Pub Date : 2024-08-01DOI: 10.3760/cma.j.cn121430-20240107-00020
Yanan Liu, Ying Ren, Cancan Chen, Shuting Zang
Extracorporeal membrane oxygenation (ECMO) provides continuous extracorporeal respiratory and circulatory support for patients with severe heart and lung failure, in order to maintain their lives. Currently, ECMO is an advanced organ support technology and its application in the clinical field of critical care is becoming increasingly common. When ECMO is implemented via percutaneous cannulation at the bilateral femoral artery and vein, the traditional patient pants cannot be used, which leads to exposure of privacy, easy catching of cold, and easy contamination of bed sheets and covers during defecation, making the patient uncomfortable and increasing the risk of infection. Changing bed sheets and covers not only increases the workload of nurses, but also easily causes pipeline displacement or slipping. It is inconvenient to observe the patient's bleeding, displacement, or dislodgement of the pipeline at any time when wearing patient pants. To solve the problems, nursing staff in the emergency intensive care unit of Henan Provincial People's Hospital have designed a protective skirt specifically designed for patients undergoing ECMO, which has obtained a National Utility Model Patent of China (patent number: ZL 2020 2 08120022.9). The special protective skirt for patients with ECMO mainly consists of a skirt body, a transparent observation window, a hip support part, and a fecal collection part. The transparent observation window is convenient for the puncture site and pipeline observation. After the hip support part is inflated, the patient can separate the perianal skin and urine and feces to avoid the occurrence of incontinence dermatitis. The fecal collection part can collect urine and feces to keep the bed unit clean. The protective skirt has a simple structure and is easy to wear and take off. While protecting patient privacy and ensuring patient comfort, it can also observe the condition of the pipeline at any time. It is suitable for patients with lower limb catheterization or urinary and fecal incontinence, and has certain clinical application and promotion value.
{"title":"[Design and application of a specialized protective skirt for patients undergoing extracorporeal membrane oxygenation].","authors":"Yanan Liu, Ying Ren, Cancan Chen, Shuting Zang","doi":"10.3760/cma.j.cn121430-20240107-00020","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240107-00020","url":null,"abstract":"<p><p>Extracorporeal membrane oxygenation (ECMO) provides continuous extracorporeal respiratory and circulatory support for patients with severe heart and lung failure, in order to maintain their lives. Currently, ECMO is an advanced organ support technology and its application in the clinical field of critical care is becoming increasingly common. When ECMO is implemented via percutaneous cannulation at the bilateral femoral artery and vein, the traditional patient pants cannot be used, which leads to exposure of privacy, easy catching of cold, and easy contamination of bed sheets and covers during defecation, making the patient uncomfortable and increasing the risk of infection. Changing bed sheets and covers not only increases the workload of nurses, but also easily causes pipeline displacement or slipping. It is inconvenient to observe the patient's bleeding, displacement, or dislodgement of the pipeline at any time when wearing patient pants. To solve the problems, nursing staff in the emergency intensive care unit of Henan Provincial People's Hospital have designed a protective skirt specifically designed for patients undergoing ECMO, which has obtained a National Utility Model Patent of China (patent number: ZL 2020 2 08120022.9). The special protective skirt for patients with ECMO mainly consists of a skirt body, a transparent observation window, a hip support part, and a fecal collection part. The transparent observation window is convenient for the puncture site and pipeline observation. After the hip support part is inflated, the patient can separate the perianal skin and urine and feces to avoid the occurrence of incontinence dermatitis. The fecal collection part can collect urine and feces to keep the bed unit clean. The protective skirt has a simple structure and is easy to wear and take off. While protecting patient privacy and ensuring patient comfort, it can also observe the condition of the pipeline at any time. It is suitable for patients with lower limb catheterization or urinary and fecal incontinence, and has certain clinical application and promotion value.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.3760/cma.j.cn121430-20231012-00864
Weiwei Xu, Jingjing Li
<p><strong>Objective: </strong>To evaluate the difference in efficacy of two fluid resuscitation regimens, crystalloid alone versus crystalloid combined with plasma infusion, on the prognosis of septic patients with hypoalbuminemia.</p><p><strong>Methods: </strong>A retrospective study was conducted. Septic patients with hypoalbuminemia admitted to the department of critical care medicine of Dongtai People's Hospital from January 2017 to December 2022 were selected as study subjects. Patients were divided into single group (crystalloid alone) and combined group (crystalloid combined with plasma) according to the fluid resuscitation regimen at the time of admission. General information, as well as coagulation indices before resuscitation (on day 1) and day 3 of resuscitation were collected. The primary study endpoint was 28-day mortality. The single and combined groups were stratified according to albumin level at resuscitation (< 25 g/L, 25-30 g/L, and > 30 g/L) to compare the differences in 28-day mortality among patients with different albumin levels. Kaplan-Meier survival curves of patients' 28-day prognosis were plotted.</p><p><strong>Results: </strong>A total of 164 septic patients with hypoalbuminemia were included, including 60 patients in the single group and 104 patients in the combined group. (1) There were no significantly differences in age, gender, acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), as well as pre-resuscitation platelet count (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, antithrombin- III (AT- III), international normalized ratio (INR), fibrin degradation product (FDP), serum lactic acid (Lac), and albumin level between the two groups, indicating comparability. (2) The levels of PT and AT- III in the combined group improved significantly on day 3 compared to before resuscitation, and the level of AT- III in the combined group improved more significantly on day 3 compared to the single group [(79.80±17.95)% vs. (66.67±18.69)%, P < 0.01]. Lac and albumin levels improved significantly after resuscitation in both the single and combined groups, but there were no significantly differences in the degree of improvement between the two groups. (3) There was no significantly difference in the 28-day mortality between the single group and the combined group [55.0% (33/60) vs. 42.3% (44/104), P > 0.05]. The 28-day mortality of patients with albumin < 25 g/L was significantly higher than that with albumin 25-30 g/L and > 30 g/L [63.1% (41/65) vs. 36.2% (25/69), 36.7% (11/30), both P < 0.05]. (4) Kaplan-Meier survival curve analysis showed that there was no significantly difference in 28-day cumulative survival rate between the single group and the combined group (Log-Rank: χ <sup>2</sup> = 2.067,P = 0.151). The median survival rate of albumin was 27.1 g/L [95% confidence interval (95%CI) was 24.203-29.997] in the single group and 28.7 g
{"title":"[Effect of fluid resuscitation with crystalloid combined with plasma on the prognosis of septic patients with hypoalbuminemia].","authors":"Weiwei Xu, Jingjing Li","doi":"10.3760/cma.j.cn121430-20231012-00864","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20231012-00864","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the difference in efficacy of two fluid resuscitation regimens, crystalloid alone versus crystalloid combined with plasma infusion, on the prognosis of septic patients with hypoalbuminemia.</p><p><strong>Methods: </strong>A retrospective study was conducted. Septic patients with hypoalbuminemia admitted to the department of critical care medicine of Dongtai People's Hospital from January 2017 to December 2022 were selected as study subjects. Patients were divided into single group (crystalloid alone) and combined group (crystalloid combined with plasma) according to the fluid resuscitation regimen at the time of admission. General information, as well as coagulation indices before resuscitation (on day 1) and day 3 of resuscitation were collected. The primary study endpoint was 28-day mortality. The single and combined groups were stratified according to albumin level at resuscitation (< 25 g/L, 25-30 g/L, and > 30 g/L) to compare the differences in 28-day mortality among patients with different albumin levels. Kaplan-Meier survival curves of patients' 28-day prognosis were plotted.</p><p><strong>Results: </strong>A total of 164 septic patients with hypoalbuminemia were included, including 60 patients in the single group and 104 patients in the combined group. (1) There were no significantly differences in age, gender, acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), as well as pre-resuscitation platelet count (PLT), prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, antithrombin- III (AT- III), international normalized ratio (INR), fibrin degradation product (FDP), serum lactic acid (Lac), and albumin level between the two groups, indicating comparability. (2) The levels of PT and AT- III in the combined group improved significantly on day 3 compared to before resuscitation, and the level of AT- III in the combined group improved more significantly on day 3 compared to the single group [(79.80±17.95)% vs. (66.67±18.69)%, P < 0.01]. Lac and albumin levels improved significantly after resuscitation in both the single and combined groups, but there were no significantly differences in the degree of improvement between the two groups. (3) There was no significantly difference in the 28-day mortality between the single group and the combined group [55.0% (33/60) vs. 42.3% (44/104), P > 0.05]. The 28-day mortality of patients with albumin < 25 g/L was significantly higher than that with albumin 25-30 g/L and > 30 g/L [63.1% (41/65) vs. 36.2% (25/69), 36.7% (11/30), both P < 0.05]. (4) Kaplan-Meier survival curve analysis showed that there was no significantly difference in 28-day cumulative survival rate between the single group and the combined group (Log-Rank: χ <sup>2</sup> = 2.067,P = 0.151). The median survival rate of albumin was 27.1 g/L [95% confidence interval (95%CI) was 24.203-29.997] in the single group and 28.7 g","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.3760/cma.j.cn121430-20231019-00885
Yuanwen Ye, Feifei Li, Baohua Yang, Liangen Lin, Linglong Chen
<p><strong>Objective: </strong>To explore the optimal pulse oxygen saturation (SpO<sub>2</sub>) range during hospitalization for patients with sepsis.</p><p><strong>Methods: </strong>A case-control study design was employed. Demographic information, vital signs, comorbidities, laboratory parameters, critical illness scores, clinical treatment information, and clinical outcomes of sepsis patients were extracted from the Medical Information Mart for Intensive Care- IV (MIMIC- IV). A generalized additive model (GAM) combined with a Loess smoothing function was employed to analyze and visualize the nonlinear relationship between SpO<sub>2</sub> levels during hospitalization and in-hospital all-cause mortality. The optimal range of SpO<sub>2</sub> was determined, and Logistic regression model along with Kaplan-Meier curve were utilized to validate the association between the determined range of SpO<sub>2</sub> and in-hospital all-cause mortality.</p><p><strong>Results: </strong>A total of 5 937 patients met the inclusion criteria, among whom 1 191 (20.1%) died during hospitalization. GAM analysis revealed a nonlinear and U-shaped relationship between SpO<sub>2</sub> levels and in-hospital all-cause mortality among sepsis patients during hospitalization. Multivariable Logistic regression analysis further confirmed that patients with SpO<sub>2</sub> levels between 0.96 and 0.98 during hospitalization had a decreased mortality compared to those with SpO<sub>2</sub> < 0.96 [hypoxia group; odds ratio (OR) = 2.659, 95% confidence interval (95%CI) was 2.190-3.229, P < 0.001] and SpO<sub>2</sub> > 0.98 (hyperoxia group; OR = 1.594, 95%CI was 1.337-1.900, P < 0.001). Kaplan-Meier survival curve showed that patients with SpO<sub>2</sub> between 0.96 and 0.98 during hospitalization had a higher probability of survival than those patient with SpO<sub>2</sub> < 0.96 and SpO<sub>2</sub> > 0.98 (Log-Rank test: χ <sup>2</sup> = 113.400, P < 0.001). Sensitivity analyses demonstrated that, with the exception of subgroups with smaller sample sizes, across the strata of age, gender, body mass index (BMI), admission type, race, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, respiratory rate, body temperature, myocardial infarction, congestive heart failure, cerebrovascular disease, chronic liver disease, diabetes mellitus, sequential organ failure assessment (SOFA), simplified acute physiology score II (SAPS II), systemic inflammatory response syndrome score (SIRS), and Glasgow coma score (GCS), the mortality of patients with SpO<sub>2</sub> between 0.96 and 0.98 was significantly lower than those of patients with SpO<sub>2</sub> < 0.96 and SpO<sub>2</sub> > 0.98.</p><p><strong>Conclusions: </strong>During hospitalization, the level of SpO<sub>2</sub> among sepsis patients exhibits a U-shaped relationship with in-hospital all-cause mortality, indicating that heightened and diminished oxygen levels are both associated with increased
{"title":"[Exploring the optimal range of pulse oxygen saturation in patients with sepsis: a retrospective study based on MIMIC- IV data].","authors":"Yuanwen Ye, Feifei Li, Baohua Yang, Liangen Lin, Linglong Chen","doi":"10.3760/cma.j.cn121430-20231019-00885","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20231019-00885","url":null,"abstract":"<p><strong>Objective: </strong>To explore the optimal pulse oxygen saturation (SpO<sub>2</sub>) range during hospitalization for patients with sepsis.</p><p><strong>Methods: </strong>A case-control study design was employed. Demographic information, vital signs, comorbidities, laboratory parameters, critical illness scores, clinical treatment information, and clinical outcomes of sepsis patients were extracted from the Medical Information Mart for Intensive Care- IV (MIMIC- IV). A generalized additive model (GAM) combined with a Loess smoothing function was employed to analyze and visualize the nonlinear relationship between SpO<sub>2</sub> levels during hospitalization and in-hospital all-cause mortality. The optimal range of SpO<sub>2</sub> was determined, and Logistic regression model along with Kaplan-Meier curve were utilized to validate the association between the determined range of SpO<sub>2</sub> and in-hospital all-cause mortality.</p><p><strong>Results: </strong>A total of 5 937 patients met the inclusion criteria, among whom 1 191 (20.1%) died during hospitalization. GAM analysis revealed a nonlinear and U-shaped relationship between SpO<sub>2</sub> levels and in-hospital all-cause mortality among sepsis patients during hospitalization. Multivariable Logistic regression analysis further confirmed that patients with SpO<sub>2</sub> levels between 0.96 and 0.98 during hospitalization had a decreased mortality compared to those with SpO<sub>2</sub> < 0.96 [hypoxia group; odds ratio (OR) = 2.659, 95% confidence interval (95%CI) was 2.190-3.229, P < 0.001] and SpO<sub>2</sub> > 0.98 (hyperoxia group; OR = 1.594, 95%CI was 1.337-1.900, P < 0.001). Kaplan-Meier survival curve showed that patients with SpO<sub>2</sub> between 0.96 and 0.98 during hospitalization had a higher probability of survival than those patient with SpO<sub>2</sub> < 0.96 and SpO<sub>2</sub> > 0.98 (Log-Rank test: χ <sup>2</sup> = 113.400, P < 0.001). Sensitivity analyses demonstrated that, with the exception of subgroups with smaller sample sizes, across the strata of age, gender, body mass index (BMI), admission type, race, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, respiratory rate, body temperature, myocardial infarction, congestive heart failure, cerebrovascular disease, chronic liver disease, diabetes mellitus, sequential organ failure assessment (SOFA), simplified acute physiology score II (SAPS II), systemic inflammatory response syndrome score (SIRS), and Glasgow coma score (GCS), the mortality of patients with SpO<sub>2</sub> between 0.96 and 0.98 was significantly lower than those of patients with SpO<sub>2</sub> < 0.96 and SpO<sub>2</sub> > 0.98.</p><p><strong>Conclusions: </strong>During hospitalization, the level of SpO<sub>2</sub> among sepsis patients exhibits a U-shaped relationship with in-hospital all-cause mortality, indicating that heightened and diminished oxygen levels are both associated with increased ","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.3760/cma.j.cn121430-20231127-01012
Hailong Si, Shutian Gao, Yundou Wang
Artificial intelligence (AI) technology is advancing rapidly, constantly presenting its application value and broad prospects in the medical field. Especially in the early intervention of burn diseases, the new developments, applications, and challenges of AI technology have a significant impact on the clinical outcomes of burn patients. Based on this, this article reviews the concept, classification, learning style, and application of AI in the early diagnosis and treatment of burn diseases, with a focus on discussing the challenges and suggestions of the application of AI technology in the medical field, in order to provide reference and suggestions for the better application of AI in the early diagnosis and treatment of burn diseases.
{"title":"[Research progress on the application of artificial intelligence in the early diagnosis and treatment of burn diseases].","authors":"Hailong Si, Shutian Gao, Yundou Wang","doi":"10.3760/cma.j.cn121430-20231127-01012","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20231127-01012","url":null,"abstract":"<p><p>Artificial intelligence (AI) technology is advancing rapidly, constantly presenting its application value and broad prospects in the medical field. Especially in the early intervention of burn diseases, the new developments, applications, and challenges of AI technology have a significant impact on the clinical outcomes of burn patients. Based on this, this article reviews the concept, classification, learning style, and application of AI in the early diagnosis and treatment of burn diseases, with a focus on discussing the challenges and suggestions of the application of AI technology in the medical field, in order to provide reference and suggestions for the better application of AI in the early diagnosis and treatment of burn diseases.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.3760/cma.j.cn121430-20231120-00996
Jing Liang, Jie Zhang, Shuo Zhang
<p><strong>Objective: </strong>To observe the effect of Wenyang Baidu Yin on early microcirculation indicators in patients with sepsis (syndrome of Yang deficiency and turbid toxin), analyze the specific therapeutic effect, and provide a new perspective for clinical treatment of microcirculation disorders in sepsis.</p><p><strong>Methods: </strong>Sixty-four patients with sepsis admitted to the intensive care unit (ICU) of Shanxi Province Hospital of Integrated Traditional Chinese and Western Medicine from January 2022 to July 2023 were enrolled. Patients were divided into control group and observation group by randomly number table method, with 32 cases in each group. The control group received conventional Western medicine treatment. On the basis of conventional Western medicine treatment, the observation group was given Wenyang Baidu Yin 200 mL/d (100 mL each time, with an interval of 12 hours) orally or by nasal feeding for 3 consecutive days. The central venous oxygen saturation (ScvO<sub>2</sub>), difference of central venous-to-arterial partial pressure of carbon dioxide (Pcv-aCO<sub>2</sub>), arterial lactic acid (Lac), pulse perfusion index (PI), capillary refill time (CRT), and skin mottling score (SMS) of two groups were detected before treatment and at 6, 12, 24, and 48 hours of treatment; simultaneously record the traditional Chinese medicine (TCM) syndrome score before treatment and at 72 hours of treatment, as well as the sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE) before treatment and at 24 hours and 72 hours of treatment.</p><p><strong>Results: </strong>There were no statistically significant differences in gender, age, and various microcirculation indicators before treatment between the two groups, indicating consistent baseline characteristics. Compared with before treatment, the microcirculation indicators ScvO<sub>2</sub>, Pcv-aCO<sub>2</sub>, Lac, PI, CRT, and SMS in both groups showed significant improvement after treatment. Moreover, the observation group showed more significant improvements in Lac and PI compared to the control group at 24 hours and 48 hours of treatment [Lac (mmol/L): 2.45±0.92 vs. 3.07±1.07 at 24 hours, 2.06±0.87 vs. 2.59±1.01 at 48 hours; PI: 3.45±0.89 vs. 2.92±0.98 at 24 hours, 3.56±0.99 vs. 3.01±0.87 at 48 hours, all P < 0.05]. CRT and SMS showed more significant improvements compared to the control group at 48 hours of treatment [CRT (s): 2.04±1.08 vs. 2.62±0.99, SMS: 0.5 (0.0, 1.0) vs. 1.0 (1.0, 1.0), both P < 0.05], while there were no statistically significant differences in ScvO<sub>2</sub> and Pcv-aCO<sub>2</sub> at each time point between the two groups. After treatment, the APACHE score, SOFA score, and TCM syndrome score improved in both groups compared to before treatment, and the improvement degree of each score in the observation group was significantly higher than that in the control group [72 hours APACHE II score: 15.0 (12.2, 1
目的观察温阳白术散对脓毒症（阳虚浊毒证）患者早期微循环指标的影响，分析其具体疗效，为临床治疗脓毒症微循环障碍提供新的视角：方法：选取2022年1月至2023年7月山西省中西医结合医院重症监护室（ICU）收治的64例脓毒症患者为研究对象。采用随机数字表法将患者分为对照组和观察组，每组32例。对照组接受常规西医治疗。观察组在常规西药治疗的基础上，给予温阳白术散 200 mL/d（每次 100 mL，间隔 12 小时）口服或鼻饲，连续 3 天。检测两组治疗前及治疗 6、12、24、48 小时的中心静脉血氧饱和度（ScvO2）、中心静脉-动脉二氧化碳分压差（Pcv-aCO2）、动脉乳酸（Lac）、脉搏灌注指数（PI）、毛细血管再充盈时间（CRT）和皮肤斑驳评分（SMS）；同时记录治疗前和治疗 72 小时的中医证候评分，以及治疗前、治疗 24 小时和治疗 72 小时的序贯器官功能衰竭评估（SOFA）和急性生理与慢性健康评估（APACHE）。结果显示两组患者治疗前的性别、年龄和各项微循环指标差异无统计学意义，表明基线特征一致。与治疗前相比，两组患者治疗后微循环指标ScvO2、Pcv-aCO2、Lac、PI、CRT和SMS均有明显改善。此外，在治疗 24 小时和 48 小时时，观察组的 Lac 和 PI 与对照组相比有更明显的改善[Lac（mmol/L）：24 小时时为 2.45±0.92 vs. 3.07±1.07，48 小时时为 2.06±0.87 vs. 2.59±1.01；PI：24小时为3.45±0.89 vs. 2.92±0.98，48小时为3.56±0.99 vs. 3.01±0.87，所有P均<0.05]。与对照组相比，CRT 和 SMS 在治疗 48 小时后有更明显的改善 [CRT (s): 2.04±1.08 vs. 2.62±0.99，SMS: 0.5 (0.0, 1.0) vs. 1.0 (1.0, 1.0)，均 P <0.05]，而两组在每个时间点的 ScvO2 和 Pcv-aCO2 差异均无统计学意义。治疗后，两组患者的 APACHE 评分、SOFA 评分、中医综合征评分均较治疗前有所改善，且观察组各项评分改善程度明显高于对照组[72 小时 APACHE II 评分：15.0（12.2，16.0）vs.17.0（13.5，20.0），72小时SOFA评分：6.0（6.0，8.0）vs.10.0（8.0，13.0），72小时中医综合征评分：10.13±3.73vs.14.63±5.55，均P<0.05]：在常规西医治疗的基础上，联合温阳白术散能够在一定程度上明显改善败血症（阳虚浊毒证）患者的微循环障碍，从而改善患者预后。
{"title":"[Effect of Wenyang Baidu Yin on early microcirculation disturbance in patients with sepsis (syndrome of Yang deficiency and turbid toxin): a randomized controlled trial].","authors":"Jing Liang, Jie Zhang, Shuo Zhang","doi":"10.3760/cma.j.cn121430-20231120-00996","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20231120-00996","url":null,"abstract":"<p><strong>Objective: </strong>To observe the effect of Wenyang Baidu Yin on early microcirculation indicators in patients with sepsis (syndrome of Yang deficiency and turbid toxin), analyze the specific therapeutic effect, and provide a new perspective for clinical treatment of microcirculation disorders in sepsis.</p><p><strong>Methods: </strong>Sixty-four patients with sepsis admitted to the intensive care unit (ICU) of Shanxi Province Hospital of Integrated Traditional Chinese and Western Medicine from January 2022 to July 2023 were enrolled. Patients were divided into control group and observation group by randomly number table method, with 32 cases in each group. The control group received conventional Western medicine treatment. On the basis of conventional Western medicine treatment, the observation group was given Wenyang Baidu Yin 200 mL/d (100 mL each time, with an interval of 12 hours) orally or by nasal feeding for 3 consecutive days. The central venous oxygen saturation (ScvO<sub>2</sub>), difference of central venous-to-arterial partial pressure of carbon dioxide (Pcv-aCO<sub>2</sub>), arterial lactic acid (Lac), pulse perfusion index (PI), capillary refill time (CRT), and skin mottling score (SMS) of two groups were detected before treatment and at 6, 12, 24, and 48 hours of treatment; simultaneously record the traditional Chinese medicine (TCM) syndrome score before treatment and at 72 hours of treatment, as well as the sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE) before treatment and at 24 hours and 72 hours of treatment.</p><p><strong>Results: </strong>There were no statistically significant differences in gender, age, and various microcirculation indicators before treatment between the two groups, indicating consistent baseline characteristics. Compared with before treatment, the microcirculation indicators ScvO<sub>2</sub>, Pcv-aCO<sub>2</sub>, Lac, PI, CRT, and SMS in both groups showed significant improvement after treatment. Moreover, the observation group showed more significant improvements in Lac and PI compared to the control group at 24 hours and 48 hours of treatment [Lac (mmol/L): 2.45±0.92 vs. 3.07±1.07 at 24 hours, 2.06±0.87 vs. 2.59±1.01 at 48 hours; PI: 3.45±0.89 vs. 2.92±0.98 at 24 hours, 3.56±0.99 vs. 3.01±0.87 at 48 hours, all P < 0.05]. CRT and SMS showed more significant improvements compared to the control group at 48 hours of treatment [CRT (s): 2.04±1.08 vs. 2.62±0.99, SMS: 0.5 (0.0, 1.0) vs. 1.0 (1.0, 1.0), both P < 0.05], while there were no statistically significant differences in ScvO<sub>2</sub> and Pcv-aCO<sub>2</sub> at each time point between the two groups. After treatment, the APACHE score, SOFA score, and TCM syndrome score improved in both groups compared to before treatment, and the improvement degree of each score in the observation group was significantly higher than that in the control group [72 hours APACHE II score: 15.0 (12.2, 1","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.3760/cma.j.cn121430-20231121-01003
Gang Wang, Jianfeng Duan, Ke Cao, Tao Gao, Anqi Jiang, Yun Xu, Zhanghua Zhu, Wenkui Yu
<p><strong>Objective: </strong>To investigate the protective effects and mechanisms of targeted inhibition of type 3 deiodinase (Dio3) on skeletal muscle mitochondria in sepsis.</p><p><strong>Methods: </strong>(1) In vivo experiments: adeno-associated virus (AAV) was employed to specifically target Dio3 expression in the anterior tibial muscle of rats, and a septic rat model was generated using cecal ligation and puncture (CLP). The male Sprague-Dawley (SD) rats were divided into shNC+Sham group, shD3+Sham group, shNC+CLP group, and shD3+CLP group by random number table method, with 8 rats in each group. After CLP modeling, tibial samples were collected and Western blotting analysis was conducted to assess the protein levels of Dio3, peroxisome proliferator-activated receptor-γ coactivator-1α (PGC1α), and silence-regulatory protein 1 (SIRT1). Real-time fluorescence quantitative polymerase chain reaction (RT-qPCR) was utilized to examine mRNA expression of genes including thyroid hormone receptors (THRα, THRβ), monocarboxylate transporter 10 (MCT10), mitochondrial DNA (mtDNA), and PGC1α. Transmission electron microscopy was employed to investigate mitochondrial morphology. (2) In vitro experiments: involved culturing C2C12 myoblasts, interfering with Dio3 expression using lentivirus, and constructing an endotoxin cell model by treating cells with lipopolysaccharide (LPS). C2C12 cells were divided into shNC group, shD3 group, shNC+LPS group, and shD3+LPS group. Immunofluorescence colocalization analysis was performed to determine the intracellular distribution of PGC1α. Co-immunoprecipitation assay coupled with Western blotting was carried out to evaluate the acetylation level of PGC1α.</p><p><strong>Results: </strong>(1) In vivo experiments: compared with the shNC+Sham group, the expression of Dio3 protein in skeletal muscle of the shNC+CLP group was significantly increased (Dio3/β-Tubulin: 3.32±0.70 vs. 1.00±0.49, P < 0.05), however, there was no significant difference in the shD3+Sham group. Dio3 expression in the shD3+CLP group was markedly reduced relative to the shNC+CLP group (Dio3/β-Tubulin: 1.42±0.54 vs. 3.32±0.70, P < 0.05). Compared with the shNC+CLP group, the expression of T3-regulated genes in the shD3+CLP group were restored [THRα mRNA (2<sup>-ΔΔCt</sup>): 0.67±0.05 vs. 0.33±0.01, THRβ mRNA (2<sup>-ΔΔCt</sup>): 0.94±0.05 vs. 0.67±0.02, MCT10 mRNA (2<sup>-ΔΔCt</sup>): 0.65±0.03 vs. 0.57±0.02, all P < 0.05]. Morphology analysis by electron microscopy suggested prominent mitochondrial damage in the skeletal muscle of the shNC+CLP group, while the shD3+CLP group exhibited a marked improvement. Compared with the shNC+Sham group, the shNC+CLP group significantly reduced the number of mitochondria (cells/HP: 10.375±1.375 vs. 13.750±2.063, P < 0.05), while the shD3+CLP group significantly increased the number of mitochondria compared to the shNC+CLP group (cells/HP: 11.250±2.063 vs. 10.375±1.375, P < 0.05). The expression of mtDNA in shNC+CL
目的方法：（1）体内实验：采用腺相关病毒（AAV）在大鼠胫前肌中特异性靶向表达Dio3，并采用盲肠结扎法（CLP）建立败血症大鼠模型。采用随机数字表法将雄性斯普拉格-道利（SD）大鼠分为 shNC+Sham 组、shD3+Sham 组、shNC+CLP 组和 shD3+CLP 组，每组 8 只。CLP建模后，收集胫骨样本并进行Western印迹分析，以评估Dio3、过氧化物酶体增殖激活受体-γ辅助激活剂-1α（PGC1α）和沉默调节蛋白1（SIRT1）的蛋白水平。利用实时荧光定量聚合酶链反应（RT-qPCR）检测了甲状腺激素受体（THRα、THRβ）、单羧酸盐转运体 10（MCT10）、线粒体 DNA（mtDNA）和 PGC1α 等基因的 mRNA 表达。透射电子显微镜用于研究线粒体形态。(2）体外实验：包括培养 C2C12 肌母细胞，使用慢病毒干扰 Dio3 的表达，并通过脂多糖（LPS）处理细胞构建内毒素细胞模型。C2C12细胞分为shNC组、shD3组、shNC+LPS组和shD3+LPS组。免疫荧光共定位分析测定了PGC1α在细胞内的分布。结果：（1）体内实验：与 shNC+Sham 组相比，shNC+CLP 组骨骼肌中 Dio3 蛋白的表达显著增加（Dio3/β-Tubulin：3.32±0.70 vs. 1.00±0.49，P <0.05），但 shD3+Sham 组无显著差异。与 shNC+CLP 组相比，shD3+CLP 组的 Dio3 表达明显减少（Dio3/β-Tubulin：1.42±0.54 vs. 3.32±0.70，P＜0.05）。与 shNC+CLP 组相比，shD3+CLP 组 T3 调控基因的表达得到恢复 [THRα mRNA (2-ΔΔCt)：0.67±0.05 vs. 0.33±0.01, THRβ mRNA (2-ΔΔCt)：0.94±0.05 vs. 0.67±0.02, MCT10 mRNA (2-ΔΔCt)：0.65±0.03 vs. 0.57±0.02，所有 P <0.05]。电镜形态学分析表明，shNC+CLP 组骨骼肌线粒体损伤明显，而 shD3+CLP 组骨骼肌线粒体损伤明显改善。与 shNC+Sham 组相比，shNC+CLP 组线粒体数量明显减少（细胞/HP：10.375±1.375 vs. 13.750±2.063，P＜0.05），而 shD3+CLP 组线粒体数量明显增加（细胞/HP：11.250±2.063 vs. 10.375±1.375，P＜0.05）。与 shNC+Sham 组相比，shNC+CLP 组的 mtDNA 表达明显减少（拷贝数：0.842±0.035 vs. 1.002±0.064，P <0.05）。shD3+CLP 组与 shNC+CLP 组的 mtDNA 表达量虽无差异，但与 shD3+Sham 组相比有显著增加（拷贝数：0.758±0.035 vs. 0.474±0.050，P＜0.05）。与 shNC+CLP 组相比，shD3+CLP 组的 PGC1α 表达在转录和蛋白水平上都有显著改善 [PGC1α mRNA (2-ΔΔCt)：1.49±0.13 vs. 0.68±0.06，PGC1α/β-Tubulin：0.76±0.02 vs. 0.62±0.04，均 P <0.05]。(2）体外实验：C2C12细胞经24小时LPS处理后，PGC1α的细胞定位变得弥散；干扰Dio3的表达可促进PGC1α向核周和核内转位。此外，shD3+LPS 组的乙酰化 PGC1α 水平明显低于 shNC+LPS 组（乙酰化 PGC1α/β-Tubulin: 0.59±0.01 vs. 1.24±0.01，P < 0.05），而去乙酰化剂 SIRT1 的表达在 Dio3 抑制后大幅升高（SIRT1/β-Tubulin：1.04±0.04 vs. 0.58±0.03，P < 0.05）。当使用EX527抑制SIRT1活性时，与shD3+LPS组相比，PGC1α蛋白表达明显减少（PGC1α/β-Tubulin：0.92±0.03 vs. 1.58±0.03，P＜0.05）：结论：抑制骨骼肌中的Dio3可通过激活SIRT1减少PGC1α的乙酰化，促进PGC1α的核转位，从而保护骨骼肌免受脓毒症诱导的线粒体损伤。
{"title":"[Inhibition of type 3 deiodinase expression can improve mitochondrial function in skeletal muscle of sepsis by up-regulating peroxisome proliferator-activated receptor-γ coactivator-1α].","authors":"Gang Wang, Jianfeng Duan, Ke Cao, Tao Gao, Anqi Jiang, Yun Xu, Zhanghua Zhu, Wenkui Yu","doi":"10.3760/cma.j.cn121430-20231121-01003","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20231121-01003","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the protective effects and mechanisms of targeted inhibition of type 3 deiodinase (Dio3) on skeletal muscle mitochondria in sepsis.</p><p><strong>Methods: </strong>(1) In vivo experiments: adeno-associated virus (AAV) was employed to specifically target Dio3 expression in the anterior tibial muscle of rats, and a septic rat model was generated using cecal ligation and puncture (CLP). The male Sprague-Dawley (SD) rats were divided into shNC+Sham group, shD3+Sham group, shNC+CLP group, and shD3+CLP group by random number table method, with 8 rats in each group. After CLP modeling, tibial samples were collected and Western blotting analysis was conducted to assess the protein levels of Dio3, peroxisome proliferator-activated receptor-γ coactivator-1α (PGC1α), and silence-regulatory protein 1 (SIRT1). Real-time fluorescence quantitative polymerase chain reaction (RT-qPCR) was utilized to examine mRNA expression of genes including thyroid hormone receptors (THRα, THRβ), monocarboxylate transporter 10 (MCT10), mitochondrial DNA (mtDNA), and PGC1α. Transmission electron microscopy was employed to investigate mitochondrial morphology. (2) In vitro experiments: involved culturing C2C12 myoblasts, interfering with Dio3 expression using lentivirus, and constructing an endotoxin cell model by treating cells with lipopolysaccharide (LPS). C2C12 cells were divided into shNC group, shD3 group, shNC+LPS group, and shD3+LPS group. Immunofluorescence colocalization analysis was performed to determine the intracellular distribution of PGC1α. Co-immunoprecipitation assay coupled with Western blotting was carried out to evaluate the acetylation level of PGC1α.</p><p><strong>Results: </strong>(1) In vivo experiments: compared with the shNC+Sham group, the expression of Dio3 protein in skeletal muscle of the shNC+CLP group was significantly increased (Dio3/β-Tubulin: 3.32±0.70 vs. 1.00±0.49, P < 0.05), however, there was no significant difference in the shD3+Sham group. Dio3 expression in the shD3+CLP group was markedly reduced relative to the shNC+CLP group (Dio3/β-Tubulin: 1.42±0.54 vs. 3.32±0.70, P < 0.05). Compared with the shNC+CLP group, the expression of T3-regulated genes in the shD3+CLP group were restored [THRα mRNA (2<sup>-ΔΔCt</sup>): 0.67±0.05 vs. 0.33±0.01, THRβ mRNA (2<sup>-ΔΔCt</sup>): 0.94±0.05 vs. 0.67±0.02, MCT10 mRNA (2<sup>-ΔΔCt</sup>): 0.65±0.03 vs. 0.57±0.02, all P < 0.05]. Morphology analysis by electron microscopy suggested prominent mitochondrial damage in the skeletal muscle of the shNC+CLP group, while the shD3+CLP group exhibited a marked improvement. Compared with the shNC+Sham group, the shNC+CLP group significantly reduced the number of mitochondria (cells/HP: 10.375±1.375 vs. 13.750±2.063, P < 0.05), while the shD3+CLP group significantly increased the number of mitochondria compared to the shNC+CLP group (cells/HP: 11.250±2.063 vs. 10.375±1.375, P < 0.05). The expression of mtDNA in shNC+CL","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.3760/cma.j.cn121430-20240109-00024
Junma Xu, Yi Xie, Dong Yuan, Chan Shao, Fangqin Xu, Shu Han
Objective: To explore the feasibility and safety of integrating the geriatric intensive care unit (GICU) into the friendly management model of the elderly critically ill patients.
Methods: A prospective controlled study was conducted. Patients with elderly critically ill admitted to the GICU and the general intensive care unit (ICU) of Jintan First People's Hospital of Changzhou from December 2021 to May 2023 were enrolled. Patients in the ICU group received the traditional intensive care and nursing mode. In addition to the ICU group basic medical care measures, the patients in the GICU group were treated with friendly management models such as flexible visitation, diagnosis and treatment environment optimization, caring diagnosis and treatment, and family participation in hospice care according to their condition assessment. The gender, age, main diagnosis, and acute physiology and chronic health evaluation II (APACHE II) at admission were recorded and compared between the two groups. During the treatment period, the incidence of nosocomial infection, unplanned extubation, falling out of bed/fall, unexpected readmission to ICU/GICU, and ICU/GICU mortality, the incidence of post-intensive care syndrome (PICS), the satisfaction rate of patients/families with medical care, and the satisfaction rate of patients/families with diagnosis and treatment environment were recorded and compared between the two groups.
Results: According to the admission criteria for ICU and GICU, as well as the willingness of the patients and/or their families, a total of 59 patients were finally included in the ICU group, and 48 patients were enrolled in the GICU group. There were no significantly differences in gender, age, main diagnosis and APACHE II score between the two groups, and there were comparability. There were no significantly differences in the incidence of adverse events such as nosocomial infection [13.6% (8/59) vs. 12.5% (6/48)], unplanned extubation [5.1% (3/59) vs. 6.2% (3/48)], falling out of bed/fall [3.4% (2/59) vs. 0% (0/48)], unexpected readmission to ICU/GICU [8.5% (5/59) vs. 10.4% (5/48)], and ICU/GICU mortality [6.8% (4/59) vs. 6.2 (3/48)] between the ICU group and GICU group (all P > 0.05). Compared with the ICU group, the incidence of PICS in GICU group was significantly lower [8.3% (4/48) vs. 25.4% (15/59), P < 0.05], the satisfaction rate of patients/families with medical care [89.6% (43/48) vs. 74.6% (44/59)] and satisfaction rate of patients/families with diagnosis and treatment environment [87.5% (42/48) vs. 67.8% (40/59)] were significantly increased (both P < 0.05).
Conclusions: The use GICU as a friendly management model for elderly critically ill patients is feasible and safe, and it is worthy of further exploration and research.
目的探讨将老年重症监护病房（GICU）纳入老年重症患者友好管理模式的可行性和安全性：方法：进行前瞻性对照研究。方法：本研究为前瞻性对照研究，研究对象为2021年12月至2023年5月入住常州市金坛区第一人民医院老年重症监护室（GICU）和普通重症监护室（ICU）的老年重症患者。ICU 组患者接受传统的重症监护和护理模式。GICU组患者除接受ICU组基本医疗护理措施外，根据病情评估结果，采用弹性探视、诊疗环境优化、关爱诊疗、家属参与临终关怀等友善管理模式。记录两组患者的性别、年龄、主要诊断、入院时急性生理学和慢性病健康评估 II（APACHE II）等情况，并进行比较。在治疗期间，记录并比较两组患者的院内感染、非计划拔管、坠床/跌倒、ICU/GICU意外再入院、ICU/GICU死亡率、重症监护后综合征（PICS）发生率、患者/家属对医疗护理的满意率、患者/家属对诊疗环境的满意率：根据 ICU 和 GICU 的入院标准以及患者和/或家属的意愿，最终共有 59 名患者被纳入 ICU 组，48 名患者被纳入 GICU 组。两组患者在性别、年龄、主要诊断和 APACHE II 评分方面无明显差异，具有可比性。两组患者的不良事件发生率无明显差异，如院内感染 [13.6% (8/59) vs. 12.5% (6/48)]、意外拔管 [5.1% (3/59) vs. 6.2% (3/48)]、坠床/跌倒 [3.4% (2/59) vs. 0% (0/48)]、ICU/GICU意外再入院[8.5% (5/59) vs. 10.4% (5/48)]、ICU/GICU死亡率[6.8% (4/59) vs. 6.2 (3/48)]（所有P>0.05）。与ICU组相比，GICU组的PICS发生率明显降低[8.3% (4/48) vs. 25.4% (15/59)，P < 0.05]，患者/家属对医疗护理的满意度[89.6% (43/48) vs. 74.6% (44/59)]和患者/家属对诊疗环境的满意度[87.5% (42/48) vs. 67.8% (40/59)]明显提高（均P < 0.05）：结论：将 GICU 作为老年重症患者的友好管理模式是可行和安全的，值得进一步探索和研究。
{"title":"[Feasibility and safety study of building a friendly management model for elderly critically ill patients based on geriatric intensive care unit: a prospective controlled study].","authors":"Junma Xu, Yi Xie, Dong Yuan, Chan Shao, Fangqin Xu, Shu Han","doi":"10.3760/cma.j.cn121430-20240109-00024","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240109-00024","url":null,"abstract":"<p><strong>Objective: </strong>To explore the feasibility and safety of integrating the geriatric intensive care unit (GICU) into the friendly management model of the elderly critically ill patients.</p><p><strong>Methods: </strong>A prospective controlled study was conducted. Patients with elderly critically ill admitted to the GICU and the general intensive care unit (ICU) of Jintan First People's Hospital of Changzhou from December 2021 to May 2023 were enrolled. Patients in the ICU group received the traditional intensive care and nursing mode. In addition to the ICU group basic medical care measures, the patients in the GICU group were treated with friendly management models such as flexible visitation, diagnosis and treatment environment optimization, caring diagnosis and treatment, and family participation in hospice care according to their condition assessment. The gender, age, main diagnosis, and acute physiology and chronic health evaluation II (APACHE II) at admission were recorded and compared between the two groups. During the treatment period, the incidence of nosocomial infection, unplanned extubation, falling out of bed/fall, unexpected readmission to ICU/GICU, and ICU/GICU mortality, the incidence of post-intensive care syndrome (PICS), the satisfaction rate of patients/families with medical care, and the satisfaction rate of patients/families with diagnosis and treatment environment were recorded and compared between the two groups.</p><p><strong>Results: </strong>According to the admission criteria for ICU and GICU, as well as the willingness of the patients and/or their families, a total of 59 patients were finally included in the ICU group, and 48 patients were enrolled in the GICU group. There were no significantly differences in gender, age, main diagnosis and APACHE II score between the two groups, and there were comparability. There were no significantly differences in the incidence of adverse events such as nosocomial infection [13.6% (8/59) vs. 12.5% (6/48)], unplanned extubation [5.1% (3/59) vs. 6.2% (3/48)], falling out of bed/fall [3.4% (2/59) vs. 0% (0/48)], unexpected readmission to ICU/GICU [8.5% (5/59) vs. 10.4% (5/48)], and ICU/GICU mortality [6.8% (4/59) vs. 6.2 (3/48)] between the ICU group and GICU group (all P > 0.05). Compared with the ICU group, the incidence of PICS in GICU group was significantly lower [8.3% (4/48) vs. 25.4% (15/59), P < 0.05], the satisfaction rate of patients/families with medical care [89.6% (43/48) vs. 74.6% (44/59)] and satisfaction rate of patients/families with diagnosis and treatment environment [87.5% (42/48) vs. 67.8% (40/59)] were significantly increased (both P < 0.05).</p><p><strong>Conclusions: </strong>The use GICU as a friendly management model for elderly critically ill patients is feasible and safe, and it is worthy of further exploration and research.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To investigate the causal association between immune cell and different types of sepsis by using Mendelian randomization (MR) method, and to find the immune cell phenotypes causally associated with sepsis.
Methods: Summary data for various circulating immune cell phenotypes were obtained from the GWAS catalog (GCST90001391-GCST90002121). Sepsis data were sourced from the UK Biobank database. Single nucleotide polymorphisms (SNP) were used as instrumental variables. The correlation threshold of P < 5×10-6 was used to identify the strongly correlated instrumental variables, and the code was used to remove the linkage disequilibrium and the instrumental variables with F-value < 10. Inverse variance weighting (IVW) was used as the main research method to evaluate the stability and reliability of the results, including Cochran's Q test, MR-Egger regression and Leave one out. Reverse MR analysis was performed based on the immunophenotypic results of the removal of horizontal pleiotropy, and the immune cell phenotype with one-way causal association was obtained. Odds ratio (OR) and 95% confidence interval (95%CI) were used to represent the effect value of the results.
Results: CD16 on CD14-CD16+; monocyte had horizontal pleiotropy in sepsis (OR = 0.965 4, 95%CI was 0.933 5-0.998 3, P = 0.039 6). There were five immunophenotypes that had reverse causal associations with the types associated with sepsis. After excluding immune cell phenotypes with horizontal pleiotropy and reverse causation, a total of 42 immune cell phenotypes with sepsis, 36 immune cell phenotypes with sepsis (28-day death in critical care), 32 immune cell phenotypes with sepsis (critical care), 44 immune cell phenotypes with sepsis (28-day death), and 30 immune cell phenotypes had potential causal associations with sepsis (under 75 years old). After false discovery rate (FDR) correction, the correlations between BAFF-R on IgD- CD38br and sepsis (28-day death) were negative and strong (OR = 0.737 8, 95%CI was 0.635 9-0.856 0, P = 6.05×10-5, PFDR = 0.044 2).
Conclusions: A variety of immune cell phenotypes may have a protective effect on sepsis, especially BAFF-R on IgD- CD38br expression is negatively correlated with sepsis (28-day death), which provides a new idea for immune modulation therapy in sepsis.
{"title":"[Causal association between immune cells and sepsis: a based on Mendelian randomization method study].","authors":"Qiushuang Yu, Lingxu Li, Yina Tao, Longqiang Zhang, Junfeng Hu, Huaxue Wang","doi":"10.3760/cma.j.cn121430-20240527-00462","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240527-00462","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the causal association between immune cell and different types of sepsis by using Mendelian randomization (MR) method, and to find the immune cell phenotypes causally associated with sepsis.</p><p><strong>Methods: </strong>Summary data for various circulating immune cell phenotypes were obtained from the GWAS catalog (GCST90001391-GCST90002121). Sepsis data were sourced from the UK Biobank database. Single nucleotide polymorphisms (SNP) were used as instrumental variables. The correlation threshold of P < 5×10<sup>-6</sup> was used to identify the strongly correlated instrumental variables, and the code was used to remove the linkage disequilibrium and the instrumental variables with F-value < 10. Inverse variance weighting (IVW) was used as the main research method to evaluate the stability and reliability of the results, including Cochran's Q test, MR-Egger regression and Leave one out. Reverse MR analysis was performed based on the immunophenotypic results of the removal of horizontal pleiotropy, and the immune cell phenotype with one-way causal association was obtained. Odds ratio (OR) and 95% confidence interval (95%CI) were used to represent the effect value of the results.</p><p><strong>Results: </strong>CD16 on CD14<sup>-</sup>CD16<sup>+</sup>; monocyte had horizontal pleiotropy in sepsis (OR = 0.965 4, 95%CI was 0.933 5-0.998 3, P = 0.039 6). There were five immunophenotypes that had reverse causal associations with the types associated with sepsis. After excluding immune cell phenotypes with horizontal pleiotropy and reverse causation, a total of 42 immune cell phenotypes with sepsis, 36 immune cell phenotypes with sepsis (28-day death in critical care), 32 immune cell phenotypes with sepsis (critical care), 44 immune cell phenotypes with sepsis (28-day death), and 30 immune cell phenotypes had potential causal associations with sepsis (under 75 years old). After false discovery rate (FDR) correction, the correlations between BAFF-R on IgD<sup>-</sup> CD38br and sepsis (28-day death) were negative and strong (OR = 0.737 8, 95%CI was 0.635 9-0.856 0, P = 6.05×10<sup>-5</sup>, P<sub>FDR</sub> = 0.044 2).</p><p><strong>Conclusions: </strong>A variety of immune cell phenotypes may have a protective effect on sepsis, especially BAFF-R on IgD<sup>-</sup> CD38br expression is negatively correlated with sepsis (28-day death), which provides a new idea for immune modulation therapy in sepsis.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.3760/cma.j.cn121430-20231117-00988
Zhiyi Liu, Guanghui Xiu
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection, with increasing mortality as septic shock and organ failure progress. Mechanisms such as vascular endothelial dysfunction, microcirculatory disorders, coagulation abnormalities, immune suppression, mitochondrial damage, cell pyroptosis, ferroptosis, endoplasmic reticulum stress, and autophagy play crucial roles in organ dysfunction and death caused by sepsis. Concurrently, the imbalance of the gut microbiota also plays an undeniable role in the development of sepsis, with recent studies demonstrating a close connection between the gut microbiome and sepsis. Thus, how to improve the prognosis of patients with sepsis by reconstructing gut microbiota has become a focus of interest for critical care physicians. This article reviews the research progress on the correlation between gut microbiota and sepsis, providing clinical physicians with more therapeutic strategies to improve patient prognosis.
{"title":"[Research progress on the correlation between intestinal microecology and sepsis].","authors":"Zhiyi Liu, Guanghui Xiu","doi":"10.3760/cma.j.cn121430-20231117-00988","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20231117-00988","url":null,"abstract":"<p><p>Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection, with increasing mortality as septic shock and organ failure progress. Mechanisms such as vascular endothelial dysfunction, microcirculatory disorders, coagulation abnormalities, immune suppression, mitochondrial damage, cell pyroptosis, ferroptosis, endoplasmic reticulum stress, and autophagy play crucial roles in organ dysfunction and death caused by sepsis. Concurrently, the imbalance of the gut microbiota also plays an undeniable role in the development of sepsis, with recent studies demonstrating a close connection between the gut microbiome and sepsis. Thus, how to improve the prognosis of patients with sepsis by reconstructing gut microbiota has become a focus of interest for critical care physicians. This article reviews the research progress on the correlation between gut microbiota and sepsis, providing clinical physicians with more therapeutic strategies to improve patient prognosis.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.3760/cma.j.cn121430-20240508-00408
Medicine Chinese Society Of Critical Care, Medicine Critical Care Medicine Branch Of Beijing Association Of Holistic Integrative, Working Group Of The Expert Recommendations On The Clinical Application Of Mechanical Insufflation-Exsufflation In Mechanically Ventilated Patients
Mechanical ventilated patients are a high-risk group with impaired cough ability and require corresponding medical techniques for cough assistance to clear airway secretions. Mechanical insufflation-exsufflation (MI-E) technology is widely used in patients with cough weakness caused by neuromuscular diseases. However, there is currently a lack of standardized application procedures for mechanically ventilated patients who retain artificial airways, which can affect treatment outcomes. Chinese Society of Critical Care Medicine organized experts including critical care physicians, nurses, respiratory therapists that focused on the clinical application of mechanical insufflation-exsufflation in mechanically ventilated patients. Through systematic collection, extraction, and summary of evidence-based clinical practice evidence and clinical experience, suggestions are proposed. Expert recommendations on the clinical application of mechanical insufflation-exsufflation in mechanically ventilated patients (2024) was formed by using improved Delphi method, hoping to provide references for standardized application of this technology. At the same time, those recommendations will also provide a reference for future clinical research on the application of mechanical insufflation-exsufflation technology in mechanically ventilated patients.
{"title":"[Expert recommendations on the clinical application of mechanical insufflation-exsufflation in mechanically ventilated patients (2024)].","authors":"Medicine Chinese Society Of Critical Care, Medicine Critical Care Medicine Branch Of Beijing Association Of Holistic Integrative, Working Group Of The Expert Recommendations On The Clinical Application Of Mechanical Insufflation-Exsufflation In Mechanically Ventilated Patients","doi":"10.3760/cma.j.cn121430-20240508-00408","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240508-00408","url":null,"abstract":"<p><p>Mechanical ventilated patients are a high-risk group with impaired cough ability and require corresponding medical techniques for cough assistance to clear airway secretions. Mechanical insufflation-exsufflation (MI-E) technology is widely used in patients with cough weakness caused by neuromuscular diseases. However, there is currently a lack of standardized application procedures for mechanically ventilated patients who retain artificial airways, which can affect treatment outcomes. Chinese Society of Critical Care Medicine organized experts including critical care physicians, nurses, respiratory therapists that focused on the clinical application of mechanical insufflation-exsufflation in mechanically ventilated patients. Through systematic collection, extraction, and summary of evidence-based clinical practice evidence and clinical experience, suggestions are proposed. Expert recommendations on the clinical application of mechanical insufflation-exsufflation in mechanically ventilated patients (2024) was formed by using improved Delphi method, hoping to provide references for standardized application of this technology. At the same time, those recommendations will also provide a reference for future clinical research on the application of mechanical insufflation-exsufflation technology in mechanically ventilated patients.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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