Objective To investigate the risk factors and prognosis of acute kidney injury (AKI) in elderly patients with sepsis in intensive care unit (ICU).Methods Clinical data of 108 elderly patients diagnosed as sepsis admitted in ICU in our hospital,from May 2010 to May 2014 were analyzed retrospectively.Patients were divided into two groups:the AKI group and the non-AKI group.Clinical characteristics,laboratory and physiologic data were compared between groups.Multivariate Logistic regression analysis was used to analyze the independent risk factors for AKI in these patients,and clinical outcome was retrospectively analyzed.Results Among the 108 elderly patients,60 patients developed AKI and the incidence was 55.6％.Baseline glomerular filtration rate (GFR) and mean arterial pressure (MAP) were lower in the AKI group than in non-AKI group (t=4.536 and 3.28).Prothrombin time (PT) (t=3.053),multiple organ dysfunction score (MODS) (t =2.201),acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score (t=3.423),the incidence of septic shock (x2 =5.400) and patients undergoing surgical operation within two weeks (x2 =5.625) were higher or longer in AKI group than in non-AKI group (all P＜0.05).Multivariate Logistic regression analysis showed that MAP (OR =0.833),baseline GFR (OR=0.776),MODS (OR=2.039) were independent risk factors for AKI occurrence.Hospital mortality,length of stay in ICU and hospitalization time were higher or longer in AKI group than in non-AKI group (P=0.001,0.026 and 0.042).Conclusions MAP,baseline GFR and MODS are the independent risk factors for AKI occurrence in elderly adults with sepsis in ICU.Hospital mortality,length of stay in ICU and hospitalization time are increased in sepsis patients combined with AKI.

China ; Occupational Health Services ; Pilot Projects

Objective To investigate the causes and outcome of different treatment methods of iatrogenic rectovaginal fistula. Methods Clinical data of 52 patients with iatrogenic rectovaginal fistula were analyzed retrospectively. Results Twenty-two fistulae occurred after gynecological operation (42.3%), fourteen after obstetric injury (26.9%), thirteen after colorectal operation (25.0%) and three due to miscellaneous causes (5.8%). The fistulae were located in the lower rectum in 27 cases(51.9%), mid rectum in 10 cases(19.2%) and upper rectum in 15 cases(28.9%). They were treated by non-surgical treatment in 9 cases(17.3%), permanent diverting stoma(loop transverse colostomy) in 8 cases(15.4%), and surgical repair by various approaches in 35 cases(67.3%). The fistulae of all nine patients who received non-surgical treatment failed to heal. Eight patients who received permanent diverting stoma had symptomatic improvement without fistula healing. The overall cure rate of surgical repairs in 35 cases was 77.1%(27/35). The cure rates of trans-sphincteric (Mason′s operation), transanal, transabdominal, transperineal and transvaginal approaches were 100%(8/8), 100%(2/2), 83.3%(5/6), 0%(0/1) and 66.7%(12/18), respectively. The cure rate of Mason′s operation for the mid and lower rectovaginal fistulae was higher than that of transvaginal approach (100% vs 66.7%). Conclusions Iatrogenic rectovaginal fistula is caused by obstetric injury or injury of rectovaginal septum due to surgical mismanagement. Surgical repair is the only method that can cure rectovaginal fistulae. Mason′s operation is a favorable treatment method for the mid and lower (especially mid) rectovaginal fistulae.

Abstract: Objective　To investigate the clinical characteristics and diagnosis key points of brain abscess caused by Nocardia asiatica, and provide a clinical basis for diagnosing and treating intracranial infection caused by Nocardia. Methods　A case of pulmonary Nocardia asiatica complicated with brain abscess diagnosed at the Second Affiliated Hospital of Hainan Medical University was selected to analyze the clinical manifestations, cerebrospinal fluid characteristics, pulmonary and cranial imaging features, and treatment plan, and to summarize the diagnosis and treatment experience. Results　The patient was an elderly woman with a history of diabetes, dry cough was the first symptom without fever or headache. At the beginning of the course, it was diagnosed as pulmonary infection and tuberculosis in the local hospital, and received conventional antimicrobial and anti-tuberculosis therapies, but showed no improvement. The patient developed progressive limb weakness, followed by consciousness disorders, and coma. Cerebrospinal fluid (CSF) adenosine deaminase and lactate dehydrogenase were not abnormal, CSF pressure, protein and white blood cells were high, mainly with multiple nuclear cells. CSF glucose and chloride were normal in the early stage of the disease, but decreased significantly in the later stage. Metagenomic analysis of cerebrospinal fluid indicated Nocardia asiatica with a specific sequence number of 537. Lung CT showed exudation, abscess, and cavity in the right lung. Skull MRI scan + enhancement suggested multiple scattered abscesses in both cerebral hemispheres. The abscesses were of different sizes and showed ring enhancement, with extensive surrounding edema, and ventricular compression. After treatment with meropenem, linezolid, and compound sulfamethoxazole tablets, the cerebrospinal fluid recovered, and the lesions in the lungs and intracranial structures improved. Conclusions　Brain abscess caused by Nocardia asiatica is similar to the tuberculous brain in clinical symptoms, cerebrospinal fluid examination, craniocerebral imaging, so we should be alert to the possibility of Nocardia infection in patients with diabetes. At the same time, metagenomic testing of the cerebrospinal fluid can help confirm the diagnosis. The mortality and disability rates of brain abscess caused by Nocardia are high. Early diagnosis and treatment can improve the prognosis.

eEF1A2 might be a putative oncoprotein in HCC .eEF1A2 over-expression has noticeable effects on the HCC cell prolifera-tion enhancement , differentiation inhibition , and cell cycle acceleration through the G 0/G1 phase to S phase and G 2/M phases.

ObjectiveTo investigate the profile of Th17/Treg balance in the peripheral blood of patients with systemic lupus erythematosus (SLE).MethodsThirty-two SLE patients in active disease were selected and 30 SLE patients in remission were included in this study.The control group was consisted of 25healthy individuals.The expressions of IL-17 and FoxP3 on CD4+ T cells in the peripheral blood were assessed by flow cytometry and the mRNA levels of these two cytokines were examined by quantitative PCR respectively.ANOVA was used for statistical analysis.ResultsThe percentage of CD4+IL-17+ T cells and IL-17mRNA expression of the active group were significantly higher than those of the remission group and control group[(l.0l±0.22)％,(2.04±0.63)vs (0.48±0.16)％,(1.12±0.34) vs (0.41±0.12)％,1; P＜0.01].There was no difference between the remission group and control group(P＞0.05).However,the percentage of CI4+FoxP3 + T cells and FoxP3 mRNA expression of the active group were significantly lower than those of the remission group and control group [(2.36±t0.54)％,(0.42±0.16) vs (4.34±0.95)％,(0.87±t0.28) vs (5.09±11.17)％,1; P＜0.01 ],and there was also significant differencesbetween the remission group and control group(P＜0.05).ConclusionThl7/Treg balance shift may exist in the peripheral blood of patients with SLE and the degree of imbalance may be related to disease activity of SLE.

Objective To study the positive end-expiratory pressure (PEEP) adjustment after recruitment maneuver during acute respiratory distress syndrome (ARDS) especially in the presence of tonic diaphragm electrical activity (Tonic EAdi) in order to obtain optimum PEEP and in turn to get successful oxygenation.Methods Rabbit model of ARDS was nade by intratracheal instillation of hydrochloric acid.After sufficient recruitment maneuvers,the rabbits were randomly (random number) divided into two groups,namely Tonic EAdi group ( n =5 ) and maximum oxygenation group ( n =5 ).In Tonic EAdi group,the regulation of PEEP was guided by Tonic EAdi.In maximum oxygenation group,PEEP was adjusted as per maximum oxygenation.The differences in magnitude of PEEP,pulmonary mechanics,gas exchange and hemodynamics were compared between two groups.The t-test was used to compare continuous variables between the two independent samples,and the difference was statistically significant when P ＜ 0.05.Results (1) PEEP:The PEEP was (10.7 + 1.4) cmH2O (1 cm H2O=0.098 kPa) in Tonic EAdi group and (10.0 ± 2.8) cm H2O in maximum oxygenation group (P ＞ 0.05). (2) Pulmonary mechanics:After PEEP adjustment,there was no significant difference in tidal volume ( Vr),peak pressure (Ppeak) and mean pressure (Pmean) between the two groups (P ＞ 0.05 ).(3) Gas exchange:After PEEP adjustment,there was no significant difference in oxygenation index (PaO2/FiO2) and partial pressure of arterial carbon dioxide ( PaCO2 ) between the two groups (P ＞ 0.05).Conclusions Tonic EAdi could be a good indicator for regulating PEEP in ARDS.

Objective To detect the changes of hemodynamics in patients with portal vein embolization (PVE) before surgery for hilar cholangiocarcinoma, and analyze the relationship between hemodynamics and liver hypertrophy. Methods The clinical data of 21 patients with hilar cholangiocarcinoma who were admitted to the Eastern Hepatobiliary Surgery Hospital from April 2008 to December 2009 were retrospectively analyzed.Relevant hemodynamic variables were detected and analyzed before and 3, 7, 14 days after PVE. Data were processed using Student t test or linear correlation analysis. Results The main portal vein pressure after PVE was (25.9 ± 4.1 ) cm H2O ( 1 cm H2O = 0.098 kPa), which was ( 3.5 ± 2.5 ) cm H2O higher than that before PVE [( 22.4 ± 4.1 ) cm H2O] ( t = - 6. 504, P ＜ 0.05 ). The blood flow velocity in the non-embolized branch of portal vein increased after PVE, and reached peak [(26 ±9)cm/s] at the seventh day after PVE. A positive correlation was found between the hypertrophic rate of the non-embolized lobes and the ratio of embolized lobes to total liver volume ( r = 0. 593, P ＜ 0. 05 ). Conclusion Greater scope of the embolized vascular bed of portal vein induces higher hypertrophic rate of non-embolized liver.

A rapid and simple method for the determination of cyanide in blood was developed based on pinhole shell-isolated nanoparticles (pinSHINs)-enhanced Raman spectroscopy and an online lysis-purging and trapping approach.In the online lysis-purging and trapping device, the bound cyanide in blood can be cleaved through sulfuric acid acidification, and transferred into HCN volatile gas, then purged into alkaline solution to form NaCN solution, thus high-efficient liberation and entrapment of cyanide from the methemoglobin-bound form can be achieved.The pinSHINs substrate is quite stable to weaken the gold-dissolution effect caused by cyanide under strong alkaline condition, and therefore the detection window can be prolonged to 1 h comparing with 5 min of AuNPs.A limit of detection down to 10 μg/L and a linear range from 100-2000 μg/L in blood were achieved in this method.This method was further applied to rapid measurement of blood samples of cyanide exposed rats and clinic poisoned patients, which provided a sensitive, selective and reliable way for rapid detection of cyanide poisoning.

Inflammatory bowel disease (IBD) is a chronic, repeated intestinal inflammatory disease. Clinically commonly used therapeutic drugs have some disadvantages, such as poor efficacy and many adverse reactions after long-term application. Although new biological therapies such as anti-tumor necrosis factor agents, overcome common adverse reactions, also have problems such as high price, difficult storage, drug resistance and recurrence after application. In recent years, many new therapeutic methods for inflammatory bowel disease have emerged, for example, modulators that inhibit lymphocyte migration (integrin inhibitors and sphingosine 1-phosphate receptor agonists) have been introduced into the clinical treatment of inflammatory bowel disease, inflammatory cytokine inhibitors (interleukin-23 inhibitors, Janus kinase inhibitors, phosphodiesterase inhibitors, etc.) and inhibitors targeting fibrosis and intestinal tissue degradation and remodeling (matrix metalloproteinase inhibitors) are also being evaluated in clinical trials of IBD. Based on the mechanisms of action, this paper intends to outline the current mainstream IBD therapies and some emerging drugs, and briefly introduce their targets to provide reference for IBD drug design and development.