Pub Date : 2024-09-01DOI: 10.3760/cma.j.cn121430-20240531-00480
Yan Xu, Dechang Chen
Critical care rehabilitation is an essential component of treating critically ill patients. Implementing early rehabilitation is safe and feasible, with benefits and early rehabilitation is both safe and feasible, with benefits far outweighing potential risks. An individualized rehabilitation plan is necessary for initiating early rehabilitation treatment. This includes identifying the rehabilitation needs of critically ill patients, timely seizing opportunities for rehabilitation intervention, and implementing safe rehabilitation measures through position training, exercise training, respiratory training, and monitoring the rehabilitation process. There remains considerable heterogeneity in the clinical practice of early rehabilitation treatment for critically ill patients. This article provides an updated overview of evidence-based medicine for early rehabilitation treatment of critically ill patients, aiming to offer a reference for clinical medical staff in formulating critical care rehabilitation treatment strategies for these patients.
{"title":"[Research progress on the timing and implementation of early rehabilitation for critically ill patient].","authors":"Yan Xu, Dechang Chen","doi":"10.3760/cma.j.cn121430-20240531-00480","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240531-00480","url":null,"abstract":"<p><p>Critical care rehabilitation is an essential component of treating critically ill patients. Implementing early rehabilitation is safe and feasible, with benefits and early rehabilitation is both safe and feasible, with benefits far outweighing potential risks. An individualized rehabilitation plan is necessary for initiating early rehabilitation treatment. This includes identifying the rehabilitation needs of critically ill patients, timely seizing opportunities for rehabilitation intervention, and implementing safe rehabilitation measures through position training, exercise training, respiratory training, and monitoring the rehabilitation process. There remains considerable heterogeneity in the clinical practice of early rehabilitation treatment for critically ill patients. This article provides an updated overview of evidence-based medicine for early rehabilitation treatment of critically ill patients, aiming to offer a reference for clinical medical staff in formulating critical care rehabilitation treatment strategies for these patients.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 9","pages":"992-996"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393868","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 : 2024-09-01DOI: 10.3760/cma.j.cn121430-20240318-00247
Xinlei Chen, Huihui Wang, Ping Geng, Bingyu Ling, Aiwen Ma, Min Xu, Dingyu Tan
<p><strong>Objective: </strong>To investigate the value of early tight junction protein Claudin-5 levels in predicting the severity of acute pancreatitis (AP).</p><p><strong>Methods: </strong>A prospective observational study was conducted, including patients diagnosed with AP and admitted to the Northern Jiangsu People's Hospital from December 1, 2021 to November 30, 2022. Eligible healthy volunteers were randomly selected to serve as healthy controls during the same period. Patients were classified into mild acute pancreatitis (MAP) group, moderate-severe acute pancreatitis (MSAP) group, and severe acute pancreatitis (SAP) group based on the 2012 Atlanta classification criteria. Patients with SAP were then divided into three subgroups of 1, 3, and 7 days based on the duration of hospitalization. Baseline data, such as gender, age, underlying disease, and probable etiology, was collected from all enrolled individuals. The enzyme-linked immunosorbent assay (ELISA) was employed to detect serum Claudin-5 levels in each cohort of enrollees. Data on additional serologic indicators, including hematocrit (HCT), albumin (Alb), serum Ca<sup>2+</sup>, C-reactive protein (CRP), and procalcitonin (PCT) levels, were obtained via the in-hospital test query system in each group of patients with AP. The modified Marshall score (mMarshall), modified CT severity index (mCTSI) score, bedside severity index of severity in acute pancreatitis (BISAP) score, and acute physiology and chronic health evaluation II (APACHE II) were recorded for each group of patients with AP. Differences in the above indicators between groups were analyzed and compared. Spearman's correlation method was employed to examine the relationship between Claudin-5 levels and each influential factor. The receiver operator characteristic curve (ROC curve) was plotted to analyze the predictive value of each influencing factor on SAP. Ridge regression was used to screen for independent risk factors for SAP.</p><p><strong>Results: </strong>A total of 109 patients with AP were enrolled, comprising 66 in the MAP group, 15 in the MSAP group, and 28 in the SAP group. Additionally, 27 healthy volunteers were enrolled as the healthy control group. No statistically significant differences were observed in gender and age among the enrolled groups, and no statistically significant differences were identified among the three groups of patients with AP in terms of underlying disease and etiologic composition. As the disease progressed, serum Claudin-5 levels exhibited a notable increase across all AP patient groups, and they were all significantly higher than those in the healthy control group [ng/L: 888.58 (574.52, 1 141.59), 3 749.02 (2 784.93, 5 789.92), 4 667.81 (3 935.21, 7 315.66) vs. 291.13 (250.19, 314.75), all P < 0.05]. Subgroup analyses showed that as the disease duration prolonged, patients in the SAP group exhibited a notable decline in Claudin-5 levels at 3 days post-admission, compared with those
目的探讨早期紧密连接蛋白Claudin-5水平在预测急性胰腺炎（AP）严重程度中的价值：方法：开展一项前瞻性观察研究，研究对象包括2021年12月1日至2022年11月30日期间苏北人民医院收治的确诊为急性胰腺炎的患者。同期随机抽取符合条件的健康志愿者作为健康对照。根据2012年亚特兰大分级标准，将患者分为轻度急性胰腺炎（MAP）组、中重度急性胰腺炎（MSAP）组和重度急性胰腺炎（SAP）组。然后根据住院时间将 SAP 患者分为 1 天、3 天和 7 天三个亚组。我们收集了所有入组患者的基线数据，如性别、年龄、基础疾病和可能的病因。采用酶联免疫吸附试验（ELISA）检测每组入选者的血清 Claudin-5 水平。其他血清学指标的数据，包括血细胞比容（HCT）、白蛋白（Alb）、血清 Ca2+、C 反应蛋白（CRP）和降钙素原（PCT）水平，均通过院内检测查询系统获得。记录每组 AP 患者的改良马歇尔评分（mMarshall）、改良 CT 严重程度指数（mCTSI）评分、急性胰腺炎床旁严重程度指数（BISAP）评分和急性生理学和慢性健康评估 II（APACHE II）。分析并比较各组间上述指标的差异。采用斯皮尔曼相关法研究 Claudin-5 水平与各影响因素之间的关系。绘制接收器操作特征曲线（ROC 曲线），分析各影响因素对 SAP 的预测价值。采用岭回归筛选 SAP 的独立危险因素：共纳入 109 名 AP 患者，其中 MAP 组 66 人，MSAP 组 15 人，SAP 组 28 人。此外，还有 27 名健康志愿者作为健康对照组。三组 AP 患者的性别和年龄差异无统计学意义，在基础疾病和病因组成方面也无统计学意义。随着病情的发展，所有 AP 患者组的血清 Claudin-5 水平均出现明显升高，且均显著高于健康对照组 [ng/L: 888.58 (574.52, 1 141.59), 3 749.02 (2 784.93, 5 789.92), 4 667.81 (3 935.21, 7 315.66) vs. 291.13 (250.19, 314.75), 均 P < 0.05]。亚组分析显示，随着病程的延长，SAP 组患者入院后 3 天的 Claudin-5 水平与入院后 1 天的水平相比明显下降 [ng/L: 2 052.59 (1 089.43, 4 006.47) vs. 4 667.81 (3 935.21, 7 315.66)，P < 0.05]。斯皮尔曼相关性分析显示，AP 患者血清 Claudin-5 水平与 CRP、PCT、HCT 以及 mMarshall、mCTSI 和 BISAP 评分呈显著正相关（r 值分别为 0.570、0.525、0.323、0.774、0.670、0.652，均 P <0.001），与 Alb 呈显著负相关（r = -0.394，P <0.001）。在 AP 患者中观察到一个明显的趋势，即随着病情的发展，HCT 水平上升，Alb 水平下降（均为 P <0.05）。SAP患者在治疗后上述现象有所改善，间接表明血清Claudin-5水平是血管渗漏的阳性指标。ROC 曲线分析显示，AP 患者血清 Claudin-5 水平对 SAP 早期预测的准确性最高，ROC 曲线下面积（AUC）为 0.948。当血清Claudin-5水平≥2 997 ng/L时，早期筛查SAP的敏感性为100%，特异性为88.89%。多因素脊回归分析表明，血清Claudin-5水平、PCT和APACHE II评分可作为早期预测SAP的独立危险因素（均P＜0.05）：血清Claudin-5水平有助于早期预测SAP，并与炎症反应和血管渗漏密切相关。
{"title":"[Serum Claudin-5 levels facilitate the early prediction of severe acute pancreatitis: a prospective observational study].","authors":"Xinlei Chen, Huihui Wang, Ping Geng, Bingyu Ling, Aiwen Ma, Min Xu, Dingyu Tan","doi":"10.3760/cma.j.cn121430-20240318-00247","DOIUrl":"10.3760/cma.j.cn121430-20240318-00247","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the value of early tight junction protein Claudin-5 levels in predicting the severity of acute pancreatitis (AP).</p><p><strong>Methods: </strong>A prospective observational study was conducted, including patients diagnosed with AP and admitted to the Northern Jiangsu People's Hospital from December 1, 2021 to November 30, 2022. Eligible healthy volunteers were randomly selected to serve as healthy controls during the same period. Patients were classified into mild acute pancreatitis (MAP) group, moderate-severe acute pancreatitis (MSAP) group, and severe acute pancreatitis (SAP) group based on the 2012 Atlanta classification criteria. Patients with SAP were then divided into three subgroups of 1, 3, and 7 days based on the duration of hospitalization. Baseline data, such as gender, age, underlying disease, and probable etiology, was collected from all enrolled individuals. The enzyme-linked immunosorbent assay (ELISA) was employed to detect serum Claudin-5 levels in each cohort of enrollees. Data on additional serologic indicators, including hematocrit (HCT), albumin (Alb), serum Ca<sup>2+</sup>, C-reactive protein (CRP), and procalcitonin (PCT) levels, were obtained via the in-hospital test query system in each group of patients with AP. The modified Marshall score (mMarshall), modified CT severity index (mCTSI) score, bedside severity index of severity in acute pancreatitis (BISAP) score, and acute physiology and chronic health evaluation II (APACHE II) were recorded for each group of patients with AP. Differences in the above indicators between groups were analyzed and compared. Spearman's correlation method was employed to examine the relationship between Claudin-5 levels and each influential factor. The receiver operator characteristic curve (ROC curve) was plotted to analyze the predictive value of each influencing factor on SAP. Ridge regression was used to screen for independent risk factors for SAP.</p><p><strong>Results: </strong>A total of 109 patients with AP were enrolled, comprising 66 in the MAP group, 15 in the MSAP group, and 28 in the SAP group. Additionally, 27 healthy volunteers were enrolled as the healthy control group. No statistically significant differences were observed in gender and age among the enrolled groups, and no statistically significant differences were identified among the three groups of patients with AP in terms of underlying disease and etiologic composition. As the disease progressed, serum Claudin-5 levels exhibited a notable increase across all AP patient groups, and they were all significantly higher than those in the healthy control group [ng/L: 888.58 (574.52, 1 141.59), 3 749.02 (2 784.93, 5 789.92), 4 667.81 (3 935.21, 7 315.66) vs. 291.13 (250.19, 314.75), all P < 0.05]. Subgroup analyses showed that as the disease duration prolonged, patients in the SAP group exhibited a notable decline in Claudin-5 levels at 3 days post-admission, compared with those","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 9","pages":"930-936"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393870","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 : 2024-09-01DOI: 10.3760/cma.j.cn121430-20240617-00513
Le An, Rui Shao, Xingsheng Wang, Ziren Tang
With the development of medicine, the survival rate of patients with traumatic brain injury has gradually increased, and more lives have been successfully saved. However, the number of comatose patients has also risen, leading to prolonged medical care that increases economic burdens on families and society. The awakening of comatose patients is of great significance. As a non-invasive brain stimulation technique, median nerve electrical stimulation (MNS) has been widely used in clinical awakening therapy, and multiple clinical studies have confirmed the effectiveness of this technology. This article summarizes the research progress of this technology from the aspects of coma mechanism, median nerve pathway, awakening mechanism of MNS, clinical application of MNS, parameter setting of electrical stimulation, and neurological function evaluation.
{"title":"[Research progress on median nerve electrical stimulation for awakening comatose patients with brain injury].","authors":"Le An, Rui Shao, Xingsheng Wang, Ziren Tang","doi":"10.3760/cma.j.cn121430-20240617-00513","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240617-00513","url":null,"abstract":"<p><p>With the development of medicine, the survival rate of patients with traumatic brain injury has gradually increased, and more lives have been successfully saved. However, the number of comatose patients has also risen, leading to prolonged medical care that increases economic burdens on families and society. The awakening of comatose patients is of great significance. As a non-invasive brain stimulation technique, median nerve electrical stimulation (MNS) has been widely used in clinical awakening therapy, and multiple clinical studies have confirmed the effectiveness of this technology. This article summarizes the research progress of this technology from the aspects of coma mechanism, median nerve pathway, awakening mechanism of MNS, clinical application of MNS, parameter setting of electrical stimulation, and neurological function evaluation.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 9","pages":"997-1000"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393867","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 : 2024-09-01DOI: 10.3760/cma.j.cn121430-20240202-00109
Huaibiao Wu, Hao Zhang, Chengjun Guo
<p><strong>Objective: </strong>To construct and validate a predictive model for the risk of cerebrogenic multiple organ dysfunction syndrome (CMODS) in patients with acute cerebral hemorrhage.</p><p><strong>Methods: </strong>Clinical data of 93 patients with acute cerebral hemorrhage admitted to Wannan Rehabilitation Hospital from January 2019 to June 2023 were retrospectively analyzed. Data included baseline information, disease severity score, laboratory examination indicators, cerebral hemorrhage status, treatment status, etc. Patients were divided into CMODS group and non-CMODS group according to whether CMODS occurred during hospitalization. The clinical data of the two groups were compared. Multivariate Logistic regression was used to analyze the risk factors of CMODS in patients with acute cerebral hemorrhage. A nomogram model was constructed to predict the risk of CMODS in patients with acute cerebral hemorrhage, and the model was validated. Receiver operator characteristic curve (ROC curve) was used to evaluate the predictive efficiency of nomogram model for CMODS in patients with acute cerebral hemorrhage.</p><p><strong>Results: </strong>A total of 93 patients with acute cerebral hemorrhage were enrolled, including 26 patients in CMODS group and 67 patients in non-CMODS group. Compared with the non-CMODS group, the ratio of diabetes, acute physiological and chronic health evaluation II (APACHE II)≥35 score, cerebral hemorrhage volume ≥30 mL, endotoxemia, and national institutes of health stroke scale (NIHSS) and intracranial pressure of patients in the CMODS group were significantly higher, while the Glasgow coma score (GCS) was significantly lower and the length of hospital stay was significantly longer, with statistically significant differences (all P < 0.05). Multivariate Logistic regression analysis showed that diabetes mellitus [odds ratio (OR) = 3.615, 95% confidence interval (95%CI) was 1.487-8.785, P = 0.000], APACHE II score (OR = 4.697, 95%CI was 1.933-11.416, P = 0.000), endotoxemia (OR = 4.577, 95%CI was 1.883-11.123, P = 0.000), and cerebral hemorrhage volume (OR = 4.039, 95%CI was 1.662-9.816, P = 0.000) were the risk factors for CMODS in patients with acute cerebral hemorrhage. Taking the above risk factors as predictive variables, a nomogram prediction model was established. The verification results of the nomogram model showed that the C index was 0.804 (95%CI was 0.768-0.841), and the calibration curve was close to the ideal curve with good fit (P > 0.05). ROC curve results showed that the sensitivity and specificity of the nomogram model in predicting CMODS in patients with acute cerebral hemorrhage were 76.92%, 86.57%, respectively, and the area under the ROC curve (AUC) was 0.855 (95%CI was 0.776-0.935).</p><p><strong>Conclusions: </strong>Diabetes mellitus, APACHE II score, endotoxemia and intracerebral hemorrhage are risk factors for CMODS in patients with acute cerebral hemorrhage. The risk prediction model base
{"title":"[Establishment of a risk prediction model for cerebrogenic multiple organ dysfunction syndrome in patients with acute cerebral hemorrhage].","authors":"Huaibiao Wu, Hao Zhang, Chengjun Guo","doi":"10.3760/cma.j.cn121430-20240202-00109","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240202-00109","url":null,"abstract":"<p><strong>Objective: </strong>To construct and validate a predictive model for the risk of cerebrogenic multiple organ dysfunction syndrome (CMODS) in patients with acute cerebral hemorrhage.</p><p><strong>Methods: </strong>Clinical data of 93 patients with acute cerebral hemorrhage admitted to Wannan Rehabilitation Hospital from January 2019 to June 2023 were retrospectively analyzed. Data included baseline information, disease severity score, laboratory examination indicators, cerebral hemorrhage status, treatment status, etc. Patients were divided into CMODS group and non-CMODS group according to whether CMODS occurred during hospitalization. The clinical data of the two groups were compared. Multivariate Logistic regression was used to analyze the risk factors of CMODS in patients with acute cerebral hemorrhage. A nomogram model was constructed to predict the risk of CMODS in patients with acute cerebral hemorrhage, and the model was validated. Receiver operator characteristic curve (ROC curve) was used to evaluate the predictive efficiency of nomogram model for CMODS in patients with acute cerebral hemorrhage.</p><p><strong>Results: </strong>A total of 93 patients with acute cerebral hemorrhage were enrolled, including 26 patients in CMODS group and 67 patients in non-CMODS group. Compared with the non-CMODS group, the ratio of diabetes, acute physiological and chronic health evaluation II (APACHE II)≥35 score, cerebral hemorrhage volume ≥30 mL, endotoxemia, and national institutes of health stroke scale (NIHSS) and intracranial pressure of patients in the CMODS group were significantly higher, while the Glasgow coma score (GCS) was significantly lower and the length of hospital stay was significantly longer, with statistically significant differences (all P < 0.05). Multivariate Logistic regression analysis showed that diabetes mellitus [odds ratio (OR) = 3.615, 95% confidence interval (95%CI) was 1.487-8.785, P = 0.000], APACHE II score (OR = 4.697, 95%CI was 1.933-11.416, P = 0.000), endotoxemia (OR = 4.577, 95%CI was 1.883-11.123, P = 0.000), and cerebral hemorrhage volume (OR = 4.039, 95%CI was 1.662-9.816, P = 0.000) were the risk factors for CMODS in patients with acute cerebral hemorrhage. Taking the above risk factors as predictive variables, a nomogram prediction model was established. The verification results of the nomogram model showed that the C index was 0.804 (95%CI was 0.768-0.841), and the calibration curve was close to the ideal curve with good fit (P > 0.05). ROC curve results showed that the sensitivity and specificity of the nomogram model in predicting CMODS in patients with acute cerebral hemorrhage were 76.92%, 86.57%, respectively, and the area under the ROC curve (AUC) was 0.855 (95%CI was 0.776-0.935).</p><p><strong>Conclusions: </strong>Diabetes mellitus, APACHE II score, endotoxemia and intracerebral hemorrhage are risk factors for CMODS in patients with acute cerebral hemorrhage. The risk prediction model base","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 9","pages":"966-971"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393862","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 : 2024-09-01DOI: 10.3760/cma.j.cn121430-20240226-00160
Yundi Chen, Yuanxiu He, Han Qin, Song Qin
<p><strong>Objective: </strong>To investigate whether annexin A1 (ANXA1) improves sepsis-induced lung injury by activating G protein-coupled formyl peptide receptor type 2 (FPR2)-dependent endothelial nitric oxide synthase (eNOS) pathway.</p><p><strong>Methods: </strong>Twenty-four male SD rats were randomly divided into normal group (Control group), lipopolysaccharide (LPS) induced lung injury model group (LPS group), LPS+ANXA1 mimetic peptide group (LPS+Ac2-26 group) and LPS+ANXA1 mimetic peptide+FPR2 inhibitor group (LPS+Ac2-26+WRW4 group), with 6 rats in each group. On the third day before modeling, rats of the LPS+Ac2-26 group were injected with 1 mg/kg Ac2-26 by the tail vein and rats of LPS+Ac2-26+WRW4 group were injected with 1 mg/kg Ac2-26 and 2.2 mg/kg WRW4 by the tail vein. The rats of control group and LPS group were injected same volume of physiological saline. After 48 hours of modeling, the rats were anesthetized and the carotid blood was taken to detect the oxygenation index (OI). Lung tissue was taken from the euthanized rats. The wet/dry (W/D) ratio was determined. The pathological changes of lung tissue were observed under light microscope and pathological score was performed. The levels of tumor necrosis factor-α (TNF-α), interleukins (IL-1β, IL-6, IL-10), malondialdehyde (MDA) and myeloperoxidase (MPO) were detected by enzyme-linked immunosorbent assay (ELISA). The protein expressions of eNOS, inducible nitric oxide synthase (iNOS) and nuclear factor-κB (NF-κB) were detected by Western blotting.</p><p><strong>Results: </strong>Under light microscope, compared with LPS group, the infiltration degree of inflammatory cells in the lung tissue of LPS+Ac2-26 group was reduced, and the thickness of the alveolar septum was improved. The degree of inflammatory cell infiltration in the lung tissue of LPS+Ac2-26+WRW4 group was more severe than that of LPS+Ac2-26 group, and the thickness of the alveolar septum increased. These findings suggested that ANXA1 significantly inhibited inflammatory cell infiltration and improved alveolar septal thickness, WRW4 reversed the lung improvement effects of ANXA1. Compared with control group, OI in LPS group was significantly decreased, and W/D ratio, pathological score and TNF-α, IL-1β, IL-6, MDA and MPO levels in lung tissue were significantly increased. Compared with LPS group, OI and IL-10 levels in lung tissue were significantly increased in LPS+Ac2-26 group, while W/D ratio, pathological score, TNF-α, IL-1β, IL-6, MDA and MPO levels in lung tissue were significantly decreased. These results indicated that ANXA1 can improve the oxygenation capacity, improve lung tissue leakage, reduce edema, and inhibit lung tissue inflammation in rats with lung injury. Compared with LPS+Ac2-26 group, the LPS+Ac2-26+WRW4 group showed significant decreases in OI and lung tissue IL-10 level [OI (mmHg, 1 mmHg ≈ 0.133 kPa): 132.16±24.00 vs. 248.67±18.70, IL-10 (ng/L): 27.30±3.04 vs. 36.10±3.92, both P < 0.05], the l
目的研究附件素A1（ANXA1）是否能通过激活G蛋白偶联甲酰肽受体2型（FPR2）依赖的内皮一氧化氮合酶（eNOS）通路改善脓毒症诱导的肺损伤：将24只雄性SD大鼠随机分为正常组（对照组）、脂多糖（LPS）诱导肺损伤模型组（LPS组）、LPS+ANXA1模拟肽组（LPS+Ac2-26组）和LPS+ANXA1模拟肽+FPR2抑制剂组（LPS+Ac2-26+WRW4组），每组6只。造模前第三天，LPS+Ac2-26 组大鼠尾静脉注射 1 mg/kg Ac2-26，LPS+Ac2-26+WRW4 组大鼠尾静脉注射 1 mg/kg Ac2-26 和 2.2 mg/kg WRW4。对照组和 LPS 组大鼠注射相同体积的生理盐水。建模 48 小时后，对大鼠进行麻醉，抽取颈动脉血液检测氧合指数（OI）。从安乐死的大鼠身上提取肺组织。测定干湿比（W/D）。在光学显微镜下观察肺组织的病理变化，并进行病理评分。用酶联免疫吸附试验（ELISA）检测肿瘤坏死因子-α（TNF-α）、白细胞介素（IL-1β、IL-6、IL-10）、丙二醛（MDA）和髓过氧化物酶（MPO）的水平。用 Western 印迹法检测 eNOS、诱导型一氧化氮合酶（iNOS）和核因子-κB（NF-κB）的蛋白表达：光镜下，与 LPS 组相比，LPS+Ac2-26 组肺组织中炎性细胞浸润程度降低，肺泡间隔厚度增加。LPS+Ac2-26+WRW4组的肺组织炎症细胞浸润程度比LPS+Ac2-26组严重，肺泡间隔厚度增加。这些结果表明，ANXA1能显著抑制炎症细胞浸润并改善肺泡间隔厚度，而WRW4能逆转ANXA1的肺改善作用。与对照组相比，LPS组的OI明显降低，W/D比值、病理评分、肺组织中TNF-α、IL-1β、IL-6、MDA和MPO水平明显升高。与LPS组相比，LPS+Ac2-26组肺组织中OI和IL-10水平明显升高，而W/D比值、病理评分、TNF-α、IL-1β、IL-6、MDA和MPO水平明显降低。这些结果表明，ANXA1能提高肺损伤大鼠的氧合能力，改善肺组织渗漏，减轻水肿，抑制肺组织炎症。与 LPS+Ac2-26 组相比，LPS+Ac2-26+WRW4 组的 OI 和肺组织 IL-10 水平明显下降[OI（mmHg，1 mmHg ≈ 0.133 kPa）：132.16±24.00 与 LPS+Ac2-26+WRW4 组：132.16±24.00]：132.16±24.00 vs. 248.67±18.70，IL-10（ng/L）：27.30±3.04 vs. 36.10±3.92，均P＜0.05]，肺组织W/D比值、病理评分及TNF-α、IL-1β、IL-6、MDA和MPO水平明显升高[W/D比值：5.29±0.02 vs. 4.83±0.02，病理评分：5.00±0.28 vs. 2.67±0.52，TNF-α（ng/L）：39.80±4.36 vs. 32.10±2.15，IL-1β（ng/L）：200.00±15.68 vs. 152.60±9.74，IL-6（ng/L）：181.50±18.02 vs. 148.50±7.34，MDA（mmol/mg）：82.01±8.22 vs. 70.43±5.69，MPO（pg/mg）：6.50±0.32 vs. 4.60±0.56，所有 P <0.05]。这些结果表明，WRW4 可以阻断 ANXA1 的上述改善作用。Western blotting 结果显示，与对照组相比，LPS 组 eNOS、iNOS 和 NF-κB 的表达明显上调。与 LPS 组相比，LPS+Ac2-26 组 eNOS 蛋白表达明显上调（eNOS/β-actin：0.25±0.01 vs. 0.14±0.01，P < 0.05），iNOS 和 NF-κB 蛋白表达明显下调（iNOS/β-actin：0.09±0.02 vs. 0.12±0.02，NF-κB/β-actin：0.35±0.06 vs. 0.59±0.13，均 P <0.05）。这些结果表明，ANXA1可能激活了eNOS通路并下调了NF-κB的表达。与 LPS+Ac2-26 组相比，LPS+Ac2-26+WRW4 组 eNOS 蛋白表达明显下调（eNOS/β-actin：0.17±0.02 vs. 0.25±0.01，P < 0.05），而 iNOS 和 NF-κB 蛋白表达明显上调（iNOS/β-actin：0.12±0.02 vs. 0.09±0.02，NF-κB/β-actin：0.52±0.10 vs. 0.35±0.06，均 P <0.05）。这些结果表明，WRW4阻断了ANXA1对eNOS通路的激活：结论：ANXA1可通过激活FPR2依赖的eNOS通路改善脓毒症相关肺损伤。
{"title":"[Annexin A1 activates the G protein-coupled formyl peptide receptor type 2-dependent endothelial nitric oxide synthase pathway to alleviate sepsis associated acute lung injury].","authors":"Yundi Chen, Yuanxiu He, Han Qin, Song Qin","doi":"10.3760/cma.j.cn121430-20240226-00160","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240226-00160","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether annexin A1 (ANXA1) improves sepsis-induced lung injury by activating G protein-coupled formyl peptide receptor type 2 (FPR2)-dependent endothelial nitric oxide synthase (eNOS) pathway.</p><p><strong>Methods: </strong>Twenty-four male SD rats were randomly divided into normal group (Control group), lipopolysaccharide (LPS) induced lung injury model group (LPS group), LPS+ANXA1 mimetic peptide group (LPS+Ac2-26 group) and LPS+ANXA1 mimetic peptide+FPR2 inhibitor group (LPS+Ac2-26+WRW4 group), with 6 rats in each group. On the third day before modeling, rats of the LPS+Ac2-26 group were injected with 1 mg/kg Ac2-26 by the tail vein and rats of LPS+Ac2-26+WRW4 group were injected with 1 mg/kg Ac2-26 and 2.2 mg/kg WRW4 by the tail vein. The rats of control group and LPS group were injected same volume of physiological saline. After 48 hours of modeling, the rats were anesthetized and the carotid blood was taken to detect the oxygenation index (OI). Lung tissue was taken from the euthanized rats. The wet/dry (W/D) ratio was determined. The pathological changes of lung tissue were observed under light microscope and pathological score was performed. The levels of tumor necrosis factor-α (TNF-α), interleukins (IL-1β, IL-6, IL-10), malondialdehyde (MDA) and myeloperoxidase (MPO) were detected by enzyme-linked immunosorbent assay (ELISA). The protein expressions of eNOS, inducible nitric oxide synthase (iNOS) and nuclear factor-κB (NF-κB) were detected by Western blotting.</p><p><strong>Results: </strong>Under light microscope, compared with LPS group, the infiltration degree of inflammatory cells in the lung tissue of LPS+Ac2-26 group was reduced, and the thickness of the alveolar septum was improved. The degree of inflammatory cell infiltration in the lung tissue of LPS+Ac2-26+WRW4 group was more severe than that of LPS+Ac2-26 group, and the thickness of the alveolar septum increased. These findings suggested that ANXA1 significantly inhibited inflammatory cell infiltration and improved alveolar septal thickness, WRW4 reversed the lung improvement effects of ANXA1. Compared with control group, OI in LPS group was significantly decreased, and W/D ratio, pathological score and TNF-α, IL-1β, IL-6, MDA and MPO levels in lung tissue were significantly increased. Compared with LPS group, OI and IL-10 levels in lung tissue were significantly increased in LPS+Ac2-26 group, while W/D ratio, pathological score, TNF-α, IL-1β, IL-6, MDA and MPO levels in lung tissue were significantly decreased. These results indicated that ANXA1 can improve the oxygenation capacity, improve lung tissue leakage, reduce edema, and inhibit lung tissue inflammation in rats with lung injury. Compared with LPS+Ac2-26 group, the LPS+Ac2-26+WRW4 group showed significant decreases in OI and lung tissue IL-10 level [OI (mmHg, 1 mmHg ≈ 0.133 kPa): 132.16±24.00 vs. 248.67±18.70, IL-10 (ng/L): 27.30±3.04 vs. 36.10±3.92, both P < 0.05], the l","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 9","pages":"924-929"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393842","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}
<p><strong>Objective: </strong>To explore the value of circ_0054633 in early diagnosis and prognosis prediction of acute lung injury/acute respiratory distress syndrome (ALI/ARDS) in children with severe pneumonia.</p><p><strong>Methods: </strong>A retrospective case-control study was conducted on children with diagnosed severe pneumonia admitted to Tianjin Children's Hospital from July 1, 2022, to February 29, 2024. The clinical data was collected by electronic medical record system and clinical follow-up, including gender, age, lung injury prediction score (LIPS), pediatric critical illness score (PCIS), serum circ_0054633, interleukin-6 (IL-6), the indicators of the arterial blood-gas analysis, oxygenation index (PaO<sub>2</sub>/FiO<sub>2</sub>) within 24 hours of admission and the survival status of 28 days. According to whether ALI/ARDS occurred, they were divided into the ALI/ARDS group and the non-ALI/ARDS group. The differences of clinical data between the two groups were compared, and multivariate Logistic regression was used to analyze the risk factors for ALI/ARDS in children with severe pneumonia. The receiver operator characteristic curve (ROC curve) will be used to explore the early diagnostic value of ALI/ARDS in children with severe pneumonia. The patients of ALI/ARDS were divided into mild group, moderate group and severe group according to the level of PaO<sub>2</sub>/FiO<sub>2</sub>. The levels of serum circ_0054633 and IL-6 in various severity ALI/ARDS were compared. The differences of serum circ_0054633, IL-6 levels, PCIS score and LIPS score were compared between the two groups of ALI/ARDS patients according to different prognoses in 28 days, as well as the correlation between various risk factors and circ_0054633.</p><p><strong>Results: </strong>A total 74 children with severe pneumonia were included, with 34 cases in the ALI/ARDS group and 40 cases in the non-ALI/ARDS group. In ALI/ARDS group, there were 9 cases in the mild group, 15 cases in the moderate group and 10 cases in the severe group; while 12 cases died and 22 cases survived after 28 days. The serum circ_0054633, IL-6 level and LIPS score were higher in the ALI/ARDS group than the non-ALI/ARDS group, while the PCIS score was lower, and the two groups had significant difference. Multivariate Logistic regression analysis showed that circ_0054633 was independent predictors of ALI/ARDS in children with severe pneumonia [odds ratio (OR) = 3.853, 95% confidence interval (95%CI) was 1.912-7.805, P = 0.017]. ROC curve analysis showed that the cut-off values for circ_0054633 in the diagnosis of ALI/ARDS were 3.955, sensitivity was 79.4%, specificity was 92.5%, area under the ROC curve (AUC) was 0.892. The serum circ_0054633 and IL-6 levels were higher in the children who died in 28 days than the children who were survived, while the PCIS score was lower, and the two groups had significant difference. Spearman correlation analysis showed that the level of circ_0054633 in
{"title":"[Early diagnostic and prognosis prediction of circ_0054633 for acute lung injury/acute respiratory distress syndrome in children with severe pneumonia].","authors":"Shiyin Mu, Yingxue Zou, Yongsheng Guo, Mei Yu, Bing Huang, Weiwei Gao, Tian Zhang","doi":"10.3760/cma.j.cn121430-20240506-00403","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240506-00403","url":null,"abstract":"<p><strong>Objective: </strong>To explore the value of circ_0054633 in early diagnosis and prognosis prediction of acute lung injury/acute respiratory distress syndrome (ALI/ARDS) in children with severe pneumonia.</p><p><strong>Methods: </strong>A retrospective case-control study was conducted on children with diagnosed severe pneumonia admitted to Tianjin Children's Hospital from July 1, 2022, to February 29, 2024. The clinical data was collected by electronic medical record system and clinical follow-up, including gender, age, lung injury prediction score (LIPS), pediatric critical illness score (PCIS), serum circ_0054633, interleukin-6 (IL-6), the indicators of the arterial blood-gas analysis, oxygenation index (PaO<sub>2</sub>/FiO<sub>2</sub>) within 24 hours of admission and the survival status of 28 days. According to whether ALI/ARDS occurred, they were divided into the ALI/ARDS group and the non-ALI/ARDS group. The differences of clinical data between the two groups were compared, and multivariate Logistic regression was used to analyze the risk factors for ALI/ARDS in children with severe pneumonia. The receiver operator characteristic curve (ROC curve) will be used to explore the early diagnostic value of ALI/ARDS in children with severe pneumonia. The patients of ALI/ARDS were divided into mild group, moderate group and severe group according to the level of PaO<sub>2</sub>/FiO<sub>2</sub>. The levels of serum circ_0054633 and IL-6 in various severity ALI/ARDS were compared. The differences of serum circ_0054633, IL-6 levels, PCIS score and LIPS score were compared between the two groups of ALI/ARDS patients according to different prognoses in 28 days, as well as the correlation between various risk factors and circ_0054633.</p><p><strong>Results: </strong>A total 74 children with severe pneumonia were included, with 34 cases in the ALI/ARDS group and 40 cases in the non-ALI/ARDS group. In ALI/ARDS group, there were 9 cases in the mild group, 15 cases in the moderate group and 10 cases in the severe group; while 12 cases died and 22 cases survived after 28 days. The serum circ_0054633, IL-6 level and LIPS score were higher in the ALI/ARDS group than the non-ALI/ARDS group, while the PCIS score was lower, and the two groups had significant difference. Multivariate Logistic regression analysis showed that circ_0054633 was independent predictors of ALI/ARDS in children with severe pneumonia [odds ratio (OR) = 3.853, 95% confidence interval (95%CI) was 1.912-7.805, P = 0.017]. ROC curve analysis showed that the cut-off values for circ_0054633 in the diagnosis of ALI/ARDS were 3.955, sensitivity was 79.4%, specificity was 92.5%, area under the ROC curve (AUC) was 0.892. The serum circ_0054633 and IL-6 levels were higher in the children who died in 28 days than the children who were survived, while the PCIS score was lower, and the two groups had significant difference. Spearman correlation analysis showed that the level of circ_0054633 in ","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 9","pages":"957-961"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393846","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}
<p><strong>Objective: </strong>To observe the clinical effect of initiating continuous blood purification (CBP) treatment at different times for patients with severe acute pancreatitis (SAP), and to explore the optimal timing for starting CBP treatment for SAP, so as to provide evidence for clinicians to start CBP treatment.</p><p><strong>Methods: </strong>A retrospective cohort study was used to select patients with SAP who received CBP treatment in People's Hospital of Hunan Province from January 2020 to December 2023. According to the timing of CBP initiation, the patients were divided into early initiation group (diagnosis of SAP to the first CBP treatment time < 24 hours) and late initiation group (diagnosis of SAP to the first CBP treatment time of 24-48 hours). The general data, acute physiology and chronic health evaluation II (APACHE II), bedside index for severity in acute pancreatitis (BISAP) score and laboratory indicators, local complications and systemic complications, intensive care unit (ICU) treatment time, hospital stay, treatment cost, and clinical outcome of the two groups were collected and compared.</p><p><strong>Results: </strong>A total of 130 patients with SAP who received CBP treatment were enrolled, including 90 patients in the early initiation group and 40 patients in the late initiation group. Before treatment, there were no significant differences in gender, age, APACHE II score, BISAP score, etiology and laboratory examination indexes between the early initiation group and late initiation group. At 48, 72, 96 hours after treatment, the blood calcium level of the two groups was significantly higher than that before treatment, and the levels of white blood cell count (WBC), C-reactive protein (CRP), lactic acid, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), APACHE II score and BISAP score were significantly lower than those before treatment. The WBC level, APACHE II score and BISAP score of the late initiation group were significantly lower than those of the early initiation group at 72 hours and 96 hours after treatment [WBC (×10<sup>9</sup>/L): 10.96 (8.68, 13.04) vs. 12.45 (8.93, 16.30) at 72 hours after treatment, and 10.18 (8.68, 12.42) vs. 11.96 (8.81, 16.87) at 96 hours after treatment; APACHE II score: 9.50 (5.75, 12.00) vs. 11.00 (6.25, 14.00) at 72 hours after treatment, and 10.00 (4.00, 12.00) vs. 12.00 (7.00, 14.75) at 96 hours after treatment; BISAP score: 2.35±1.03 vs. 2.76±1.10 at 72 hours after treatment, and 2.08±1.21 vs. 2.70±1.11 at 96 hours after treatment], the differences were statistically significant (all P < 0.05). In terms of complications, the incidence of pancreatic abscess in the late initiation group was significantly lower than that in the early initiation group [5.00% (2/40) vs. 20.00% (18/90)], but the incidence of abdominal compartment syndrome was significantly higher than that in the early initiation group [42.50% (17/40) vs. 13.33% (12/90)], the differences were statistica
目的观察重症急性胰腺炎（SAP）患者在不同时期开始连续性血液净化（CBP）治疗的临床效果，探讨SAP开始CBP治疗的最佳时机，为临床医生开始CBP治疗提供依据：方法：采用回顾性队列研究，选择2020年1月至2023年12月在湖南省人民医院接受CBP治疗的SAP患者。根据开始 CBP 治疗的时间，将患者分为早期开始治疗组（确诊为 SAP 至首次 CBP 治疗时间小于 24 小时）和晚期开始治疗组（确诊为 SAP 至首次 CBP 治疗时间为 24-48 小时）。收集并比较两组患者的一般资料、急性生理学和慢性健康评价II（APACHE II）、急性胰腺炎床旁严重程度指数（BISAP）评分和实验室指标、局部并发症和全身并发症、重症监护室（ICU）治疗时间、住院时间、治疗费用和临床疗效：共有130名SAP患者接受了CBP治疗，其中早期启动组90人，晚期启动组40人。治疗前，早期启动组和晚期启动组在性别、年龄、APACHE II评分、BISAP评分、病因和实验室检查指标方面无明显差异。治疗后 48、72、96 小时，两组血钙水平均明显高于治疗前，白细胞计数（WBC）、C 反应蛋白（CRP）、乳酸、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、APACHE II 评分、BISAP 评分均明显低于治疗前。治疗后 72 小时和 96 小时，起始晚期组的白细胞水平、APACHE II 评分和 BISAP 评分均明显低于起始早期组[治疗后 72 小时，白细胞（×109/L）：10.96（8.68，13.04） vs. 12.45（8.93，16.30）；治疗后 96 小时，白细胞（×109/L）：10.18（8.68，12.42） vs. 11.96（8.81，16.87）；APACHE II 评分：9.50 (5.75, 12.00) vs. 11.00 (6.25, 14.00) at 72 hours after treatment, and 10.00 (4.00, 12.00) vs. 12.00 (7.00, 14.75) at 96 hours after treatment; BISAP score: 2.35±1.03 vs. 2.76±1.10 at 72 hours after treatment, and 2.08±1.21 vs. 2.70±1.11 at 96 hours after treatment]，差异均有统计学意义（均 P < 0.05）。在并发症方面，晚期起始组胰腺脓肿的发生率明显低于早期起始组[5.00%（2/40） vs. 20.00%（18/90）]，但腹腔隔室综合征的发生率明显高于早期起始组[42.50%（17/40） vs. 13.33%（12/90）]，差异均有统计学意义（均 P < 0.05）。此外，早期启动组的重症监护室治疗时间明显短于晚期启动组[天数：11.00 (6.00, 20.00) vs. 15.00 (9.75, 25.00)，P < 0.05]，两组的住院费用、住院时间和死亡率差异无统计学意义：CBP能有效提高血钙水平，降低乳酸和炎症因子水平。结论：CBP 能有效提高血钙水平，降低乳酸水平和炎症因子，在确诊 SAP 后 24-48 小时内开始使用 CBP 能更快地降低白细胞水平和疾病严重程度评分，减少胰腺脓肿的发生。在确诊 SAP 后 24 小时内开始 CBP 可降低腹腔间隔综合征的发生率，缩短重症监护室的治疗时间。
{"title":"[Study on the clinical effect of initiating continuous blood purification at different times for severe acute pancreatitis].","authors":"Feiyang Chen, Ruoyu Xie, Xiaotong Han, Fengling Ning, Yun Chen, Huimin Liu, Lilei Liu, Xiang Li","doi":"10.3760/cma.j.cn121430-20240408-00317","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240408-00317","url":null,"abstract":"<p><strong>Objective: </strong>To observe the clinical effect of initiating continuous blood purification (CBP) treatment at different times for patients with severe acute pancreatitis (SAP), and to explore the optimal timing for starting CBP treatment for SAP, so as to provide evidence for clinicians to start CBP treatment.</p><p><strong>Methods: </strong>A retrospective cohort study was used to select patients with SAP who received CBP treatment in People's Hospital of Hunan Province from January 2020 to December 2023. According to the timing of CBP initiation, the patients were divided into early initiation group (diagnosis of SAP to the first CBP treatment time < 24 hours) and late initiation group (diagnosis of SAP to the first CBP treatment time of 24-48 hours). The general data, acute physiology and chronic health evaluation II (APACHE II), bedside index for severity in acute pancreatitis (BISAP) score and laboratory indicators, local complications and systemic complications, intensive care unit (ICU) treatment time, hospital stay, treatment cost, and clinical outcome of the two groups were collected and compared.</p><p><strong>Results: </strong>A total of 130 patients with SAP who received CBP treatment were enrolled, including 90 patients in the early initiation group and 40 patients in the late initiation group. Before treatment, there were no significant differences in gender, age, APACHE II score, BISAP score, etiology and laboratory examination indexes between the early initiation group and late initiation group. At 48, 72, 96 hours after treatment, the blood calcium level of the two groups was significantly higher than that before treatment, and the levels of white blood cell count (WBC), C-reactive protein (CRP), lactic acid, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), APACHE II score and BISAP score were significantly lower than those before treatment. The WBC level, APACHE II score and BISAP score of the late initiation group were significantly lower than those of the early initiation group at 72 hours and 96 hours after treatment [WBC (×10<sup>9</sup>/L): 10.96 (8.68, 13.04) vs. 12.45 (8.93, 16.30) at 72 hours after treatment, and 10.18 (8.68, 12.42) vs. 11.96 (8.81, 16.87) at 96 hours after treatment; APACHE II score: 9.50 (5.75, 12.00) vs. 11.00 (6.25, 14.00) at 72 hours after treatment, and 10.00 (4.00, 12.00) vs. 12.00 (7.00, 14.75) at 96 hours after treatment; BISAP score: 2.35±1.03 vs. 2.76±1.10 at 72 hours after treatment, and 2.08±1.21 vs. 2.70±1.11 at 96 hours after treatment], the differences were statistically significant (all P < 0.05). In terms of complications, the incidence of pancreatic abscess in the late initiation group was significantly lower than that in the early initiation group [5.00% (2/40) vs. 20.00% (18/90)], but the incidence of abdominal compartment syndrome was significantly higher than that in the early initiation group [42.50% (17/40) vs. 13.33% (12/90)], the differences were statistica","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 9","pages":"937-942"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393871","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 effect of ultra-early enteral nutrition (UEEN) support on the prognosis of young and middle-aged postoperative patients with cerebral hemorrhage.
Methods: The clinical data of young and middle-aged patients (aged 18-59 years) admitted to Tianjin Fifth Central Hospital from January 2020 to June 2023 after surgery for intracerebral hemorrhage were retrospectively analyzed, and the general data, nutritional indexes, gastrointestinal complications, neurological function recovery and long-term prognosis of the patients were recorded. According to the time of initiation of enteral nutrition (EN) support, patients were divided into UEEN group (EN implementation within 12 hour after surgery) and early enteral nutrition (EEN) group (EN implementation within 24 to 48 hour after surgery). The differences of the above indexes between the two groups were analyzed and compared.
Results: A total of 64 young and middle-aged postoperative patients with cerebral hemorrhage were enrolled, including 32 cases in the UEEN group and 32 cases in the EEN group. There were no significant differences in gender, age, proportion of hypertension and diabetes, Glasgow coma score (GCS) on admission and surgical methods between the two groups. In terms of nutritional indexes, serum total protein, albumin and hemoglobin levels of patients in both groups on day 7 after admission were lower than those on day 1, and higher than those on day 3, and the above indexes levels in UEEN group were significantly higher than those in EEN group on day 7 [total protein (g/L): 63.05±5.79 vs. 59.02±6.63, albumin (g/L): 40.40±5.26 vs. 37.66±4.63, hemoglobin (g/L): 133.33±12.58 vs. 123.80±22.12, all P < 0.05]. In terms of gastrointestinal complications, the incidence of stress ulcer in the UEEN group within 14 days after admission was significantly lower than that in the EEN group [12.5% (4/32) vs. 31.3% (10/32), P < 0.05], but there was no statistically significant difference in feeding intolerance symptoms between the two groups. In terms of neurological recovery and long-term prognosis, GCS scores and Barthel index scores of 14 days after admission were higher than those of 1 day after admission, but there was no statistical significance between the two groups. Six months after surgery, Glasgow outcome scale (GOS) and Barthel index score of the UEEN group were significantly higher than those of the EEN group (GOS score: 3.81±1.06 vs. 3.18±1.07, Barthel index score: 60.78±7.24 vs. 54.52±5.13, both P < 0.05).
Conclusions: UEEN support can improve the nutritional level of young and middle-aged postoperative patients with cerebral hemorrhage, reduce the occurrence of postoperative gastrointestinal complications, promote the recovery of neurological function, and improve the long-term prognosis.
目的：探讨超早期肠内营养支持对中青年脑出血术后患者预后的影响：研究超早期肠内营养支持对中青年脑出血术后患者预后的影响：回顾性分析天津市第五中心医院2020年1月-2023年6月收治的脑出血术后中青年患者（18-59岁）的临床资料，记录患者的一般资料、营养指标、胃肠道并发症、神经功能恢复情况及远期预后。根据开始肠内营养（EN）支持的时间，将患者分为UEEN组（术后12小时内开始肠内营养）和早期肠内营养（EEN）组（术后24至48小时内开始肠内营养）。分析并比较两组患者上述指标的差异：共纳入64例中青年脑出血术后患者，其中UEEN组32例，EEN组32例。两组患者在性别、年龄、高血压和糖尿病比例、入院时格拉斯哥昏迷评分（GCS）以及手术方式等方面无明显差异。营养指标方面，两组患者入院后第7天血清总蛋白、白蛋白、血红蛋白水平均低于第1天，高于第3天，且第7天UEEN组上述指标水平明显高于EEN组[总蛋白（g/L）：63.05±5.79 vs. 59.02±6.63，白蛋白（g/L）：40.40±5.26 vs. 37.66±4.63，血红蛋白（g/L）：133.33±12.58 vs. 123.80±22.12，均P＜0.05]。在胃肠道并发症方面，UEEN组入院后14天内应激性溃疡的发生率明显低于EEN组[12.5%（4/32）vs 31.3%（10/32），P<0.05]，但两组患者的喂养不耐受症状差异无统计学意义。在神经功能恢复和长期预后方面，入院后14天的GCS评分和Barthel指数评分均高于入院后1天的评分，但两组间无统计学意义。术后6个月，UEEN组的格拉斯哥结果量表（GOS）和Barthel指数评分明显高于EEN组（GOS评分：3.81±1.06 vs. 3.18±1.07，Barthel指数评分：60.78±7.24 vs. 54.52±5.13，P均<0.05）：UEEN支持可以改善中青年脑出血术后患者的营养水平，减少术后胃肠道并发症的发生，促进神经功能的恢复，改善远期预后。
{"title":"[Impact of ultra-early enteral nutrition support on the prognosis of young and middle-aged postoperative patients with cerebral hemorrhage].","authors":"Lili Bai, Qingguo Feng, Hongyun Teng, Liyan Guo, Dangqing Wang, Yuanzheng Zhang","doi":"10.3760/cma.j.cn121430-20240326-00283","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240326-00283","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effect of ultra-early enteral nutrition (UEEN) support on the prognosis of young and middle-aged postoperative patients with cerebral hemorrhage.</p><p><strong>Methods: </strong>The clinical data of young and middle-aged patients (aged 18-59 years) admitted to Tianjin Fifth Central Hospital from January 2020 to June 2023 after surgery for intracerebral hemorrhage were retrospectively analyzed, and the general data, nutritional indexes, gastrointestinal complications, neurological function recovery and long-term prognosis of the patients were recorded. According to the time of initiation of enteral nutrition (EN) support, patients were divided into UEEN group (EN implementation within 12 hour after surgery) and early enteral nutrition (EEN) group (EN implementation within 24 to 48 hour after surgery). The differences of the above indexes between the two groups were analyzed and compared.</p><p><strong>Results: </strong>A total of 64 young and middle-aged postoperative patients with cerebral hemorrhage were enrolled, including 32 cases in the UEEN group and 32 cases in the EEN group. There were no significant differences in gender, age, proportion of hypertension and diabetes, Glasgow coma score (GCS) on admission and surgical methods between the two groups. In terms of nutritional indexes, serum total protein, albumin and hemoglobin levels of patients in both groups on day 7 after admission were lower than those on day 1, and higher than those on day 3, and the above indexes levels in UEEN group were significantly higher than those in EEN group on day 7 [total protein (g/L): 63.05±5.79 vs. 59.02±6.63, albumin (g/L): 40.40±5.26 vs. 37.66±4.63, hemoglobin (g/L): 133.33±12.58 vs. 123.80±22.12, all P < 0.05]. In terms of gastrointestinal complications, the incidence of stress ulcer in the UEEN group within 14 days after admission was significantly lower than that in the EEN group [12.5% (4/32) vs. 31.3% (10/32), P < 0.05], but there was no statistically significant difference in feeding intolerance symptoms between the two groups. In terms of neurological recovery and long-term prognosis, GCS scores and Barthel index scores of 14 days after admission were higher than those of 1 day after admission, but there was no statistical significance between the two groups. Six months after surgery, Glasgow outcome scale (GOS) and Barthel index score of the UEEN group were significantly higher than those of the EEN group (GOS score: 3.81±1.06 vs. 3.18±1.07, Barthel index score: 60.78±7.24 vs. 54.52±5.13, both P < 0.05).</p><p><strong>Conclusions: </strong>UEEN support can improve the nutritional level of young and middle-aged postoperative patients with cerebral hemorrhage, reduce the occurrence of postoperative gastrointestinal complications, promote the recovery of neurological function, and improve the long-term prognosis.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 9","pages":"985-988"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393865","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 : 2024-09-01DOI: 10.3760/cma.j.cn121430-20240116-00051
Xuechao Zhang, Shuyuan Qian, Le Wang, Jiagui Zhao, Jing Wang, Baoqun Xu, Wei Wang
Extracorporeal membrane oxygenation (ECMO) is an important treatment for extracorporeal cardiopulmonary life support for clinically critical patients. Currently, ECMO tubing is commonly fixed by tie-wraps or tourniquets, which have shortcomings such as easy loosening and potential damage to the tubing. Improper fixation of the catheter can lead to a series of adverse events, such as accidental disconnection of the tubing, rupture of the tubing, tubing folding, and air ingress into the tubing. In order to overcome the above problems, the research team of Zhongda Hospital, Southeast University invented a device for ECMO line fixation and obtained a national utility model patent of China (patent number: ZL 2019 2 2282849.3). The tool is mainly composed of several devices, including a line fixation clamp, a clip fixation device, and a base plate, which is uniquely designed and easy to operate. During ECMO therapy, this device ensures effective stabilization of the ECMO tubing, preventing unexpected incidents due to catheter loosening and facilitating the observation of ECMO catheter insertion markings. Pipeline can be effectively fixed to avoid the occurrence of accidents due to the loosening of the catheter, and at the same time, it is convenient to observe the placement scale of the ECMO catheter. The novelty and uniqueness of the fixation device materials also effectively prevent the occurrence of pressure injuries during its use.
{"title":"[Design and application of an extracorporeal membrane oxygenation-specific line fixation device].","authors":"Xuechao Zhang, Shuyuan Qian, Le Wang, Jiagui Zhao, Jing Wang, Baoqun Xu, Wei Wang","doi":"10.3760/cma.j.cn121430-20240116-00051","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240116-00051","url":null,"abstract":"<p><p>Extracorporeal membrane oxygenation (ECMO) is an important treatment for extracorporeal cardiopulmonary life support for clinically critical patients. Currently, ECMO tubing is commonly fixed by tie-wraps or tourniquets, which have shortcomings such as easy loosening and potential damage to the tubing. Improper fixation of the catheter can lead to a series of adverse events, such as accidental disconnection of the tubing, rupture of the tubing, tubing folding, and air ingress into the tubing. In order to overcome the above problems, the research team of Zhongda Hospital, Southeast University invented a device for ECMO line fixation and obtained a national utility model patent of China (patent number: ZL 2019 2 2282849.3). The tool is mainly composed of several devices, including a line fixation clamp, a clip fixation device, and a base plate, which is uniquely designed and easy to operate. During ECMO therapy, this device ensures effective stabilization of the ECMO tubing, preventing unexpected incidents due to catheter loosening and facilitating the observation of ECMO catheter insertion markings. Pipeline can be effectively fixed to avoid the occurrence of accidents due to the loosening of the catheter, and at the same time, it is convenient to observe the placement scale of the ECMO catheter. The novelty and uniqueness of the fixation device materials also effectively prevent the occurrence of pressure injuries during its use.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 9","pages":"989-991"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393845","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 : 2024-09-01DOI: 10.3760/cma.j.cn121430-20240612-00507
Association Emergency Medicine Association Of Wuhan Medical
Point-of-care testing (POCT) is a testing approach that can be completed promptly, and for patients with acute and severe diseases, it can help clinicians identify changes in patients' conditions early and save patients' lives. Currently, the application of POCT in critical and emergency situations lacks a comprehensive clinical management consensus, leading to a lack of standardized guidance for its practical application. In order to standardize the application of POCT in critical and emergency situations, Emergency Medicine Association of Wuhan Medical Association organized multiple experts in the field of emergency and critical care to discuss and identify the current clinical issues that require standardized consensus in the application of POCT in emergency and critical care. Furthermore, a comprehensive literature search of domestic and international literature was conducted, and discussions and modifications were organized among emergency and critical care medicine experts. Ultimately, the Expert management consensus for the application of point-of-care testing in emergency and critical care (2024), which involves personnel management, equipment management and data management was formed. This consensus aims to provide more comprehensive standards and guidance for the application of POCT in critical care, thereby improving the quality of patient care and medical efficiency.
{"title":"[Expert management consensus for the application of point-of-care testing in emergency and critical care (2024)].","authors":"Association Emergency Medicine Association Of Wuhan Medical","doi":"10.3760/cma.j.cn121430-20240612-00507","DOIUrl":"https://doi.org/10.3760/cma.j.cn121430-20240612-00507","url":null,"abstract":"<p><p>Point-of-care testing (POCT) is a testing approach that can be completed promptly, and for patients with acute and severe diseases, it can help clinicians identify changes in patients' conditions early and save patients' lives. Currently, the application of POCT in critical and emergency situations lacks a comprehensive clinical management consensus, leading to a lack of standardized guidance for its practical application. In order to standardize the application of POCT in critical and emergency situations, Emergency Medicine Association of Wuhan Medical Association organized multiple experts in the field of emergency and critical care to discuss and identify the current clinical issues that require standardized consensus in the application of POCT in emergency and critical care. Furthermore, a comprehensive literature search of domestic and international literature was conducted, and discussions and modifications were organized among emergency and critical care medicine experts. Ultimately, the Expert management consensus for the application of point-of-care testing in emergency and critical care (2024), which involves personnel management, equipment management and data management was formed. This consensus aims to provide more comprehensive standards and guidance for the application of POCT in critical care, thereby improving the quality of patient care and medical efficiency.</p>","PeriodicalId":24079,"journal":{"name":"Zhonghua wei zhong bing ji jiu yi xue","volume":"36 9","pages":"897-909"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142393863","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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