Objective To observe the effect of venous-to-arterial carbon dioxide difference to arterial-to-venous oxygen content difference [(Pv-aCO2)/(Ca-vO2)] ratio combined with critical ultrasound during the phases of fluid resuscitation of critical patients with septic shock. Methods Ninety-two critical patients with septic shock admitted to department of intensive care unit (ICU) of Anji County People's Hospital from July 2016 to December 2017 were enrolled, and they were divided into study group (42 cases) and control group (50 cases) according to random number table method. Two groups of patients were given supportive treatment such as antibiotic therapy, vasoactive drugs to support blood pressure, mechanical ventilation (MV), transfusion and nutritional therapy. The fluid resuscitation in patients of control group was guided through monitoring central venous pressure (CVP) and lactic acid (Lac). Patients in study group were given (Pv-aCO2)/(Ca-vO2) ratio combined with critical ultrasound directed therapy on the basis of the monitoring method of the control group. The differences in heart rate (HR), mean arterial pressure (MAP), CVP, Lac, central venous oxygen saturation (ScvO2), (Pv-aCO2)/(Ca-vO2) ratio, dosage of noradrenalin (NE), fluid intake in 6 hours, sequential organ failure assessment (SOFA) of 24 hours, time of MV, length of ICU stay, 28-day mortality rate, and incidence of pulmonary edema were compared. The correlation between (Pv-aCO2)/(Ca-vO2) ratio and Lac in study group was analyzed by Spearman analysis. Results In two groups, the HR, Lac, and (Pv-aCO2)/(Ca-vO2) ratio were significantly lower after 6 hours of treatment than those at admission, and MAP, CVP and ScvO2 were significantly increased compared with those at admission (all P < 0.05). The Lac and (Pv-aCO2)/(Ca-vO2) ratio in study group were significantly lower than those in control group at 6 hours after fluid resuscitation [Lac (mmol/L): 4.1±2.2 vs. 4.6±2.3, (Pv-aCO2)/(Ca-vO2) ratio:0.7±0.2 vs. 0.8±0.3, both P < 0.05], and MAP, CVP and ScvO2 were higher than those in control group [MAP (mmHg, 1 mmHg = 0.133 kPa): 78.6±10.3 vs. 71.4±11.5, CVP (mmHg): 13.2±5.1 vs. 9.8±4.4, ScvO2: 0.73±0.08 vs. 0.70±0.08, all P < 0.05]. In study group, the dosage of NE, fluid intake in 6 hours, and incidence of pulmonary edema were less than those in control group [dosage of NE (μg·kg-1·min-1): 0.22±0.16 vs. 0.43±0.11, fluid intake in 6 hours (mL): 1 290±518 vs. 1 560±426, incidence of pulmonary edema: 19.05% (8/42) vs. 32.00% (16/50)], 24 hours SOFA declined (9.3±3.2 vs. 12.6±3.8), and time of MV and length of ICU stay were obviously shortened [time of MV (hours):70.48±8.65 vs. 88.35±10.37, length of ICU stay (days): 7.28±2.07 vs. 8.42±1.51, all P < 0.05]. The 28-day mortality in study group had a trend of decrease compared with that in control group [40.5 % (17/42) vs. 44% (22/50)], but there was no statistical significant difference between two groups (P > 0.05). There was a significant positive correlation between the (Pv-aCO2)/(Ca-vO2) ratio and Lac in study group (r = 0.532, P < 0.001). Conclusion (Pv-aCO2)/(Ca-vO2) ratio combined with critical ultrasound can better guide the volume management of critical patients with septic shock, reduce the usage of vasoactive drugs and incidence of pulmonary edema, and decrease the time of MV and length of ICU stay.

Objective To provide theoretic rationales and clinical experience for post-transplant lymphoproliferative disorder (PTLD ) by comparing the characteristics of PTLD in kidney and hematopoietic stem cell transplant recipients and reviewing the relevant literature reports .Methods Twenty-seven adult PTLD patients from 2000 to 2017 were retrospectively reviewed .There were 11 kidney transplant recipients (KT group) and 16 hematopoietic stem cell transplant recipients (HSCT group) .Clinical characteristics and outcomes were analyzed between two groups .Cox's proportional hazard model was utilized for evaluating the prognostic factors .Results The incidence of PTLD for KT and HSCT groups were 0 .5 ％ and 1 .1 ％ respectively .PTLD patients of KT group had a later onset than that of HSCT group (105 .1 vs 3 .1 months , P<0 .01) .Also Epstein-Barr virus was less frequently detected in KT group (36 .4 ％ vs 81 .3 ％ , P< 0 .05) .The 5-year overall survival was (46 .8％ ± 10 .5％ ) .According to Cox analysis ,application of antithymocyte globulin (ATG) and high ECOG scores were risk factors for a poor prognosis of PTLD .Conclusions Most cases of KT-PTLD have a late onset . In contrast , HSCT-PTLD has an earlier onset and a higher incidence of EBV infectious .And application of ATG and high ECOG scores are poor prognosis factors of PTLD .

OBJECTIVE: To analyze the characteristics of BK polymavirus (BKV) infection and the optimal time window for intervention in kidney transplant recipients (KTRs). METHODS: We retrospectively analyzed the clinical data and treatment regimens in 226 KTRs in our center between January, 2013 and January, 2018. Among the recipients, 157 had a urine BKV load ≥1.0×10 copy/mL after transplantation, and 69 had a urine BKV load below 1.0×10 copy/mL (control group). RESULTS: Among the 157 KTRs, 60 (38.2%) recipients were positive for urine BKV, 66 (42.0%) had BKV viruria, and 31(19.7%) had BKV viremia. The incidence of positive urine occult blood was significantly higher in BKV-positive recipients than in the control group ( < 0.05). The change of urine BKV load was linearly related to that of Tacrolimus trough blood level (=0.351, < 0.05). In urine BKV positive group, the average estimated glomerular filtration rate (eGFR) was below the baseline level (60 mL·min·1.73 m) upon diagnosis of BKV infection reactivation, and recovered the normal level after intervention. In patients with BKV viruria and viremia, the average eGFR failed to return to the baseline level in spite of improvement of the renal function after intervention. CONCLUSIONS Positive urine occult blood after transplantation may be associated with BKV infection reactivation in some of the KTRs. BKV infection is sensitive to changes of plasma concentration of immunosuppressive agents. Early intervention of BKV replication in KTRs with appropriate dose reduction for immunosuppression can help to control virus replication and stabilize the allograft function.
BK Virus ; physiology ; Humans ; Kidney Transplantation ; Polyomavirus Infections ; virology ; Retrospective Studies ; Transplant Recipients ; Tumor Virus Infections ; virology ; Viral Load ; Virus Replication