PURPOSE: The purpose of this study was to identify the effects of exhalation breathing exercises using expirometer and that of inhalation breathing exercises using incentive spirometry on pulmonary function and complications in elderly patients with upper-abdominal surgery. METHODS: The research design was a nonequivalent control group non-synchronized design. Participants were 63 patients who underwent upper-abdominal surgery under general anesthesia (32 in experiment group, 31 in control group). They were recruited at P university hospital from August 1 to November 30, 2015. Effects were evaluated by measuring pulmonary functions (Forced Vital Capacity [FVC], Forced Expiratory Volume in 1 second [FEV1]) and pulmonary complications. Data were analyzed using SPSS/WIN 18.0 program. RESULTS: There was no difference in FVC between the experimental group and the control group, but FEV1 in the experimental group increased significantly compared to the control group by time change (p=.001). Also, there were no pulmonary complications in the experimental group but there were 5 cases (16.1%)(p=.018) in the control group. CONCLUSION: Findings indicate that exhalation breathing exercises by elderly patients following upper-abdominal surgery is an effective nursing intervention in enhancing pulmonary function and preventing pulmonary complications.
Aged* ; Anesthesia, General ; Breathing Exercises* ; Exhalation* ; Forced Expiratory Volume ; Humans ; Inhalation* ; Motivation ; Nursing ; Research Design ; Respiration* ; Spirometry ; Vital Capacity

Fluid therapy has been the focus of attention and dispute. In this paper, there are three aspects including postoperative bowel function, surgical prognosis, and acute diffuse peritonitis. Colloidal supplement and appropriate crystal/colloid ratio should be noted in low perfusion conditions. The different types of fluid in recent studies did not show a significant difference in the long term. The new evidence will be noted in fluid therapy among 2012 SSC Severe Sepsis and Septic Shock Guideline update (unpublished).
Digestive System Surgical Procedures ; Fluid Therapy ; Humans ; Perioperative Care ; Peritonitis ; therapy ; Prognosis ; Shock, Septic ; therapy

To investigate the sources of inconsistent findings between two randomized control trials ["initiation strategies for renal-replacement therapy in the intensive care unit" (AKIKI trial)vs "effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury" (ELAIN trial)],regarding "timing of renal replacement therapy (RRT) on mortality in patients with acute kidney injury (AKI).By reanalysis of the published data,it was found that demographics,severity of primary disease and stage of AKI before initiation of RRT were quite different between AKIKI and ELAIN trials.Interestingly,similar mortalities were demonstrated in late group of ELAIN trial,both of early and late groups of AKIKI trial [all patients were classified at Kidney Disease:Improving Global Outcomes (KDIGO) classification stage 3 of AKI,P＞0.05] although a significant reduction of mortality was determined in early group of ELAIN trial (KDIGO stage 2 of AKI).Therefore,it was concluded that inconsistent results were largely attributable to the heterogeneity of enrolled patients between ELAIN vs AKIKI trials,including demographics and severity of AKI(AKI stage) before initiation of RRT.

Objective To investigate the clinical features and risk factors on outcomes of patients with cardio-renal syndrome (CRS) in surgical intensive care unit (SICU). Methods The clinical data of the patients admitted to SICU of Peking University People's Hospital from January 1st 2017 to December 31st 2017 were analyzed retrospectively, including gender, age, severity of the disease, underlying diseases, type of CRS, precipitating factors of CRS, cardiac and renal function [cardiac troponin I (cTnI), B-type natriuretic peptide (BNP), serum creatinine (SCr), glomerular filtration rate (eGFR)], outcomes [secondary outcomes, duration of mechanical ventilation, the length of ICU stay, the length of hospital stay, 28-day mortality and hospital mortality]. Patients were grouped according to CRS classification or hospitalization prognosis, the clinical features within different CRS types were analyzed, and risk factors on outcomes of the CRS patients were analysed by Logistic regression. Results 86 (7.3%) of the 1 172 patients during the study period had CRS. ①CRS clinical features: CRS 1-5 type patients accounted for 24.4% (21 cases), 1.2% (1 case), 20.9% (18 cases), 1.2% (1 case) and 52.3% (45 cases) respectively, CRS type 1, 3 and 5 were the main types (i.e. acute cardiac and renal dysfunction), while type 5 CRS was the highest (i.e. organ dysfunction caused by simultaneous involvement of cardiac and renal functions secondary to systemic diseases was the most common). Baseline BNP (Z = 11.365, P =0.023), SCr peak (Z = 13.405, P = 0.009) and baseline eGFR (F = 2.648, P = 0.037) were significantly different within the CRS 5 types. The basic cardiac function of type 1 CRS patients was significantly worse than that of type 3 and type 5 CRS patients [baseline BNP (μg/L): 434.2 (187.0, 1 252.0) vs. 154.9 (66.4, 272.5), 268.5 (124.1, 486.6), both P <0.05]. The basic renal function of type 3 CRS patients was significantly worse than that of type 5 CRS patients [baseline eGFR (mL/min): 71.0±30.3 vs. 88.3±29.0, P < 0.05]. The severity of acute kidney injury (AKI) in type 3 CRS patients was significantly higher than that in type 1 and type 5 CRS patients [SCr peak (μmol/L): 285.0 (171.5, 420.6) vs. 143.0 (99.5, 213.5), 189.0 (105.5, 280.5), both P < 0.01]. There were no significant differences in gender, age, department, acute physiology and chronic health evaluationⅡ (APACHEⅡ), intraoperative blood loss, basic cTnI and SCr levels, BNP peak, AKI staging and prognostic indicators among patients with various types of CRS. ② Death risk analysis:43 (50%) of the 86 CRS patients died during the hospital stay. Compared with the survival patients, CRS death patients were older [years old: 72 (57, 80) vs. 62 (50, 73)] and had higher APACHEⅡ score [22 (17, 29) vs. 18 (15, 21)], with higher proportion of cerebrovascular disease (9.3% vs. 0). Regarding to precipitating factors of CRS, sepsis/septic shock (41.9% vs. 18.6%) and surgery stress (9.3% vs. 0) were remarkably increased in death patients. Death patients had higher cTnI and SCr peak [cTnI peak (μg/L): 1.155 (0.192, 5.125) vs. 0.122 (0.045, 0.610), SCr peak (μmol/L): 208 (143, 295) vs. 146 (101, 289)] and also high proportion of AKI stage 3 (41.9% vs. 20.9%), higher rate of secondary infection (67.4% vs. 30.2%), prolonged duration of mechanical ventilation and the length of ICU stay [hours: 179 (61, 470) vs. 37 (7, 134);days: 10 (4, 24) vs. 5 (2, 11)], with statistically significant differences (all P < 0.05). Logistic regression analysis showed that the elderly [odds ratio (OR) = 1.053, 95% confidence interval (95%CI) = 1.003-1.094, P = 0.010], high APACHE Ⅱscore (OR = 1.165, 95%CI = 1.057-1.285, P = 0.002), sepsis/septic shock (OR = 4.561, 95%CI = 1.351-15.391, P = 0.014) and AKI stage 3 (OR = 5.468, 95%CI = 1.457-20.530, P = 0.012) were independent risk factors for hospital death in CRS patients. Conclusions Surgical ICU patients with CRS are characterized by acute cardiac and renal dysfunction. CRS type 5 is the most common and has a high fatality rate. Age, severity of illness, sepsis/septic shock and AKI stage 3 are independent risk factors of death.

Objective: To investigate the value of serum miR-133a in early diagnosis and the assessment of 30-day incidence of cardiovascular adverse events in patients with acute myocardial infarction (AMI). Methods: Ninety patients with acute chest pain within 6 h were included, and 63 cases of AMI, 13 cases of unstable angina pectoris (UAP) and 14 cases of control (chest pain of other causes) were finally diagnosed. The levels of troponin I (cTnI), creatine kinase MB (CK-MB) and myoglobin (Mb) were measured by electrochemical fluorescence. Quantitative real-time PCR (qPCR) was used to detect the expression of miR-133a in the serum of patients immediately after admission and 24 h after percutaneous coronary intervention (PCI). The Gensini score of patients who underwent coronary angiography was recorded. The incidence of cardiovascular adverse events was observed within 30 days. Spearman correlation analysis, multivariate Logistic regression analysis and receiver operator characteristic curve (ROC curve) were used to analyze the corresponding data. Results: The expression of miR-133a in the AMI group was significantly higher than that in the UAP group and the control group (both P<0.05). Spearman correlation analysis showed that the expression of miR-133a was positively correlated with cTnI, CK-MB, MB level and Gensini scores (all P<0.05). Multivariate Logistic regression analysis showed that miR-133a and the history of coronary heart disease were independent risk factors for AMI. ROC curve showed that the area under the curve (AUC) of miR-133a in the diagnosis of AMI was 0.816 (95% CI 0.716-0.917), and the AUC of 30 days cardiovascular adverse event was 0.700 (95% CI 0.535-0.865). Conclusion: The expression of miR-133a in patients with AMI is significantly increased, which is expected to be a biomarker for early diagnosis of AMI. The expression level of miR-133a in serum may be related to the severity of coronary artery disease and short-term prognosis.

Atherosclerosis is an inflammatory disease of arterial wall caused by many factors, which is the main pathological basis of many cardiovascular diseases. Currently, "inflammatory response" theory is widely accepted as pathogenesis of atherosclerosis. Abnormal increase of apolipoprotein ApoB-100, a composition of low density lipoprotein (LDL), which causes pathological inflammation, is a major factor leading to atherosclerosis. Therefore, inhibition of ApoB-100 induced pathological inflammatory response by immunotherapy is expected to delay the development of atherosclerosis. This review focused on the recent advances of ApoB-100 vaccine and other ApoB-100 inhibitors against atherosclerosis.

Exosomes are natural nano vesicles secreted by living cells, which play an important role in cellular communication and substance transportation. As a kind of carrier of human endogenous for drug transportation, many advantages of exosomes are in sight, for example, low toxicity, non immunogenicity, good permeability and high-targeting. In recent years, small molecular chemical drugs, nucleic acids and proteins have been successfully delivered by exosomes. This novel carrier is expected to provide strong support for the clinical treatment of myocardial ischemia. The research progress of exosomes as a kind of carrier in the treatment of myocardial ischemia was briefly summarized in this article.

Klebsiella pneumoniae is the most common cause of nosocomial respiratory tract, and the second most frequent cause of Gram-negative bacteraemia and urinary tract infections. Drug resistant isolates remain an important hospital-acquired bacterial pathogen, prolong hospital stays, and are especially problematic in high impact medical areas such as intensive care units. A variety of preventive measures were applied to reduce such incidences. The immune therapies for Klebsiella pneumoniae include active immunization and passive immunization. Many trials for constructing effective vaccines are followed, including inactivated vaccines, polysaccharide vaccine, conjugate vaccine, protein vaccine, and nano vaccine. This review was about the development of vaccines for the prevention of Klebsiella pneumoniae.

Coronary atherosclerotic heart disease (CHD) remains the leading cause of morbidity and mortality in the world, with elevated low density lipoprotein-cholesterol (LDL-C) levels as a major risk factor. Lower levels of LDL-C can effectively reduce the risk of CHD. To date, lipid-lowering medicines such as statins are effective in lowering LDL-C, but a proportion of patients do not achieve lipid reduction target with statins or are intolerant to statins. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are a new class of agents reducing LDL-C which gain more and more concerns. Through inhibitory effect on PCSK9 and increasing low-density lipoprotein receptors recycling, they can significantly reduce serum LDL-C levels. PCSK9 inhibitors are currently in phase III of clinical trials, and the results showed that they had good lipid-lowering effects and tolerability. This review provided an overview of the latest advances and challenges about PCSK9 inhibitors.

Elevated low density lipoprotein cholesterol (LDL-C) is a major risk factor for cardiovascular disease. Studies show that proprotein convertase subtilisin/kexin type 9 (PCSK9) is a circulation enzyme and serves a pivotal function in the degradation of low density lipoprotein receptor, which contributes to the decrease in hepatic cholesterol uptake and increase in circulating LDL-C. PCSK9 inhibitor can significantly elevate the surface of low density lipoprotein receptor of liver cells and bond more LDL-C to decrease the level of LDL-C. Thus PCSK9 has emerged as a popular target for the development of new cholesterol lowering drugs and therapeutic intervention of cardiovascular disease. In this article, the history, mechanism of action, metabolic effects of PCSK9 and the clinical outcomes of PCSK9 inhibitors will be briefly reviewed.