleeding anemia: cluster A (n = 1,835) was characterized by advanced age and heart issues; cluster B (n = 3,043) was characterized by mild disease and relatively high hemoglobin levels; and cluster C (n = 1,943) was characterized by severe disease, low mean arterial pressure, bloodstream infection, coagulopathy, high lactate levels, and high mortality. Only for patients in cluster C, RBC transfusion exhibited protective effects in terms of the 14-day [hazard ratio (HR), 0.50; 95% confidence interval (CI), 0.41 - 0.61; p < 0.001], 28-day (HR, 0.61; 95% CI, 0.51 - 0.72; p < 0.001), and 90-day (HR, 0.67; 95% CI, 0.58 - 0.78; p < 0.001) mortality after adjusting the confounding variables. CONCLUSIONS: Utilizing unsupervised cluster analysis, we identified three phenotypes of septic patients with moderate non-bleeding anemia who had different responses to RBC transfusion. In the future, randomized controlled trials about prognostic outcomes of RBC transfusions can focus on the specific phenotype of sepsis.

Thermoelectric Performance of n-Type Magnetic Element Doped Bi2S3.

Thermoelectric technology offers great potential for converting waste heat into electrical energy and is an emission-free technique for solid-state cooling. Conventional high-performance thermoelectric materials such as Bi2Te3 and PbTe use rare or toxic elements. Sulfur is an inexpensive and nontoxic alternative to tellurium. However, achieving high efficiencies with Bi2S3 is challenging due to its high electrical resistivity that reduces its power factor. Here, we report Bi2S3 codoped with Cr and Cl to enhance its thermoelectric properties. An enhanced conductivity was achieved due to an increase in the carrier concentration by the substitution of S with Cl. High values of the Seebeck coefficients were obtained despite high carrier concentrations; this is attributed to an increase in the effective mass, resulting from the magnetic drag introduced by the magnetic Cr dopant. A peak power factor of 566 µW m-1 K-2 was obtained for a cast sample of Bi2-x/3Cr x/3S3-x Cl x with x = 0.01 at 320 K, as high as the highest values reported in the literature for sintered samples. These results support the success of codoping thermoelectric materials with isovalent magnetic and carrier concentration tuning elements to enhance the thermoelectric properties of eco-friendly materials.

Ecofriendly Highly Robust Ag8SiSe6-Based Thermoelectric Composites with Excellent Performance Near Room Temperature.

Bi2(TeSe)3 is a dominant n-type thermoelectric material used in commercial applications. However, its toxicity and rarity hamper further large-scale industrial applications. Herein, we develop a Ag8SiSe6-based composite as a promising n-type semiconductor with the advantages of nontoxicity and elemental abundance. Ag8SiSe6 composites with Ag2Se and Si nanoprecipitation are fabricated by a unique precipitation reaction sensitive to the hot pressing process. The energy-filtering effect between these phases optimizes electrical resistivity (∼14.59 µΩ·m) and the Seebeck coefficient (above -150 µV·K-1) of the composites, resulting in a maximum power factor of ∼1772 µW·m-1·K-2(@125 °C), which is the highest value in an argyrodite system near room temperature. Nanoprecipitation of Ag2Se and Si can also scatter more phonons and further reduce the lattice thermal conductivity to 0.20 W·m-1·K-1. As a result, a maximum ZT value of ∼0.9 (@125 °C) and an average ZT value of ∼0.7 (25-200 °C) are obtained in the composite with 12 vol % Ag2Se and 0.23 vol % Si, which is sintered at 525 °C. These thermoelectric properties are comparable to those of a commercial n-type Bi2Te3 compound. In addition, the Ag8SiSe6 composite has robust mechanical properties (Vickers hardness of >110 HV and bending strength of 70.6 MPa), much better than those of other thermoelectric compounds, because of which Ag8SiSe6 has great commercial application as an alternative to Bi2Te3-based compounds.

In Situ Reaction Induced Core-Shell Structure to Ultralow κlat and High Thermoelectric Performance of SnTe.

Lead-free chalcogenide SnTe has been demonstrated to be an efficient medium temperature thermoelectric (TE) material. However, high intrinsic Sn vacancies as well as high thermal conductivity devalue its performance. Here, ß-Zn4Sb3 is incorporated into the SnTe matrix to regulate the thermoelectric performance of SnTe. Sequential in situ reactions take place between the ß-Zn4Sb3 additive and SnTe matrix, and an interesting "core-shell" microstructure (Sb@ZnTe) is obtained; the composition of SnTe matrix is also tuned and thus Sn vacancies are compensated effectively. Benefitting from the synergistic effect of the in situ reactions, an ultralow κlat ≈0.48 W m-1 K-1 at 873 K is obtained and the carrier concentrations and electrical properties are also improved successfully. Finally, a maximum ZT ≈1.32, which increases by ≈220% over the pristine SnTe, is achieved in the SnTe-1.5% ß-Zn4Sb3 sample at 873 K. This work provides a new strategy to regulate the TE performance of SnTe and also offers a new insight to other related thermoelectric materials.

All-Inorganic CsPbBr3 Perovskite Solar Cells with 10.45% Efficiency by Evaporation-Assisted Deposition and Setting Intermediate Energy Levels.

Nowadays, inorganic CsPbBr3 perovskite is emerging as a promising candidate as a light-absorbing layer in photovoltaic devices due to its excellent photoelectric property and superior stability under humidity and thermal attacks in comparison with organic cation-based hybrid perovskites. However, the impure perovskite phase and severe interfacial charge recombination have limited the further improvement of device performance. In this work, a vapor-assisted solution technique was introduced to prepare a high-purity CsPbBr3 film in a perovskite solar cell (PSC). To further reduce the electron-hole recombination and enhance charge extraction, we introduced the novel intermediate energy level of manganese sulfide (MnS) as a hole transport layer in CsPbBr3 PSC. The as-optimized CsPbBr3 PSC based on all-inorganic transport layers delivers a power conversion efficiency (PCE) of 10.45% in comparison with 8.16% for the device free of an intermediate layer, which is one of the highest PCEs achieved among the CsPbBr3-based PSCs to date. Moreover, the optimized device retained 80% PCE of its initial efficiency over 90 days under 80% relative humidity at 85 °C, indicating an excellent environmental tolerance to boost the commercial application of low-cost, efficient, and stable all-inorganic PSCs.

Left-Sided Ventricular-arterial Coupling and Volume Responsiveness in Septic Shock Patients.

BACKGROUND: Suboptimal ventricular arterial coupling (VAC) is one of the pivotal determinants of inefficient heart performance despite appropriate administration of fluids or vasopressors in shocks. Here, we investigate the performance of VAC in patients who are unresponsive to fluid administration in septic shock. METHODS: This is a retrospective observational study of septic shock patients (n = 35). VAC was evaluated by effective arterial elastance (EaI), left ventricular end-systolic elastance (EesI), and EaI/EesI. Septic shock patients successfully fluid resuscitated after pulse indicator continuous cardiac output (PiCCO) monitoring, defined as an increase in general end-diastolic ventricular volume (GEDVI) more than 10%, were divided into volume responsive (VVr), and volume unresponsive (VVur) groups based on a cardiac index increase above 10%. We hypothesize that two groups of patients will exhibit dissimilarities of VAC variation, defined as EaI/EesI variation (ΔEaI/EesI). RESULTS: Variations of EaI (ΔEaI), and EaI/EesI (ΔEaI/EesI), and systemic vascular resistance index (ΔSVRI) were significantly lower in the VVr group than those in the VVur group (P < 0.05). Variations of cardiac index (ΔCI), stroke volume index (ΔSVI), and EesI (ΔEesI) were significantly higher in patients with ΔEaI/EesI ≤ 0. Concomitantly, ΔEaI and ΔSVRI were significantly diminished as compared with patients with ΔEaI/EesI > 0 (P < 0.05). ΔCI has an inverse relationship with both ΔEaI (r = -0.46, P = 0.006), ΔEaI/EesI (r = -0.65, P < 0.001), and ΔSVRI (r = -0.59, P < 0.001). We observed more patients who were fluid responsive in the ΔEaI/EesI ≤ 0 group than in the group with ΔEaI/EesI > 0 (88.89% vs. 26.92%, P = 0.01). CONCLUSIONS: Variation of VAC is often related to suboptimal ventricular volume responsiveness among patients with septic shock.

Meta-analysis of high doses of ambroxol treatment for acute lung injury/acute respiratory distress syndrome based on randomized controlled trials.

This study seeks to evaluate the potential benefits of high doses of ambroxol treatment for acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) by conducting a meta-analysis based on randomized controlled trials (RCTs). We searched the Pubmed, Embase, China National Knowledge Infrastructure, and Wanfang databases through December 2013. Only RCTs evaluating high doses of ambroxol (≥15 mg/kg or 1000 mg/day) treatment for patients with ALI/ARDS were selected. We included 10 RCTs involving 508 patients. Adjuvant treatment with high doses of ambroxol increased PaO(2)/FiO(2) (weight mean differences [WMD] = 69.18, 95% confidence intervals [CI]: 41.71-96.65), PO(2) (WMD = 11.74, 95% CI: 8.50-14.99), and SaO(2) (WMD = 2.15, 95% CI: 1.60-2.71) compared with usual treatment. Treatment with high doses of ambroxol appeared to reduce serum tumor necrosis factor-α level (WMD -7.92 µg/L; 95% CI, -10.94 to -4.9) and interleukin-6 level (WMD = -20.65 µg/L, 95% CI: -24.74 to -16.55) and to increase serum superoxide dismutase level (WMD = 19.07 NU/mL, 95% CI: 6.16-31.97). The findings suggest that treatment with high doses of ambroxol appears to improve PaO(2)/FiO(2), PO(2), and SaO(2), and the benefits might be related to ambroxol's anti-oxidant and anti-inflammatory properties.

Pain assessment using the critical-care pain observation tool in Chinese critically ill ventilated adults.

CONTEXT: The psychometric properties of the Critical-Care Pain Observation Tool (CPOT) need to be tested in general intensive care unit patient populations in China. OBJECTIVES: To further evaluate the psychometric properties of the CPOT and provide a pain assessment method for Chinese critically ill ventilated adults by validating a translation of the CPOT. METHODS: A total of 63 conscious ventilated Chinese adults were repeatedly assessed by two independent raters using the CPOT at rest as well as before and during the two procedures: 1) nociceptive procedure (turning) and 2) non-nociceptive procedure (taking noninvasive blood pressure). A total of 12 assessments were included. RESULTS: The principal component factor analysis revealed that the domain structure of the CPOT was acceptable. Cronbach's α coefficient as a measure for the internal consistency ranged from 0.57 to 0.86; intraclass correlation coefficients as a measure for inter-rater reliability ranged from 0.80 to 0.91; Spearman nonparametric coefficients as a measure for test-retest reliability ranged from 0.81 to 0.93. The CPOT total score was significantly higher during the nociceptive procedure, indicating that its discriminant validity was good. Self-reported pain was obtained as the gold standard; the receiver operating characteristic curve analysis determined the best cutoff value of the CPOT (>2) with the specificity (73.3-81.8%) and sensitivity (80.8-89.4%) as well as the area under the curve (range 0.849-0.902). CONCLUSION: The CPOT has good psychometric properties and can be used as a reliable and valid instrument for pain assessment in Chinese critically ill ventilated adults.

[A correlation of pulse pressure and prognosis of refractory septic shock patients].

OBJECTIVE: To explore the correlation of pulse pressure(PP) and outcome in refractory septic shock patients. METHODS: A total of 68 patients with refractory septic shock consecutively admitted in our ICU from January 2012 to December 2012 were retrospectively studied. Hemodynamic data and arterial lactate concentration were collected at the time of admission and 24 hours after admission. The outcome of Day 28 post-diagnosis was also recorded. RESULTS: (1) Compared with the survivors, heart rate (HR) at 24 hours after admission was higher in non-survivors, while 24 h lactate clearance rate (rLac) was lower in them (P < 0.05). Other hemodynamic parameters showed no difference between the non-survivors and the survivors at 24 hours after admission, including central venous pressure (CVP), mean arterial pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), PP, pulse pressure/heart rate (PP/HR), pulse pressure/mean arterial pressure (PP/MAP), pulse pressure/systolic pressure (PP/SBP), pulse pressure/diastolic pressure (PP/DBP), the value of SBP above MAP (SMP)and the value of DBP below MAP (MDP). (2)The mortality rate was higher in the patients with HR ≥ 100 b/min than those with HR<100 b/min, but without statistical significance (56.25% vs 36.11%, P = 0.096). Compared with the survivors, no matter with HR ≥ 100 b/min or HR<100 b/min, lactate (Lac) at the 24 hours after admission was higher in all the non-survivors (P < 0.05), while with lower rLac (P < 0.05). In those with HR ≥ 100 b/min, the following hemodynamic parameters were higher in the non-survivors than in the survivors, including PP, PP/HR, PP/MAP, PP/SBP, PP/DBP, SMP and MDP (all P values<0.05), while no statistical difference was observed in those with HR<100 b/min. (3) The mortality rate showed no statistical difference in those with MAP ≥ 85 mmHg (1 mmHg = 0.133 kPa) and with MAP < 85 mmHg (42.42% vs 48.57%, P = 0.611) . No matter MAP ≥ 85 mmHg or MAP < 85 mmHg, compared with the survivors, all the non-survivors had higher Lac at the 24 hours after admission (P < 0.05), while with lower rLac (P < 0.05). In those with MAP ≥ 85 mmHg, HR was higher in the non-survivors than the survivors (P < 0.05). In those with MAP < 85 mmHg, compared with the survivors, the non-survivors had higher PP, PP/MAP, PP/SBP, PP/DBP, SMP and MDP (P < 0.05), while with lower DBP (P < 0.05). CONCLUSION: PP is correlated with the outcome in refractory septic shock patients. When the HR and MAP differ, PP has different effect on the outcome and contributes more to the tissue perfusion and outcome in those with higher HR and lower MAP.

[Clinical role of evaluating vascular paralysis in septic shock patients].

OBJECTIVE: To explore the effects of vascular paralysis upon prognosis and tissue perfusion in septic shock patients. METHODS: A total of 73 septic shock patients consecutively admitted into our department from January 2010 to July 2011 were retrospectively studied. Their hemodynamic data, arterial lactate concentration and APACHEII (acute physiology & chronic health evaluation II) score at the beginning of cardiac output monitoring (0h), as well as the outcome of Day 28 post-diagnosis were recorded. Stroke volume index (SVI) and cardiac index (CI) were obtained through transpulmonary thermodilution technique by pulse induced continuous cardiac output (PiCCO) system. RESULTS: (1) APACHEII score at 0h was higher in non-survivors than those in survivors ((14.6 ± 5.6) vs (20.4 ± 4.8), P < 0.01). Stroke systemic vascular resistance index (SSVRI), pulse pressure/stroke volume index (PP/SVI), effective arterial elastance index (EaI), 24h lactate clearance rate (24rLac) , 72h lactate clearance rate (72rLac) and 7d lactate clearance rate (7rLac) in non-survivors were all lower than those in survivors (P < 0.05); (2) SVRI, SSVRI, PP/SVI and EaI were all correlated significantly with 24rLac, 72rLac and 7rLac [ (212.7 ± 52.6) vs (185.4 ± 50.5) , PP/SVI: (2.8 ± 0.7) vs (2.5 ± 0.6), EaI: (5.0 ± 1.2) vs (4.3 ± 1.1), 24/72/7 rLac: (18.4 ± 46.4) vs (21.5 ± 49.7), (19.9 ± 49.6) vs (-21.5 ± 46.3), (35.5 ± 45.8) vs (-59.5 ± 64.5), P < 0.00]. CONCLUSION: Vascular paralysis is correlated with prognosis and tissue perfusion in septic shock patients. And SSVRI, PP/SVI and EaI are more significant.

[Variations of left ventricular-arterial coupling in septic shock].

OBJECTIVE: To explore the variations of left ventricular-arterial coupling and elucidate its mechanisms in septic shock. METHODS: Septic shock rabbits were established by an intravenous injection of endotoxin. A total of 12 rabbits were divided randomly into sham operation group (S, n = 6) and endotoxin injection group (E, n = 6). Ultrasonic echocardiography and hemodynamic monitoring were conducted at 0h (30-min post-operation), 2h (1-hour after endotoxin or saline injection) and 4h (3-hour after endotoxin or saline injection) and the relative hemodynamic indices were recorded. RESULTS: (1) In E group, end-systolic elastance (Ees) at 2h was lower than that at 0h (75.72 ± 5.16 vs 90.77 ± 7.17 mm Hg/ml) and Ees at 4h was lower than that at 2h (58.45 ± 3.63 vs 75.72 ± 5.16 mm Hg/ml, P < 0.05); (2) In E group, left ventricular diastolic volume (LVDV) at 2h and 4h were both lower than that at 0h (3.26 ± 0.21 vs 3.58 ± 0.25 ml, 3.27 ± 0.19 vs 3.58 ± 0.25 ml). And left ventricular end diastolic compliance (Ced) at 4h were lower than that at 0h and 2h (0.61 ± 0.05 vs 0.74 ± 0.07 ml/mm Hg, 0.61 ± 0.05 vs 0.75 ± 0.08 ml/mm Hg, P < 0.05); (3) In E group, Ea at 2h and 4h was lower than that at 0h (41.35 ± 2.87 vs 50.46 ± 3.22 mm Hg/ml, 40.13 ± 2.68 vs 50.46 ± 3.22 mm Hg/ml, P < 0.05); (4) In E group, Ea/Ees at 4h was higher than that at 0h and 4h (0.70 ± 0.07 vs 0.57 ± 0.06, 0.70 ± 0.07 vs 0.56 ± 0.05, P < 0.05). And Ea/Ees at 2h had no significant difference with that at 0h (0.56 ± 0.05 vs 0.57 ± 0.06, P < 0.05). CONCLUSION: During compensatory stage of septic shock, left ventricular-arterial coupling shows no significant variation. However, during decompensatory stage of septic shock, there is significant left ventricular-arterial decoupling. The main reason for decoupling lies in that the decrease of left myocardial contractility is more significant than that of left ventricular afterload. And ventricular diastolic dysfunction may also participate.

[Left ventricular-arterial coupling in the resuscitation of refractory septic shock].

OBJECTIVE: To explore the role of left ventricular-arterial coupling in the resuscitation of refractory septic shock. METHODS: A total of 58 patients with refractory septic shock admitted from January 2010 to July 2011 were retrospectively studied. Hemodynamic data, arterial lactate concentration and APACHEII (acute physiology & chronic health evaluation II) score at the beginning of and 24 hours after cardiac output monitoring, as well as the outcome of Day 28 post-diagnosis were recorded. Stroke volume index (SVI), cardiac index (CI) and global end diastolic volume index (GEDVI) were obtained through transpulmonary thermodilution technique by a pulse induced continuous cardiac output (PiCCO) system. Left ventricular end systolic volume index (LVESVI) was approximated to (GEDVI/4-SVI) while effective arterial elastance index/ventricular end systolic elastance index (EaI/EesI) was approximated to LVESVI/SVI. RESULTS: (1) APACHEII score at the 24th hour, 24 hs lactate clearance rate and 24 hs Ea/Ees variation (ΔEa/Ees) were higher in non-survivors than those in survivors; (2) binary Logistic regression analysis showed that ΔEa/Ees and APACHEII score at the 24th hour were the independent risk factors of mortality for refractory septic shock. And the OR value of ΔEa/Ees was higher than that of APACHEII score (2.04 vs 1.63). Their areas of ROC curve were 0.705 (95%CI 0.569 - 0.841, P = 0.007) and 0.939 (95%CI 0.878 - 1.000, P = 0.000) respectively; (3) all hemodynamic parameters at the beginning had no difference between ΔEa/Ees > 0 and ΔEa/Ees ≤ 0 groups. CI, SVI, EGDT (early goal-directed therapy) compliance rate at the 24th hour in the ΔEa/Ees > 0 group were lower than those in the ΔEa/Ees ≤ 0 group. The effective arterial elastance index (EaI) at the 24th hour and the mortality rate of Day 28 in the ΔEa/Ees > 0 group were higher than those in the ΔEa/Ees ≤ 0 group; (4) during the 24 hs treatment, ΔEa/Ees was correlated negatively with the variations of CI, SVI, EesI and lactate clearance rate and positively with the variations of heart rate, GEDVI, systolic vascular resistance index and EaI. CONCLUSION: ΔEa/Ees may be used as an excellent marker of predicting the outcome of refractory septic shock. Lowing Ea/Ees in resuscitation has beneficial effects on EGDT compliance, lactate clearance and outcome.

[Effects of central venous pressure on acute kidney injury in septic shock].

OBJECTIVE: To investigate the effects of central venous pressure on acute kidney injury (AKI) in septic shock. METHODS: A total of 86 septic shock patients with PiCCO (pulse indicator continuous cardiac output) monitoring admitted at our department from January 2009 to January 2011 were retrospectively studied. They were divided into 2 groups based on central venous pressure (CVP) at 24 hs after PiCCO monitoring. There were 41 cases in low CVP group (CVP ≤ 10 mm Hg and 45 cases in high CVP group (CVP > 10 mm Hg). Their hemodynamic data, lactate concentration, ScvO2 (central venous oxygen saturation), APACHEII (acute physiology & chronic health evaluation II) score and serum creatinine were obtained at the beginning and 24 hours after PiCCO monitoring. The incidence and mortality of AKI, the outcome of these patients in ICU and at Day 28 post-diagnosis were recorded. RESULTS: (1) The incidences of AKI were 51.2% (21/41) and 75.6% (34/45) in low and high CVP groups respectively; (2) Nine cases (22.0%) died in ICU in low CVP group and 20 cases (44.4%) in high CVP group. And 12 cases (29.3%) died within 28 days in low CVP group while 21 cases (46.7%) in high CVP group. CONCLUSION: A high CVP may increase the incidence and morbidity of AKI in septic shock. And an excessively high CVP should be prevented.